Radiological and Histological Evaluation of the Effects of Cortical Perforations on Bone Healing in Mandibular Onlay Graft Procedures

Dayangac, Emre; Araz, Kenan; Oğuz, Yener; Bacanli, Didem; Çaylak, Berrin; Uçkan, Sina

doi:10.1111/cid.12238

Cited by 10 publications

(11 citation statements)

References 27 publications

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“…It was found in several studies in animal models that cortical perforation did neither improve osteoblastic nor osteoclastic activity after healing, with no appreciable histological differences between the groups. Elsewhere, no differences in terms of augmented tissue, bone density, and thickness were reported, and even a better maintenance of the block thickness placed in the recipient area without perforations was observed 27,31,33,35,36 …”

Section: Discussionmentioning

confidence: 99%

“…Elsewhere, no differences in terms of augmented tissue, bone density, and thickness were reported, and even a better maintenance of the block thickness placed in the recipient area without perforations was observed. 27,31,33,35,36 Nevertheless, other studies that support the effectiveness of perforating the cortex of the recipient site have been carried out, which described that it resulted in a more effective graft revascularization and bone formation during the initial stages of healing. [37][38][39][40] Other authors have also suggested the usefulness of performing perforations not only in the recipient bed but also in cortical grafts.…”

Section: Importance Of Perforating the Cortex Of The Recipient Sitementioning

confidence: 99%

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The role of cortical perforations in allogeneic block grafting for lateral augmentation in maxilla: A randomized clinical trial

Tresguerres

Iglesias

et al. 2021

Clin Implant Dent Rel Res

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Background The need of decortication on the recipient site remains unclear for bone regeneration. To our knowledge, there are no human clinical trials that studied the influence of decortication on cancellous allogeneic block grafting. Purpose The aim of the present study is to evaluate the influence of perforating the cortex of the recipient site on cancellous allogeneic block graft integration and revascularization in the maxilla. Material and Methods Twenty‐six patients referred for lateral bone augmentation were included in this clinical trial. Patients received freeze‐dried bone allograft cancellous blocks obtained from the iliac crest; cortical perforations of the recipient bed were performed in the test group while in the control group it was left intact. After a 4‐month healing period another surgery was performed to place dental implants, and a bone biopsy was collected using a trephine. All samples underwent micro‐CT scans, and were processed for histomorphometric and immunohistochemical analysis. Implant survival comparisons were made using a repeated measures analysis of variance (ANOVA) while all other variables were compared using the analysis of covariance (ANCOVA). Results One hundred and nineteen implants were placed into 110 augmented sites. One hundred percent implant survival rate was reported during 24 months follow‐up period. No differences were reported in bleeding on probing at 1 (5.6 vs 9%) and 2 years (13.2 vs 12.1%), probing pocket depth at 1 (3.4 ± 0.95 vs 3.6 ± 1.12 mm) and 2 years (3.8 ± 1.02 vs 4.1 ± 1.46 mm), and marginal bone loss at 1 (0.2 ± 0.52 vs 0.3 ± 0.57 mm) and 2 years (0.6 ± 0.91 vs 0.5 ± 0.87 mm). No statistically significant differences were found in the micro‐CT and histomorphometric analysis in terms of newly formed bone (25.7 ± 11.2% vs 22.3 ± 9.7%), soft tissue (33.0 ± 14.7% vs 36.5 ± 15.7%), remnant allograft (39.3 ± 20.4% vs 41.2 ± 22.7%), and bone mineralization (57.2 ± 10.6% vs 53.8 ± 8.7%). Perforating the cortex of the recipient site had no significant effect on angiogenesis as shown by immunohistochemical analysis of CD34 positive blood vessels (39.21 ± 10.53/mm2 vs 34.16 ± 12.67/mm2). Conclusion Cancellous allogeneic bone block grafts are a clinically acceptable alternative for horizontal bone augmentation. Cortical perforations of the recipient site in the maxilla did not improve angiogenesis nor bone formation within the block graft.

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Section: Discussionmentioning

confidence: 99%

Section: Importance Of Perforating the Cortex Of The Recipient Sitementioning

confidence: 99%

The role of cortical perforations in allogeneic block grafting for lateral augmentation in maxilla: A randomized clinical trial

Tresguerres

Iglesias

et al. 2021

Clin Implant Dent Rel Res

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“…Although perforations or decorticalization in the bone cortical of the receptor bone bed are widely performed with the aim of promoting revascularization and improving the incorporation process, 4–6,46,47 excessive resorption can occur in the receptor bone bed in which the graft can submerge, decreasing its volume and final thickness 6,46,47 . Conversely, when demineralization of the graft‐bed contacting surfaces was compared to perforations in rabbit tibial bone, no significant resorption was observed in the receptor bed and the graft volume was better preserved 19 .…”

Section: Discussionmentioning

confidence: 99%

Bone demineralization improves onlay graft consolidation: A histological study in rat calvaria

Carvalho

Veronesi

Manfredi

et al. 2020

Journal of Periodontology

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Background Previous data suggest that bone demineralization may promote bone graft consolidation as well as proliferation and differentiation of pre‐osteoblasts, but the biological mechanisms involved in this process need to be clarified. This study investigated the effects of bone demineralization with citric acid (CA) and tetracycline (TCN) on the repair of onlay bone grafts. Methods Onlay bone grafts were performed on the calvaria of 126 Wistar rats. The contacting surfaces between bone graft and receptor bone bed were demineralized for 15, 30, and 60 seconds with TCN (50 mg/mL), or 10% CA, (pH 1), constituting the following test groups (n = 18): TCN15, TCN30, TCN60, CA15, CA30, and CA60. Control grafts (C) were performed without demineralization (n = 18). After 7, 30, and 60 days, biopsies were obtained for quantitative and qualitative histological analysis (a = 6). Results Demineralization accelerated the bone repair early from 7 days of healing. Higher percentage area of newly formed bone was observed in CA15 and TCN60 groups when compared to C in all evaluation periods (P = 0.02). At 30 days, C specimens had lower percentage of consolidated surfaces than TCN60, TCN30 and CA15 (P = 0.0015). At 60 days, CA15, CA60, and TCN60 presented bone surfaces almost completely filled by newly formed bone, against about 75% in C specimens (P = 0.0015). Conclusions Both CA and TCN were effective in accelerating osteogenesis at the interface between bone grafts and receptor bone beds, especially when applied for 15 seconds and 60 seconds, respectively.

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“…Several surgical techniques have been adopted to manage an extremely atrophic maxillary alveolar ridges such as guided bone regeneration (GBR), 1 cortical onlay bone grafting, 2 distraction osteogenesis, 3 and inlay technique 4 . Although these techniques are popular for augmentation of deficient alveolar bone, they were associated with a lot of complications such as additional surgical interventions with subsequent increase of the treatment cost and period, and donor site morbidity 5 …”

Section: Introductionmentioning

confidence: 99%

Maxillary horizontal alveolar ridge augmentation using computer guided ridge splitting with simultaneous implant placement versus conventional technique: A randomized clinical trial

Hamzah

Mounir

Ali

et al. 2021

Clin Implant Dent Rel Res

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Background Ridge splitting technique is considered one of the successful horizontal bone augmentation procedures especially for the maxillary bone, the aim of this study was to compare marginal bone loss using a novel ridge splitting protocol versus the conventional technique. Material & Methods This was a randomized clinical trial including 20 patients who were randomly assigned to ridge splitting with simultaneous implant placement at the anterior maxillary aesthetic zone (10 patients, 29 dental implant) using patient specific guides (PSGs) or conventional technique (10 patients, 29 dental implant). In the control group free hand ridge splitting was done, while in the study group all the splitting and drilling procedures were done through specific slits and sleeves at the patient specific guides. Radiographic Assessment included measurements of linear changes in the vertical dimensions of the labial plate of bone on cross sectional cuts of computed tomography (CBCT) using mimics software. Results Wound healing was uneventful for all the patients except one patient in the control group that showed bad split and another showed buccal fenestration. The study group showed lower bone loss (1.38 ± 0.61 mm) compared to the control group (2.42 ± 0.63 mm), with statistical significance difference (P value = 0.001). The loss percentage also was higher in the study group (10.99 ± 4.76%) compared to the control group (19.12 ± 4.53%), and there was statistical significance difference between the two groups (P value = 0.001). Conclusion Ridge splitting using PSGs appear to be efficient and promising than the free hand technique.

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Radiological and Histological Evaluation of the Effects of Cortical Perforations on Bone Healing in Mandibular Onlay Graft Procedures

Abstract: In augmentation with mandibular onlay bone grafts, cortical perforations in the recipient site make no distinct contribution to bone healing within 12 weeks.

Cited by 10 publications

References 27 publications

The role of cortical perforations in allogeneic block grafting for lateral augmentation in maxilla: A randomized clinical trial

The role of cortical perforations in allogeneic block grafting for lateral augmentation in maxilla: A randomized clinical trial

Bone demineralization improves onlay graft consolidation: A histological study in rat calvaria

Maxillary horizontal alveolar ridge augmentation using computer guided ridge splitting with simultaneous implant placement versus conventional technique: A randomized clinical trial

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