Monje Alberto, Monje Florencio, Hernández-Alfaro Federico, Gonzalez-García Raúl, Suárez-López del Amo Fernando, Galindo-Moreno Pablo, Montanero-Fernández Jesús, Wang Hom-Lay
1 Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Mich.
2 Center of Implantology, Oral and Maxillofacial Surgery (CICOM), Badajoz, Spain.
J Oral Implantol. 2015 Jul;41 Spec No:366-71. doi: 10.1563/AAID-JOI-D-13-00219. Epub 2014 Apr 4.
The aim of the present study was to use cone-beam computerized tomography (CBCT) to assess horizontal bone augmentation using block grafts, harvested from either the iliac crest (IC) or mandibular ramus (MR) combined with particulate xenograft and a collagen membrane for in the severe maxillary anterior ridge defects (cases Class III-IV according to Cadwood and Howell's classification). Fourteen healthy partially edentulous patients requiring extensive horizontal bone reconstruction in the anterior maxilla were selected for the study. Nineteen onlay block grafts (from IC or MR) were placed. The amount of horizontal bone gain was recorded by CBCT at 3 levels (5, 7, and 11 mm from the residual ridge) and at the time of bone grafting as well as the time of implant placement (≈5 months). Both block donor sites provided enough ridge width for proper implant placement. Nonetheless, IC had significantly greater ridge width gain than MR (Student t test) (4.93 mm vs 3.23 mm). This was further confirmed by nonparametric Mann-Whitney test (P = .007). Moreover, mean pristine ridge and grafted ridge values showed a direct association (Spearman coefficient of correlation = .336). A combination of block graft, obtained from the IC or MR, combined with particulate xenograft then covered with an absorbable collagen membrane is a predictable technique for augmenting anterior maxillary horizontal ridge deficiency.
本研究的目的是使用锥形束计算机断层扫描（CBCT）评估在上颌前部严重牙槽嵴缺损（根据Cadwood和Howell分类为III-IV类病例）中，采用取自髂嵴（IC）或下颌升支（MR）的块状骨移植联合颗粒异种移植物及胶原膜进行水平骨增量的情况。选择了14例需要在上颌前部进行广泛水平骨重建的健康部分缺牙患者进行研究。植入了19块（取自IC或MR）块状骨移植体。通过CBCT在3个水平（距残余牙槽嵴5、7和11 mm处）以及植骨时和种植体植入时（约5个月）记录水平骨增量。两个块状骨供区均提供了足够的牙槽嵴宽度以进行合适的种植体植入。尽管如此，IC的牙槽嵴宽度增量显著大于MR（学生t检验）（4.93 mm对3.23 mm）。非参数曼-惠特尼检验进一步证实了这一点（P = .007）。此外，原始牙槽嵴和植骨后牙槽嵴的平均值显示出直接相关性（Spearman相关系数 = .336）。取自IC或MR的块状骨移植联合颗粒异种移植物然后覆盖可吸收胶原膜的联合技术是一种可预测的增加上颌前部水平牙槽嵴缺损的技术。
