Esthetic outcome of implant-based reconstructions in augmented bone: comparison of autologous and allogeneic bone block grafting with the pink esthetic score (PES)

Abstract

Introduction: To determine the esthetic outcome of implant-based reconstructions after autologous and allogeneic bone grafting.

Methods: From 2003 to 2009, 67 patients underwent alveolar ridge augmentation and were enrolled in the study, 41 meet the inclusion criteria and 31 agreed to take part in the study. Patients were 18-69 years old (mean: 49.3 ± 13.8 years), and predominantly female. Patients received bone block grafts either autologous (n = 48) (AUBB) or allografts (ABB) (n = 19). Implants were inserted 4-7 months (autografts) or 5-6 months (allografts) after bone grafting. The Pink Esthetic Score (PES) as well as radiographic and subjective assessments were employed for the outcome analysis. The PES was assessed twice within one month based on digital photographic images that were randomly rearranged between evaluations by three independent, experienced investigators.

Results: Across all observations and investigators, the average PES was 7.5 ± 2.6 without differences between implants inserted in auto- and allografted bone, respectively. Patients assessed the allograft procedures as less painful and would have repeated it more often. The intra-rater reliability was excellent (correlation coefficients 0.7-0.9). The inter-observer agreement was lower (correlation coefficients 0.6-0.8).

Conclusions: Bone grafting with ABB allografts yields equivalent results to autologous grafting, and patients appreciate the omission of bone harvesting. The PES is a reliable method but should be performed by the same individual.

Figures

Figure 1

Well integrated autograft harvested from the ramus area. Bone blocks from linea obliqua externa are consisting mainly of cancellous bone. Even after 6 months the block seems to be integrated very nicely but still has a white color indicating incomplete turn over in living bone.

Figure 2

ABB reduce surgery time and trauma. At baseline the allograft made of spongous bone derived from femur heads of living donators is adapted to the recipient site and fixed by screws.

Figure 3

ABB integrated nicely after 6 months. Clinically the ABB seems to be integrated more nicely than the autograft. It is bleeding and the former spongous structure changed and a closed surface is visible.

Figure 4

Pink esthetic score depending on the time of assessment and grafting method. Three due to the augmentation method blinded investigators performed the PES assessment. After one month, the investigators reassessed all images that had been rearranged in a different random order. There was no appreciable difference between the first and second assessment in either group.

Figure 5

Pink esthetic score depending on the investigator and grafting method. The intra-rater reliability between the three investigators was excellent.

Figure 6

Correlation between patient age and PES (p < 0.05). Age had significant influence on the PES. The 95% confidence interval for patients in their 20s roughly reached from 8 to 11 points, while it was between 4 and 8 in patients in their 80s.