The influence of connective tissue grafting on the reconstruction of a missing facial bone wall using immediate implant placement and simultaneous bone reconstruction: a retrospective long-term cohort study.

PURPOSE: This retrospective cohort study evaluates the influence of connective tissue grafts (CTG) on bone regeneration at implant sites with total loss of the buccal bone wall treated with flapless immediate implant placement (IIP) and reconstruction with autogenous bone chips (AB) within a follow-up of up to 13 years. METHODS: Sixty implants were inserted in 55 patients in sites with total loss of the buccal bone wall between 2008 and 2021. The implants were inserted and the buccal gaps were grafted by AB. A subgroup of 34 sites was grafted additionally with CTG using tunnel technique. Primary outcome was the vertical bone regeneration in height and thickness. Secondary outcome parameters were interproximal marginal bone level, recession, soft tissue esthetics (PES), width of keratinized mucosa (KMW) and probing depths (PPD). RESULTS: Mean follow-up period was 60.8 months. In 55 sites a complete vertical bone regeneration was documented. The mean buccal bone level increased by 10.6 mm significantly. The thickness of the buccal bone wall ranged between 1.7 and 1.9 mm, and was significantly thicker in sites without CTG. Interproximal marginal bone level was at implant shoulder level. The mean recession improved significantly by 1.2 mm. In sites with CTG, recessions and PES improved significantly more. CONCLUSIONS: Additional CTG in extraction sites with total buccal bone loss followed by IIP with simultaneous AB grafting led to improved PES and recession, but also to a thinner buccal bone wall compared to sites grafted just with AB.

Reconstructive Surgery with Autogenous Chin Block Graft for Esthetic Rehabilitation of Deficient Anterior Maxillary Region.

Endosseous implants have revolutionized the field of Implants and Prosthodontics. Implant placement is a viable option in the treatment of partial and full edentulism. However, placement of implants in alveolar deficiencies may lead to adverse angulations, mechanical overload and esthetic dissatisfaction. When minimum dimensions for implant placement are not present in alveolar process, it is necessary to augment the size of the ridge. This can be achieved by various methods and materials. Here in this article presented a successful case of a 27 year old male patient with horizontal ridge augmentation in anterior left central incisor region using autogenous chin graft followed by the placement of implants after a period of six months of grafting and finally the prosthesis given after a period of six months of healing of implants.

Introduction of temporomandibular joint and skull base combined reconstruction by autogenous bone graft.

OBJECTIVE: This study introduces the application of autogenous bone graft for the reconstruction of temporomandibular joint (TMJ) and skull base combined defects. MATERIALS AND METHODS: Patients treated with autogenous bone grafts for reconstruction of the TMJ and skull base were reviewed. All patients underwent virtual surgical design to confirm the osteotomies of the combined lesion and the selections of autogenous bone graft, fabrication of surgical templates to transfer the plan to actual operation, and reconstruction of autogenous bone graft for the TMJ and/or skull base. Surgical outcomes were assessed by clinical examinations and radiological data. RESULTS: Twenty-two patients were involved in this study. Ten patients underwent reconstruction of the skull base by a free iliac or temporal bone graft and preservation of the TMJ. Twelve patients underwent skull base reconstruction by the same methods and total reconstruction of the TMJ by half sternoclavicular joint flap or costochondral bone graft. No severe complications occurred after surgery. The occlusion relationship was stable and similar to that of the preoperative state. The pain and maximal interincisal opening were significantly improved by the 101.2-month follow-up. CONCLUSION: Autogenous bone graft is a good alternative for repairing the TMJ and the skull base structure and function. CLINICAL RELEVANCE: The study introduced the application of autogenous bone graft for the reconstruction of temporomandibular joint and skull base combined defect, which is a good way to repair the defect and restore the function.

Biological Reconstruction of Posteromedial Tibial Defect with Autogenous Bone Graft in Complex Knee Arthroplasty.

