The role of cortical perforations in bone regeneration: a systematic review

Alvira-González, Joaquín; Stavola, Luca De

doi:10.1016/j.ijom.2019.10.011

Cited by 12 publications

(12 citation statements)

References 35 publications

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“…Maxilla is a well‐vascularized bone, which receives blood supply from a large number of arteries, vessels, and arterioles; most of them converge in the periodontal, endosseous, and periosteal plexus, giving maxilla an excellent vascularization. Facial blood vessels can also irrigate this bone, and arteries of the craniofacial mass arrive to the soft and hard palate, improving maxilla blood supply 15 . Therefore, this great vascularization and the thin cortical of maxilla may make unnecessary the bone decortication prior to block placement. A minimum mechanical injury of the recipient site, such as periosteum removal or osteosynthesis screws placement, could start up the repairing process 17,33 …”

Section: Discussionmentioning

confidence: 99%

“…Bone decortication may enhance the healing process and improve the physical properties of the connection between graft and the recipient site, favoring bone interlocking. Nonetheless, there is not enough bibliographic evidence to endorse this idea because of the lack of human clinical trials and the variability of animal studies results 16,17 …”

Section: Introductionmentioning

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: Introductionmentioning

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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“…Recipient site perforation helped induce angiogenesis and early graft integration with the host site. The literature presents scarce data concerning the same; however, positive results, in this case, encourage further exploration of surgical techniques [7,8]. Undertaking tertiary grafting not only helped achieve the required bone dimension for implant placement but its subsequent loading using a dental implant will ensure a functional stimulation of the graft thereby preventing its loss over time.…”

Section: Discussionmentioning

confidence: 83%

Comprehensive Morpho-Functional and Dental Rehabilitation of a Complete Unilateral Cleft Lip and Palate Patient

Mallick¹,

Pisulkar²,

Reddy³

et al. 2022

Cureus

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Congenital clefts cause compromised function and esthetics, inadvertently affecting a patient's social and mental health. These defects can be successfully managed by a multidisciplinary team that can provide holistic care from birth till adulthood and beyond. A 17-year-old girl with left side congenital cleft, who had undergone cleft surgeries at our center, reported with a chief complaint of a missing front tooth in the upper region. Clinical and radiographic investigations showed a need for tertiary grafting, which was done using an autologous iliac graft. After six months, a dental implant was placed and immediately loaded after implant stability quotient assessment. Treatment of cleft patients is arduous and technique sensitive and should be done following pre-defined protocols. Each case should be handled by a multidisciplinary team giving attention to each aspect of the treatment requirement. It is an added advantage if the treatment is holistically catered at a single center as it provides patient comfort and avoids patient dependence on past records.

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“…Large perforations were found to be associated with relatively quicker bone formation 30 . A recent systematic review, however, concluded that the evidence in support of creating perforations in GBR and with autologous bone blocks is limited 32 . This author does not routinely perforate the recipient bone bed and has not seen a difference in outcomes.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Perforating the recipient bone bed is recommended by some surgeons to enhance healing 30–32 . By perforating the cortical bone with a small bur, the marrow cavity is opened and bleeds into the defect.…”

Section: Surgical Techniquementioning

confidence: 99%

The Aesthetic Contour Graft ‐ Enhancing peri‐implant soft tissue contours and pontic sites with guided bone regeneration

Hayashi

2022

J Esthet Restor Dent

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Objective In this article, we will discuss strategies for enhancing peri‐implant soft tissue contours and pontic sites with hard tissue augmentation. Clinical consideration One of the keys to the esthetic illusion of an implant‐supported restoration is to create an ideal emergence profile. A critical part of any emergence profile is based on the height and thickness of the tissue surrounding the restoration and whether there are any defects in this tissue. Even when there is adequate bone in which to place implants, if any irregular ridge anatomy that supports this tissue is not corrected, then an unesthetic appearance of the restoration can result due to the lack of soft tissue with which to develop a proper emergence profile. Conclusion Most peri‐implant soft tissue deficiencies represent an underlying bony defect that can be corrected or enhanced through bone augmentation. Clinical significance Traditional methods of enhancing soft tissue emergence profiles around implants and pontic sites mostly involve the use of soft tissue augmentation techniques. Although there are few reports of the use of bone augmentation for this purpose, soft tissue contours can be enhanced by augmenting the underlying bone contours and, in many instances, may obviate the need for subsequent soft tissue augmentation.

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The role of cortical perforations in bone regeneration: a systematic review

Cited by 12 publications

References 35 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

Comprehensive Morpho-Functional and Dental Rehabilitation of a Complete Unilateral Cleft Lip and Palate Patient

The Aesthetic Contour Graft ‐ Enhancing peri‐implant soft tissue contours and pontic sites with guided bone regeneration

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