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Ridge Augmentation (ridge + augmentation)

Distribution by Scientific Domains

Medical Sciences	100%

Kinds of Ridge Augmentation

alveolar ridge augmentation

lateral ridge augmentation

Selected Abstracts

rhBMP-2/,BSM® Induces Significant Vertical Alveolar Ridge Augmentation and Dental Implant Osseointegration

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 4 2002
Ulf M.E. Wikesjö DDS
ABSTRACT Background: Recombinant human bone morphogenetic protein 2 (rhBMP-2) in a carrier has been shown to induce significant bone formation. Several candidate carriers, however, lack structural integrity to offset compressive forces that may compromise rhBMP-2 bone induction, in particular, for challenging onlay indications such as alveolar ridge augmentation. Purpose: The objective of this study was to evaluate rhBMP-2 in a calcium-phosphate cement carrier, ,BSM, for vertical alveolar ridge augmentation and immediate dental implant Osseointegration. Materials and Methods: Six adult Hound Labrador mongrels with 5 mm critical size supra-alveolar peri-implant defects were used. Three animals received rhBMP-2/,BSM (rhBMP-2 at 0.40 and 0.75 mg/mL) in contralateral jaw quadrants (total implant volume/defect , 1.5 mL). Three animals received ,BSM without rhBMP-2 (control group). The animals were euthanized at 16 weeks post surgery, and block biopsies were processed for histologie and histometric analysis. Results: rhBMP-2/,BSM induced substantial augmentation of the alveolar ridge. Control sites exhibited limited new bone formation. Vertical bone augmentation averaged (SD) 4.9 ± 1.0 mm (rhBMP-2 at 0.40 mg/mL), 5.3 ± 0.3 mm (rhBMP-2 at 0.75 mg/mL), and 0.4 ± 0.4 mm (control); new bone area 8.5 ± 4.2 mm 2, 9.0 ± 1.9 mm 2, and 0.5 ± 0.4 mm 2; new bone density 55.1 ± 6.4%, 61.1 ± 6.0%, and 67.7 ± 9.5%; and new bone-implant contact 26.9 ± 17.5%, 28.5 ± 1.4%, and 24.6 ± 16.1%, respectively. Residual ,BSM comprised 1% of the new bone. Bone density for the contiguous resident bone ranged from 65 to 71%, and bone-implant contact ranged from 49 to 64%. Conclusions: Surgical implantation of rhBMP-2/,BSM appears an effective protocol for vertical alveolar ridge augmentation procedures and immediate dental implant Osseointegration and for onlay indications of lesser complexity. [source]

PC01,Pre-Congress Courses 1 , Vertical Ridge Augmentation

CLINICAL ORAL IMPLANTS RESEARCH, Issue 9 2009
Article first published online: 13 AUG 200
First page of article [source]

Platelet-rich plasma may prevent titanium-mesh exposure in alveolar ridge augmentation with anorganic bovine bone

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 10 2010
Jesús Torres
Torres J, Tamimi F, Alkhraisat MH, Manchón Á, Linares R, Prados-Frutos JC, Hernández G, López Cabarcos E. Platelet-rich plasma may prevent titanium-mesh exposure in alveolar ridge augmentation with anorganic bovine bone. J Clin Periodontol 2010; 37: 943,951. doi: 10.1111/j.1600-051X.2010.01615.x. Abstract Objective: Bone augmentation with the titanium-mesh (Ti-mesh) technique is susceptible to a large rate of complications such as morbidity of bone graft donor site, and mesh exposure to the oral cavity. The purpose of this study was to evaluate the effectiveness of anorganic bovine bone (ABB) in alveolar bone augmentation with the Ti-mesh technique. In addition, we investigated the effect of platelet-rich plasma (PRP) in preventing mesh exposure by using it to cover the Ti-mesh. Patients and Methods: Patients included in the clinical trial were randomly allocated by a blinded assistant into two groups. The 30 patients recruited for this study underwent 43 alveolar bone augmentation with the Ti-mesh technique using ABB as graft material in all of them. In 15 patients, the Ti-meshes were covered with PRP (PRP group) whereas in the other 15 the Ti-meshes were not (control group). After 6 months, patients were called for clinical, radiographic, and histological evaluation, and implant placement surgery. A total of 97 implants were placed in the augmented bone and their evolution was followed up for a period of 24 months. Results: Significant differences were found between the two study groups in terms of complications and bone formation. In the control group, 28.5% of the cases suffered from mesh exposure, while in the PRP group, no exposures were registered. Radiographic analysis revealed that bone augmentation was higher in the PRP group than in the control group. Overall, 97.3% of implants placed in the control group and 100% of those placed in the PRP group were successful during the monitoring period. We suggest that the positive effect of PRP on the Ti-mesh technique is due to its capacity to improve soft tissue healing, thereby protecting the mesh and graft material secured beneath the gingival tissues. Conclusions: Alveolar bone augmentation using ABB alone in the Ti-mesh technique is sufficient for implant rehabilitation. Besides, covering the Ti-meshes with PRP was a determining factor in avoiding mesh exposure. Ti-mesh exposure provoked significant bone loss, but in most cases it did not affect the subsequent placement of implants. [source]

Alveolar ridge augmentation using implants coated with recombinant human growth/differentiation factor-5: histologic observations

