Split-Block Graft Versus Cortico-cancellous Block Graft for Horizontal Ridge Augmentation: Cone Beam Computed Tomography and Histomorphometric Study
DOI:
https://doi.org/10.14295/bds.2021.v24i3.2464Abstract
Objective: The aim of this study was to compare the horizontal dimensional changes of split-bone block and cortico-cancellous block graft in horizontal ridge augmentation using Cone Beam Computed Tomography (CBCT). The quality of the regenerated bone in both groups was compared histologically and histomorphometrically. Material and methods: Twenty patients were randomly divided in two equal groups (n= 10): Split-bone block group which was harvested from the external oblique ridge or cortico-cancellous block graft group which was harvested from the mandibular symphysis. Pre-augmentation crestal ridge width was measured using bone caliper. CBCT scans were taken on the 2nd week and 4th month post-operatively to measure crestal and total horizontal ridge dimensions. A biopsy was collected from the regenerated ridge immediately before implant insertion on the 4th month post-operatively. Results: Pre-augmentation crestal bone widths of both groups were comparable (P= 0.870). On the 2nd week and 4th month post-operatively, split-bone block showed a significantly wider crestal (P= 0.028 and P= 0.001 respectively) and total horizontal ridge dimension (P= 0.025 and P= 0.002 respectively), and on the 4th month post-operatively, it showed significantly lesser resorption at crest (P= 0.040) and in total horizontal ridge dimension (P= 0.017) than cortico-cancellous block. Histologically, the regenerated bone quality was similar in both groups. Histomorphometric analysis showed a non-significant difference in percentage of mature (P= 0.365) and immature collagen (P= 0.531) between both groups. Conclusion: Split-bone block maintained a significantly wider ridge and experienced less resorption after 4 months than the cortico-cancellous block graft, with no difference in regenerated bone quality between both groups.
Keywords
Dental implants; CBCT; Cortico-cancellous block graft; Histomorphometric analysis; Split-bone block technique.
References
Schropp L, Wenzel A, Kostopoulos L, Karring T. Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent. 2003;23(4):313-23.
Chappuis V, Cavusoglu Y, Buser D, von Arx T. Lateral ridge augmentation using autogenous block grafts and guided bone regeneration: a 10-year prospective case series study. Clin Oral Impl Res. 2016;19(1):85-96. doi: 10.1111/cid.12438.
Aloy-Prosper A, Penarrocha-Oltra D, Penarrocha-Diago M, Penarrocha-Diago M. The outcome of intraoral onlay block bone grafts on alveolar ridge augmentations: a systematic review. Med Oral Patol Oral Cir Bucal. 2015;20(2):e251-8. doi: 10.4317/medoral.20194.
D'Addona A, Nowzari H. Intramembranous autogenous osseous transplants in aesthetic treatment of alveolar atrophy. Periodontol 2000. 2001;27(1):148-61. doi: 10.1034/j.1600-0757.2001.027001148.x.
Fu JH, Wang HL. Horizontal bone augmentation: the decision tree. Int J Periodontics Restorative Dent. 2011;31(4):429-36.
Khoury F, Khoury CH. Mandibular bone block grafts: diagnosis, instrumentation, harvesting techniques and surgical procedures. In: Khoury F, Antoun, H, Missika P, editors. Bone Augmentation in Oral Implantology. Chicago: Quintessence; 2007:115-212.
Stimmelmayr M, Gernet W, Edelhoff D, Güth J, Happe A, Beuer F. Two-stage horizontal bone grafting with the modified shell technique for subsequent implant placement: a case series. Int J Periodontics Restorative Dent. 2014;34(2):269-76. doi: 10.11607/prd.1374.
D'Souza K, Aras M. Types of implant surgical guides in dentistry: a review. J Oral Implantol. 2012;38(5):643-52. doi: 10.1563/AAID-JOI-D-11-00018.
Proussaefs P, Lozada J. The use of intraorally harvested autogenous block grafts for vertical alveolar ridge augmentation: a human study. Int J Periodontics Restorative Dent. 2005;25(4):351-63.
Khoury F, Hanser T. Mandibular bone block harvesting from the retromolar region: A 10-year prospective clinical study. Int J Oral Maxillofac Implants. 2015;30(3):688-97. doi: 10.11607/jomi.4117.
Pikos M. Mandibular block autografts for alveolar ridge augmentation. Atlas Oral Maxillofac Surg Clin North Am. 2005;13(2):91-107. doi: 10.1016/j.cxom.2005.05.003.
Ozaki W. Buchman S. Volume maintenance of onlay bone grafts in the craniofacial skeleton: micro-architecture versus embryologic origin. Plast Reconstr Surg. 1998;102(2):291-9. doi: 10.1097/00006534-199808000-00001.
Myeroff C, Archdeacon M. Autogenous bone graft: donor sites and techniques. J Bone Joint Surg Am. 2011;93(23):2227-36. doi: 10.2106/JBJS.J.01513.
Nefussi JR. Bone biology and physiology of the implant bone site. In: Khoury F, Antoun H, Missika P, editors. Bone Augmentation in Oral Implantology. Chicago: Quintessence; 2007:1-27.
Marx R. Bone and bone graft healing. Oral Maxillofac Surg Clin North Am. 2007;19(4):455-66. doi: 10.1016/j.coms.2007.07.008.
Oh KC, Cha JK, Kim CS, Choi SH, Chai JK, Jung UW. The influence of perforating the autogenous block bone and the recipient bed in dogs, part I: a radiographic analysis. Clin Oral Implants Res. 2011;22(11):1298-302. doi: 10.1111/j.1600-0501.2010.02110.x.
Ozaki W, Buchman S, Goldstein S, Fyhrie D. A comparative analysis of the microarchitecture of cortical membranous and cortical endochondral onlay bone grafts in the craniofacial skeleton. Plast Reconstr Surg. 1999;104(1):139-47.
Khoury F, Hanser T. Three-dimensional vertical alveolar ridge augmentation in the posterior maxilla: a 10-year clinical study. Int J Oral Maxillofac Implants. 2019;34(2):471-480. doi: 10.11607/jomi.6869.
Caballe-Serrano J, Bosshardt D, Buser D, Gruber R. Proteomic analysis of porcine bone-conditioned medium. Int J Oral Maxillofac Implants. 2014;29(5):1208-15. doi: 10.11607/jomi.3708.
Broggini N, Bosshardt DD, Jensen SS, Bornstein MM, Wang CC, Buser D. Bone healing around nanocrystalline hydroxyapatite, deproteinized bovine bone mineral, biphasic calcium phosphate, and autogenous bone in mandibular bone defects. J Biomed Mater Res B Appl Biomater. 2015;103(7):1478-87. doi: 10.1002/jbm.b.33319.
Janner S, Bosshardt D, Cochran D, Chappuis V, Huynh-Ba G, Jones A, Buser D. The influence of collagen membrane and autogenous bone chips on bone augmentation in the anterior maxilla: a preclinical study. Clin Oral Implants Res. 2017;28(11), 1368-80. doi: 10.1111/clr.12996.
Thoma DS, Maggetti I, Waller T, Hämmerle CHF, Jung RE. Clinical and patient-reported outcomes of implants placed in autogenous bone grafts and implants placed in native bone: A case-control study with a follow-up of 5-16 years. Clin Oral Implants Res. 2019;30(3):242-251. doi: 10.1111/clr.13410.
De Stavola L, Tunkel J. A new approach to maintenance of regenerated autogenous bone volume: delayed relining with xenograft and resorbable membrane. Int J Oral Maxillofac Implants. 2013;28(4):1062-7. doi: 10.11607/jomi.2726.
Antoun H, Sitbon JM, Martinez H, Missika P. A prospective randomized study comparing two techniques of bone augmentation: onlay graft alone or associated with a membrane. Clin Oral Implants Res. 2001;12(6):632-9. doi: 10.1034/j.1600-0501.2001.120612.x.
Spin-Neto R, Landazuri Del Barrio R., Pereira L, Marcantonio R, Marcantonio E, Marcantonio E Jr. Clinical similarities and histological diversity comparing fresh frozen onlay bone blocks allografts and autografts in human maxillary reconstruction. Clin Oral Impl Res. 2011;15(4):490-7. doi: 10.1111/j.1708-8208.2011.00382.x.
Spin-Neto R, Stavropoulos A, Coletti FL, Faeda RS, Pereira LAVD, Marcantonio E Jr. Graft incorporation and implant osseointegration following the use of autologous and fresh frozen allogeneic block bone grafts for lateral ridge augmentation. Clin Oral Impl Res. 2014;25(2):226-33. doi: 10.1111/clr.12107.
Spin-Neto R, Stavropoulos A, Coletti FL, Pereira LAVD, Marcantonio E, Wenzel A. Remodeling of cortical and corticocancellous fresh-frozen allogeneic block bone grafts: a radiographic and histomorphometric comparison to autologous bone grafts. Clin Oral Impl Res. 2015;26(7):747-52. doi: 10.1111/clr.12343.
De Santis E, Lang NP, Favero G, Beolchini M, Morelli F, Botticelli D. Healing at mandibular block-grafted sites: an experimental study in dogs. Clin Oral Impl Res. 2015;26(5):516-22. doi: 10.1111/clr.12434.
Downloads
Published
Versions
- 2021-07-30 (4)
- 2021-07-01 (3)
- 2021-07-01 (2)