Autogenous bone grafts in oral implantology-is it still a "gold standard"? A consecutive review of 279 patients with 456 clinical procedures

Andreas Sakkas, Frank Wilde, Marcus Heufelder, Karsten Winter, Alexander Schramm, Andreas Sakkas, Frank Wilde, Marcus Heufelder, Karsten Winter, Alexander Schramm

Abstract

Background: This study assessed the clinical outcomes of graft success rate and early implant survival rate after preprosthetic alveolar ridge reconstruction with autologous bone grafts.

Methods: A consecutive retrospective study was conducted on all patients who were treated at the military outpatient clinic of the Department of Oral and Plastic Maxillofacial Surgery at the military hospital in Ulm (Germany) in the years of 2009 until 2011 with autologous bone transplantation prior to secondary implant insertion. Intraoral donor sites (crista zygomatico-alveolaris, ramus mandible, symphysis mandible, and anterior sinus wall) and extraoral donor site (iliac crest) were used. A total of 279 patients underwent after a healing period of 3-5 months routinely computer tomography scans followed by virtual implant planning. The implants were inserted using guided oral implantation as described by Naziri et al. All records of all the consecutive patients were reviewed according to patient age, history of periodontitis, smoking status, jaw area and dental situation, augmentation method, intra- and postoperative surgical complications, and surgeon's qualifications. Evaluated was the augmentation surgical outcome regarding bone graft loss and early implant loss postoperatively at the time of prosthodontic restauration as well a follow-up period of 2 years after loading.

Results: A total of 279 patients underwent 456 autologous augmentation procedures in 546 edentulous areas. One hundred thirteen crista zygomatico-alveolaris grafts, 104 ramus mandible grafts, 11 symphysis grafts, 116 grafts from the anterior superior iliac crest, and 112 sinus lift augmentations with bone scrapes from the anterior facial wall had been performed. There was no drop out or loss of follow-up of any case that had been treated in our clinical center in this 3-year period. Four hundred thirty-six (95.6%) of the bone grafts healed successfully, and 20 grafts (4.4%) in 20 patients had been lost. Fourteen out of 20 patients with total graft failure were secondarily re-augmented, and six patients wished no further harvesting procedure. In the six patients, a partial graft resorption was detected at the time of implantation and additional simultaneous augmentation during implant insertion was necessary. No long-term nerve injury occurred. Five hundred twenty-five out of 546 initially planned implants in 259 patients could be inserted into successfully augmented areas, whereas 21 implants in 20 patients due to graft loss could not be inserted. A final rehabilitation as preplanned with dental implants was possible in 273 of the 279 patients. The early implant failure rate was 0.38% concerning two out of the 525 inserted implants which had to be removed before the prosthodontic restoration. Two implants after iliac crest augmentation were lost within a period of 2 years after loading, concerning a total implant survival rate after 2 years of occlusal loading rate of 99.6% after autologous bone augmentation prior to implant insertion.

Conclusions: This review demonstrates the predictability of autologous bone material in alveolar ridge reconstructions prior to implant insertion, independent from donor and recipient site including even autologous bone chips for sinus elevation. Due to the low harvesting morbidity of autologous bone grafts, the clinical results of our study indicate that autologous bone grafts still remain the "gold standard" in alveolar ridge augmentation prior to oral implantation.

Keywords: Autologous bone augmentation; Complications; Dental implants; Donor site; Gold standard; Intraoral bone grafts.

