Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv 6139001, Israel.
The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
Int J Environ Res Public Health. 2021 Feb 27;18(5):2341. doi: 10.3390/ijerph18052341.
Edentulism and terminal dentition are still considered significant problems in the dental field, posing a great challenge for surgical and restorative solutions especially with immediate loading protocols. When the implant placement is planned immediately after extraction with irregular bone topography or there is an un-leveled alveolar ridge topography for any other reason, bone reduction may be required to level the alveolar crest in order to create the desired bone architecture allowing for sufficient bone width for implant placement and to insure adequate inter-arch restorative space. Bone reduction protocols exist in analog and digitally planned methodologies, with or without surgical guides to achieve the desired bone level based upon the desired position of the implants with regard to the restorative outcome. The objective of this paper was to scrutinize the literature regarding the practice of bone reduction in conjunction with implant placement, and to review different types of bone reduction surgical guides. Results: The literature reveals different protocols that provide for bone reduction with a variety of bone reduction methods. The digitally-planned surgical guide based on Cone-Beam computerized tomography (CBCT) scan reconstructed data can improve accuracy, reduce surgical time, and deliver the desired bone level for the implant placement with fewer surgical and restorative complications. The clinician's choice is based on personal experience, training, and comfort with a specific guide type. Conclusions: Bone reduction, when required, is an indispensable step in the surgical procedure to attain suitable width of bone in anticipation of implant placement ideally determined by the desired tooth position and required restorative space based on material selection for the chosen framework design, i.e., hybrid, monolithic zirconia. Additionally, bone reduction and implant placement can be accomplished in the same surgical procedure, minimizing trauma and the need for two separate interventions.
无牙颌和末端牙列仍然被认为是口腔医学领域的重大问题，尤其是对于即刻负载方案的手术和修复解决方案来说，这是一个巨大的挑战。当种植体的放置计划是在拔牙后立即进行，且骨表面不规则，或者由于其他原因牙槽嵴表面不平整时，可能需要进行骨修整以平整牙槽嵴顶，从而创建所需的骨结构，为种植体的放置提供足够的骨宽度，并确保足够的跨牙弓修复空间。骨修整方案存在于模拟和数字化规划方法中，无论是否使用手术导板，都可以根据种植体相对于修复效果的期望位置，实现所需的骨水平。本文的目的是仔细研究关于种植体放置时进行骨修整的文献，并回顾不同类型的骨修整手术导板。结果：文献表明，有不同的方案可以提供各种骨修整方法的骨修整。基于锥形束计算机断层扫描（CBCT）扫描重建数据的数字化规划手术导板可以提高准确性，减少手术时间，并为种植体放置提供所需的骨水平，减少手术和修复并发症。临床医生的选择基于个人经验、培训和对特定导板类型的舒适度。结论：在手术过程中，当需要骨修整时，这是获得预期种植体放置所需的合适骨宽度的不可或缺的步骤，理想情况下，这是根据所需的牙齿位置和基于所选框架设计（即混合、整体氧化锆）的材料选择来确定的所需修复空间。此外，骨修整和种植体放置可以在同一手术过程中完成，最大限度地减少创伤和对两次单独干预的需求。
