Vertical ridge augmentation using the modified shell technique – a case series

Stimmelmayr, Michael; Beuer, Florian; Schlee, Markus; Edelhoff, Daniel; Güth, Jan‐Frederik

doi:10.1016/j.bjoms.2014.08.009

Cited by 12 publications

(16 citation statements)

References 14 publications

(16 reference statements)

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“…1,2,12,13 From today's perspective, the clinical use of autogenous bone block grafts seems to be indispensable for a predictable augmentation result within the scope of vertical reconstructions. 1,3,4,19,21,23,25,31 This is due to the osteoconductive, above all, osteoinductive, and osteogenetic potential of autogenous transplants. 1,3,4 The potential of osteoinduction and ostegenesis also accelerates the formation of new bone and thus leads to a reduction of the treatment time compared to augmentation techniques with bone substitute material.…”

Section: Discussionmentioning

confidence: 99%

“…This, in turn, causes an improvement of the graft's osteoconductive potential and thus its accelerated revascularization and regeneration. 25,27 One reason for the controversial volume stability of autogenous bone transplants discussed in the literature, therefore, appears to be the different processing of the bone block transplants. 1,15,16 The described resorption of autogenous bone block grafts is usually attributable to the use of mandibular full-thickness bone block grafts, which, due to their low surface area, are exposed to many remodeling effects such as osteoclast activity in nonrevitalized transplant areas and ultimately end in volume loss.…”

Section: Discussionmentioning

confidence: 99%

“…1,18,23,24 Autogenous bone grafts are utilized in different consistency and shapes, with or without membranes, using different techniques and approaches to reconstruct the missing vertical alveolar volume. 1,18,20,21,25 However, some risks related to these surgeries are still present, for example, soft tissue necrosis with graft exposure as well as poor revascularization of the mandibular cortical graft leading in many cases to an increased resorption of the grafted area. 1,15,23,[26][27][28][29][30][31] The split bone block (SBB) technique, 1,23 using a combination of autogenous thin bone blocks and small pieces of bone (bone chips), was described as a biologic modification of the grafting procedure that accelerates the regeneration of the graft through improvement of the osteoconductive properties, especially in vertical bone reconstructions.…”

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confidence: 99%

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Three-Dimensional Vertical Alveolar Ridge Augmentation in the Posterior Maxilla: A 10-year Clinical Study

Khoury¹,

Hanser²

2019

Int J Oral Maxillofac Implants

100

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The aim of this clinical study was to evaluate the long-term outcome of the split bone block (SBB) technique for vertical bone augmentation in the posterior maxilla in combination with sinus floor elevation using a tunneling approach. Materials and Methods: Patients were treated for extensive vertical and horizontal alveolar bone defects without simultaneous implant placement and followed up for at least 10 years postoperatively. Autogenous bone blocks were harvested from the mandibular retromolar area following the MicroSaw protocol. The harvested bone blocks were split longitudinally according to the SBB technique. Implants were inserted and exposed after every 3 months, and prosthetic restoration was performed. Results: One hundred forty-two consecutively treated patients, 154 grafted sites, and 356 inserted implants were documented. Minimal graft exposure (1 to 3 mm) 4 to 8 weeks postoperatively was documented in two sites; infection of the grafted area occurred in one other case. The mean preoperative clinical vertical defect was 7.8 ± 3.9 mm, and the mean horizontal width was 3.1 ± 2.2 mm. Postoperatively, the mean vertical gained dimension was 7.6 ± 3.4 mm (maximum: 13 mm), and the mean width was 8.3 ± 1.8 mm. Implants could be inserted in all sites, with additional local small augmentation in 21 cases. The amount of maximum vertical bone resorption was 0.21 ± 0.18 mm after 1 year, 0.26 ± 0.21 mm after 3 years, 0.32 ± 0.19 mm after 5 years, and 0.63 ± 0.32 mm after 10 years. As part of a total patient dropout of 16.9%, four implants were lost within 10 years. The mean vertically gained bone was stable at 6.82 ± 0.28 mm (maximum: 12 mm). The resorption rate after 10 years was 8.3%. Conclusion: The described tunneling flap approach allows a hermetic soft tissue closure, characterized by a reduction of dehiscence and a secure bone graft healing. The combination of thin autogenous bone blocks and bone particles according to the SBB technique allows an acceleration of transplant revascularization, and thus, of graft regeneration, allowing a shortening of the patient treatment time as well as long-term three-dimensional volumetric bone stability.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Three-Dimensional Vertical Alveolar Ridge Augmentation in the Posterior Maxilla: A 10-year Clinical Study

Khoury¹,

Hanser²

2019

Int J Oral Maxillofac Implants

100

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“…The following advantages were postulated:Sufficient volume stability and adequate bone consolidation are ensured by application of rhBMP-2 and VEGF directly on implantation site.No membranes, screws or titan meshes are necessary to hold the augmentative materials in place or prevent soft tissue from ingrowth.In comparison to other studies and techniques no consecutive surgery is necessary in order to remove foreign materials [49, 50]. …”

Section: Introductionmentioning

confidence: 99%

“…In comparison to other studies and techniques no consecutive surgery is necessary in order to remove foreign materials [49, 50]. …”

Section: Introductionmentioning

confidence: 99%

Vertical bone regeneration using rhBMP-2 and VEGF

et al. 2017

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BackgroundSufficient vertical and lateral bone supply and a competent osteogenic healing process are prerequisities for the successful osseointegration of dental implants in the alveolar bone. Several techniques including autologous bone grafts and guided bone regeneration are applied to improve quality and quantity of bone at the implantation site. Depending on the amount of lacking bone one- or two-stage procedures are required. Vertical bone augmentation has proven to be a challenge particularly in terms of bone volume stability. This study focuses on the three dimensional vertical bone generation in a one stage procedure in vivo. Therefore, a collagenous disc-shaped scaffold (ICBM = Insoluble Collagenous Bone Matrix) containing rhBMP-2 (Bone Morphogenetic Protein-2) and/or VEGF (Vascular Endothelial Growth Factor) was applied around the coronal part of a dental implant during insertion. RhBMP-2 and VEGF released directly at the implantation site were assumed to induce the generation of new vertical bone around the implant.MethodsOne hundred eight titanium implants were inserted into the mandible and the tibia of 12 mini pigs. Four experimental groups were formed: Control group, ICBM, ICBM + BMP-2, and ICBM + BMP-2 + VEGF.After 1, 4 and 12 weeks the animals were sacrificed and bone generation was investigated histologically and histomorphometrically.ResultsAfter 12 weeks the combination of ICBM + rhBMP2 + VEGF showed significantly more bone volume density (BVD%), a higher vertical bone gain (VBG) and more vertical bone gain around the implant (PVBG) in comparison to the control group.ConclusionBy using collagenous disc-shaped matrices in combination with rhBMP-2 and VEGF vertical bone can be generated in a one stage procedure without donor site morbidity. The results of the presenting study suggest that the combination of rhBMP-2 and VEGF applied locally by using a collagenous carrier improves vertical bone generation in vivo. Further research is needed to establish whether this technique is applicable in clinical routines.

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