Gultekin B Alper, Cansiz Erol, Borahan M Oguz
Research Assistant, Department of Oral Implantology, Istanbul University Faculty of Dentistry, Istanbul, Turkey.
Assistant Professor, Department of Oral and Maxillofacial Surgery, Istanbul University Faculty of Dentistry, Istanbul, Turkey.
J Oral Maxillofac Surg. 2017 Apr;75(4):709-722. doi: 10.1016/j.joms.2016.11.019. Epub 2016 Nov 26.
To evaluate the rate of graft resorption in autogenous iliac bone grafting (IBG) and guided bone regeneration (GBR) in patients with atrophic maxillae.
We performed a retrospective study involving patients requiring implant placement who underwent IBG or GBR. Volumetric changes of the graft sites were evaluated by imaging studies. The primary predictor and outcome variables were augmentation technique and rate of volumetric resorption, respectively. Secondary outcome variables included bone gain, success of grafting, insertion torque of implants, and requirement for vestibuloplasty.
The sample comprised 39 patients (21 with GBR and 18 with IBG). One patient in the IBG group had temporary sensory disturbance at the donor site, and one patient in the GBR group had late exposure of the nonresorbable membrane. The average values of percent volume reduction in the GBR and IBG groups were 12.26% ± 2.35% and 35.94% ± 7.94%, respectively, after healing and 15.87% ± 1.99% and 41.62% ± 6.97%, respectively, at last follow-up. The IBG group exhibited a significantly higher reduction in bone volume than the GBR group at both time points (P = .001). The mean values of horizontal and vertical bone gain after healing in the IBG group were significantly higher than those in the GBR group (P = .006 and P = .001, respectively). The mean implant torque during implant placement in the GBR group was significantly higher than that in the IBG group (P = .024). There was no significant difference in the requirement for vestibuloplasty between the two groups (P > .05).
Although both hard tissue augmentation approaches provide an adequate volume of bone graft for implant insertion, IBG results in greater graft resorption at maxillary augmented sites than GBR. Clinicians should consider the differences in the extent of graft resorption between the two methods while choosing the treatment approach.
评估萎缩性上颌骨患者自体髂骨移植（IBG）和引导骨再生（GBR）中植骨吸收的发生率。
我们进行了一项回顾性研究，纳入了接受IBG或GBR治疗且需要植入种植体的患者。通过影像学研究评估植骨部位的体积变化。主要预测变量和结果变量分别为增骨技术和体积吸收速率。次要结果变量包括骨增量、植骨成功率、种植体植入扭矩以及前庭成形术的需求。
样本包括39例患者（21例行GBR，18例行IBG）。IBG组有1例患者在供区出现暂时性感觉障碍，GBR组有1例患者出现不可吸收膜的晚期暴露。愈合后GBR组和IBG组体积减少百分比的平均值分别为12.26%±2.35%和35.94%±7.94%，末次随访时分别为15.87%±1.99%和41.62%±6.97%。在两个时间点，IBG组的骨体积减少均显著高于GBR组（P = 0.001）。IBG组愈合后水平和垂直方向的平均骨增量显著高于GBR组（分别为P = 0.006和P = 0.001）。GBR组种植体植入时的平均扭矩显著高于IBG组（P = 0.024）。两组在前庭成形术需求方面无显著差异（P>0.05）。
尽管两种硬组织增量方法都能为种植体植入提供足够的骨量，但与GBR相比，IBG导致上颌骨增量部位的植骨吸收更多。临床医生在选择治疗方法时应考虑两种方法在植骨吸收程度上的差异。
