Article

Short‐term outcomes of staged lateral alveolar ridge augmentation using autogenous tooth roots. A prospective controlled clinical study

Authors:
  • Carolinum, Goethe-Universität Frankfurt am Main
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Abstract

Objectives: To assess the short-term clinical outcomes of lateral alveolar ridge augmentation using autogenous tooth roots (TR) and autogenous bone blocks (AB). Material & methods: A total of n=23 patients (23 implants) were available for the analysis. Each subject was allocated to lateral ridge augmentation using either 1) healthy autogenous tooth roots (e.g. retained wisdom or impacted teeth) (n=13), or 2) cortical autogenous bone blocks harvested from the retromolar area (n=10). Clinical parameters (e.g. bleeding on probing - BOP, probing pocket depth - PD, mucosal recession - MR, clinical attachment level - CAL) were recorded at (V8) and after 26±4 weeks (V9) of implant loading. Results: TR and AB groups were associated with comparable (p>0.05) changes in mean BOP (-23.0±34.3%; -11.75±24.9%), PD (-0.03±0.14 mm; -0.1±0.29 mm), MR (0.0±0.0 mm; 0.0±0.0 mm) and CAL (-0.03±0.14 mm; -0.1±0.29 mm) values. The regression analysis failed to reveal any significant correlations between changes in BOP and PD values and the initial as well as the ridge width measured at 26 weeks. Conclusions: TR and AB were associated with comparable clinical short-term outcomes. This article is protected by copyright. All rights reserved.

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... Consequently, nine studies were included in this systematic review. [3][4][5]8,22,[26][27][28][29] Out of these, five randomized controlled trials (RCTs) were included in the meta-analysis. Fig. 1 shows the flowchart of the search process and results. ...
... Table 1 summarizes the characteristics of the included studies. Five studies were RCTs, 3,8,22,26,27 one was a controlled clinical trial (CCT), 28 and three were retrospective in their design. 4,5,29 The articles were published between 2014 and 2021. ...
... 22,27,29 Bone grafting was immediate in three studies, 3 3,8,27 One study compared secondary ISQ between autogenous dentin blocks and autogenous bone blocks, presenting values of 73.3 and 74.7, respectively, and indicating no significant difference between the groups. 5 Reported complications in the ADG group were peri-implant mucositis, 3,28 haematoma, membrane exposure, 3 and wound dehiscence. 3,5 One of the two studies on immediate implant placement had two cases of failure, one in each of the groups, ADG and Bio-Oss. ...
Article
The aim of this study was to determine whether the autogenous dentin graft (ADG) shows comparable results and similar clinical performance to other graft materials when utilized for implant placement. Four databases were searched, and controlled human studies that applied autogenous dentin for implant surgery, comparing it with other bone grafts, were included. Nine articles met the inclusion criteria, five of which were randomized controlled trials and were included in the meta-analysis. ADG showed equivalent primary and secondary implant stability when compared to Bio-Oss (primary: mean difference −0.74, 95% confidence interval (CI) − 3.36 to 1.88, P = 0.58; secondary: mean difference − 1.29, 95% CI − 5.69 to 3.11, P = 0.57). The standardized mean difference (SMD) of marginal bone loss at 6 months and at the final follow-up (18 months) showed the two grafts to be similar (6 months: SMD −0.26, 95% CI −0.64 to 0.12, P = 0.18; final follow-up: SMD −0.12, 95% CI −0.50 to 0.26, P = 0.53), and survival after immediate implant placement was the same in the two groups: 97.37% and 97.30%, respectively. Incidences of complications with the autogenous dentin particles or blocks were in line with those of Bio-Oss or autogenous bone blocks, respectively. This meta-analysis indicates that the autogenous dentin graft is an effective option for bone augmentation around dental implants, with acceptable implant stability, marginal bone loss, and incidences of complications and failure.
... As a result, a total of 20 articles were included in this review. [9][10][11][12]16,17,[25][26][27][28][29][30][31][32][33][34][35][36][37][38] Fig. 1 shows the flowchart of the search process and outcome. ...
... Using the Cochrane Collaboration tool (RoB 2), three studies were judged to have a high risk of bias 16,28,29 : two of these studies had missing outcome data 28,29 and the third study used a questionable method for measuring or reporting the outcome. 16 Three of the studies were determined to have some concerns, [25][26][27] while the studies by Elfana et al., 17 Minetti et al., 30 and Schwarz et al. 11 were judged to have a low risk of bias ( Supplementary Material Fig. S1). ...
... Using the Cochrane Collaboration tool (RoB 2), three studies were judged to have a high risk of bias 16,28,29 : two of these studies had missing outcome data 28,29 and the third study used a questionable method for measuring or reporting the outcome. 16 Three of the studies were determined to have some concerns, [25][26][27] while the studies by Elfana et al., 17 Minetti et al., 30 and Schwarz et al. 11 were judged to have a low risk of bias ( Supplementary Material Fig. S1). ...
Article
This systematic review was conducted to evaluate the available literature on the clinical outcomes of the use of autogenous tooth bone graft prepared chairside, and its current applications. A literature search was done to answer the focused questions "In partially edentulous patients, what are the alveolar ridge volumetric changes, histological findings, and implant survival rates in sites augmented with autogenous tooth bone graft prepared chairside?" Twenty articles were included at the end of the database search. Reported alveolar bone dimension changes after ridge preservation ranged between − 0.64 mm and + 2.26 mm for height, and between − 1.21 mm and + 0.41 mm for width. Augmented sites showed a significant increase in their dimensions in all investigations. The implant survival rate was 98.8% for delayed placement and 97.4% for immediate placement. Additional reports were found on the percentage bone formation following the use of this graft at different postoperative time points, which showed a higher bone volume with time. Currently available studies have included small samples, with short follow-up periods, and most have lacked a control group. Within the limitations of this review, the available evidence suggests that the autogenous tooth bone graft prepared chairside is as effective as other bone grafting materials.
... A total of 34 abstracts were reviewed and full-text analysis included 13 articles. Finally, one comparative [31], and two noncomparative studies were included [32,33]. The level of agreement between the two authors (J.V. and K.B.Ø.) in selecting abstracts and studies to be read in full text were measured at k = 0.86 and 0.96, indicating strong and almost perfect reliability of agreement. ...
... Reasons for excluding ten studies after full-text assessment were: an experimental study in animals (n = 1) [34], less than five patients included (n = 3) [35][36][37], unspecified numbers of LARA procedures (n = 1) [38], and studies could not be excluded before meticulous reading (n = 2) [39,40]. Three studies were excluded [41][42][43], because identical patient samples with a longer observation period were presented in two of the included studies [31,33]. However, additional information's from these excluded studies are presented in the following sections. ...
... The included studies of the present systematic review consisted of one prospective, non-randomized controlled trial [31], and two prospective noncomparative observational studies [32,33]. Partial edentulous patients in need of an implant-supported fixed restoration combined with a horizontal alveolar ridge deficiency of the maxilla and mandible were enrolled. ...
Article
Full-text available
Objectives: The objective of the present systematic review was to evaluate the current knowledge of implant treatment outcome following lateral alveolar ridge augmentation with autogenous tooth block graft compared with autogenous bone block graft prior to implant placement. Material and Methods: MEDLINE (PubMed), Embase and Cochrane Library search in combination with hand-search of relevant journals was conducted including human studies published in English through December 20, 2021. Comparative and non-comparative studies assessing lateral alveolar ridge augmentation with autogenous tooth block graft were included. Quality and risk-of-bias assessment were evaluated by Cochrane risk of bias tool, Newcastle-Ottawa Scale and GRADE system. Results: One comparative study characterized by low grade and two non-comparative studies fulfilled the inclusion criteria. No significant difference in short-term implant survival, health status of the peri-implant tissue or frequency of complications between the two treatment modalities was observed. Postoperative dimensional changes of the alveolar ridge width were significant diminished with tooth block compared with bone block (P = 0.0029). Consequently, the gain in alveolar ridge width was significantly higher with tooth block, after 26 weeks (P = 0.014). However, a higher frequency of short-term peri-implant mucositis was observed with tooth block. Conclusions: Lateral alveolar ridge augmentation with tooth block seems to be a suitable alternative to bone block. However, results of the present systematic review are based on short-term studies involving small patient samples. Further long-term randomized controlled trials are therefore needed before definite conclusions can be provided about the beneficial use of tooth block compared with bone block.
... Autologous tooth roots have gained increasing attention for oral bone augmentation [1] and were systematically investigated for lateral augmentation in deficient extraction sockets [2] and ridges prior to implant placement [3]. This clinical concept is based on radiological analyses [4,5], case reports [6,7] and preclinical studies [8][9][10]. These studies support the clinical use of autologous tooth roots and particularly dentine as a graft material for bone augmentation. ...
... The clinical principle is based on the similarities of dentine and bone; both being mineralized tissues, osteoconductive and subjected to bone remodeling during the course of graft consolidation. Thus, dentine in the same way as bone serves as a grafting material; however, in contrast to bone that is protected by the soft tissue, the tooth crown and potentially also parts of the root dentine are exposed to the oral cavity [2,7]. It can thus not be ruled out that at least a contaminating microbiome is co-transplanted with the teeth roots [11,12]. ...
... In the clinical scenario, caries-free, partially or fully retained or impacted wisdom teeth without signs of local pathologies are used for auto transplantation. These teeth are not or only marginally contaminated with plaque, as canines, premolars and molars were also used for preparing block grafts [2,7]. Importantly, periodontally diseased tooth roots were applied for lateral alveolar ridge augmentation, at least in a canine model [6]. ...
Article
Full-text available
Particulate autogenous tooth roots are used for alveolar bone augmentation surgery; however, dental plaque may provoke an inflammatory response that may counteract the desired graft consolidation process. Traditional mechanical cleaning of extracted teeth may be of support to lower a possible inflammatory response of the autograft. To test this assumption, extracted porcine teeth were left either uncleaned or underwent mechanical cleaning with a toothbrush and toothpaste before being fragmented and subjected to acid lysis, termed as unclean acid dentine lysate (ucADL) and clean acid dentine lysate (cADL), respectively. The inflammatory responses of murine macrophage RAW 264.7 cells being exposed to the respective acid dentine lysates were evaluated at the level of inflammatory gene expression and IL6 immunoassays. We report here that acid lysates obtained from uncleaned teeth provoked a robust increase in IL1β, IL6, and COX2 in RAW 264.7 cells. The mechanical removal of dental plaque significantly reduced the inflammatory response. Consistently, Limulus tests revealed that tooth cleaning lowers the presence of endotoxins in dentine lysates. To further prove the involvement of endotoxins, a toll-like receptor 4 (TLR4) inhibitor TAK242 was introduced. TAK242 abolished the inflammatory response provoked by acid lysates obtained from uncleaned teeth in RAW 264.7 cells. Moreover, nuclear translocation and phosphorylation of the TLR4 downstream NFκB-p65 were attenuated at the presence of cleaned versus uncleaned dentine lysates. Taken together, our data support the importance of dental plaque removal of teeth being extracted for alveolar bone augmentation surgery.
... Further, assignment of augmentation method was not random, therefore uncontrolled confounding may have influenced the results. However, clinical characteristics of the augmentation groups in this study have been presented before [40], and clinically important differences between the augmentation groups were not seen. Therefore, although randomization would have been preferable, we believe that the augmentation groups were clinically similar enough to allow the comparisons made in this report. ...
... Clinical success of lateral root graft augmentation has already been demonstrated in previous studies [17,18] and a previous report from this study confirms that the implants were healthily retained until the end of follow-up, i.e. 37 to 54 weeks after Implantation [40]. However, none of these reports described microbiological colonization at implantation sites. ...
Article
Full-text available
Objective To characterize a potential pathogenic role of Mycoplasma salivarium and bacterial co-detection patterns on different implant augmentation types. Material and methods 36 patients were non-randomly assigned to autogenous lateral alveolar ridge augmentation with either cortical autogenous bone blocks, or healthy autogenous tooth roots or non-preservable teeth. Mucosal inflammation was assessed by probing pocket depth (PD) at all sampling sites and by bleeding on probing (BOP) in a subset of sampling sites, and standardized biofilm samples were obtained from the submucosal peri-implant sulcus and sulcus of a contralateral tooth at two times (t1 after implant placement; t2 after six months). Seven bacterial species were quantified using Taqman PCR. Results Mucosal inflammation did not differ between augmentation groups, but peri-implant sulci showed increased abundance of M . salivarium after augmentation with autogenous tooth roots lasting for at least six months (t1 p = 0.05, t2 p = 0.011). In M . salivarium- positive samples, Tannerella forsythia was correlated with PD (R = 0.25, p = 0.035) This correlation was not observed in M . salivarium- negative samples. Compared to all other samples, PD was deeper in co-detection (i.e., simultaneous M . salivarium and T . forsythia ) positive samples (p = 0.022). No association of single or co-detection of bacteria with BOP was observed. Conclusion Presence of M . salivarium in peri-implant sulci varies with augmentation method and is associated with increased PD but not BOP. A potential causal role of M . salivarium in inflammation through a mechanism involving co-presence of T . forsythia requires further study.
... One study performed lateral alveolar ridge augmentation comparing the use of autogenous tooth roots versus the use of autogenous bone blocks [62]. In this particular study, after 26 weeks of healing, the implants were placed with no significant difference between groups (p > 0.05) in terms of primary implant stability quotient [62]. ...
... One study performed lateral alveolar ridge augmentation comparing the use of autogenous tooth roots versus the use of autogenous bone blocks [62]. In this particular study, after 26 weeks of healing, the implants were placed with no significant difference between groups (p > 0.05) in terms of primary implant stability quotient [62]. ...
Article
Full-text available
Alveolar ridge resorption is a natural consequence of teeth extraction, with unpleasant aesthetic and functional consequences that might compromise a future oral rehabilitation. To minimize the biological consequences of alveolar ridge resorption, several surgical procedures have been designed, the so-called alveolar ridge preservation (ARP) techniques. One important characteristic is the concomitant use of biomaterial in ARP. In the past decade, autogenous teeth as a bone graft material in post-extraction sockets have been proposed with very interesting outcomes, yet with different protocols of preparation. Here we summarize the available evidence on autogenous teeth as a biomaterial in ARP, its different protocols and future directions.
... The autologous demineralized dentin matrix was intensively investigated by the group of Kim et al. [10][11][12], while Schwarz et al. were in favor of mineralized autogenous tooth roots [13][14][15][16][17]. Histological analysis revealed a resorption and substitution of autogenous tooth roots by a non-mineralized, well-vascularized tissue zone, which was gradually invaded by a network of woven bone in a canine model [18]. ...
Article
Full-text available
Autogenous tooth roots are increasingly applied as a grafting material in alveolar bone augmentation. Since tooth roots undergo creeping substitution similar to bone grafts, it can be hypothesized that osteoclasts release the growth factors stored in the dentin thereby influencing bone formation. To test this hypothesis, collagen membranes were either soaked in acid dentin lysates (ADL) from extracted porcine teeth or serum–free medium followed by lyophilization. Thereafter, these membranes covered standardized 5-mm-diameter critical-size defects in calvarial bone on rats. After four weeks of healing, micro-computed tomography and histological analyses using undecalcified thin ground sections were performed. Micro-computed tomography of the inner 4.5 mm calvaria defects revealed a median bone defect coverage of 91% (CI: 87–95) in the ADL group and 94% (CI: 65–100) in the control group, without significant differences between the groups (intergroup p > 0.05). Furthermore, bone volume (BV) was similar between ADL group (5.7 mm3, CI: 3.4–7.1) and control group (5.7 mm3, CI: 2.9–9.7). Histomorphometry of the defect area confirmed these findings with bone area values amounting to 2.1 mm2 (CI: 1.2–2.6) in the ADL group and 2.0 mm2 (CI: 1.1–3.0) in the control group. Together, these data suggest that acid dentin lysate lyophilized onto collagen membranes failed to modulate the robust bone formation when placed onto calvarial defects.
... The autologous demineralized dentin matrix was intensively investigated by the group of Kim et al. [10][11][12], while Schwarz et al. were in favor of mineralized autogenous tooth roots [13][14][15][16][17]. Histological analysis revealed a resorption and substitution of autogenous tooth roots by a non-mineralized, well-vascularized tissue zone, which was gradually invaded by a network of woven bone in a canine model [18]. ...
Article
Full-text available
Autogenous tooth roots are increasingly applied as grafting material in alveolar bone aug-14 mentation. Since tooth roots undergo creeping substitution similar to bone grafts, it can be hypoth-15 esized that osteoclasts release the growth factors stored in the dentin thereby influencing the process 16 of graft consolidation. To test this hypothesis, collagen membranes were either soaked in acid dentin 17 lysates from extracted porcine teeth or serum-free medium followed by lyophilization. Thereafter, 18 these membranes covered standardized 5-mm-diameter critical-size defects in calvarial bone on 19 rats. After four weeks of healing, micro-computed tomography and histological analyses using un-20 decalcified thin ground sections were performed. Micro-computed tomography of the inner 4.5 mm 21 calvaria defects revealed a median bone defect coverage of 91% (CI: 87-95) in the ADL group and 22 94% (CI: 65-100) in the control group, respectively. Furthermore, we observed no significant changes 23 in bone volume (BV) in the ADL group when compared to the control group, 5.7 mm3 (CI: 3.4-7.1) 24 versus 5.7 mm3 (CI: 2.9-9.7), respectively. Histomorphometry of the defect area confirmed these 25 findings with values of 2.1 mm2 (CI: 1.2-2.6) in ADL group and 2.0 mm2 (CI: 1.1-3.0) in the control 26 group. Together, these data suggest that acid dentine lysate lyophilized onto collagen membranes 27 did not modulate the robust bone formation when placed onto calvarial defects. 28
Article
Objectives: To assess and compare the efficacy and safety of autogenous tooth roots (TRs) and autogenous bone blocks (ABs) for combined vertical and horizontal alveolar ridge augmentation and two-stage implant placement. Materials and methods: A total of 28 patients in need of implant therapy and vertical ridge augmentation were allocated to parallel groups receiving either healthy autogenous tooth roots (e.g., retained wisdom teeth) (n = 14, n = 15 defects) or cortical autogenous bone blocks harvested from the retromolar area (n = 14, n = 17 defects). After 26 weeks of submerged healing, the clinical reduction in ridge height (RH) deficiency was defined as the primary outcome. Results: Both surgical procedures were associated with a similar mean reduction in RH deficiency values, amounting to 4.48 ± 2.42 mm (median: 4.25; 95% CI: 3.08-5.88) in the TR group and 4.46 ± 3.31 mm (median: 3.00; 95% CI: 2.54-6.38) in the AB group (p = .60, Mann-Whitney U-test). In all patients investigated, the reduction in RH deficiency values allowed for an adequate implant placement at the respective sites. The frequency of complications (e.g., soft tissue dehiscences) was low (TR: n = 4; AB: n = 0). Conclusions: Up to staged-implant placement, both TR and AB grafts appeared to be associated with comparable efficacy and safety for combined vertical and horizontal alveolar ridge augmentation.
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Autologous dentin as a bone substitute can be used in regenerative dentistry. Extracted teeth are not discarded but recycled and used in block or particulate form for lateral ridge augmentation before implant insertion. Due to the growth factors contained in the dentin and the autologous origin, a stable and good osseointegration of the augmentation material can be expected. This case report demonstrates how the dentin of an autologous wisdom tooth is used for lateral ridge augmentation in area 15 in a 30-year old female patient. The patient was successfully rehabilitated with an implant afterwards. Even though the indication range is limited due to the availability of dentin and the size of the defect, the procedure represents a promising and comparatively minimally invasive autologous augmentation procedure to expand the oral surgical field in regenerative dentistry.
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Aim The aim of this systematic review was to critically evaluate the currently existing clinical evidence on the efficacy of autogenous teeth (AT) for the reconstruction of alveolar ridge deficiencies. Materials and methods A search protocol was developed to answer the focused question: “In patients exhibiting alveolar ridge deficiencies and being in need of an implant retained restoration, what is the efficacy of reconstructive procedures employing AT on changes in ridge dimensions compared with control measures?” Uncontrolled studies were also included to assess the overall efficacy of AT for specific procedures. Results A total of six studies (one randomized, one non-randomized controlled, two observational, one controlled case series, one retrospective) were identified. Two studies used AT for staged lateral augmentation, whereas four studies used AT as a demineralized dentin matrix (AutoBT) for the simultaneous grafting of dehiscence-type defects, vertical augmentation of post-extraction sockets, and lateral/transcrestal sinus floor elevation. The reported clinical outcomes following the application of either AT or AutoBT were within the range of those data noted in the respective control groups. Adverse events were commonly not observed. Conclusions The available limited studies involved relatively small patient samples and short follow-up periods but pointed to the potential of AT to serve as an alternative material for the reconstruction of alveolar ridge deficiencies. Clinical relevance AT appear to be effective in reconstructing alveolar ridge deficiencies.
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Objectives Previous research revealed that autogenous tooth roots may be biologically equivalent to conventional bone grafts for lateral ridge augmentation. However, these analyses were limited to two dimensions, whereas healing is a volumetric process. The present study aimed at volumetrically assessing the microstructure following lateral ridge augmentation using extracted tooth roots. Material and methods The roots of differently conditioned maxillary premolars (i.e., healthy: PM-C; endodontically treated: PM-E; ligature-induced periodontitis: PM-P) and retromolar cortical autogenous bone (AB) blocks were used for lateral ridge augmentation at chronic-type defects in the lower quadrants of n = 16 foxhounds. At 12 weeks, titanium implants were inserted and left to heal for another 3 weeks. Tissue biopsies were scanned using microcomputed tomography (μCT), and volumes of interest were separated at the buccal and oral aspects to measure bone volume per tissue volume (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), and connectivity density (Conn.D). Results All groups investigated revealed comparable BV/TV, Tb.Th, Tb.Sp, and Conn.D values at either the augmented buccal or pristine oral aspects, respectively. A gradual but heterogeneous replacement of grafts was observed in all groups, but residual PM fragments were particularly noted in PM-C and PM-P groups. Conclusions Differently conditioned PM and AB grafts were associated with a comparable bone microstructure within the grafted area. The duration of replacement resorption may vary considerably among the subjects. Clinical relevance Autogenous tooth roots may serve as potential alternative to AB for localized alveolar ridge augmentation.
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A classification for peri‐implant diseases and conditions was presented. Focused questions on the characteristics of peri‐implant health, peri‐implant mucositis, peri‐implantitis, and soft‐ and hard‐tissue deficiencies were addressed. Peri‐implant health is characterized by the absence of erythema, bleeding on probing, swelling, and suppuration. It is not possible to define a range of probing depths compatible with health; Peri‐implant health can exist around implants with reduced bone support. The main clinical characteristic of peri‐implant mucositis is bleeding on gentle probing. Erythema, swelling, and/or suppuration may also be present. An increase in probing depth is often observed in the presence of peri‐implant mucositis due to swelling or decrease in probing resistance. There is strong evidence from animal and human experimental studies that plaque is the etiological factor for peri‐implant mucositis. Peri‐implantitis is a plaque‐associated pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri‐implant mucosa and subsequent progressive loss of supporting bone. Peri‐implantitis sites exhibit clinical signs of inflammation, bleeding on probing, and/or suppuration, increased probing depths and/or recession of the mucosal margin in addition to radiographic bone loss. The evidence is equivocal regarding the effect of keratinized mucosa on the long‐term health of the peri‐implant tissue. It appears, however, that keratinized mucosa may have advantages regarding patient comfort and ease of plaque removal. Case definitions in day‐to‐day clinical practice and in epidemiological or disease‐surveillance studies for peri‐implant health, peri‐implant mucositis, and peri‐implantitis were introduced. The proposed case definitions should be viewed within the context that there is no generic implant and that there are numerous implant designs with different surface characteristics, surgical and loading protocols. It is recommended that the clinician obtain baseline radiographic and probing measurements following the completion of the implant‐supported prosthesis.
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Objectives: One task of Working Group 1 at the 2nd Consensus Meeting of the Osteology Foundation was to comprehensively assess the effects of hard tissue augmentation procedures on peri-implant health or disease. Materials and methods: One systematic review and meta-analysis on the effects of hard tissue augmentation procedures included a total of eight studies (n = 12 publications). Consensus statements, clinical recommendations, and implications for future research were based on structured group discussions and plenary session approval. Results: After 1-10 years of follow- up, lateral bone augmentation procedures were associated with peri-implant tissue stability, as evidenced by minimal and non-significant changes in bleeding on probing, probing depth, and marginal bone levels. Case definitions based on clinical and radiographic parameters to differentiate peri-implant health from disease have been inconsistently employed in the studies investigated. Conclusions: Lateral bone augmentation procedures are associated with peri-implant tissue stability on short-term (1-3 years) and midterm follow-ups to long-term (>3 years) follow-ups.
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Objectives: This systematic review evaluated the evidence on the effect of the interventions aimed for lateral ridge augmentation (both simultaneously with implant placement or as a staged procedure) on peri-implant health or disease. Methods: A protocol was developed to answer the following PICO question: "In patients with horizontal alveolar ridge deficiencies (population), what is the effect of lateral bone augmentation procedures (intervention and comparison) on peri-implant health (outcome)?" Included studies were randomised controlled trials or controlled clinical trials with a follow-up of at least 12 months after implant loading. Meta-analyses were performed whenever possible, including subgroup analysis based on follow-up. Results: Twelve final publications from eight investigations were included. The results from the meta-analysis indicated that irrespective of the type of intervention, the inflammatory changes, based on bleeding on probing (%) were minimal, both at short- (n = 1; weighted mean difference [WMD] = -1.00; 95% CI [-14.04; 12.04]; p = .881) and long-term (n = 5; WMD = -5.63; 95% CI [-18.42; 7.16]; p = .881). When comparing different treatment modalities, no significant differences were observed (n = 6; WMD = -3.36; 95% CI [-12.49; 5.77]; p < .471). Similarly, changes in probing pocket depth and marginal bone levels were not significantly different among groups. The incidence of peri-implantitis was evaluated in three investigations and varied from 16% to 26% after a follow-up period of 6-8 years. Conclusions: The results from this systematic review and meta-analysis have shown that lateral ridge augmentation procedures can maintain peri-implant health over time with low mucosal inflammatory changes and a relatively small incidence of peri-implant bone loss.
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Purpose: To evaluate the use of chemically unchanged tooth material in lateral alveolar ridge augmentation or for the filling of jaw defects. Materials and methods: A total of 20 patients underwent either lateral augmentation of the alveolar process (11 patients) or filling of jaw defects (6 patients) with autogenous unaltered tooth material in a longitudinal 2-year study. In three patients, the jaw defect was so marked that a bone block graft had to be used for augmentation in addition to particulate dental material. In four patients, an autogenous tooth block was exclusively used; in seven, crushed tooth material was exclusively used; and in the remaining six, dystopic teeth that had been extracted were removed, crushed, and reinserted into the defect in particulate form. Fully impacted teeth served as autogenous donor teeth. Results: After a healing time of 3 to 6 months, 28 implants could be placed (10 immediate implants, 18 delayed implants). At 6, 12, and 24 months postrestoration, peri-implant bone loss as assessed by x-ray was 0 mm, 0.4 mm, and 0.6 mm, respectively. Peri-implant probing depth was 1 mm after 1 year and 2 mm after 2 years. Bleeding on probing was not seen in any of the implants after 2 years. Conclusion: Autogenous tooth material appears to be suitable for the restoration of lateral and intraosseous defects of the alveolar ridge with both complete blocks and in particulate form. However, additional long-term studies with higher case numbers will be required for substantiating these results.
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Background/purpose The use of membrane in preventing soft tissue ingrowth during guided bone regeneration (GBR) procedure for better clinical results is controversial. The present study compares and analyzes the clinical results of GBR using the autogenous tooth bone graft (AutoBT; Korea Tooth Bank Co., Seoul, Korea) material with and without the resorbable membrane (Bio-Arm, ACE Surgical. Supply Company, Inc., USA). Materials and methods Patients who received dental implants with simultaneous GBR from the same clinician at the Dental Department of Seoul National University Bundang Hospital from March 2009 to May 2012 were selected in this study. A total of 20 patients with a total number of 30 dental implants were included in this study. The patients who received GBR with resorbable membrane were in Group 1 and those without membrane were in Group 2. AutoBT was grafted in all patients. In each group, pre- and postoperative bone loss, regeneration in percentage (%), and complications were evaluated. Results There was no statistically significant difference in pre- and postoperative reduction of bone defect height, bone level change, and bone regeneration in percentage (%) between the two groups (P > 0.05). Conclusion Both groups showed clinically acceptable bone regeneration without any eventful complications. Within the limitation of this study, we can carefully conclude that the use of resorbable membrane is not a critical factor in GBR when using AutoBT.
Article
Objectives To assess the influence of autoclavation on the efficacy of extracted tooth roots (TR) used for vertical alveolar ridge augmentation and two‐stage osseointegration. Material & Methods Maxillary premolars were randomly assigned to either autoclavation (TR‐A) or were left untreated (TR‐C) and used as block grafts for vertical alveolar ridge augmentation in both lower quadrants (n=4 beagle dogs). At 12 weeks, titanium implants were inserted and left to heal for 3 weeks. Histological analyses considered vertical bone gain (BD‐BC); augmented area (AA) and bone‐to‐implant contact (BIC) at vestibular (v) and oral (o) aspects. Results Both TR‐C and TR‐A (exposures n=3) grafts were associated with a replacement resorption and marked vertical bone gain. Median BD‐BC [TR‐C: 1.45 (v) to 1.62 mm (o) vs. TR‐A: 0.97 (v) to 1.79 mm (o)] and AA [TR‐C: 0.64 (v) to 2.36 mm² (o) vs. TR‐A: 0.22 (v) to 2.36 mm² (o) ] values were comparable in both groups. V BIC [TR‐C: 49.32 (v) to 52.97% (o) vs. TR‐A: 25.34 (v) to 46.11% (o)] values were significantly higher in the TR‐C group. Conclusions Both TR‐C and TR‐A grafts equally supported vertical alveolar ridge augmentation, however, osseointegration was partially facilitated in the TR‐C group. This article is protected by copyright. All rights reserved.
