The Fate of Lateral Ridge Augmentation: A Systematic Review and Meta-Analysis

Abstract

Owing to volumetric changes after tooth extraction, lateral ridge augmentation has become a common procedure prior or simultaneous to implant placement. Nonetheless, little is known with regard to the dimensional remodeling after healing of these lateral ridge augmentation procedures. Hence, the purpose of this systematic review was to assess the stability of bone grafting material between augmentation procedures and final healing, in terms of resorption rate. Materials and Methods: An electronic and hand literature search was conducted in several databases, such as the Cochrane Oral Health Group Trials Register, Embase, and Cochrane Central Register of Controlled Trials, up until February 2017. Only randomized controlled trials (RCTs) with a mean follow-up of at least 6 months after implant placement aiming to evaluate the stability of grafting material for lateral ridge augmentation were included and quantitatively analyzed. Results: A total of 35 articles were evaluated; however, only 17 RCTs met the inclusion criteria. A total of 15 studies reported information on bone resorption, leading to a total sample of 304 implants. The estimated overall mean horizontal bone gain at the time of regeneration was 3.71 ± 0.24 mm, with 4.18 ± 0.56 mm for the block graft technique and 3.61 ± 0.27 mm for guided bone regeneration (GBR). The estimated overall net bone gain at final re-evaluation (11.9 ± 7.8) was 2.86 ± 0.23 mm. The estimated mean (± SD) resorption after 6 months was 1.13 ± 0.25 mm, with 0.75 ± 0.59 mm for the block graft technique and 1.22 ± 0.28 mm for GBR. The implant survival rate was 97% to 100%. Conclusion: Regardless of the material used for regeneration, different degrees of graft resorption should be expected. Given the sample of investigations analyzed in this review, block grafts seemed to maintain the volume of the initial augmentation site more than GBR techniques. During the initial stages of healing, the GBR technique experienced more changes compared with block grafts. The resorption of the xenograft group was inferior compared with the combination of xenograft and autologous bone groups. Consequently, overcorrection of the horizontal defects should be performed to compensate for the resorption of the grafting materials.

A retrospective 10‐year mean follow‐up of implants placed in ridges grafted using autogenous mandibular blocks covered with bovine bone mineral and collagen membrane

“…The blocks were fixed with titanium micro‐screws (1.5 mm in diameter), and all remaining gaps between the bone blocks and the recipient sites were filled with autogenous bone particles obtained with scrapers. A mild over‐correction of the defect was always performed both during vertical and horizontal augmentations. A layer of slowly resorbable xenograft (Bio‐Oss ® , Geistlich Pharma) mixed with autogenous bone chips was placed over the grafts and stabilized with collagen membranes (Bio‐Gide ® , Geistlich Pharma) to eliminate sharp edges, to harmonize the shape of the reconstructed area, and to reduce the risk of bone resorption (Chiapasco et al, ; Cordaro et al, ; Elnayef et al, ; Proussaefs & Lozada, ; Sanz‐Sánchez et al, ; Von Arx & Buser, ; Wiltfang et al, ). Periosteal releasing incisions of the flaps were performed to obtain a tension‐free and water‐tight closure with horizontal internal mattress and simple interrupted sutures using 4/0 or 5/0 silk or PGA.…”

“…Among these, the use of autogenous bone blocks taken from the mandibular ramus is one of the most frequently used procedures. Furthermore, the combination of autogenous blocks with particulated xenografts such us bovine bone mineral (BBM) and resorbable collagen membranes have shown to provide better outcomes in terms of maintenance of initial bone gain over time as compared with the use of bone blocks only (Chiapasco et al, ; Cordaro, Torsello, Miuccio, Di Torresanto, & Eliopoulos, ; Elnayef et al, ; Jensen & Terheyden, ; Milinkovic & Cordaro, ; Proussaefs & Lozada, ; Sanz‐Sánchez et al, ; Von Arx & Buser, ; Wiltfang et al, ).…”

Cell therapy for orofacial bone regeneration: A systematic review and meta‐analysis

“…Several regenerative surgical approaches have been proposed to prevent and/or reconstruct alveolar defects, most commonly, alveolar ridge/socket preservation (SP) following dental extraction (Avila‐Ortiz et al., ), vertical and horizontal ridge augmentation (RA) (Daugela, Cicciu, & Saulacic, ; Elnayef et al., , ), maxillary sinus‐floor augmentation (SA) (Danesh‐Sani et al., ), and alveolar cleft (AC) repair in the palatal aspect of the maxilla (Wu et al., ). All of these techniques mainly involve the use of autogenous bone (AB) grafts and/or bone substitute materials, and often in combination with barrier membranes, that is the guided bone regeneration (GBR) principle (Elgali, Omar, Dahlin, & Thomsen, ); in the case of more advanced (e.g., segmental) defects, vascularized tissue flaps are used (Hayden, Mullin, & Patel, ).…”

The influence of wound closure on graft stability: An in vitro comparison of different bone grafting techniques for the treatment of one‐wall horizontal bone defects

“…However, graft success is highly dependent on different factors, with defect morphology and defect size being of great importance . Often, studies lack information on defect characteristics or present very heterogeneous types of treated defects, as shown in a recent review . Consequently, the authors recommend that the evaluated defect types should be taken into account in relation to the results of a study.…”

“…The authors attributed this negative effect mainly to the instability of the graft particles due to mucosal pressure. They recommend caution when using particulate grafts for larger bone defects and assume that block grafts have a better regenerative potential in these situations . Furthermore, horizontal bone defect types show more reliable results than do vertical defects with GBR, which could also be attributed to the higher mucosal pressure.…”