Purpose: We conducted this study to examine the clinical outcomes of primary total knee arthroplasty (TKA) with autogenous bone graft for a tibial bony defect with a minimum follow-up of 12 months. Methods: A total of 21 individuals underwent primary TKA with autogenous on-lay bone grafting (ABG) for restoration of posteromedial tibial deformities between January 2016 and November 2021. The patients were clinically assessed using the knee society score (KSS), varus score, and range of motion (ROM) preoperatively and postoperatively to compare using a single sample t test. Postoperative complications were also considered. Results: KSS before and after surgery was reported to be statistically significant [mean difference = -55.32 (6.81); P < 0.001]. The mean KSS before surgery was 21.14 (7.03) while improved to the mean KSS after surgery of 76.45 (3.05). ROM score before and after surgery was reported to be statistically significant [mean difference = -30.45 (8.99); P < 0.001]. The mean ROM before surgery was 75.45 (6.71) while the improved mean ROM after surgery of 105.91 (5.03). Varus score before and after surgery was reported to be statistically significant [mean difference = 18.45 (3.75); P < 0.001]. Conclusion: The mechanical axis and stability of the knee were effectively restored, with significant differences in preoperative and postoperative results, indicating that this technique is a reasonable and versatile option when reconstructing moderate-to-severe bone loss in TKA.

Mandibular Block Graft for Localised Ridge Augmentation Followed by Delayed Implant Placement: A Case Report.

The presence of adequate ridge width is an important prerequisite for implant placement. Reconstruction of the alveolar ridge can be done through various bone augmentation procedures. Autogenous bone grafts are being used for ridge augmentation for a long time and are still considered the gold standard for jaw reconstruction. Intraoral autogenous bone grafts from sites such as mandibular symphysis and ramus offer various advantages over the extraoral sites. This case report describes the use of an autogenous block graft from mandibular symphysis for a ridge augmentation procedure in the maxillary anterior region followed by delayed implant placement. Six months postoperative clinical and radiographic examination revealed significant increase width of the ridge and appropriate implant placement with satisfactory esthetic and functional results.

Successful Management of Late Sinus Graft Infection via Functional Endoscopic Sinus Surgery and Press-Fit Block Bone Graft: A Case Report.

The purpose of this case report is to feature an interesting case where a staged approach was used to manage a failed implant site that led to a late sinus graft infection and sinusitis with an oroantral fistula (OAF), by using functional endoscopic sinus surgery (FESS) and an intraoral press-fit block bone graft technique. Sixteen years ago, a 60-year-old female patient underwent maxillary sinus augmentation (MSA) with 3 implants placed simultaneously in the right atrophic ridge. However, No. 3 and 4 implants were removed due to advanced peri-implantitis. The patient later developed purulent discharge from the site, headache, and complained of air leakage due to an OAF. The patient was referred to an otolaryngologist for FESS to treat the sinusitis. Two months after FESS, the sinus was re-entered. Residual inflammatory tissues and necrotic graft particles in the OAF site were removed. A block bone harvested from the maxillary tuberosity was press-fitted to the OAF site and grafted. After 4 months of grafting, the grafted bone was well incorporated with the surrounding native bone. Two implants were successfully placed in the grafted site with good initial stability. The prosthesis was delivered 6 months after implant placement. After the 2 years of follow-up, patient was functioning well without sinus complications. Within limitation of this case report, the staged approach via FESS and intraoral press-fit block bone graft is an effective method that can be used to successfully manage OAF and vertical defects at the implant site.

Horizontal Bone Augmentation With Autogenous and Collagenated Xenogeneic Bone Blocks: A Split-Mouth Prospective Clinical, Tomographic, and Histological Pilot Study.

