Horizontal ridge augmentation using GBR with a native collagen membrane and 1:1 ratio of particulate xenograft and autologous bone: A 3‐year after final loading prospective clinical study

Abstract

Background: Cawood-Howell class IV atrophies, also known as "knife-edge" ridges, represent a serious horizontal defect, making the placement of regular implants challenging.Aim: To clinically and radiographically evaluate bone regeneration of severe horizontal bone defects with 3 years of follow-up.Materials and Methods: This study was designed as a single cohort, prospective clinical trial. Patients having horizontal bone width of 4 mm or less in the posterior mandible or maxilla were treated with resorbable collagen membranes and a 1:1 mixture of anorganic bovine bone (ABB) and autogenous bone. Implants were inserted and loaded 7 months later. Outcomes were implant and prosthetic survival rates, any biological and prosthetic complications, horizontal and volumetric bone dimensional changes measured on cone beam computer tomography (CBCT), peri-implant marginal bone level (MBL) changes measured on periapical radiographs, plaque index (PI), and bleeding on probing (BOP). Results: Eighteen patients received 55 implants. No patient dropped-out. No implant and prosthetic failures and no complications were recorded. Super imposition of pre and 7-month postoperative CBCT scans revealed an average horizontal bone gain of 5.03 ± 2.15 mm (95% CI: 4.13-5.92 mm). After 3 years, mean MBL was 1.15 ± 0.28 mm (95% CI 0.84-1.22 mm). The PI was 11.6%, and BOP was 5.2%. Conclusion: Within the limitations of the present study, high implant survival rate and high average bone augmentation seem to validate the use of collagen resorbable membranes with a 1:1 mixture of particulate ABB and autogenous bone for the reconstruction of Cawood-Howell class IV alveolar ridge atrophies. K E Y W O R D S bone reconstruction, collagen membranes, GBR, horizontal GBR implant threads. All readable radiographs were displayed in an image analysis program (DFW2.8 for windows, Soredex) on a 24-in. LCD screen (iMac, Apple, Cupertino, California) and evaluated under standardized conditions (SO 12646:2004). The software has been calibrated for all single images using the known distance of two adjacent threads. Measurements of the mesial and distal bone crest level adjacent to each implant were made to the nearest 0.01 mm and averaged at patient level. | Periodontal parametersPlaque index (PI), defined as plaque absent or present (0/1), and bleeding on probing (BoP), defined as absent or present bleeding on probing (0/1), were recorded 1 year after final prosthesis delivery and 3 years after final loading.Complications were evaluated and treated by the same clinician that performed the augmentation and implant placement procedure.Volumetric dimensional changes, as well as the peri-implant marginal bone level changes were evaluated by an expert radiologist not previously involved in the study. Another clinician (G.F.) not previously involved in the study, made all the others outcomes.

Horizontal Ridge Augmentation and Contextual Implant Placement with a Resorbable Membrane and Particulated Anorganic Bovine Bone-Derived Mineral

“…Guided bone regeneration is thought to be the most commonly used alveolar bone's reconstructing method, also used to treat peri-implant bone deficiencies [17–20]. Research indicates that survival rates of implants positioned in the sites enlarged by GBR are comparable to those found for implants in pristine sites [16, 21–23]. In particular, the implant survival rate in the sites that have received GBR procedures through the use of xenogenic materials is greater compared to the sites that have received GBR procedures through the insertion of autogenous bone blocks; in a prospective study by Meloni et al (2019), data confirm the 1-year results allowing for the use of collagen resorbable membrane in GBR procedures for horizontal ridge augmentation; although the two-stage approach needs a longer time before prosthesis delivery, this technique seems to be safe and predictable for large reconstruction and can be applied in daily practice [24].…”

Customized allogeneic bone grafts for maxillary horizontal augmentation: A 5‐year follow‐up radiographic and histologic evaluation

“…One intriguing aspect of this case report is that other procedures facilitating the regeneration of such an extensive bone defect, like autologous bone blocks or individualized titan meshes, depend on harvesting autologous bone tissue which was hard to conduct within the oral cavity of the here described patient 23,31 . As the residual width of the ridge was insufficient for ridge splitting, one very prominent option for the augmentation of the patient's bone defect is the application of bone harvested from the iliac crest, which would have meant surgery under general anesthesia in a university hospital.…”

“…Although regeneration of large osseous defects has been demonstrated with a variety of augmentation techniques, most require bone harvesting procedures. One example is the application of a mixture of particulate autologous bone and anorganic bovine bone in combination with collagen membranes in a conventional GBR approach, with which 5 mm horizontal bone gain was achieved 23 . However, biopsy specimens of sinuses grafted with xenogenic bone grafts demonstrated that this material is rather integrated than remodeled, which results in less vital bone being regenerated 24…”

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

“…The so‐called bone ring technique, as using a ring‐shaped autogenous bone block, has emerged recently and been documented in several medical records showing excellent outcomes for the dimensional bone augmentation . Nevertheless, most of the reports only emphasizes on the vertical augmentation and the existing proposal for horizontal bone augmentation is lack of investigation on the stability of the biomaterials and reflects drawbacks such as aggravating intraoperative pain due to the secondary surgical site and occurrence of the accompanying complications such as infection and paraesthesia of chin due to the incisal nerve injury …”

“…[22][23][24][25] Nevertheless, most of the reports only emphasizes on the vertical augmentation and the existing proposal for horizontal bone augmentation is lack of investigation on the stability of the biomaterials and reflects drawbacks such as aggravating intraoperative pain due to the secondary surgical site and occurrence of the accompanying complications such as infection and paraesthesia of chin due to the incisal nerve injury. 26,27 Consequently, in this study, we mainly compared the volume alteration and bone profile maintenance ability between in-situ bone ring and tent-pole technique for the localized bone defect in anterior area to evaluate their effects on horizontal bone augmentation.…”