Ersanli Selim, Arısan Volkan, Bedeloğlu Elçin
Department of Oral Impantology, Faculty of Dentistry, Istanbul University, 34093-Capa, Istanbul, Turkey.
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul Aydın University, 34088-Florya, Istanbul, Turkey.
BMC Oral Health. 2016 Jan 26;16:4. doi: 10.1186/s12903-016-0161-8.
The absence of sufficient bone volume is the most relevant problem in implant dentistry. Grafting from exogenous sources may provide a limited gain but exhibits poor performance in large bone defects. Autogenous bone block transfer (ABBT) from the mandibular symphysis and ramus has been used with varying rates of success. The aim of this study was to compare the efficacy of symphysal and ramus ABBT for the restoration of lost horizontal alveolar bone volume in the anterior maxilla. Implants placed in the augmented areas were also evaluated.
The maxillary alveolar bone deficits of 32 patients were treated by similar-sized autogenous bone blocks (7 × 7 × 4 mm) harvested from the symphysis or ramus area. After 4 to 5 months of healing, implants were inserted. At the end of the osseointegration period, the implants were restored by fixed prostheses. Baseline bone thickness was determined by Cone beam computed tomography and was compared to post-op and one-year post-loading bone thickness values where the implants were inserted. Any complications or consequences were noted. The success and survival of the 45 implants were evaluated. The results were analyzed using the Student t-test and Fisher's exact test (p < 0.05).
Post-op complications were frequent in both groups. Baseline bone thickness values were similar at the beginning of the study (p = 0.71) and exhibited a significant increase after the ABBT surgery (6.29 (SD 0.86) and 6.01 (SD 0.92) mm in the symphysis and ramus groups, respectively). The amount of bone thickness gain was 4.34 mm (SD: 0.92) and 4.36 mm (SD: 1.01) in the symphysis and ramus groups, respectively. After one year, the mean surface resorption was 0.6 mm (SD: 0.78) and 0.80 mm (SD: 0.56) for the symphysis and ramus groups, respectively (p = 0.089). The success and survival rates of the implants were 94.11 and 96.42 %, respectively. No graft failures were observed.
Both symphysal and ramus ABBT procedures were successful for the restoration of a horizontal bone defect in the anterior maxilla. Ramus harvesting may be advisable due to fewer complications. Implants placed in the grafted regions exhibited a high success and survival rate within the one-year follow-up period.
骨量不足是种植牙科中最相关的问题。外源性骨移植可能只能带来有限的骨量增加，且在大的骨缺损中效果不佳。取自下颌骨联合和升支的自体骨块移植（ABBT）已被应用，成功率各异。本研究的目的是比较下颌骨联合和升支ABBT在上颌前部恢复水平牙槽骨量损失方面的疗效。同时也评估了植入于植骨区的种植体。
32例患者的上颌牙槽骨缺损采用从下颌联合或升支区域获取的大小相似的自体骨块（7×7×4mm）进行治疗。愈合4至5个月后植入种植体。在骨整合期结束时，用固定修复体修复种植体。通过锥形束计算机断层扫描确定基线骨厚度，并与种植体植入部位的术后及加载后一年的骨厚度值进行比较。记录任何并发症或后果。评估45枚种植体的成功率和存留率。结果采用学生t检验和Fisher精确检验进行分析（p<0.05）。
两组术后并发症均较为常见。研究开始时基线骨厚度值相似（p=0.71），自体骨块移植手术后骨厚度显著增加（下颌骨联合组和升支组分别为6.29（标准差0.86）和6.01（标准差0.92）mm）。下颌骨联合组和升支组的骨厚度增加量分别为4.34mm（标准差：0.92）和4.36mm（标准差：1.01）。一年后，下颌骨联合组和升支组的平均表面吸收分别为0.6mm（标准差：0.78）和0.80mm（标准差：0.56）（p=0.089）。种植体的成功率和存留率分别为94.11%和96.42%。未观察到植骨失败。
下颌骨联合和升支ABBT手术在上颌前部水平骨缺损的修复中均取得成功。由于并发症较少，可取用升支骨。在随访一年期间，植入于植骨区的种植体显示出较高的成功率和存留率。