The aim of this study was to compare the clinical, tomographic, and histological performance of collagenated xenogeneic bone blocks (CXBB) in horizontal bone augmentations for implant placement. Five patients with an absence of the 4 upper incisors and an HAC 3 horizontal bone defect, with a remaining of 3 to 5 mm, underwent a bone-grafting procedure with CXBB (test group [TG], n = 5) and autogenous graft (control group [CG], n = 5), with one type of graft used on the right side and other type on the left side. Changes in bone thickness and density (tomographic evaluation), levels of complications (clinically), and distribution pattern between mineralized and nonmineralized tissue (histomorphometrically) were analyzed. Tomographic analysis showed a horizontal bone increase of 4.25 ± 0.78 mm in the TG and 3.08 ± 0.8 mm in the CG between baseline and 8 months postoperatively (P < .05). The horizontal loss between the day of installation of the blocks and 8 months postoperatively was 1.02 ± 0.39 mm for the TG and 1.10 ± 0.71 mm for the CG (P > .05). With regard to bone density, the TG blocks right after installation had 440.2 ± 89.15 HU, and after 8 months, the region reached 730.7 ± 130.98 HU, representing an increase of 29.05%. For the CG blocks, bone density increased from 1052.2 ± 398.35 HU to 1222.5 ± 453.28 HU, representing an increase of 17.03%. The increase in bone density was significantly higher in the TG (P < .05). Clinically, no cases of exposure of the bone blocks and no failure of incorporation were observed. Histomorphometrically, the percentage of mineralized tissue was lower in the TG than in the CG (48.10% ± 2.88% and 53.53% ± 1.05%, respectively), and the opposite was verified for the levels of nonmineralized tissue (52.79% ± 2.88% and 46.47% ± 1.05%, respectively; P < .05). The use of CXBB achieved higher levels of horizontal gain, with lower bone density and lower levels of mineralized tissue when compared with the use of autogenous blocks.

Is local autogenous morselized bone harvested from decompression through a posterior-transforaminal approach sufficient for single-level interbody fusion in the lower lumbar spine?

BACKGROUND: To determine the volume and applicability of local autogenous morselized bone (LAMB) harvested and used during posterior-transforaminal lumbar interbody fusion (P-TLIF) in the lower lumbar spine. METHODS: Clinical and radiographic data of 147 patients (87 males) undergoing P-TLIF from January 2017 to December 2019 for lumbar degenerative diseases were retrospectively analyzed. Computed tomography was used to assess the fusion status (at 6 months, 1 year, and the last follow-up postoperatively), restored disc height, graft fusion area and volume, and the minimum required bone volume (MRBV). Clinical outcomes of P-TLIF were assessed using the Oswestry Disability Index (ODI) and visual analog scale (VAS) for low back pain (LBP) and leg pain (LP). RESULTS: The mean follow-up period was 28.4 ± 4.49 months. The patient's age and diagnosis were correlated to the volume and weight of LAMB (mean volume and weight: 3.50 ± 0.45 mL and 3.88 ± 0.47 g, respectively). The ratio of actual fusion area to the total disc endplate and the ratio of actual fusion volume to the total volume of the disc space were > 40%. MRBV ranged from 1.83 ± 0.48 cm3 to 2.97 ± 0.68 cm3. The proportion of grade 4 or 5 fusions increased from 60.6% at 6 months to 96.6% at the last follow-up. The ODI, VAS-LP, and VAS-LBP scores significantly improved after surgery and remained unchanged during the follow-up. CONCLUSION: When combined with a cage, the volume of LAMB harvested from decompression through the unilateral approach at a single-level is sufficient to achieve a solid interbody fusion in the lower lumbar spine with excellent clinical and radiographic outcomes.

Use of Melatonin/Decorticotomy and Autogenous Bone Graft in Induced 1-Wall Defect.

PURPOSE: This study was designed to investigate the effect of intramarrow penetration (IMP) and 1% melatonin (MLN) gel on the remodelling process of autogenous bone graft (ABG) in an induced 1-osseous wall defect model. METHODS: Sixty-four intrabony induced mandibular defects were created on the distal side of premolars-P1, P2, P3, and P4 (on each side)-in 8 beagle dogs. A ligature-induced periodontitis was initiated in each defect. Defects were then divided into 4 equal groups. Group I was treated with open-flap debridement (OFD) alone, group II was treated with OFD/ABG, group III was treated with OFD/IMP/ABG, and group IV was treated with OFD/ABG/IMP/1% MLN gel. The study parameters were bone fill, histologic analysis, and immunohistochemical evaluation of endothelial nitric oxide synthase (eNOS) expression at 2-week (2W) and 8-week (8W) time intervals. RESULTS: At 8W, significant differences were revealed amongst all groups regarding the amount of bone fill and eNOS expressions (P < .001). Bone fill percentages were 55.5%, 22.3%, 16.8%, and 0% in groups IV, III, II, and I, respectively. eNOS expressions were 1.68 ± 0.06, 8.43 ± 0.04, 16.80 ± 0.17, and 1.97 ± 0.07 in groups IV, III, II, and I, respectively. The favourable results were in line with group IV. CONCLUSIONS: According to these preliminary results, defects treated by ABG augmented with IMP and 1% MLN gel revealed a greater amount of bone fill and reduced eNOS expression. This combination is therefore highly suggested as an adjunct to ABG.