Figures

Fig. 1
Fig. 1
Postoperative complications at the donor and recipient site, N refers to the total number of the donor sites (N = 300), N refers to the total number of the recipient sites (N = 378)
Fig. 2
Fig. 2
Survival rate of autologous bone grafts
Fig. 3
Fig. 3
Surgical outcome after autologous augmentation procedures from different donor sites
Fig. 4
Fig. 4
Postoperative nerve alterations. Single asterisk, N refers to the total number of the surgical approaches in the mandible (N = 155). Double asterisk, N refers to the total number of the surgical approaches in the maxilla (N = 225)
Fig. 5
Fig. 5
Survival rate of dental implants after autologous bone augmentation

References

    1. Jensen AT, Jensen SS, Worsaae N. Complications related to bone augmentation procedures of localized defects in the alveolar ridge. A retrospective clinical study. Oral Maxillofac Surg. 2016;20(2):115–122. doi: 10.1007/s10006-016-0551-8.
    1. Buser D, Dula K, Hirt HP, Schenk RK. Lateral ridge augmentation using autografts and barrier membranes: clinical study with 40 partially edentulous patients. J Oral Maxillofac Surg. 1996;54:420–432. doi: 10.1016/S0278-2391(96)90113-5.
    1. Galindo-Moreno P, Avila G, Fernández-Barbero JE, Mesa F, O’Valle-Ravassa F, Wang HL. Clinical and histologic comparison of two different composite grafts for sinus augmentation: a pilot clinical trial. Clin Oral Implants Res. 2008;19:755–759. doi: 10.1111/j.1600-0501.2008.01536.x.
    1. Chiapasco M, Zaniboni M, Rimondini L. Autogenous onlay bone grafts vs. alveolar distraction osteogenesis for the correction of vertically deficient edentulous ridges: a 2–4-year prospective study on humans. Clin Oral Implants Res. 2007;18:432–440. doi: 10.1111/j.1600-0501.2007.01351.x.
    1. Moses O, Nemcovsky CE, Langer Y, Tal H. Severely resorbed mandible treated with iliac crest autogenous bone graft and dental implants: 17-year follow-up. Int J Oral Maxillofac Implants. 2007;22:1017–1021.
    1. Zizelmann C, Schoen R, Metzger MC, Schmelzeisen R, Schramm A, Dott B, Bormann KH, Gellrich N-C. Bone formation after sinus augmentation with engineered bone. Clin Oral Implants Res. 2007;18(1):69–73. doi: 10.1111/j.1600-0501.2006.01295.x.
    1. Sbordone C, Toti P, Guidetti F, Califano L, Pannone G, Sbordone L. Volumetric changes after sinus augmentation using blocks of autogenous iliac bone or freeze-dried allogeneic bone. A non-randomized study. J Craniomaxillofac Surg. 2014;42:113–118. doi: 10.1016/j.jcms.2013.03.004.
    1. Stricker A, Schramm A, Marukawa E, Lauer G, Schmelzeisen R. Distraction osteogenesis and tissue engineering-new options for enhancing the implant site. Int J Periodontics Restorative Dent. 2003;23(3):297–302.
    1. Nkenke E, Neukam FW. Autogenous bone harvesting and grafting in advanced jaw resorption: morbidity, resorption and implant survival. Eur J Oral Implantol. 2014;7:203–217.
    1. Jensen SS, Terheyden H. Bone augmentation procedures in localized defects in the alveolar ridge: clinical results with different bone grafts and bone-substitute materials. Int J Oral Maxillofac Implants. 2009;24:218–236.
    1. Del Fabbro M, Corbella S, Weinstein T, Ceresoli V, Taschieri S. Implant survival rates after osteotome-mediated maxillary sinus augmentation: a systematic review. Clin Implant Dent Relat Res. 2012;14:159–168. doi: 10.1111/j.1708-8208.2011.00399.x.
    1. Schwartz-Arad D, Dori S. Intraoral autogenous onlay block bone grafting for implant dentistry. Refuat Hapeh Vehashinayim. 2002;19:35–39.