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 8 2010
Giuseppe Polimeni
Polimeni G, Wikesjö UME, Susin C, Qahash M, Shanaman RH, Prasad HS, Rohrer MD, Hall J. Alveolar ridge augmentation using implants coated with recombinant human growth/differentiation factor-5: histologic observations. J Clin Periodontol 2010; 37: 759-768 doi: 10.1111/j.1600-051X.2010.01579.x. Abstract Objectives: In vitro and in vivo preclinical studies suggest that growth/differentiation factor-5 (GDF-5) may induce local bone formation. The objective of this study was to evaluate the potential of recombinant human GDF-5 (rhGDF-5) coated onto an oral implant with a purpose-designed titanium porous oxide surface to stimulate local bone formation including osseointegration and vertical augmentation of the alveolar ridge. Materials and Methods: Bilateral, critical-size, 5 mm, supraalveolar peri-implant defects were created in 12 young adult Hound Labrador mongrel dogs. Six animals received implants coated with 30 or 60 ,g rhGDF-5, and six animals received implants coated with 120 ,g rhGDF-5 or left uncoated (control). Treatments were alternated between jaw quadrants. The mucoperiosteal flaps were advanced, adapted, and sutured to submerge the implants for primary intention healing. The animals received fluorescent bone markers at weeks 3, 4, 7, and 8 post-surgery when they were euthanized for histologic evaluation. Results: The clinical examination showed no noteworthy differences between implants coated with rhGDF-5. The cover screw and implant body were visible/palpable through the alveolar mucosa for both rhGDF-5-coated and control implants. There was a small increase in induced bone height for implants coated with rhGDF-5 compared with the control, induced bone height averaging (±SD) 1.6±0.6 mm for implants coated with 120 ,g rhGDF-5 versus 1.2±0.5, 1.2±0.6, and 0.6±0.2 mm for implants coated with 60 ,g rhGDF-5, 30 ,g rhGDF-5, or left uncoated, respectively (p<0.05). Bone formation was predominant at the lingual aspect of the implants. Narrow yellow and orange fluorescent markers throughout the newly formed bone indicate relatively slow new bone formation within 3,4 weeks. Implants coated with rhGDF-5 displayed limited peri-implant bone remodelling in the resident bone; the 120 ,g dose exhibiting more advanced remodelling than the 60 and 30 ,g doses. All treatment groups exhibited clinically relevant osseointegration. Conclusions: rhGDF-5-coated oral implants display a dose-dependent osteoinductive and/or osteoconductive effect, bone formation apparently benefiting from local factors. Application of rhGDF-5 appears to be safe as it is associated with limited, if any, adverse effects. [source]

Alveolar ridge augmentation using implants coated with recombinant human bone morphogenetic protein-7 (rhBMP-7/rhOP-1): histological observations

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 6 2010
Cristiano Susin
Susin C, Qahash M, Polimeni G, Lu PH, Prasad HS, Rohrer MD, Hall J, Wikesjö UME. Alveolar ridge augmentation using implants coated with recombinant human bone morphogenetic protein-7 (rhBMP-7/rhOP-1): histological observations. J Clin Periodontol 2010; 37: 574,581. doi: 10.1111/j.1600-051X.2010.01554.x. Abstract Background: Pre-clinical studies have shown that recombinant human bone morphogenetic protein-2 (rhBMP-2) coated onto purpose-designed titanium porous-oxide surface implants induces clinically relevant bone formation and osseointegration. The objective of this study was to examine the potential of rhBMP-7, also known as recombinant human osteogenic protein-1 (rhOP-1), coated onto titanium porous-oxide surface implants to support vertical alveolar ridge augmentation and implant osseointegration. Materials and Methods: Bilateral, critical-size, 5 mm, supraalveolar peri-implant defects were created in six young adult Hound Labrador mongrel dogs. The animals received implants coated with rhBMP-7 at 1.5 or 3.0 mg/ml randomized to contra-lateral jaw quadrants. The mucoperiosteal flaps were advanced, adapted, and sutured to submerge the implants for primary intention healing. The animals received fluorescent bone markers at 3, 4, 7, and 8 weeks post-surgery when they were euthanized for histological evaluation. Results: Without striking differences between treatments, the implant sites exhibited a swelling that gradually regressed to become hard to palpation disguising the implant contours. The histological evaluation showed robust bone formation; the newly formed bone assuming characteristics of the contiguous resident bone, bone formation (height and area) averaging 4.1±1.0 versus 3.6±1.7 mm and 3.6±1.9 versus 3.1±1.8 mm2; and bone density 56%versus 50% for implants coated with rhBMP-7 at 1.5 and 3.0 mg/ml, respectively. Both treatments exhibited clinically relevant osseointegration, the corresponding bone,implant contact values averaging 51% and 47%. Notable peri-implant resident bone remodelling was observed for implants coated with rhBMP-7 at 3.0 mg/ml. Conclusions: rhBMP-7 coated onto titanium porous-oxide surface implants induces clinically relevant local bone formation including osseointegration and vertical augmentation of the alveolar ridge, the higher concentration/dose associated with some local side effects. [source]

Alveolar ridge augmentation using implants coated with recombinant human bone morphogenetic protein-2: histologic observations

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 11 2008
Ulf M. E. Wikesjö
Abstract Background: Studies using ectopic rodent, orthotopic canine, and non-human primate models show that bone morphogenetic proteins (BMPs) coated onto titanium surfaces induce local bone formation. The objective of this study was to examine the ability of recombinant human BMP-2 (rhBMP-2) coated onto a titanium porous oxide implant surface to stimulate local bone formation including osseointegration and vertical augmentation of the alveolar ridge. Material and Methods: Bilateral, critical-size, 5 mm, supra-alveolar, peri-implant defects were created in 12 young adult Hound Labrador mongrel dogs. Six animals received implants coated with rhBMP-2 at 0.75 or 1.5 mg/ml, and six animals received implants coated with rhBMP-2 at 3.0 mg/ml or uncoated control. Treatments were randomized between jaw quadrants. The mucoperiosteal flaps were advanced, adapted and sutured to submerge the implants for primary intention healing. The animals received fluorescent bone markers at weeks 3, 4, 7 and 8 post-surgery when they were euthanized for histologic evaluation. Results: Jaw quadrants receiving implants coated with rhBMP-2 exhibited gradually regressing swelling that became hard to palpate disguising the contours of the implants. The histologic evaluation showed robust bone formation reaching or exceeding the implant platform. The newly formed bone exhibited characteristics of the adjoining resident Type II bone including cortex formation for sites receiving implants coated with rhBMP-2 at 0.75 or 1.5 mg/ml. Sites receiving implants coated with rhBMP-2 at 3.0 mg/ml exhibited more immature trabecular bone formation, seroma formation and peri-implant bone remodelling resulting in undesirable implant displacement. Control implants exhibited minimal, if any, bone formation. Thus, implants coated with rhBMP-2 at 0.75, 1.5 and 3.0 mg/ml exhibited significant bone formation (height and area) compared with the sham-surgery control averaging (±SD) 4.4±0.4, 4.2±0.7 and 4.2±1.2 versus 0.8±0.3 mm; and 5.0±2.2, 5.6±2.2 and 7.4±3.5 versus 0.7±0.3 mm2, respectively (p<0.01). All the treatment groups exhibited clinically relevant osseointegration. Conclusions: rhBMP-2 coated onto titanium porous oxide implant surfaces induced clinically relevant local bone formation including vertical augmentation of the alveolar ridge and osseointegration. Higher concentrations/doses were associated with untoward effects. [source]

Alveolar ridge augmentation using implants coated with recombinant human bone morphogenetic protein-7 (rhBMP-7/rhOP-1): radiographic observations

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 10 2008
Knut N. Leknes
Abstract Aim: The objective of this study was to radiographically evaluate the potential of a purpose-designed titanium porous-oxide implant surface coated with recombinant human bone morphogenetic protein-7 (rhBMP-7), also known as recombinant human osteogenic protein-1 (rhOP-1), to stimulate alveolar ridge augmentation. Material and Methods: Six young-adult Hound Labrador mongrel dogs were used. Three 10 mm titanium oral implants per jaw quadrant were placed 5 mm into the alveolar ridge in the posterior mandible following surgical extraction of the pre-molar teeth and reduction of the alveolar ridge leaving 5 mm of the implants in a supra-alveolar position. The implants had been coated with rhBMP-7 at 1.5 or 3.0 mg/ml and were randomized to contralateral jaw quadrants using a split-mouth design. The mucoperiosteal flaps were advanced, adapted, and sutured to submerge the implants. Radiographic registrations were made immediately post-surgery (baseline), and at weeks 4 and 8 (end of study). Results: rhBMP-7-coated implants exhibited robust radiographic bone formation. At 8 weeks, bone formation averaged 4.4 and 4.2 mm for implants coated with rhBMP-7 at 1.5 and 3.0 mg/ml, respectively. There were no significant differences between the rhBMP-7 concentrations at any observation interval. A majority of the implant sites showed voids within the newly formed bone at week 4 that generally resolved by week 8. The newly formed bone assumed characteristics of the resident bone. Conclusions: The titanium porous-oxide implant surface serves as an effective carrier for rhBMP-7 showing a clinically significant potential to stimulate local bone formation. [source]

Lateral ridge augmentation by the use of grafts comprised of autologous bone or a biomaterial.

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 12 2002
An experiment in the dog
Abstract Objective: The present investigation was performed to determine if a block of Bio-Oss® used as an onlay graft can be used as a scaffold for new bone formation. Material and methods: Five mongrel dogs were used. The mandibular premolars were extracted. On both sides of the mandible, the buccal bone plate was resected and defects, about 25 mm long, 8 mm high and 5 mm wide, were produced After 3 months of healing, a second surgical procedure was performed. In the left side, a block of Bio-Oss® was adjusted to the buccal bone wall. The graft had the shape of a cylinder and was retained with a miniscrew and covered with a collagen membrane. In the contra-lateral side of the mandible, a block biopsy was first obtained from the ascending ramus. This bone graft had the shape of a cylinder that was 8 mm in diameter and 3 mm thick. The graft was transferred to the experimental site, adjusted to the buccal wall, retained with a miniscrew, and covered with a membrane. The flaps were repositioned and closed with sutures to ensure a complete coverage of the experimental sites. After 6 months of healing, the dogs were sacrificed and the experimental sites dissected. The biopsies were processed for ground sectioning. The sections were stained in toluidine blue, examined in the microscope, and a number of histo- and morphometric assessments made. Results: The study demonstrated that cortical bone used as an onlay graft in the lateral aspect of the alveolar ridge, during a 6-month period of healing integrated with the host bone but underwent marked peripheral resorption. Thus, close to 30% of the height and 50% of the length of the graft was replaced with connective tissue. It was further observed that while the dimensions of a graft which contained a scaffold of cancellous bovine bone mineral remained unchanged, only moderate amounts of new bone formed at the base of this graft. Conclusion: Grafts of autologous cortical bone, placed on the surface of a one-wall defect, may undergo marked resorption during healing. A similar graft of Bio-Oss® may retain its dimension, and limited amounts of new bone will form within the biomaterial. [source]

Alveolar Ridge Regeneration with Equine Spongy Bone: A Clinical, Histological, and Immunohistochemical Case Series

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2 2009
Danilo Alessio Di Stefano DDS
ABSTRACT Background: In the case of localized ridge atrophy, a ridge augmentation procedure, with the use of bone substitutes and barrier membranes, may then be necessary. Purpose: The aim of the present study was a clinical, histological, and immunohistochemical evaluation of an equine spongy bone in alveolar ridge augmentation procedures. Materials and Methods: Five patients showing horizontal mandibular ridge defects participated in this study. A ridge augmentation was performed through an onlay apposition of equine bone covered by a titanium-reinforced membrane. After 6 months of healing, five bone cores from nonaugmented sites (control) and five from augmented sites (test) were retrieved. Results: In test sites, no postoperative complications occurred. Horizontal bone width increased from ,4 to ,7 mm. In control sites, the newly formed bone represented 33%, and in test sites, 35% of the total area. The mean value of the microvessel density was 25.6 +/, 3.425 per mm2 in controls, while 33.3 +/, 2.5 vessels per mm2 in the test sites were found (p < .05). Both groups showed a high intensity (++) of vascular endothelial growth factor expression in the newly formed bone, while a low intensity (+) was found in the mature bone. Conclusion: Equine bone appeared to be biocompatible and to be associated with new vessel ingrowth. Within the limits of the small sample size, the present study indicated that equine bone could be used in mandibular ridge augmentations. [source]

rhBMP-2/,BSM® Induces Significant Vertical Alveolar Ridge Augmentation and Dental Implant Osseointegration

Initial pattern of angiogenesis and bone formation following lateral ridge augmentation using rhPDGF and guided bone regeneration: an immunohistochemical study in dogs

CLINICAL ORAL IMPLANTS RESEARCH, Issue 1 2010
Frank Schwarz
Abstract Objectives: To evaluate (i) the effects of rhPDGF-BB on localized ridge augmentation using a natural bone mineral (NBM), and (ii) the influence of a collagen membrane (CM) on factor activity. Materials and methods: Chronic-type alveolar ridge defects (n=4 dogs) were randomly allocated in a split-mouth design as follows: upper jaw: NBM+rhPDGF-BB+CM (test) vs. NBM+rhPDGF-BB (control), and lower jaw: NBM+rhPDGF-BB+CM (test) vs. NBM+CM (control). After 3 weeks, dissected blocks were prepared for immunohistochemical (angiogenesis , TG) and histomorphometrical analysis [e.g. augmented area (AA), mineralized , (MT), non-mineralized tissue (NMT) (mm2)]. Results: Lower jaw: TG and mineralization of AA mainly originated from the defect borders. Test sites revealed a pronounced TG antigen reactivity and higher AA and MT values (mean and median). Upper jaw: control sites revealed a dislocation of AA in caudal direction, but also an improved vascularization in the peripheral wound area. While MT values (median) appeared to be comparable in both groups, AA, NMT, and NBM values (mean and median) tended to be higher at test sites. Conclusions: It was concluded that (i) rhPDGF-BB soak-loaded on NBM might have the potential to support bone formation at chronic-type lateral ridge defects, and (ii) the application of CM did not seem to interfere with the factor activity, but ensured a stabilization of the graft particles. To cited this article: Schwarz F, Ferrari D, Podolsky L, Mihatovic I, Becker J. Initial pattern of angiogenesis and bone formation following lateral ridge augmentation using rhPDGF and guided bone regeneration: an immunohistochemical study in dogs. Clin. Oral Impl. Res. 21, 2010; 90,99. [source]

Vertical ridge augmentation of the atrophic posterior mandible with interpositional bloc grafts: bone from the iliac crest vs. bovine anorganic bone.

