Leong Daylene Jack-Min, Oh Tae-Ju, Benavides Erika, Al-Hezaimi Khalid, Misch Carl E, Wang Hom-Lay
*Private Practitioner, Singapore, Singapore. †Clinical Professor and Vice Chair, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI. ‡Clinical Associate Professor, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI. §Associate Professor, Engineer Abdullah Bagshan Research Chair for Growth Factors and Bone Regeneration, College of Dentistry, King Saud University, Riyadh, Saudi Arabia. ‖Private Practice, Beverly Hills, MI. ¶Professor and Director of Graduate Periodontics, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI.
Implant Dent. 2015 Feb;24(1):4-12. doi: 10.1097/ID.0000000000000180.
The purpose of this randomized controlled clinical trial was to evaluate 2 different techniques for vertical ridge augmentation (VRA) of the posterior mandible.
Sixteen subjects with 19 posterior mandibular edentulous sites requiring VRA were recruited for the study. Sites were randomly treated with either block allograft (BA; N = 9) or sandwich bone augmentation (SBA; N = 10). Clinical measurements were recorded at the time of surgery (baseline) and 6-month reentry with a custom-made acrylic surgical template.
The mean vertical bone gain (VBG) after mean 6.8 months was 44.5% (mean = 1.78 mm [0-5 mm]) in the BA group and 33.3% (mean = 1.0 mm [-1 to 3 mm]) in the SBA group. Significantly higher rates of incision line openings and wound dehiscences were found in the BA group (n = 7/9, 77.8%) as compared with the SBA group (n = 3/10, 30%) (P = 0.037). After adjusting for graft exposure, BA group demonstrated significantly higher VBG than SBA (difference = 2.26 mm, P < 0.001). In addition, graft exposure resulted in significantly less VBG in both groups (P < 0.001).
A higher tendency of wound exposure during VRA was demonstrated when a BA was used compared with the SBA technique. However, if wound exposure could be prevented, higher vertical ridge gain could be achieved with a BA.
The use of a BA in VRA resulted in a maximum of 2 mm more bone height gain compared with the SBA technique if the primary coverage can be achieved during the healing.
本随机对照临床试验的目的是评估两种不同的下颌后牙区垂直骨增量（VRA）技术。
招募了16名有19个下颌后牙无牙区需要进行VRA的受试者参与本研究。这些部位被随机采用块状异体骨移植（BA；n = 9）或三明治式骨增量术（SBA；n = 10）进行治疗。在手术时（基线）和6个月再次手术时使用定制的丙烯酸手术模板记录临床测量数据。
平均6.8个月后，BA组的平均垂直骨增量（VBG）为44.5%（平均值 = 1.78 mm [0 - 5 mm]），SBA组为33.3%（平均值 = 1.0 mm [-1至3 mm]）。与SBA组（n = 3/10，30%）相比，BA组（n = 7/9，77.8%）的切口裂开和伤口裂开发生率显著更高（P = 0.037）。在调整移植物暴露因素后，BA组的VBG显著高于SBA组（差异 = 2.26 mm，P < 0.001）。此外，移植物暴露在两组中均导致显著更少的VBG（P < 0.001）。
与SBA技术相比，使用BA进行VRA时伤口暴露的倾向更高。然而，如果能够防止伤口暴露，使用BA可以实现更高的垂直骨嵴增量。
如果在愈合过程中能够实现初次覆盖，与SBA技术相比，在VRA中使用BA可使骨高度增量最多多2 mm。