    1. Misch CM. Ridge augmentation using mandibular ramus bone grafts for the placement of dental implants: presentation of a technique. Pract Periodontics Aesthet Dent. 1996;8:127–135.
    1. Altiparmak N, Soydan SS, Uckan S. The effect of conventional surgery and piezoelectric surgery bone harvesting techniques on the donor site morbidity of the mandibular ramus and symphysis. Int J Oral Maxillofac Surg. 2015;44:1131–1137. doi: 10.1016/j.ijom.2015.04.009.
    1. 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;25:351–363.
    1. Fakhry A. The mandibular retromolar area as a donor site in maxillofacial bone grafting: surgical notes. Int J Periodontics Restorative Dent. 2011;31:275–283.
    1. Sakkas A, Schramm A, Karsten W, Gellrich NC, Wilde F. A clinical study of the outcomes and complications associated with zygomatic buttress block bone graft for limited preimplant augmentation procedures. J Craniomaxillofac Surg. 2016;44(3):249–256. doi: 10.1016/j.jcms.2015.12.003.
    1. Fiorellini JP, Nevins ML. Localized ridge augmentation/preservation. A systematic review. Ann Periodontol. 2003;8:321–327. doi: 10.1902/annals.2003.8.1.321.
    1. Chiapasco M, Zaniboni M, Boisco M. Augmentation procedures for the rehabilitation of deficient edentulous ridges with oral implants. Clin Oral Implants Res. 2006;17:136–159. doi: 10.1111/j.1600-0501.2006.01357.x.
    1. Esposito M, Grusovin MG, Felice P, Karatzopoulos G, Worthington HV, Coulthard P. The efficacy of horizontal and vertical bone augmentation procedures for dental implants—a Cochrane systematic review. Eur J Oral Implantol. 2009;2:167–184.
    1. Clementini M, Morlupi A, Agrestini C, Ottria L. Success rate of dental implants inserted in autologous bone graft regenerated areas: a systematic review. Oral Implantol. 2011;4:3–10.
    1. Kuchler U, von Arx T. Horizontal ridge augmentation in conjunction with or prior to implant placement in the anterior maxilla: a systematic review. Int J Oral Maxillofac Implants. 2014;29:14–24. doi: 10.11607/jomi.2014suppl.g1.1.
    1. Leonetti JA, Koup R. Localized maxillary ridge augmentation with a block allograft for dental implant placement: case reports. Implant Dent. 2003;12:217–226. doi: 10.1097/01.ID.0000078233.89631.F8.
    1. Aghaloo TL, Moy PK. Which hard tissue augmentation techniques are the most successful in furnishing bony support for implant placement? Int J Oral Maxillofac Implants. 2007;22:49–70.
    1. Margonar R, dos Santos PL, Queiroz TP, Marcantonio E. Rehabilitation of atrophic maxilla using the combination of autogenous and allogeneic bone grafts followed by protocol-type prosthesis. J Craniofac Surg. 2010;21:1894–1896. doi: 10.1097/SCS.0b013e3181f4af65.
    1. Fugazzotto PA. GBR using bovine bone matrix and resorbable and nonresorbable membranes. Part 2: clinical results. Int J Periodontics Restorative Dent. 2003;23:599–605.
    1. Lange DE, Plagmann HC, Eenboom A, Promesberger A. Clinical methods for the objective evaluation of oral hygiene. Dtsch Zahnarztl Z. 1977;32:44–47.
    1. Mühlemann HR, Son S. Gingival sulcus bleeding—a leading symptom in initial gingivitis. Helv Odontol Acta. 1971;15:107–113.
    1. Cawood JI, Howell RA. A classification of the edentulous jaws. Int J Oral Maxillofac Surg. 1988;17:232–236. doi: 10.1016/S0901-5027(88)80047-X.
    1. Schramm A, Schön R, Rücker M, Barth E-L, Zizelmann C, Gellrich N-C. Computer assisted oral and maxillofacial reconstruction. Int J Comp Techn. 2006;14(1):71–77.
    1. Schramm A, Gellrich N-C, Schmelzeisen R. Navigational surgery of the facial skeleton. New York: Springer Berlin Heidelberg; 2007.
    1. Schramm A, Gellrich N.C. Intraoperative Navigation und computerassistierte Chirurgie. In: Schwenzer N und Ehrenfeld M. Zahn-Mund-Kieferheilkunde, Mund-Kiefer-Gesichtschirurgie. 4. Auflage, (ed. Thieme). Stuttgart New York, 2010;479–499.
    1. Naziri E, Schramm A, Wilde F. Accuracy of computer-assisted implant placement with insertion templates. GMS Interdiscip Plast Reconstr Surg DGPW. 2016; May 13; 5Doc15. eCollection 2016.
    1. Buser D, Weber HP, Lang NP. Tissue integration of non-submerged implants. 1-year results of a prospective study with 100 ITI hollow-cylinder and hollow-screw implants. Clin Oral Implants Res. 1990;1:33–40. doi: 10.1034/j.1600-0501.1990.010105.x.
    1. Kerschbaum T, Haastert B. Statistische Verweildaueranalysen in der Implantologie. Implantologie. 1995;2:101–111.
    1. Sittitavornwong S, Gutta R. Bone graft harvesting from regional sites. Oral Maxillofac Surg Clin North Am. 2010;22:317–330. doi: 10.1016/j.coms.2010.04.006.
    1. Myeroff C, Archdeacon M. Autogenous bone graft: donor sites and techniques. J Bone Joint Surg Am. 2011;7:2227–2236. doi: 10.2106/JBJS.J.01513.
    1. Nkenke E, Eitner S, Radespiel-Tröger M, Vairaktaris E, Neukam FW, Fenner M. Patient-centred outcomes comparing transmucosal implant placement with an open approach in the maxilla: a prospective, non-randomized pilot study. Clin Oral Implants Res. 2007;18:197–203. doi: 10.1111/j.1600-0501.2006.01335.x.
    1. von Arx T, Buser D. Horizontal ridge augmentation using autogenous block grafts and the guided bone regeneration technique with collagen membranes: a clinical study with 42 patients. Clin Oral Implants Res. 2006;17:359–366. doi: 10.1111/j.1600-0501.2005.01234.x.
    1. Levin L, Nitzan D, Schwartz-Arad D. Success of dental implants placed in intraoral block bone grafts. J Periodontol. 2007;78:18–21. doi: 10.1902/jop.2007.060238.
    1. Andersson L. Patient self-evaluation of intra-oral bone grafting treatment to the maxillary frontal region. Dent Traumatol. 2008;24:164–169. doi: 10.1111/j.1600-9657.2007.00521.x.
    1. Sant’Ana E. Short-term survival of osseointegrated implants installed in alveolar ridge reconstructed with autogenous graft (Thesis submitted to obtain PhD). Bauru School of Dentistry, São Paulo University, 1997.
    1. Misch CM. Comparison of intraoral donor sites for onlay grafting prior to implant placement. Int J Oral Maxillofac Implants. 1997;12:767–776.
    1. Sàndor GK, Nish IA, Carmichael RP. Comparison of conventional surgery with motorized trephine in bone harvest from the anterior iliac crest. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95:150–155. doi: 10.1067/moe.2003.42.
    1. Raghoebar GM, Meijndert L, Kalk WW, Vissink A. Morbidity of mandibular bone harvesting: a comparative study. Int J Oral Maxillofac Implants. 2007;22:359–365.
    1. Cordaro L, Torsello F, Accorsi Ribeiro C, Liberatore M, Mirisola Di Torresanto V. Inlay-onlay grafting for three-dimensional reconstruction of the posterior atrophic maxilla with mandibular bone. Int J Oral Maxillofac Surg. 2010;39:350–357. doi: 10.1016/j.ijom.2010.02.016.
    1. Cordaro L, Torsello F, Miuccio MT, di Torresanto VM, Eliopoulos D. Mandibular bone harvesting for alveolar reconstruction and implant placement: subjective and objective cross-sectional evaluation of donor and recipient site up to 4 years. Clin Oral Implants Res. 2011;22:1320–1326. doi: 10.1111/j.1600-0501.2010.02115.x.
    1. Stelzle F, Frenkel C, Riemann M, Knipfer C, Stockmann P, Nkenke E. The effect of load on heat production, thermal effects and expenditure of time during implant site preparation—an experimental ex vivo comparison between piezosurgery and conventional drilling. Clin Oral Implants Res. 2014;25:e140–e148. doi: 10.1111/clr.12077.
    1. Gellrich N-C, Held U, Schön R, Pailing T, Schramm A, Bormann K. Alveolar zygomatic buttress: a new donor site for limited preimplant augmentation procedures. J Oral Maxillofac Surg. 2007;65:275–280. doi: 10.1016/j.joms.2005.11.081.
    1. Verdugo F, Castillo A, Moragues MD, Pontón J. Bone microbial contamination influences autogenous grafting in sinus augmentation. J Periodontol. 2009;80:1355–1364. doi: 10.1902/jop.2009.090113.
    1. Wiltfang J, Schultze-Mosgau S, Merten HA, Kessler P, Ludwig A, Engelke W. Endoscopic and ultrasonographic evaluation of the maxillary sinus after combined sinus floor augmentation and implant insertion. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89:288–291. doi: 10.1016/S1079-2104(00)70090-4.
    1. Barone A, Santini S, Sbordone L, Crespi R, Covani U. A clinical study of the outcomes and complications associated with maxillary sinus augmentation. Int J Oral Maxillofac Implants. 2006;21:81–85.
    1. Felice P, Pistilli R, Piattelli M, Soardi E, Barausse C, Esposito M. 1-stage versus 2-stage lateral sinus lift procedures: 1-year post-loading results of a multicentre randomised controlled trial. Eur J Oral Implantol. 2014;7:65–75.
    1. Raghoebar GM, Meijer HJ, Telleman G, Vissink A. Maxillary sinus floor augmentation surgery with autogenous bone grafts as ceiling: a pilot study and test of principle. Clin Implant Dent Relat Res. 2013;15:550–557. doi: 10.1111/j.1708-8208.2011.00409.x.
    1. Scabbia A, Cho KS, Sigurdsson TJ, Kim CK, Trombelli L. Cigarette smoking negatively affects healing response following flap debridement surgery. J Periodontol. 2001;72:43–49. doi: 10.1902/jop.2001.72.1.43.
    1. Sakkas A, Konstantinidis I, Winter K, Schramm A, Wilde F. Effect of Schneiderian membrane perforation on sinus lift graft outcome using two different donor sites: a retrospective study of 105 maxillary sinus elevation procedures. GMS Interdiscip Plast Reconstr Surg DGPW. 2016; Mar 2;5:Doc11. doi: 10.3205/iprs000090. eCollection 2016.
    1. Scarano A, Degidi M, Iezzi G, Pecora G, Piattelli M, Orsini G, Caputi S, Perrotti V, Mangano C, Piattelli A. Maxillary sinus augmentation with different biomaterials: a comparative histologic and histomorphometric study in man. Implant Dent. 2006;15(2):197–207. doi: 10.1097/01.id.0000220120.54308.f3.
    1. Garofalo GS. Autogenous, allogenetic and xenogenetic grafts for maxillary sinus elevation: literature review, current status and prospects. Minerva Stomatol. 2007;56(7–8):373–392.
    1. Del Fabbro M, Testori T, Francetti L, Weinstein R. Systematic review of survival rates for implants placed in the grafted maxillary sinus. Int J Periodontics Restorative Dent. 2004;24:565–577.
    1. Chiapasco M, Zaniboni M. Clinical outcomes of GBR procedures to correct peri-implant dehiscences and fenestrations: a systematic review. Clin Oral Implants Res. 2009;20:113–123. doi: 10.1111/j.1600-0501.2009.01781.x.
    1. Felice P, Pellegrino G, Checchi L, Pistilli R, Esposito M. Vertical augmentation with interpositional blocks of anorganic bovine bone vs. 7-mm-long implants in posterior mandibles: 1-year results of a randomized clinical trial. Clin Oral Implants Res. 2010;21:1394–1403. doi: 10.1111/j.1600-0501.2010.01966.x.
