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Clinical and Radiographical Evaluation of Horizontal Ridge Augmentation Using Composite Grafts and Resorbable Membranes: Case Series

Alper Gültekin, DDS – Research Assistant, Istanbul University

Melike Aytekin, DDS – PhD Student, Istanbul University

Serdar Yalçın, DDS – Full Professor, Istanbul University


Purpose of the Study: Guided bone regeneration procedures allow safe and predictable placement of dental implants in patients lacking sufficient bone volumes. Various materials and techniques for regeneration process are present in the literature, however, there is no golden standard in both materials and techniques nor well-documentation for use of these materials in clinical studies. In this case series, clinical and radiographical outcomes of guided bone regeneration procedure using deproteinized bovine bone (DBB) and particulated autogenous bone mix have been evaluated.

Methods: Under local anesthesia, crestal and vertical incisions were made along the residual alveolar ridge. A mucoperiosteal flap was gently elevated to allow complete visualization of the defect and surrounding bone. Autogenous particulated bone was harvested from nearby the recipient site or ramus using bone scraper (Safe scraper, META, Reggio Emilia, Italy) and mixed with DBB (Cerabone, Botiss Biomaterials GmbH, Berlin, Germany) as a composite graft to be used in lateral ridge augmentation procedures for upper and lower jaws. Grafted bone sites were covered with resorbable membranes (Jason Membrane, Botiss Biomaterials GmbH, Berlin, Germany) in two-stage approach. Resorbable membrane was tacked with pins from palatinal and buccal sites after grafting. Flaps were repositioned with mattress and interrupted non-resorbable sutures with periostal releasing incisions after membranes were completely immobilized with tacks. Patients were allowed to heal 7 months before implant placement. During implant placement, grafted sites were assessed for the necessity of contour grafting. In cases which additional grafting was found necessary, only DBB with resorbable membrane were applied onto the deficient grafted site. The implants were then allowed to acquire secondary stability for the further 3–4 months before prosthodontic rehabilitation. Patients were not allowed to use any removable temporary prosthesis during healing period. Following this period, patients received cement-retained fixed porcelain fused to metal crowns-bridges or removable bar overdenture prosthetic restorations(Figures 1-21). Volumetric changes of grafted sites were measured three-dimensionally using cone beam computed tomography 3 weeks after the augmentation and before implant placement (healing periods were 7 months). The data obtained from the CBCT images were transferred to a network computer workstation, where the volumetric changes of the graft were analyzed using MIMICS 14.0 software (Materialise Europe, World Headquarters, Leuven, Belgium) Other study variables were bone grafting success, and gingival graft requirement.

Results: 13 implants were placed in 7 patients with 10 grafted sites. Only one early membrane exposure was observed as a complication and the case had been excluded from the evaluation process. Clinically, all grafted sites were sufficient for implant stability except two-sites were needed to be re-grafted during implant placement. The average percentage of volume reduction was 6.18±1.53 % before implant placement. A significant graft volume reduction was found during healing period (p < 0.01). Gingivoplasty was performed in two patients. No implants were failed during twenty months follow-up.

Conclusion: Horizontal augmentation with resorbable membranes and composite grafts is a predictable and reliable technique for implant placement. However, clinicians should take precautions with regard to contour augmentation necessity during second stage surgery.

Articles: Urban IA, Lozada JL, Jovanovic SA, Nagy K. Horizontal guided bone regeneration in the posterior maxilla using recombinant human platelet-derived growth factor: a case report. Int J Periodontics Restorative Dent. 2013 Jul-Aug;33(4):421-5 Urban IA, Jovanovic SA, Lozada JL. Vertical ridge augmentation using guided bone regeneration (GBR) in three clinical scenarios prior to implant placement: a retrospective study of 35 patients 12 to 72 months after loading.Int J Oral Maxillofac Implants. 2009 May-Jun;24(3):502-10. Nevins M, Al Hezaimi K, Schupbach P, Karimbux N, Kim DM. Vertical ridge augmentation using an equine bone and collagen block infused with recombinant human platelet-derived growth factor-BB: a randomized single-masked histologic study in non-human primates. J Periodontol. 2012 Jul;83(7):878-84. doi: 10.1902/jop.2012.110478. Epub 2012 Jan 5

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