Harvesting of Autogenous Bone Graft from the Ascending Mandibular Ramus Compared with the Chin Region: a Systematic Review and Meta-Analysis Focusing on Complications and Donor Site Morbidity

Thomas Starch-Jensen, Daniel Deluiz, Sagar Deb, Niels Henrik Bruun, Eduardo Muniz Barretto Tinoco, Thomas Starch-Jensen, Daniel Deluiz, Sagar Deb, Niels Henrik Bruun, Eduardo Muniz Barretto Tinoco

Abstract

Objectives: The aim of this systematic review was to test the hypothesis of no difference in complications and donor site morbidity following harvesting of autogenous bone graft from the ascending mandibular ramus compared with the chin region.

Material and methods: MEDLINE (PubMed), Embase and Cochrane Library search in combination with a hand-search of relevant journals was conducted including human studies published in English through June 26, 2020. Randomized and controlled trials were included. Outcome measures included pain, infection, mucosal dehiscence, altered sensation or vitality of adjacent tooth/teeth, neurosensory disturbances and patient-reported outcome measures. Risk of bias was assessed by Cochrane risk of bias tool and Newcastle-Ottawa Scale.

Results: Ten controlled trials of high-quality fulfilled inclusion criteria. Risk of infection and mucosal dehiscence seems to be comparable with the two treatment modalities. However, harvesting from the chin seems to be associated with increased risk of pain, altered sensation or loss of tooth vitality, and neurosensory disturbances. Willingness to undergo the same treatment again was reported with both treatment modalities, but significant higher satisfaction, lower discomfort and acceptance of the surgical procedure was reported following harvesting from the ascending mandibular ramus.

Conclusions: The hypothesis was rejected due to higher prevalence and severity of complications and donor site morbidity following harvesting of autogenous bone graft from the chin region. Dissimilar evaluation methods and various methodological confounding factors posed serious restrictions for literature review in a quantitative systematic manner. Conclusions drawn from results of this systematic review should therefore be interpreted with caution.

Keywords: alveolar bone grafting; alveolar ridge augmentation; dental implants; oral surgical procedures; review.

Copyright © Starch-Jensen T, Deluiz D, Deb S, Bruun NH, Tinoco EMB. Published in the JOURNAL OF ORAL & MAXILLOFACIAL RESEARCH (http://www.ejomr.org), 30 September 2020.

Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram demonstrating results of systematic literature search. Electronic search resulted in 291 entries. No additional articles were identified through hand-searching. Of these 291 articles, 66 were excluded because they had been retrieved in more than one search. A total of 31 abstracts were reviewed and full-text analysis included 13 articles. Ten controlled clinical trials were finally included in the present systematic review.
Figure 2
Figure 2
Random-effects meta-analyses using Sidik-Jonkman estimation method demonstrated no statistically significant differences in pain with the two treatment modalities.
Figure 3
Figure 3
Random-effects meta-analyses using Sidik-Jonkman estimation method demonstrated no statistically significant differences in infection with the two treatment modalities.
Figure 4
Figure 4
Random-effects meta-analyses using Sidik-Jonkman estimation method demonstrated no statistically significant differences in mucosal dehiscence with the two treatment modalities.
Figure 5
Figure 5
Random-effects meta-analyses using Sidik-Jonkman estimation method demonstrated a statistically significant higher risk of temporary neurosensory disturbances following harvesting of autogenous bone graft from the chin region.
Figure 6
Figure 6
Random-effects meta-analyses using Sidik-Jonkman estimation method demonstrated a statistically significant higher risk of permanent neurosensory disturbances following harvesting of autogenous bone graft from the chin region.