    1. Felice P, Marchetti C, Piattelli A, Pellegrino G, Checchi V, Worthington H, Esposito M. Vertical ridge augmentation of the atrophic posterior mandible with interpositional block grafts: bone from the iliac crest versus bovine anorganic bone. Eur J Oral Implantol. 2008;1:183–198.
    1. Laino L, Iezzi G, Piattelli A, Lo Muzio L, Cicciù M. Vertical ridge augmentation of the atrophic posterior mandible with sandwich technique: bone block from the chin area versus corticocancellous bone block allograft—clinical and histological prospective randomized controlled study. Biomed Res Int. 2014;982104. doi: 10.1155/2014/982104.
    1. Ponte A, Khoury F. The tunnel technique in bone grafting procedures: a clinical study (Abstract) Int J Oral Maxillofac Implants. 2004;19:766.
    1. Pommer B, Frantal S, Willer J, Posch M, Watzek G, Tepper G. Impact of dental implant length on early failure rates: a meta-analysis of observational studies. J Clin Periodontol. 2011;38:856–863. doi: 10.1111/j.1600-051X.2011.01750.x.
    1. Chiapasco M, Casentini P, Zaniboni M, Corsi E. Evaluation of peri-implant bone resorption around Straumann Bone Level implants placed in areas reconstructed with autogenous vertical onlay bone grafts. Clin Oral Implants Res. 2012;23:1012–1021. doi: 10.1111/j.1600-0501.2011.02262.x.
    1. Sclar AG. Strategies for management of single-tooth extraction sites in aesthetic implant therapy. J Oral Maxillofac Surg. 2004;62:90–105. doi: 10.1016/j.joms.2004.06.041.
    1. Widmark G, Andersson B, Ivanoff CJ. Mandibular bone graft in the anterior maxilla for single-tooth implants. Presentation of surgical method. Int J Oral Maxillofac Surg. 1997;26:106–109. doi: 10.1016/S0901-5027(05)80827-6.
    1. Laviv A, Jensen OT, Tarazi E, Casap N. Alveolar sandwich osteotomy in resorbed alveolar ridge for dental implants: a 4-year prospective study. J Oral Maxillofac Surg. 2014;72:292–303. doi: 10.1016/j.joms.2013.09.036.
    1. Heberer S, Rühe B, Krekeler L, Schink T, Nelson JJ, Nelson K. A prospective randomized split-mouth study comparing iliac onlay grafts in atrophied edentulous patients: covered with periosteum or a bioresorbable membrane. Clin Oral Implants Res. 2009;20:319–326. doi: 10.1111/j.1600-0501.2008.01638.x.
    1. Semper W, Kraft S, Mehrhof J, Nelson K. Impact of abutment rotation and angulation on marginal fit: theoretical considerations. Int J Oral Maxillofac Implants. 2010;25:752–758.
    1. Wiltfang J, Jätschmann N, Hedderich J, Neukam FW, Schlegel KA, Gierloff M. Effect of deproteinized bovine bone matrix coverage on the resorption of iliac cortico-spongeous bone grafts—a prospective study of two cohorts. Clin Oral Implants Res. 2014;25:e127–e132. doi: 10.1111/clr.12074.
    1. Chrcanovic BR, Albrektsson T, Wennerberg A. Smoking and dental implants: a systematic review and meta-analysis. J Dent. 2015;43:487–498. doi: 10.1016/j.jdent.2015.03.003.
    1. Nkenke E, Stelzle F. Clinical outcomes of sinus floor augmentation for implant placement using autogenous bone or bone substitutes: a systematic review. Clin Oral Implants Res. 2009;20:124–133. doi: 10.1111/j.1600-0501.2009.01776.x.
    1. Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M. STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg. 2014;12:1500–1524. doi: 10.1016/j.ijsu.2014.07.014.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir