Bone Grafting and Guided Bone Regeneration for Immediate Dental Implants in Humans

Abstract

This study evaluated bone regeneration and osseointegration of hydroxyapatite (HA) coated and titanium plasma sprayed (TPS) implants placed in sockets immediately after extraction in 36 adults, mean age 55.2 years (range 26 to 81 years). Twelve TPS and 10 HA‐coated implants in 20 patients were grafted with demineralized freeze‐dried bone allograft (DFDBA), covered with a barrier material, and the facial flap coronally positioned to attain primary closure (experimental). The remaining 11 TPS and 10 HAcoated implants were placed similarly, except that no DFDBA was used (control). Osseous structures were measured at the initial placement and 6‐month re‐entry surgeries. At the 6‐month re‐entry, all implants placed were clinically osseointegrated. Bone resorption at the most coronal socket crest was −1.53 mm for the grafted group and −1.59 mm for the control group. Crestal bone apposition of 1.39 mm was noted at the most apical socket crest (ASC) for the grafted group, whereas crestal resorption of −0.11 mm was noted in the ungrafted control group (P < 0.02). Bone fill from the base of the deepest osseous defect was 5.68 mm for the grafted group and 3.18 mm for the control group (P < 0.04). Complete resolution of osseous defects occurred at 15 of 22 sites in the grafted group and at 9 of 21 sites in the control group. Clinical exposure of the barrier material and a subsequent inflammatory response at 27 of 43 sites, required removal of the material prior to the 6‐month re‐entry and was associated with significantly more bone loss at the ASC sites (P < 0.01). There was no significant difference for any of the parameters when comparing the TPS with the HA‐coated implants. J Periodontol 1994;65:881–891.

Perforaciones corticales penetraciones intramedulares y decorticaciones en regeneración ósea guiada

“…Gher et al (12) reportaron que para lograr regeneración en un defecto óseo, las tasa de osteogénesis, que se extiende desde los márgenes óseos adyacentes, debe ser superior a la tasa de fibrogénesis, proveniente de los tejidos blandos adyacentes.…”

Techniques for grafting and implant placement for the extraction site

“…Grafts compensate for the bone resorption that accompanies the natural healing process in an extraction socket. [32][33][34][35] When implants are placed 8 to 16 weeks after tooth extraction, the clinician must compensate for the loss of labial bone that occurs during the early phase of extraction site healing. [36][37][38] To prevent the need for hard or soft tissue grafting when implant placement is delayed, it is recommended to place an osteoconductive graft material within the extraction site to promote bone fill, to limit labial bone collapse, and to maintain bone for optimal implant placement.…”

Bioresorbable Collagen Membranes for Guided Bone Regeneration

“…Animal experiments (Gotfredsen et al 1993;Kohal et al 1999a) and clinical studies (Gher et al 1994;Simion et al1994;Hämmerle et al 1998) have shown that premature membrane exposure and wound dehiscence impair the amount of bone regeneration. Figure 4 presents the exposure and removal of an infected e-PTFE membrane.…”