CLINICAL ORAL IMPLANTS RESEARCH, Issue 12 2009
Clinical, histological results up to one year after loading from a randomized-controlled clinical trial
Abstract Objectives: To compare two different techniques for vertical bone augmentation of the posterior mandible: bone blocs from the iliac crest vs. anorganic bovine bone blocs used as inlays. Materials and methods: Ten partially edentulous patients having 5,7 mm of residual crestal height above the mandibular canal had their posterior mandibles randomly allocated to both interventions. After 4 months implants were inserted, and after 4 months, provisional prostheses were placed. Definitive prostheses were delivered after 4 months. Histomorphometry of samples trephined at implant placement, prosthesis and implant failures, any complication after loading and peri-implant marginal bone-level changes were assessed by masked assessors. All patients were followed up to 1 year after loading. Results: Four months after bone augmentation, there was statistically significant more residual graft (between 10% and 13%) in the Bio-Oss group. There were no statistically significant differences in failures and complications. Two implants could not be placed in one patient augmented with autogenous bone because the graft failed whereas one implant and its prosthesis of the Bio-Oss group failed after loading. After implant loading only one complication (peri-implantitis) occurred at one implant of the autogenous bone group. In 16 months (from implant placement to 1 year after loading), both groups lost statistically significant amounts of peri-implant marginal bone: 0.82 mm in the autogenous bone group and 0.59 mm in the Bio-Oss group; however, there were no statistically significant differences between the groups. Conclusions: Both procedures achieved good results, but the use of bovine blocs was less invasive and may be preferable than harvesting bone from the iliac crest. [source]

Clinical and radiographic characteristics of single-tooth replacements preceded by local ridge augmentation: a prospective randomized clinical trial

CLINICAL ORAL IMPLANTS RESEARCH, Issue 12 2008
L. Meijndert
Abstract Objectives: To assess in a randomized-clinical trial the influence of three augmentation techniques (chinbone with or without a Bio-Gide® membrane and Bio-Oss® with a Bio-Gide® membrane) on the clinical and radiographic characteristics of hard and soft tissues around implants and adjacent teeth in the reconstructed maxillary anterior region, up to 1 year after functional loading. Materials and methods: Ninety-three patients requesting single-tooth replacement and presenting with a horizontal (bucco-palatinal) bone deficiency were included. After augmentation, 93 ITI-EstheticPlus implants were placed. Clinical variables, standardized photographs and radiographs were analysed to assess the impact on the levels of the marginal gingiva (MGL) and marginal bone (MBL) around implants and adjacent teeth, viz at pre-augmentation, pre-implantation (TPI) and 1 (T1) and 12 (T12) months after final crown placement. Results: Implant survival was 97.8%. No significant differences were observed in the treatment outcomes of the three augmentation modalities. Combining the three modalities, a slight but significant increase in the implants approximal pocket depth was found between T1 and T12. Approximal bone loss at the implant between T1 and T12 was 0.14 ± 0.76 mm (mesial) and 0.14 ± 0.47 mm (distal); the approximal MGL slightly increased (mesial: 0.24 ± 0.46 mm, distal: 0.25 ± 0.66 mm), and the buccal MGL decreased (0.11 ± 0.61 mm). Bone loss at the adjacent teeth, although minor, was significant between TPI and T1. No correlations were observed in changes of MBL and MGL. Conclusions: None of the three applied augmentation technique procedures influenced the characteristics of the MGL and MBL or the implant survival of single-tooth replacements. Peri-implant hard and soft tissues were very stable in the first year after loading. [source]

Lateral ridge augmentation using particulated or block bone substitutes biocoated with rhGDF-5 and rhBMP-2: an immunohistochemical study in dogs

CLINICAL ORAL IMPLANTS RESEARCH, Issue 7 2008
Frank Schwarz
Abstract Objectives: The aim of the present study was to immunohistochemically evaluate lateral ridge augmentation using a particulated (BOG) or block (BOB) natural bone mineral biocoated with rhGDF-5 and rhBMP-2 in dogs. Materials and methods: Three standardized box-shaped defects were surgically created at the buccal aspect of the alveolar ridge in each quadrant of eight beagle dogs. After 2 months of healing, the chronic-type defects were randomly allocated in a split-mouth design to either (i) BOG or (ii) BOB biocoated with (a) rhGDF-5 or (b) rhBMP-2, respectively. Uncoated grafts served as controls. After 3 and 8 weeks, dissected blocks were prepared for immunohistochemical [osteocalcin (OC)] and histomorphometrical analysis [e.g. area (mm2) of new bone fill (BF), newly formed mineralized (MT) and non-mineralized tissue (NMT)]. Results: rhBMP-2 biocoated BOG revealed significantly highest BF and MT values at 3 (upper and lower jaws , UJ/LJ , compared with BOG) and 8 weeks (UJ , compared with rhGDF-5). Biocoating of BOB using both rhGDF-5 and rhBMP-2 resulted in significantly increased MT values at 8 weeks (UJ/LJ , compared with BOB). In all groups, NMT adjacent to BOG and BOB scaffolds revealed pronounced signs of an OC antigen reactivity. Conclusions: Within the limits of the present study, it was concluded that both rhGDF-5 and rhBMP-2 have shown efficacy; however, their bone regenerative effect was markedly influenced by the carrier. [source]

Horizontal ridge augmentation using autogenous block grafts and the guided bone regeneration technique with collagen membranes: a clinical study with 42 patients

