Clinical and radiographic outcomes of allogeneic block grafts for maxillary lateral ridge augmentation: A randomized clinical trial

Abstract

Background A main drawback of bone block graft surgery is the resorption occurring in early stages of healing. To our knowledge, there are no studies comparing outcomes of freeze‐dried bone allograft (FDBA) blocks with different architecture. Purpose The aim of this work was to investigate different factors that can affect graft resorption and to compare the resorption rates of two different types of allogeneic blocks, corticocancellous and cancellous. Materials and Methods A randomized clinical trial was designed. Twenty‐eight patients referred for onlay bone augmentation prior to implant placement were included in the study. Preoperative computerized tomography (CT) was taken for all patients. Patients received FDBA blocks of either cancellous or corticocancellous bone obtained from the iliac crest. After a 4‐month follow‐up, postoperative CT was taken. Then, another surgery was performed, with the purpose to place dental implants. The aforementioned groups were compared for bone resorption and implant outcome using analysis of covariance (ANCOVA) and repeated ANOVA measures, respectively. Demographic data, trabecular bone density, and graft sites were also analyzed. Results A total of 93 implants were placed in the augmented bone sites over 28 patients. A 100% survival rate was achieved during a mean follow‐up period of 24 months in both groups. Higher bone resorption rate was found with cancellous bone grafts (29.2% ± 2.6) compared with corticocancellous grafts (19.3% ± 2.3). Moreover, higher resorption rates in patients with lower bone density (<185 Hounsfield Units) (31.7% ± 3.1) and smokers (26.39% ± 2.3) were observed when compared with patients with higher bone density (>185 Hounsfield Units) (16.8% ± 2.1) and nonsmokers (22.1% ± 2.3), respectively. Conclusion Within the limitations of this study, these findings indicate that both corticocancellous and cancellous FDBA grafts constitute a clinical acceptable alternative for bone reconstruction, although cancellous grafts present higher resorption rates. Moreover, host factors such as patient's low bone density and smoking habits may also increase graft resorption rates.

Clinical and histological sequelae of surgical complications in horizontal guided bone regeneration: a systematic review and proposal for management

“…A total of 11 studies used the staged GBR approach only [16, 18-20, 27-29, 31-34], two studies included both staged and simultaneous GBR [17,35], and the remaining ten studies performed GBR with simultaneous implant placement [21-26, 30, 36-38]. Onlay grafts were used in eight studies, of which six studies obtained grafts from intra-oral donor sites (ramus/symphysis/zygoma) [16, 18-20, 29, 34], one used extra-oral donor sites (iliac crest) [31], while the remaining study used a xenograft (deproteinised bovine bone mineral (DBBM)) block [26]. The most commonly used particulate bone substitute material in the included studies was DBBM.…”

“…The most commonly used particulate bone substitute material in the included studies was DBBM. A majority of the studies also used resorbable collagen barrier membranes [16-30, 32, 34-38], three used a nonresorbable expanded polytetrafluoroethylene (ePTFE) membrane [21,22,33], one used a resorbable polylactic (PLA) membrane [24], and one used a plasma rich in growth factors (PRGF) membrane [31].…”

“…The need for additional surgical intervention to manage minor wound dehiscences has also been looked at. While one study treated all minor wound dehiscences immediately with a PRGF membrane [31], another study treated all wound dehiscences with an initial course of systemic amoxicillin and clavulanic acid for 10 days and only proceeded to graft a dehisced site with a free gingival graft at the fifth week after surgery due to nonresolution [34]. One study reported late complications emerging only 3 to 4 months after the initial GBR, and they were treated with 0.5% chlorhexidine topical gel application, 0.12% chlorhexidine rinse, and a 1 week course of amoxicillin and clavulanic acid [29].…”

Recent Trends in the Development of Bone Regenerative Biomaterials

“…Through micro-CT scanning and histological analysis of 8 weeks after operation, it was found that both of them continued to form new bone, verifying their good osteoinduction and osteogenic ability. In recent years, many researchers have also confirmed that decalcified freeze-dried allogeneic bone has growth factors to promote bone induction, which can aggregate MSCs and support osteoblast differentiation (Clark et al, 2019;Tresguerres et al, 2019). Thus, it has been the only biomaterial approved by the Food and Drug Administration (FDA) in North America for clinical bone repair (Soardi et al, 2012).…”

Comparison of in‐situ bone ring technique and tent‐pole technique for horizontally deficient alveolar ridge in the anterior maxilla

“…To reduce such loss of bone mass to a reasonable extent, several approaches for the augmentation of absorbed alveolar ridge have emerged over the years . Ridge augmentation for horizontal alveolar ridge deficiency, as one of the reliable methods to surmount the Cawood‐Howell class IV defect, is regularly achieved by applying guided bone regeneration (GBR) technique including the use of xenogenic bone substitute materials and an absorbable membrane.…”