Evaluation of the autogenous bone block transfer for dental implant placement: Symphysal or ramus harvesting?

Abstract

BackgroundThe absence of sufficient bone volume is the most relevant problem in implant dentistry. Grafting from exogenous sources may provide a limited gain but exhibits poor performance in large bone defects. Autogenous bone block transfer (ABBT) from the mandibular symphysis and ramus has been used with varying rates of success. The aim of this study was to compare the efficacy of symphysal and ramus ABBT for the restoration of lost horizontal alveolar bone volume in the anterior maxilla. Implants placed in the augmented areas were also evaluated.MethodsThe maxillary alveolar bone deficits of 32 patients were treated by similar-sized autogenous bone blocks (7 × 7 × 4 mm) harvested from the symphysis or ramus area. After 4 to 5 months of healing, implants were inserted. At the end of the osseointegration period, the implants were restored by fixed prostheses. Baseline bone thickness was determined by Cone beam computed tomography and was compared to post-op and one-year post-loading bone thickness values where the implants were inserted. Any complications or consequences were noted. The success and survival of the 45 implants were evaluated. The results were analyzed using the Student t-test and Fisher’s exact test (p < 0.05).ResultsPost-op complications were frequent in both groups. Baseline bone thickness values were similar at the beginning of the study (p = 0.71) and exhibited a significant increase after the ABBT surgery (6.29 (SD 0.86) and 6.01 (SD 0.92) mm in the symphysis and ramus groups, respectively). The amount of bone thickness gain was 4.34 mm (SD: 0.92) and 4.36 mm (SD: 1.01) in the symphysis and ramus groups, respectively. After one year, the mean surface resorption was 0.6 mm (SD: 0.78) and 0.80 mm (SD: 0.56) for the symphysis and ramus groups, respectively (p = 0.089). The success and survival rates of the implants were 94.11 and 96.42 %, respectively. No graft failures were observed.ConclusionsBoth symphysal and ramus ABBT procedures were successful for the restoration of a horizontal bone defect in the anterior maxilla. Ramus harvesting may be advisable due to fewer complications. Implants placed in the grafted regions exhibited a high success and survival rate within the one-year follow-up period.

Comparison of Bone Resorption Rates after Intraoral Block Bone and Guided Bone Regeneration Augmentation for the Reconstruction of Horizontally Deficient Maxillary Alveolar Ridges

“…There is a great discrepancy in the literature about the extent of horizontal bone gain after bone augmentation with RBG and GBR. Previous studies involving two-stage approaches have reported a mean horizontal bone gain ranging from 4 to 6 mm after RBG [3, 4, 7, 10, 24, 25], while the mean horizontal bone gain in GBR approaches has been reported to range from 1.37 to 6 mm [18, 19, 21, 26, 27]. Our results for both groups are in agreement with those of previous studies.…”

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

“…Out of the 23 studies (Table 1), there were 11 randomised controlled clinical trials [21-24, 26, 29-32, 36, 37, 39], one prospective cohort study [34,40], three retrospective cohort studies [18,20,33], and eight case series [16,17,19,25,27,28,35,38,[41][42][43], of which two research groups independently published two follow-up papers on the same study cohort [21,22,27,28], and they have been collectively grouped under one study name for this analysis. The follow-up period after ridge augmentation or implant placement was reported in all studies except two [16,35], and it ranged from 3.1 months to 10 years.…”

Lateral Sinus Floor Elevation Performed with Trapezoidal and Modified Triangular Flap Designs: A Randomized Pilot Study of Post-Operative Pain Using Thermal Infrared Imaging

“…The placement of dental implants in the distal edentulous maxillary area is often a problem in case of the severely resorbed maxilla and presents a complex challenge to the oral and maxillofacial surgeon [ 2 , 3 , 4 , 5 ]. Inadequate bone height in the lateral part of the maxilla forms a contra-indication for implant surgery; due to the significant resorption in the posterior maxilla following tooth extraction and the pneumatization of the maxillary sinus, there is not enough bone volume to ensure primary stability of dental implants [ 6 , 7 , 8 , 9 ].…”