CLINICAL ORAL IMPLANTS RESEARCH, Issue 4 2006
Thomas Von Arx
Abstract Objective: To analyze the clinical outcome of horizontal ridge augmentation using autogenous block grafts covered with anorganic bovine bone mineral (ABBM) and a bioabsorbable collagen membrane. Material and methods: In 42 patients with severe horizontal bone atrophy, a staged approach was chosen for implant placement following horizontal ridge augmentation. A block graft was harvested from the symphysis or retromolar area, and secured to the recipient site with fixation screws. The width of the ridge was measured before and after horizontal ridge augmentation. The block graft was subsequently covered with ABBM and a collagen membrane. Following a tension-free primary wound closure and a mean healing period of 5.8 months, the sites were re-entered, and the crest width was re-assessed prior to implant placement. Results: Fifty-eight sites were augmented, including 41 sites located in the anterior maxilla. The mean initial crest width measured 3.06 mm. At re-entry, the mean width of the ridge was 7.66 mm, with a calculated mean gain of horizontal bone thickness of 4.6 mm (range 2,7 mm). Only minor surface resorption of 0.36 mm was observed from augmentation to re-entry. Conclusions: The presented technique of ridge augmentation using autogenous block grafts with ABBM filler and collagen membrane coverage demonstrated successful horizontal ridge augmentation with high predictability. The surgical method has been further simplified by using a resorbable membrane. The hydrophilic membrane was easy to apply, and did not cause wound infection in the rare instance of membrane exposure. [source]

Surgical advantages with ITI TE® implants placement in conjunction with split crest technique

CLINICAL ORAL IMPLANTS RESEARCH, Issue 2 2005
18-month results of an ongoing prospective study
Abstract: Implant rehabilitation of the edentulous maxilla may be somewhat problematic because of anatomic situations involving insufficient bone thickness. One approach in this situation is localized ridge augmentation with the split crest technique. This surgical approach allows the external cortical plate of the maxilla to be moved in a labial direction to gain an increase in width to introduce implants of appropriate diameter. This ongoing prospective study evaluated: (i) the surgical advantages that the new ITI TE® implants have showed compared with the ITI standard solid-screw implants when placed in conjunction with the split crest technique and (ii) the implant success rate associated with 42 ITI TE® implants and 40 ITI standard solid-screw implants placed in 40 patients in conjunction with the split crest technique. ITI TE® implants have shown direct and indirect advantages in reducing the risk of fracture of the labial cortical plate during all the three fundamental surgical steps of this technique: (a) the ridge expansion with osteotomes; (b) implant site preparation with drills and (c) implant insertion. The overall success rates of ITI TE® implants and standard screw implants were 100% and 95%, respectively. Based on the preliminary results of the present study, it can be concluded that ITI TE® implants inserted in conjunction with split crest technique seem to be a promising surgical procedure to treat selected anatomic situations involving insufficient maxillary bone thickness. Résumé La réhabilitation implantaire du maxillaire édenté peut être problèmatique à cause des situations anatomiques comportant une insuffisance de l'épaisseur osseuse. Une approche de cette situation est d'effectuer un épaississement du rebord localisé avec la technique du rebord osseux fendu. Cette approche chirurgicale permet au plateau cortical externe du maxillaire d'être déplacé en une direction linguale pour augmenter la largeur afin de pouvoir ensuite placer des implants d'un diamètre approprié. Cette étude prospective encore en cours a évalué 1) les avantages chirurgicaux des nouveaux implants ITI TE comparés aux implants ITI en vis solide ITI standard lorsqu'ils étaient placés en association avec cette technique de rebord osseux fendu et 2) le taux de succès implantaire associé avec 42 implants ITI TE et 40 implants vis solides ITI standard placés chez 40 patients en association