Elnayef Basel, Porta Cristina, Suárez-López Del Amo Fernando, Mordini Lorenzo, Gargallo-Albiol Jordi, Hernández-Alfaro Federico
Int J Oral Maxillofac Implants. 2018 May/Jun;33(3):622-635. doi: 10.11607/jomi.6290.
Owing to volumetric changes after tooth extraction, lateral ridge augmentation has become a common procedure prior or simultaneous to implant placement. Nonetheless, little is known with regard to the dimensional remodeling after healing of these lateral ridge augmentation procedures. Hence, the purpose of this systematic review was to assess the stability of bone grafting material between augmentation procedures and final healing, in terms of resorption rate.
An electronic and hand literature search was conducted in several databases, such as the Cochrane Oral Health Group Trials Register, Embase, and Cochrane Central Register of Controlled Trials, up until February 2017. Only randomized controlled trials (RCTs) with a mean follow-up of at least 6 months after implant placement aiming to evaluate the stability of grafting material for lateral ridge augmentation were included and quantitatively analyzed.
A total of 35 articles were evaluated; however, only 17 RCTs met the inclusion criteria. A total of 15 studies reported information on bone resorption, leading to a total sample of 304 implants. The estimated overall mean horizontal bone gain at the time of regeneration was 3.71 ± 0.24 mm, with 4.18 ± 0.56 mm for the block graft technique and 3.61 ± 0.27 mm for guided bone regeneration (GBR). The estimated overall net bone gain at final re-evaluation (11.9 ± 7.8) was 2.86 ± 0.23 mm. The estimated mean (± SD) resorption after 6 months was 1.13 ± 0.25 mm, with 0.75 ± 0.59 mm for the block graft technique and 1.22 ± 0.28 mm for GBR. The implant survival rate was 97% to 100%.
Regardless of the material used for regeneration, different degrees of graft resorption should be expected. Given the sample of investigations analyzed in this review, block grafts seemed to maintain the volume of the initial augmentation site more than GBR techniques. During the initial stages of healing, the GBR technique experienced more changes compared with block grafts. The resorption of the xenograft group was inferior compared with the combination of xenograft and autologous bone groups. Consequently, overcorrection of the horizontal defects should be performed to compensate for the resorption of the grafting materials.
由于拔牙后牙槽嵴的容积变化，在种植体植入之前或同时进行侧方牙槽嵴增量已成为一种常见的手术。然而，对于这些侧方牙槽嵴增量手术愈合后的尺寸重塑情况知之甚少。因此，本系统评价的目的是从吸收速率方面评估增量手术与最终愈合之间骨移植材料的稳定性。
截至2017年2月，在多个数据库中进行了电子和手工文献检索，如Cochrane口腔健康组试验注册库、Embase和Cochrane对照试验中央注册库。仅纳入平均随访时间至少为种植体植入后6个月、旨在评估用于侧方牙槽嵴增量的移植材料稳定性的随机对照试验（RCT）并进行定量分析。
共评估了35篇文章；然而，只有17项RCT符合纳入标准。共有15项研究报告了骨吸收信息，导致总样本量为304颗种植体。再生时估计的总体平均水平骨增量为3.71±0.24mm，块状骨移植技术为4.18±0.56mm，引导骨再生（GBR）为3.61±0.27mm。最终重新评估时（11.9±7.8）估计的总体净骨增量为2.86±0.23mm。6个月后估计的平均（±标准差）吸收量为1.13±0.25mm，块状骨移植技术为0.75±0.59mm，GBR为1.22±0.28mm。种植体存活率为97%至100%。
无论用于再生的材料如何，都应预期不同程度的移植吸收。根据本评价中分析的研究样本，块状骨移植似乎比GBR技术更能维持初始增量部位的体积。在愈合的初始阶段，与块状骨移植相比，GBR技术经历的变化更多。异种移植组的吸收情况比异种移植与自体骨联合组差。因此，应进行水平缺损的过度矫正以补偿移植材料的吸收。
