Department of Oral and Maxillofacial Sciences.
Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy.
J Craniofac Surg. 2021 Sep 1;32(6):e572-e578. doi: 10.1097/SCS.0000000000007735.
Severely atrophic alveolar ridges represent a great challenge for implant-prosthetic rehabilitations. The aim of this study was to clinically and histologically evaluate horizontal and vertical bone gain, as well as implant survival/success rate after guided bone regeneration (GBR) for the reconstruction of large bone defects. Fourteen subjects (7 males and 7 females; mean age: 48.9 ± 14.1) were enrolled in the study. They were selected according to specific inclusion criteria and all patients required GBR procedures for placing implants in severe atrophic jaws (bone height ≤6 mm). Guided bone regeneration was performed using dense polytetrafluoroethylene nonresorbable titanium-reinforced membranes associated with particulate heterologous bone grafts. Implant placement was performed 6 months after surgery at the same time as the removal of the membrane. Furthermore, a biopsy sample from the grafted sites was collected to conduct a histological analysis of the regenerated bone. Forty-seven dental implants were placed and followed up after prosthetic loading. Seventeen sites, 8 in the maxilla and 9 in the mandible, were suitable for the GBR procedure. The healing period was uneventful in 13 sites. The average value of vertical bone regeneration was 5.88 ± 1.17 mm. Postloading follow-up ranged from 24 to 59 months. During the follow-up, clinical and radiographic exams showed no significant bone resorption and, in each case, the criteria for implants' survival were respected with no signs of any complications. Histological analysis of the bone biopsy samples revealed residual graft particulate in close contact with newly formed bone. Guided bone regeneration is a reliable technique for reconstruction of severe atrophic ridges. Larger long-term follow-up studies are needed to evaluate the condition of the bone grafted over time and its ability to support functional loading of the implants.
严重萎缩的牙槽嵴对种植修复是一个巨大的挑战。本研究旨在通过临床和组织学评估，研究引导骨再生（GBR）在重建大面积骨缺损中对水平和垂直骨增量以及种植体存活率/成功率的影响。本研究共纳入 14 名受试者（7 名男性和 7 名女性；平均年龄：48.9±14.1 岁）。他们是根据特定的纳入标准选择的，所有患者都需要 GBR 手术来在严重萎缩的颌骨（骨高度≤6mm）中放置种植体。使用致密的聚四氟乙烯不可吸收的钛增强型膜与颗粒状异种骨移植物联合进行引导骨再生。手术 6 个月后，在去除膜的同时进行种植体植入。此外，从移植物部位采集活检样本，对再生骨进行组织学分析。共植入 47 颗种植体，在修复体加载后进行随访。17 个部位（上颌 8 个，下颌 9 个）适合 GBR 手术。13 个部位的愈合期无异常。垂直骨再生的平均值为 5.88±1.17mm。加载后随访时间为 24 至 59 个月。在随访期间，临床和影像学检查均未显示明显的骨质吸收，在每种情况下均符合种植体存活标准，无任何并发症迹象。对骨活检样本的组织学分析显示，残留的移植物颗粒与新形成的骨紧密接触。引导骨再生是重建严重萎缩牙槽嵴的可靠技术。需要更大规模的长期随访研究来评估随时间推移移植骨的状况及其支持种植体功能负载的能力。