avec cette technique de rebord osseux fendu. Les implants ITI TE ont montré des avantages directs et indirects en réduisant le risque de fracture de la corticale linguale durant les trois étapes chirurgicales fondamentales de cette technique : a) l'expansion du rebord alvéolaire avec les ostétomes, b) la préparation des sites implantaires avec les forets et c) l'insertion implantaire. Les taux de succès généraux des implants ITI TE et des implants vis standards étaient respectivement de 100 % et 95%. Basé sur le résultat préléminaire de cette étude, il peut être conclu que les implants ITI TE insérés en association avec la technique du rebord osseux fendu semble être un processus chirurgical prometteur pour traiter des situations anatomiques sélectionnées qui comportent une épaisseur osseuse insuffisante du maxillaire. Zusammenfassung Die Rekonstruktion einer zahnlosen Situation im Oberkiefer ist dann etwas problematischer, wenn anatomisch ungünstige Gegebenheiten wie zum Beispiel eine ungenügende vertikale Breite des Alveolarknochens besteht. Eine mögliche Vorgehensweise in dieser Situation ist die lokale Knochenaugmentation mittels Spaltung und Spreizung der Knochenkortikalis. Diese chirurgische Methode erlaubt uns, die äussere Kortikalis des Oberkiefers in labialer Richtung abzuspreizen und somit ein genügend breites Knochenbett zu erhalten, um Implantate mit dem geeigneten Durchmesser setzen zu können. Diese noch weiterverfolgte Langzeitstudie untersuchte: (i) die chirurgischen Vorteile, die uns das neue ITI TE-Implantat verglichen mit der Vollschraube des ITI-Standardimplantates in Verbindung mit der Kortikalisspreiztechnik bringt und (ii) die Implantaterfolgsrate von 42 ITI TE-Implantaten und 40 Vollschrauben der ITI-Standartimplantate, die man bei 40 Patienten in Verbindung mit der Kortikalisspreiztechnik gesetzt hat. Die ITI TE-Implantate zeigten direkte und indirekte Vorteile bei der Verminderung des Frakturrisikos in der labialen Kortikalisplatte während den drei grundlegenden Schritten dieser Technik: (a) Spreizung des Knochenkamms mit Osteotomen; (b) Vorbohren des Implantatbettes und (c) Eindrehen der Implantate. Die Erfolgsrate lag bei den ITI TE-Implantaten bei 100% und bei den Standartschraubenimplantaten bei 95%. Basierend auf diesen ersten Resultaten der Studie kann man schliessen, dass es sich bei ITI TE-Implantate, die in Verbindung mit der Kortikalisspreiztechnik eingesetzt worden waren, um eine vielversprechende chirugische Technik handelt, um ausgewählte anatomische Situationen, wie zu Beispiel eine ungenügende vertikale Breite des Alveolarknochens im Oberkiefer, zu behandeln. Resumen La rehabilitación con implantes del maxilar edéntulo puede ser un tanto problemática debido a situaciones anatómicas que comprenden situaciones de grosor óseo insuficiente. Un enfoque en esta situación, es el aumento localizado de la cresta con la técnica de cresta dividida. Este enfoque quirúrgico permite mover la placa cortical externa del maxilar en dirección labial para ganar un aumento en anchura para introducir implantes del diámetro apropiado. Este estudio prospectivo continuado evaluó: i) los avances quirúrgicos que los nuevos implantes ITI TE han mostrado en comparación con los implantes macizos roscados ITI estándar al colocarse en combinación con la técnica de cresta dividida y ii) el índice de éxito del implante asociado con 42 implantes ITI TE y 40 implantes macizos roscados estándar colocados en 40 pacientes en combinación con la técnica de cresta dividida. Los implantes ITI TE han mostrado ventajas directas e indirectas en reducir el riesgo de fractura de la placa cortical labial durante los tres pasos quirúrgicos fundamentales de esta técnica: a) expansión de la cresta con osteotomos; b) preparación del lecho implantario con fresas y c) inserción del implante. El índice total de éxito de los implantes ITI TE y de los implantes estándar roscados fue del 100% y del 95% respectivamente. Basado en los resultados preliminares del presente estudio, se puede concluir que los implantes ITI TE insertados en combinación con la técnica de cresta dividida parece ser un procedimiento quirúrgico prometedor para tratar situaciones anatómicas determinadas que conllevan un grosor óseo maxilar insuficiente. [source]

Alveolar ridge augmentation with a prototype trilayer membrane and various bone grafts: a histomorphometric study in baboons

CLINICAL ORAL IMPLANTS RESEARCH, Issue 2 2005
Dieter Busenlechner
Abstract: Barrier membranes have become a standard treatment option in alveolar ridge augmentation prior to implant placement. However, non-resorbable membranes require secondary surgery and resorbable membranes show an unfavorable degradation profile. The purpose of this study was to evaluate the potential of a slowly biodegradable/bioresorbable prototype trilayer membrane (PTLM) for supporting bone regeneration in alveolar ridge augmentation. Clinically relevant cavities were made 3 months after the extraction of the first and second molars in each jaw of six baboons. Each animal was treated with four different regimens: (1) autogenous bone block (ABB) alone, (2) ABB+PTLM, (3) deproteinized bovine bone mineral (DBBM)+PTLM and (4) no treatment. After 9 months, the baboons were sacrificed and block sections of the augmented area were subjected to histologic and histomorphometric analyses. Newly formed bone areas were determined at a distance of 1, 3, 7 and 10 mm from crestal. The data showed a well-preserved ridge profile at the membrane-protected sites, whereas non-protected bone blocks and control sites underwent severe resorption resulting in knife-edge ridge profiles. Significant differences were found between ABB+PTLM and ABB (P=0.0137,0.0232). DBBM+PTLM also produced a larger bone area compared with ABB alone (P=0.0396,0.0439). No significant difference in bone area was detectable between ABB+PTLM and DBBM+PTLM (P>0.05). The present study supports the use of the slowly biodegradable/bioresorbable PTLM with autografts and DBBM for lateral ridge augmentation in this type of bone defects. Résumé Les membranes barrière sont devenues une option de traitement standard dans l'épaississement du rebord alvéolaire avant le placement des implants. Cependant, des membranes non-résorbables requièrent une seconde chirurgie et les membranes résorbables montrent un profil de dégradation peu favorable. Le but de cette étude a été d'évaluer le potentiel d'une membrane prototype de trois épaisseurs (PTLM) qui était biodégradable/biorésorbable lentement pour aider la régénération osseuse dans les épaississements de rebord alvéolaire. Des cavités cliniques ont été creusées trois mois après l'avulsion des premières et deuxièmes molaires de chaque mâchoire chez six babouins. Chaque animal a été traité de quatre manières différentes : 1) un bloc osseux autogène (ABB), 2) ABB+PTLM, 3) la partie minérale de l'os bovin déprotéiné (DBBM)+PTLM et 4) pas de traitement. Après neuf mois les babouins ont été euthanasiés et des coupes en blocs de la région épaissie ont été soumises aux analyses histologiques et histomorphométriques. Les zones d'os néoforméétaient déterminées à une distance de 1, 3, 7 et 10 mm du rebord alvéolaire. Les données ont montré un profil bien préservé au niveau des sites protégés par les membranes tandis que les blocs osseux non-protégés et les sites contrôles subissaient une résorption importante en un profil en forme de lame de couteau. Des différences significatives ont été trouvées entre ABB+PTLM et ABB (P=0,0137 àP=0,0232). DBBM+PTLM produisait aussi une aire osseuse plus importante comparéà ABB seul (P=0,0396 àP=0,0439). Aucune différence significative dans l'aire osseuse n'était visible entre ABB+PTLM et DBBM+PTLM (P>0,05). L'étude présente prône l'utilisation de la membrane prototype en trois couches biodégradable/biorésorbable lentement avec du minéral osseux bovin déprotéiné et des autogreffes pour l'augmentation latérale du rebord alvéolaire dans ce type de lésions osseuses. Zusammenfassung Muss vor der Implantation eine Knochenkammaugmentation durchgeführt werden, so ist die GBR mit der Membrantechnik als Standardbehandlung anzuführen. Nichtresorbierbare Membranen erfordern jedoch einen chirurgischen Zweiteingriff, und resorbierbare Membranen zeigen ein ungünstiges Verhalten während der Resorptionsphase. Das Ziel dieser Studie war, bei der GBR die Platzhalterfunktion des Prototyps einer dreischichtig aufgebautenen Membran (PTLM) zu untersuchen, die langsam biologisch abgebaut und resorbiert wird. Drei Monate nach der Extraktion der ersten und zweiten Molaren in jedem Kiefer von sechs Pavianaffen präparierte man klinisch relevante Kavitäten. Jedes Tier erhielt vier verschiedene Behandlungsmodalitäten: (1) nur autologe Knochenblöcke (ABB), (2) ABB+PTLM, (3) entproteinisiertes Knochenmineral vom Rind (DBBM)+PTLM und (4) keine Behandlung. Nach 9 Monaten opferte man die Paviane, entnahm von den aufgebauten Stellen Blockbiopsien und bereitete sie für die histologischen und histomorphometrischen Analysen auf. Auf die Suche nach Regionen mit neu gebildetem Knochen ging man in 1, 3, 7 und 10 mm Entfernung vom crestalen Knochen. Die Daten zeigten bei den mit Membranen abgedeckten und geschützten Stellen ein gut erhaltenes Alveolarkammprofil. Bei den ungeschützten Knochenblöcken und den Kontrollstellen kam es zu ausgedehnten Resorptionen, es resultierten messerscharf auslaufende Kammprofile. Man fand signifikante Unterschiede zwischen ABB+PTLM und ABB (P=0.0137 zu P=0.232). Auch DBBM+PTLM brachte, verglichen mit nur ABB, eine bessere Knochenauffüllung (P=0.0396 zu P=0.0439). Zwischen den Varianten ABB+PTLM und DBBM+PTLM fanden sich im untersuchten Kochen keine signifikanten Unterschiede (P>0.05). Diese Arbeit befürwortet bei der lateralen Knochenkammaugmentation eines solchen Knochendefektes den Einsatz eines Prototyps einer dreischichtigen Membran (PTLM), die langsam biologisch abgebaut und resorbiert wird, sowie von autologen Knochentransplantaten und entproteinisiertem Knochenmineral vom Rind. Resumen Las membranas de barrera se han convertido en una opción estándar de tratamiento en aumento de la cresta alveolar previo a la colocación del implante. De todos modos, las membranas no reabsorbibles requieren de un segundo procedimiento quirúrgico y las membranas reabsorbibles muestran un perfil de degradación desfavorable. El propósito de este estudio fue evaluar el potencial de un prototipo de membrana de tres capas (PTLM) biodegradable/biorreabsorbible para apoyar la regeneración ósea en el aumento de la cresta alveolar. Se realizaron cavidades clínicamente relevantes tres meses después de la extracción del primer y segundo molares de cada mandíbula de seis babuinos. Cada animal se trató con cuatro diferentes regímenes: (1) bloque de hueso autógeno (ABB) únicamente, (2) ABB+ PTLM, (3) hueso mineral bovino desproteinizado (DBBM)+PTLM y (4) sin tratamiento. Tras 9 meses se sacrificó a los babuinos y secciones en bloque del área aumentada se sometieron a análisis histológicos e histomorfométricos. Se determinaron las áreas de hueso neoformado a una distancia de 1, 3, 7, y 10 mm de la cresta. Los datos mostraron un perfil de la cresta bien preservado en los lugares protegidos por la membrana, mientras que los bloques de hueso no protegido y los lugares de control sufrieron una severa reabsorción resultando en unos perfiles de cresta en filo de cuchillo. Se encontraron diferencias significativas entre ABB+PTLM y ABB (P=0.0137 a P=0.0232). DBBM+PTLM también produjeron unas áreas mayores de hueso comparadas con ABB únicamente (P=0.0396 a P=0.0439). No se detectaron diferencias significativas entre ABB+PTLM y DBBM+PTLM (P>0.05). El presente estudio apoya el uso del prototipo de membrana de tres capas lentamente biodegradable/biorreabsorbible con autoinjertos y hueso mineral bovino desproteinizado para aumento lateral de la cresta en este tipo de defectos. [source]