Article
Aim The aim of the current systematic review was to critically appraise evidence from randomized and prospective non‐randomized comparative clinical trials about the efficacy of lateral bone augmentation prior to implant placement and their outcome regarding bone‐width gain. Material and Methods Eight databases were searched until May 2018 for randomized and prospective non‐randomized comparative trials on lateral bone augmentation prior to implant placement. After elimination of duplicate studies, data extraction and risk‐of‐bias assessment according to the Cochrane guidelines, random‐effects meta‐analyses of Mean Differences (MD) or Relative Risks (RR) and their 95% CIs were performed, followed by subgroup, meta‐regression, and sensitivity analyses. Results A total of 25 trials (16 randomized / 9 non‐randomized) were identified, which included a total of 553 patients (42.2% male; mean age of 43.9 years). In these included studies and populations, various modalities for primary lateral bone augmentation rendered implant placement feasible. Bone width gain was significantly inversely associated with baseline bone width (pooled effect: ‐0.35 mm/mm; 95% CI: ‐0.63 to ‐0.07 mm; p=0.01). % graft resorption demonstrated a correlation with patient age (36% /year, 95% CI: ‐0.62 to ‐0.11 mm; p=0.01). The presence of xenograft added to autogenous graft led to less resorption compared to autograft alone (MD: 1.06 mm; 95% CI: 0.21 to 1.92 mm; p=0.01). Barrier membrane did not yield significant difference in terms of bone width gain (MD: ‐0.33 mm; 95% CI: ‐2.24 to 1.58 mm; p>0.05) and graft resorption (MD: 0.84 mm; 95% CI: ‐1.42 to 3.09 mm; p>0.05). Conclusions Initially smaller bone dimension favors larger bone width gain, which indicates that a severe lateral bone deficiency can be effectively augmented applying primary lateral bone augmentation. Patients’ age and recipient site (maxilla or mandible) seems to influence graft resorption. The addition of a xenograft can be helpful for reducing graft resorption.This article is protected by copyright. All rights reserved.
Article
Objectives To assess and compare the efficacy and safety of autogenous tooth roots (TR) and autogenous bone blocks (AB) for lateral alveolar ridge augmentation and two‐stage implant placement. Material & Methods A total of 30 patients in need of implant therapy and lateral ridge augmentation were allocated to parallel groups receiving either 1) healthy autogenous tooth roots (e.g. retained wisdom or impacted teeth) (n=15), or 2) cortical autogenous bone blocks harvested from the retromolar area. After 26 weeks of submerged healing, the primary endpoint was defined as the crestal ridge width (mm) (CW26) being sufficient to place an adequately dimensioned titanium implant at the respective sites. Results Soft tissue healing was uneventful in both groups. CW26 at visit 6 allowed for a successful implant placement in all patients of both TR (15/15) and AB groups (15/15). Mean CW26 values amounted to 10.06±1.85 mm (median: 11.0) in the TR and 9.20±2.09 mm (median: 8.50) in the AB group, respectively. The difference between both groups did not reach statistical significance (P=0.241). Conclusions TR may serve as an alternative graft to support lateral alveolar ridge augmentation and two‐stage implant placement. This article is protected by copyright. All rights reserved.
Article
Background: The use of autogenous block grafts harvested from intraoral donor sites has proven to be effective for the reconstruction of horizontal bone defects.
Article
Objectives: Recent animal studies have indicated, that tooth roots reveal a structural and biological potential to serve as alternative autografts for localized ridge augmentation. This proof-of-concept initial report aimed at investigating, whether this new surgical concept may be applied to humans. Material & methods: In one patient, who was in need for horizontal ridge augmentation, the roots of a retained upper wisdom tooth were separated and rigidly fixed at the defect site. After 24 weeks of submerged healing, the primary endpoint was defined as gain in ridge width (mm) being sufficient to place an adequately dimensioned titanium implant at the respective site. Secondary outcomes included safety assessments. Results: Soft tissue healing was uneventful during the entire observation period. Clinical re-entry at 24 weeks revealed, that the transplanted root was homogeneously incorporated at the former defect site and mainly replaced by a newly formed hard tissue. The gain in ridge width amounted to 4.5 mm and allowed for a successful implant placement with good primary stability. The procedure was not associated with any wound infection or adverse events. Conclusions: This novel approach may be further investigated in implant site development procedures. This article is protected by copyright. All rights reserved.
Article
Objectives: To assess the clinical outcomes of simultaneous guided bone regeneration using native (CM) and cross-linked (VN) collagen membranes at 8 years. Materials and methods: A total of n = 19 patients (19 implants) were available for the analysis. Each subject had received a simultaneous grafting of dehiscence-type defects using a natural bone mineral (NBM) and a random allocation to either CM and VN membranes (submerged healing of 4 months). Clinical parameters (e.g., bleeding on probing - BOP, probing pocket depth - PD, mucosal recession - MR, clinical attachment level - CAL) were recorded at 8 years after prosthesis installation. Results: At 8 years, CM and VN groups revealed comparable median BOP, PD, MR and CAL values at both vestibular and oral aspects. From 4 to 8 years (n = 14 patients), median CAL at the vestibular aspect improved in both groups; however, these changes were significantly higher at CM-treated sites (CM: 0.7 mm vs. VN: 0.5 mm). Conclusion: The clinical long-term outcomes at 8 years were comparable in both VN and CM groups.
Article
Objectives: To assess the efficacy of periodontally diseased tooth roots used as autografts for lateral ridge augmentation and two-stage early osseointegration of titanium implants. Material & methods: Ligature-induced periodontitis lesions were established at the maxillary premolars in n=8 foxhounds. Extracted, scaled and root planned premolar roots (PM-P) as well as retromolar cortical autogenous bone (AB) blocks were used for horizontal ridge augmentation of mandibular chronic-type defects. At 12 weeks, titanium implants were inserted and left to heal for another 3 weeks. Histological analyses included crestal ridge width - CW; augmented area - AA and bone-to-implant contact - BIC. Results: Both PM-P and AB grafts were gradually organized and replaced by newly formed bone. Median CW (PM-P: 3.83 vs. AB: 3.67 mm), AA (PM-P: 10.18 vs. AB: 9.82 mm(2) ) and BIC (PM-P: 50.00 vs. AB: 35.21%) values did not reach statistical significance between groups (p>0.05, respectively). Histologically, PM-P grafts were not associated with any inflammatory cell infiltrates. Conclusions: PM-P autografts may reveal a structural and biological potential to serve as an alternative autograft to AB. This article is protected by copyright. All rights reserved.
Article
Objectives: To assess the efficacy of tooth roots used as autografts for lateral ridge augmentation and two-stage early osseointegration of titanium implants. Material & methods: The maxillary premolars were randomly assigned to either endondontic therapy (PM-E) or were left untreated (PM-C). Retromolar cortical autogenous bone (AB) blocks served as controls. PM-E/ PM-C and AB were used for ridge augmentation at chronic-type defects in both lower quadrants (n=8 foxhounds). At 12 weeks, titanium implants were inserted and left to heal for another 3 weeks. Histological analyses considered crestal ridge width - CW; augmented area - AA and bone-to-implant contact - BIC. Results: Both PM and AB grafts (exposures: AB=3; PM-C=4; PM-E=7) were gradually involved in the bone remodeling process and associated with a replacement resorption. Median CW (PM-C: 2.70 vs. AB: 3.30 mm; PM-E: 2.96 vs. AB: 3.35 mm), AA (PM-C: 7.55 vs. AB: 8.56 mm(2) ; PM-E: 11.20 vs. AB: 6.60 mm(2) ) and BIC (PM-C: 36.96 mm vs. AB: 64.10%; PM-E: 50.79 vs. AB: 32.53%) values were comparable in both PM and AB groups (p>0.05, respectively). Conclusions: Extracted tooth roots revealed a structural and biological potential to serve as an alternative autograft to autogenous bone. A higher exposure rate may be expected when using endodontically treated teeth. This article is protected by copyright. All rights reserved.
Article
To assess the prevalence of peri-implant health or disease for a two-piece implant system with a tube-in-tube internal connection on the short-, medium- and long term. For this cross-sectional analysis, 238 patients with a total of n = 512 implants were screened in six private practices and one university clinic in Germany. Peri-implant health and disease was assessed according to strict case definitions. Binary logistic regression was used to assess the correlation with systemic factors. After a median function time of 23 months, the prevalence of peri-implant mucositis and peri-implantitis amounted to 41.6% and 13.9%, corresponding to 35.6% and 7.6% at the implant level, respectively. Factors plaque (odds ratio [OR], 8.415) and gender "male" (OR, 2.003) were significantly correlated with the event peri-implant mucositis. The event peri-implantitis was significantly correlated with plaque (OR, 9.250) and smoking (OR, 2.679). The prevalence of peri-implant diseases was correlated with patient-specific factors. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Article
To investigate the impact of a cross-linked- (VN) collagen membrane on the long-term stability of peri-implant health over 6 years. Vestibular dehiscence-type defects at titanium implants (19 patients, 19 implants) were augmented using a natural bone mineral and randomly allocated to either VN or a native collagen membrane (CM) and left to heal in a submerged position for 4 months. Clinical parameters (i.e. Bleeding on Probing-BOP, probing pocket depth-PD, mucosal recession-MR) were recorded at 4 and 6 years after prosthesis installation. At 4 and 6 years, both VN and CM revealed comparable mean BOP, PD and MR values at both vestibular and oral aspects. Changes in these parameters from 4 to 6 years were minimal (vestibular aspect-VN: -3.3 ± 48.2%, -0.1 ± 0.5 mm, -0.1 ± 0.3 mm; CM: -1.8 ± 33.7%, 0.0 ± 0.4 mm, -0.1 ± 0.7 mm) and not significantly different between groups. At 6 years, the incidence of mucositis and peri-implantitis was comparable in both groups (VN: 60.0% and 20.0%; CM: 33.3% and 33.3%). In conclusion, the present follow-up observation failed to identify any beneficial impact of VN over CM on peri-implant health at 4 and 6 years.
Article
Peri-implant diseases present in two forms - peri-implant mucositis and peri-implantitis. The literature was systematically searched and critically reviewed. Four manuscripts were produced in specific topics identified as key areas to understand the microbial aetiology and the pathogenesis of peri-implant diseases and how the implant surface structure may affect pathogenesis. While peri-implant mucositis represents the host response of the peri-implant tissues to the bacterial challenge that is not fundamentally different from gingivitis representing the host response to the bacterial challenge in the gingiva, peri-implantitis may differ from periodontitis both in the extent and the composition of cells in the lesion as well as the progression rate. A self-limiting process with a "protective" connective tissue capsule developing appears to dominate the periodontitis lesion while such a process may occasionally be lacking in peri-implantitis lesions. Bacterial biofilm formation on implant surfaces does not differ from that on tooth surfaces, but may be influenced by surface roughness. Nevertheless there is no evidence that such differences may influence the development of peri-implantitis. It was agreed that clinical and radiographic data should routinely be obtained after prosthesis installation on implants in order to establish a baseline for the diagnosis of peri-implantitis during maintenance of implant patients.