Evaluation of trephine osteotomy technique in direct sinus lifting with simultaneous implant placement.

BACKGROUND: Recently, in implant dentistry, trephine drills have been used instead of conventional drills to conserve the bone during osteotomy. AIM OF THE STUDY: To evaluate the effectiveness of trephine osteotomy for lateral sinus lifting technique associated with sinus floor augmentation using the autogenous bone resulting from implant drilling using specialized trephine drills. MATERIALS AND METHOD: 12 Patients were included and have been subjected to lateral sinus lifting using trephine osteotomy with simultaneous implant placement with delay loading. A bone graft used in sinus floor augmentation has been prepared using autogenous bone resulting from implant site preparation in addition to ß-tricalcium phosphate. RESULTS: After 6 months, the difference between the primary stability and implant stability was statistically significant p-value ≤ 0.05. After 6 months, the mean vertical bone height reached 11.71 ± 0.72 mm. The mean volume of the newly formed bone of the grafted area recorded after 6 months was 1126.7 ± 82.94 mm3. CONCLUSION: Trephine osteotomy technique in both lateral approach of sinus lifting, and implant site preparation allows preservation of autogenous bone. Moreover, the trephine osteotomy technique in the lateral approach of sinus lifting eliminates the use of an absorbable membrane.

Auto-tooth bone graft material for reconstruction of bone defects in the oral region: case reports.

We present some clinical cases of autogenous tooth graft - a modern method in which the extracted teeth are processed into a demineralised dentin matrix (DDM) and are then immediately transplanted into the post-extraction sockets or bone defects.

A comparison of three bone graft struts for interbody fusion using a posterior approach for lower lumbar spinal tuberculosis in adults: a midterm follow-up study.

BACKGROUND: This retrospective observational study was conducted to compare midterm outcomes of three bone graft struts for interbody fusion using a posterior approach in adults with lower lumbar spinal tuberculosis. METHODS: A total of 126 lower lumbar spinal tuberculosis patients were treated by one-stage posterior debridement, interbody fusion, and instrumentation. Forty-one patients (group A) were treated with autogenous bone graft for interbody fusion, 45 patients (group B) were treated with allogeneic bone grafting, and the remaining 40 (group C) patients were treated with titanium mesh cage. In addition, clinical and radiographic data were gathered and analyzed. RESULTS: At the final follow-up, all patients were completely cured. The operation period and intraoperative blood loss for groups B and C were significantly less than in group A (P = 0.000). Post-operation, neurological performance and quality of life were remarkably improved at the final follow-up. The preoperative lordosis angles of three groups were significantly improved, as evidenced by the values immediately after the operation or those at the final follow-up. The correction loss of the group C was lower than those of groups A and B (P = 0.000). All the patients obtained bone graft fusion, the fusion period of group B was longer than that of the other two groups (P = 0.000). No significant differences among the three groups in adjacent segment degeneration rates were found at the last visit (P = 0.922). CONCLUSIONS: This midterm follow-up study established that one-stage posterior debridement, interbody fusion, and instrumentation, combined with medical therapy, can effectively treat lower lumbar spinal tuberculosis. In addition, the intervertebral titanium mesh cage bone graft can provide better outcomes with regard to maintaining lordosis and preventing collapse.

Utilizing Previously Grafted Sinus as Intraoral Donor Site for Successful Augmentation in Peri-Implant Osseous Defect: A Case Report.

The purpose of this case report is to introduce a novel guided bone regeneration (GBR) technique that utilized bone harvested from previously grafted maxillary sinus with deproteinized bovine bone mineral (DBBM) 16 years ago. The patient is a 63-year-old male with hopeless maxillary right molars due to severe bone loss. Two months after the extraction, two bone blocks were harvested with a trephine drill from the lateral wall. One was used for histologic analysis and the other was crushed into particulate forms, which was used for a GBR procedure around an implant at the time of implant placement. The grafted site was then covered with a resorbable collagen membrane. The histological specimen showed newly-formed bone containing residual DBBM particles. The DBBM in the harvested bone was mostly resorbed; DBBM particles comprised only 3.6% of the total bone volume. The final prosthesis was delivered six months post-operatively. No change in crestal bone around the implant was observed throughout the 2 year follow-up period. Within the limitation of the present case report, previously grafted sinus can be a good donor site for further harvesting for a successful GBR procedure.

Evaluation of Sinus Membrane Perforation in Osteotome Sinus Floor Elevation With and Without Grafting.

The purpose of this study was to evaluate, using cone-beam computerized tomography (CBCT), the rate of sinus membrane perforation in osteotome sinus floor elevation (OSFE) performed with and without a graft material. Thirty patients with 52 OSFE sites were included in the study. Patients were divided into the control group (OSFE performed without graft material) and test groups (OSFE performed with autograft or xenograft). The autograft was harvested from the maxillary tuberosity using bone forceps. The xenograft was a commercial product originating from bovine bone. Graft volume was measured using the water displacement method. CBCT was performed at the initial examination and immediately after surgery to measure the residual bone height and to evaluate the endo-sinus bone gain and membrane perforation. The rate of sinus membrane perforation was 15.4%. Of the 52 OSFE procedures, 26.9% were performed without grafting and 34.6% and 38.5% were performed with autografts and xenografts, respectively. Membrane perforation was significantly higher in the autograft group (P = .033). The median volume of graft materials was 0.3 mL. The difference in graft volume between the autograft and xenograft was not statistically significant (P = .768). The mean endo-sinus bone gain was 6.55 mm in patients without membrane perforation and 8.71 mm in patients with membrane perforation; this difference was statistically significant (P = .035). The volume and physical properties of graft materials are important factors in membrane perforation. Further clinical studies with larger and standardized samples are needed to confirm the effect of graft materials on sinus membrane perforation in OSFE.

Comparative Evaluation of Autogenous Bone Graft and Autologous Platelet-Rich Fibrin with and Without 1.2 mg in situ Rosuvastatin Gel in the Surgical Treatment of Intrabony Defect in Chronic Periodontitis Patients.

Context: Rosuvastatin (RSV) is a new synthetic, hydrophilic statin with potent anti-inflammatory and osseodifferentiation actions. Autogenous bone graft (ABG) is still considered the gold standard in reconstructive bone surgery. Addition of platelet-rich fibrin (PRF) to ABG provides sustained release of various growth factors and facilitates survival of the graft. Aims: The study aims to clinically and radiographically compare the effectiveness of ABG and PRF with and without 1.2 mg RSV gel in the surgical treatment of intrabony defect in chronic Periodontitis patient. Settings and Design: This was a randomized controlled clinical trial. Subjects and Methods: Thirty-nine patients (one site per participant) with chronic periodontitis were randomly divided into three groups: Group 1 (open flap debridement [OFD] + placebo), Group 2 (OFD + ABG + PRF), and Group 3 (OFD + ABG + PRF + 1.2 mg RSV). Relative attachment level (RAL) and probing pocket depth (PPD) were recorded at baseline, 3, 6, and 9 months. Radiographic measurements such as defect height (A and B) and defect width (C) were calculated at baseline and 9 months. Statistical Analysis Used: Intergroup comparison was done using Kruskal-Wallis ANOVA. An intragroup comparison was done using Friedman test and Wilcoxon signed-rank test. Results: The mean PPD reduction and mean RAL gain were highly significant in Group 3 and Group 2 than Group 1. For Group 3, a significant reduction of defect height and width and a significant amount of bone fill were achieved than Group 2 and Group 1. Conclusions: Addition of 1.2 mg RSV gel, PRF, and ABG has synergistic effects, explaining their role as a regenerative material in the treatment of intrabony defects.

Alveolar Ridge Augmentation Using Autogenous Bone Graft and Platelet-Rich Fibrin to Facilitate Implant Placement.

The maxillary anterior region is considered to be the esthetic zone of human dentition. Missing teeth in this area leads to severely compromised esthetics and function. Endosseous implants are a viable treatment option in this scenario, but the placement of endosteal implants requires adequate bone volume for successful osseointegration. When the morphology of the bone does not allow proper implant placement, there are various bone augmentation procedures which aid in reconstruction of the residual alveolar ridge for ideal implant placement. The mandibular parasymphysis can act as an excellent source of autogenous bone for the augmentation of alveolar ridge deficiencies. This article describes successful augmentation of the maxillary alveolar ridge using block bone autografts harvested from the mandibular symphysis along with platelet-rich fibrin. At 6 months after surgery, implant was inserted, and after a healing period of 5 months, permanent restoration was placed.

Evaluation of the Efficacy of Mineralized Dentin Graft in the Treatment of Intraosseous Defects: An Experimental In Vivo Study.

Background and Objectives: Dentin grafts have osteoinductive and osteoconductive properties and are considered as an alternative to autogenous graft. This study evaluates the efficacy of autogenous mineralized dentin graft (AMDG) alone or with xenograft and compares it with those of various graft materials used in the treatment of intraosseous bone defects. Materials and Methods: The third incisor teeth of six sheep (2-3 years old) were extracted and AMDG was obtained. Six defects were prepared on each tibia of these six sheep: empty defect (group E); autogenous graft (group A), dentin graft (group D), xenograft (group X), autogenous + xenograft (group A + X) and dentin + xenograft (group D + X). Three sheep in each group were sacrificed in the post-operative 3rd and 6th week and the histologic analyses were performed. Results: The D and D + X groups showed histological features similar to the other groups in the 3rd and 6th weeks. No statistically significant difference was found regarding the rates of new bone formation between the D and D + X groups (p = 1.0) and the other groups at both time intervals (p > 0.05). Conclusions: Similar results observed in this study between groups A, D, X, A + X and D + X demonstrate that AMDG can be successfully used in the treatment of intraosseous bone defects. Further experimental and clinical studies are needed to be able to evaluate the effectiveness of dentin grafts in different types of indications.

Autogenous iliac crest bone grafting for tibial nonunions revisited: does approach matter?

BACKGROUND: Tibial nonunion remains a considerable burden for patients and the surgeons who treat them. In recent years, alternatives to autogenous grafts for the treatment of tibial nonunions have been sought. The purpose of this study was to evaluate the efficacy of autogenous iliac crest bone graft (ICBG) in the treatment of tibial shaft nonunions. MATERIAL AND METHODS: Sixty-nine patients were identified who underwent ICBG for repair of atrophic or oligotrophic tibial nonunion and had complete data with at least one year of follow-up (mean 27.9 months). Surgical treatments consisted of revision/supplemental fixation ± ICBG. Surgical approaches for graft placement were either posterolateral (PL), anterolateral (AL), or direct medial (DM). Healing status, time to union, postoperative pain, and functional outcomes were assessed. RESULTS: Bony union was achieved by 97.1% (67/69) of patients at a mean time of 7.8 ± 3.2 months postoperatively. There was no significant difference in mean time to union between the three surgical approach groups: (PL (44.9%) = 7.3 months, AL (20.3%) = 9.2 months, DM (34.8%) = 7.6 months; p = 0.22). Intraoperative cultures obtained at the time of nonunion surgery were positive in 27.5% of patients (19/69). Positive cultures were associated with need for secondary surgery as 8/19 patients (42.1%) with positive cultures required re-operation. Two out of four patients that developed iliac donor site hematomas/infections requiring washout had positive intraoperative cultures as well. There was no difference in final SMFA among the three surgical approach groups. CONCLUSIONS: Autogenous ICBG remains the gold standard in the management of persistent tibial nonunions regardless of surgical approach. There is a small risk for complication at the iliac crest donor site. Given the high union rate, autogenous iliac crest bone grafting for tibial nonunion remains the gold standard for this difficult condition. LEVEL OF EVIDENCE: Level III.

Regeneración ósea con injertos intraorales: rama vs. mentón. Puesta al día / Bone regeneration with intraoral graft: ramus vs. chin. Updating

La utilización de injertos intraorales en bloque es una alternativa de tratamiento válida para la regeneración en anchura de defectos óseos maxilares y mandibulares. Sin embargo, actualmente no hay consenso entre los diferentes autores en la elección del mejor tipo de bloque intraoral a utilizar. Por ende, esta puesta al día busca comparar la ganancia ósea, la tasa de complicaciones postoperatorias y el éxito del injerto entre bloques autólogos de rama mandibular y mentón. La ganancia ósea alcanzada es similar en ambos bloques. No obstante, se podría deducir una mayor ganancia al utilizar bloques de la rama mandibular cuando son evaluados mediante CBCT. Además, la tasa de reabsorción ósea fue menor con los injertos de rama. La supervivencia de los implantes es equiparable con ambos tipos de injertos. Las complicaciones que tienen lugar, en orden de frecuencia, son las alteraciones sensoriales, las necrosis pulpares, dehiscencias y hemorragias; apareciendo con mayor frecuencia en los bloques de mentón. Además, el periodo de recuperación en las zonas de rama mandibular es más lento. De este modo, a la hora de la elección parece razonable individualizar el caso y tener en consideración aspectos como la morbilidad y el acceso a la zona donante. (AU)

The use of intraoral block grafts is a valid treatment alternative for the regeneration of maxillary and mandibular horizontal bone defects. However, there is currently no consensus among different authors on the choice of the best type of intraoral bone block to use. Therefore, this update seeks to compare bone gain, post-operative complication rate and grafting success between autologous mandibular ramus and chin bone block grafts. The bone gain achieved is similar in both block grafts. However, a higher gain can be observed by CBCT when using mandibular ramus blocks. In addition, the rate of bone resorption is lower with ramus grafts. Implant survival is comparable in both types of grafts. The complications that occur, in order of frequency, are sensory alterations, pulp necrosis, dehiscence and bleeding, appearing more frequently in chin blocks. In addition, the recovery period in the mandibular ramus areas is slower. Thus, when choosing, it seems reasonable to individualize the case and take into consideration aspects such as morbidity and access to the donor area. (AU)

Incorporation of anterior iliac crest or calvarial bone grafts in reconstructed atrophied maxillae: A randomized clinical trial with histomorphometric and micro-CT analyses.

BACKGROUND: Autologous bone grafts have been applied successfully to severely atrophied maxilla via a preimplant procedure. Differences in graft incorporation at the microscopic level can be the decisive factor in the choice between anterior iliac crest and calvarial bone. PURPOSE: To compare conversion of anterior iliac crest bone and calvarial bone 4 months after grafting of the edentulous maxilla. MATERIALS AND METHODS: Twenty consecutive patients were randomly assigned to either anterior iliac crest (n = 10) or calvarial (n = 10) bone harvesting to reconstruct their atrophied maxillae. Biopsies were taken from both fresh bone grafts and reconstructed maxillae after 4 months healing, at time of implant placement. Micro-CT, histomorphometric and histological analyses were performed. RESULTS: Micro-CT analysis revealed that both the anterior iliac crest and calvarial bone grafts retained their volume and bone mass after being incorporated in the maxilla, but with a favor for calvarial bone grafts: calvarial bone grafts had a higher mineral density before and after incorporation. Both bone grafts types were well incorporated after 4 months of healing with preservation of bone volume and mineral density. Although the fresh bone biopsies were similar histomorphometrically, after 4 months of graft incorporation, the osteoid percentage and osteocyte count remained higher in the anterior iliac crest bone whereas the percentage of bone was higher in the calvarial bone grafts compared to the anterior iliac crest bone grafts. CONCLUSIONS: Both donor sites, that is, anterior iliac crest and calvarial bone, are well suited to provide a reliable and stable basis for implant placement 4 months after grafting with mineral density, porosity, and resorption rate in favor of calvarial bone grafts.