References

    1. Aludden HC, Mordenfeld A, Hallman M, Dahlin C, Jensen T. Lateral ridge augmentation with Bio-Oss alone or Bio-Oss mixed with particulate autogenous bone graft: a systematic review. Int J Oral Maxillofac Surg. 2017 Aug;46(8): 1030-1038.
    1. Troeltzsch M, Troeltzsch M, Kauffmann P, Gruber R, Brockmeyer P, Moser N, Rau A, Schliephake H. Clinical efficacy of grafting materials in alveolar ridge augmentation: A systematic review. J Craniomaxillofac Surg. 2016 Oct;44(10): 1618-1629.
    1. Sanz-Sánchez I, Ortiz-Vigón A, Sanz-Martín I, Figuero E, Sanz M. Effectiveness of Lateral Bone Augmentation on the Alveolar Crest Dimension: A Systematic Review and Meta-analysis. J Dent Res. 2015 Sep;94(9 Suppl):128S-42S.
    1. Sakkas A, Wilde F, Heufelder M, Winter K, Schramm A. Autogenous bone grafts in oral implantology-is it still a "gold standard"? A consecutive review of 279 patients with 456 clinical procedures. Int J Implant Dent. 2017 Dec;3(1):23.
    1. Carlsen A, Gorst-Rasmussen A, Jensen T. Donor site morbidity associated with autogenous bone harvesting from the ascending mandibular ramus. Implant Dent. 2013 Oct;22(5):503-6.
    1. Weibull L, Widmark G, Ivanoff CJ, Borg E, Rasmusson L. Morbidity after chin bone harvesting--a retrospective long-term follow-up study. Clin Implant Dent Relat Res. 2009 Jun;11(2):149-57.
    1. Nkenke E, Neukam FW. Autogenous bone harvesting and grafting in advanced jaw resorption: morbidity, resorption and implant survival. Eur J Oral Implantol. 2014 Summer;7 Suppl 2:S203-17.
    1. Cricchio G, Lundgren S. Donor site morbidity in two different approaches to anterior iliac crest bone harvesting. Clin Implant Dent Relat Res. 2003;5(3):161-9.
    1. Scheerlinck LM, Muradin MS, van der Bilt A, Meijer GJ, Koole R, Van Cann EM. Donor site complications in bone grafting: comparison of iliac crest, calvarial, and mandibular ramus bone. Int J Oral Maxillofac Implants. 2013 Jan-Feb;28(1):222-7.
    1. Falkensammer N, Kirmeier R, Arnetzl C, Wildburger A, Eskici A, Jakse N. Modified iliac bone harvesting--morbidity and patients' experience. J Oral Maxillofac Surg. 2009 Aug;67(8):1700-5.
    1. Jakoi AM, Iorio JA, Cahill PJ. Autologous bone graft harvesting: a review of grafts and surgical techniques. Musculoskelet Surg. 2015 Dec;99(3):171-8.
    1. Yates DM, Brockhoff HC 2nd, Finn R, Phillips C. Comparison of intraoral harvest sites for Yates DM, Brockhoff HC 2nd, Finn R, Phillips C. Comparison of intraoral harvest sites for corticocancellous bone grafts. J Oral Maxillofac Surg. 2013 Mar;71(3):497-504.
    1. Sittitavornwong S, Gutta R. Bone graft harvesting from regional sites. Oral Maxillofac Surg Clin North Am. 2010 Aug;22(3):317-30, v-vi.
    1. Aloy-Prósper A, Peñarrocha-Oltra D, Peñarrocha-Diago M, Peñarrocha-Diago M. The outcome of intraoral onlay block bone grafts on alveolar ridge augmentations: a systematic review. Med Oral Patol Oral Cir Bucal. 2015 Mar 1;20(2): e251-8.
    1. Kamal M, Gremse F, Rosenhain S, Bartella AK, Hölzle F, Kessler P, Lethaus B. Comparison of Bone Grafts From Various Donor Sites in Human Bone Specimens. J Craniofac Surg. 2018 Sep;29(6):1661-1665.
    1. Zeltner M, Flückiger LB, Hämmerle CH, Hüsler J, Benic GI. Volumetric analysis of chin and mandibular retromolar region as donor sites for cortico-cancellous bone blocks. Clin Oral Implants Res. 2016 Aug;27(8):999-1004.
    1. Reininger D, Cobo-Vázquez C, Monteserín-Matesanz M, López-Quiles J. Complications in the use of the mandibular body, ramus and symphysis as donor sites in bone graft surgery. A systematic review. Med Oral Patol Oral Cir Bucal. 2016 Mar 1;21(2):e241-9.
    1. Khoury F, Hanser T. Mandibular bone block harvesting from the retromolar region: a 10-year prospective clinical study. Int J Oral Maxillofac Implants. 2015 May-Jun;30(3):688-97.
    1. Chiapasco M, Casentini P, Zaniboni M. Bone augmentation procedures in implant dentistry. Int J Oral Maxillofac Implants. 2009;24 Suppl:237-59.
    1. Welch V, Petticrew M, Tugwell P, Moher D, O'Neill J, Waters E, White H. PRISMA-Equity Bellagio group. PRISMA-Equity 2012 extension: reporting guidelines for systematic reviews with a focus on health equity. PLoS Med. 2012;9(10):e1001333.
    1. Higgins JPT, Altman DG, Sterne JAC. Chapter 8: assessing risk of bias in included studies. In: Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). The Cochrane Collaboration. 2011. URL:
    1. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA. Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011 Oct 18;343:d5928.
    1. Wells G, Shea B, O'Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2013. URL: .
    1. Misch CM. Comparison of intraoral donor sites for onlay grafting prior to implant placement. Int J Oral Maxillofac Implants. 1997 Nov-Dec;12(6):767-76.
    1. Cordaro L, Amadé DS, Cordaro M. Clinical results of alveolar ridge augmentation with mandibular block bone grafts in partially edentulous patients prior to implant placement. Clin Oral Implants Res. 2002 Feb;13(1):103-11.
    1. Clavero J, Lundgren S. Ramus or chin grafts for maxillary sinus inlay and local onlay augmentation: comparison of donor site morbidity and complications. Clin Implant Dent Relat Res. 2003;5(3):154-60.
    1. Silva FM, Cortez AL, Moreira RW, Mazzonetto R. Complications of intraoral donor site for bone grafting prior to implant placement. Implant Dent. 2006 Dec;15(4):420-6.
    1. Raghoebar GM, Meijndert L, Kalk WW, Vissink A. Morbidity of mandibular bone harvesting: a comparative study. Int J Oral Maxillofac Implants. 2007 May-Jun;22(3):359-65.
    1. Andersson L. Patient self-evaluation of intra-oral bone grafting treatment to the maxillary frontal region. Dent Traumatol. 2008 Apr;24(2):164-9.
    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 Nov;22(11):1320-6.
    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 Sep;44(9):1131-7.
    1. Ersanli S, Arısan V, Bedeloğlu E. Evaluation of the autogenous bone block transfer for dental implant placement: Symphysal or ramus harvesting? BMC Oral Health. 2016 Jan 26;16:4.
    1. Pereira RS, Pavelski MD, Griza GL, Boos FBJD, Hochuli-Vieira E. Prospective evaluation of morbidity in patients who underwent autogenous bone-graft harvesting from the mandibular symphysis and retromolar regions. Clin Implant Dent Relat Res. 2019 Aug;21(4):753-757.
    1. Stübinger S, Nuss K, Landes C, von Rechenberg B, Sader R. Harvesting of intraoral autogenous block grafts from the chin and ramus region: preliminary results with a variable square pulse Er:YAG laser. Lasers Surg Med. 2008 Jul;40(5):312-8.
    1. Hof M, Tepper G, Semo B, Arnhart C, Watzek G, Pommer B. Patients' perspectives on dental implant and bone graft surgery: questionnaire-based interview survey. Clin Oral Implants Res. 2014 Jan;25(1):42-5.
    1. Reissmann DR, Dietze B, Vogeler M, Schmelzeisen R, Heydecke G. Impact of donor site for bone graft harvesting for dental implants on health-related and oral health-related quality of life. Clin Oral Implants Res. 2013 Jun;24(6):698-705.
    1. Sakkas A, Schramm A, Winter K, Wilde F. Risk factors for post-operative complications after procedures for autologous bone augmentation from different donor sites. J Craniomaxillofac Surg. 2018 Feb;46(2):312-322.
    1. Chiapasco M, Abati S, Romeo E, Vogel G. Clinical outcome of autogenous bone blocks or guided bone regeneration with e-PTFE membranes for the reconstruction of narrow edentulous ridges. Clin Oral Implants Res. 1999 Aug;10(4):278-88.
    1. Nkenke E, Schultze-Mosgau S, Radespiel-Tröger M, Kloss F, Neukam FW. Morbidity of harvesting of chin grafts: a prospective study. Clin Oral Implants Res. 2001 Oct;12(5):495-502.
    1. Joshi A. An investigation of post-operative morbidity following chin graft surgery. Br Dent J. 2004 Feb 28;196(4):215-8; discussion 211.
    1. von Arx T, Häfliger J, Chappuis V. Neurosensory disturbances following bone harvesting in the symphysis: a prospective clinical study. Clin Oral Implants Res. 2005 Aug;16(4):432-9.
    1. Nóia CF, Ortega-Lopes R, Fernandes Moreira RW, Mazzonetto R. Prospective clinical assessment of pulp sensitivity after chin bone harvesting. Implant Dent. 2013 Apr;22(2):199-202.
    1. Nkenke E, Radespiel-Tröger M, Wiltfang J, Schultze-Mosgau S, Winkler G, Neukam FW. Morbidity of harvesting of retromolar bone grafts: a prospective study. Clin Oral Implants Res. 2002 Oct;13(5):514-21.
    1. Pommer B, Tepper G, Gahleitner A, Zechner W, Watzek G. New safety margins for chin bone harvesting based on the course of the mandibular incisive canal in CT. Clin Oral Implants Res. 2008 Dec;19(12):1312-6.
    1. Nóia CF, Ortega-Lopes R, Ricardo de Albergaria Barbosa J, Barbeiro RH, Mazzonetto R. Evaluation of patients' perceptions of alterations after chin bone graft harvesting. Implant Dent. 2012 Oct;21(5):411-4.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner