Mertens Christian, Büsch Christopher, Ristow Oliver, Hoffmann Jürgen, Wang Hom-Lay, Hoffmann Korbinian Jochen
Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany.
Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany.
Clin Implant Dent Relat Res. 2024 Dec;26(6):1069-1085. doi: 10.1111/cid.13370. Epub 2024 Aug 8.
Challenging defect configurations and dimensions arise from severe, localized vertical alveolar ridge defects caused by trauma or prior surgery. This study aims to analyze three-dimensional bone gain, assess marginal bone stability in such defect configurations, and evaluate the impact of grafting outside the bone contour on the overall outcome, with a focus on iliac crest block grafts as a valid treatment option.
The prospective cohort study evaluated patients who required vertical block grafting due to localized bone defects in the maxilla or mandible and who had received iliac grafts. Three-dimensional bone gain was analyzed using cone beam computed tomography (CBCT) after 3 months of bone healing for each treated site and implant position. A comparison between bone grafts inside and outside the bone contour was conducted. Marginal bone stability was measured using intraoral radiographs during routine annual follow-up visits.
Seventy patients with 89 treated sites were evaluated. After 3 months of graft healing, the mean vertical bone gain was 11.03 ± 3.54 mm, the mean horizontal bone gain was 7.18 ± 2.00 mm, and the mean graft length was 28.19 ± 11.01 mm. A total of 217 implants were placed in the augmented regions. On implant level, a mean vertical bone gain of 10.44 ± 3.44 mm and a mean horizontal bone gain of 6.54 ± 1.86 mm were measured. Over a 43-month observation period, mesial and distal marginal bone loss averaged 0.44 ± 0.92 mm and 0.49 ± 1.05 mm, respectively. Eight implants were diagnosed with periimplantitis, resulting in the loss of four implants, while no early implant losses were reported.
Within the limitations of this study, vertical bone grafts with iliac crest block grafts were found to be a dependable treatment option for dental implant placement, and placing block grafts outside the bone contour did not lead to inferior outcomes.
严重的局部垂直牙槽嵴缺损由创伤或既往手术引起，会产生具有挑战性的缺损形态和尺寸。本研究旨在分析三维骨增量，评估此类缺损形态下的边缘骨稳定性，并评估在骨轮廓外植骨对总体结果的影响，重点关注髂嵴块状植骨作为一种有效的治疗选择。
这项前瞻性队列研究评估了因上颌骨或下颌骨局部骨缺损而需要进行垂直块状植骨且接受了髂骨移植的患者。在每个治疗部位和种植体位置骨愈合3个月后，使用锥形束计算机断层扫描（CBCT）分析三维骨增量。对骨轮廓内和骨轮廓外的骨移植进行了比较。在常规年度随访期间，使用口腔内X光片测量边缘骨稳定性。
对70例患者的89个治疗部位进行了评估。植骨愈合3个月后，平均垂直骨增量为11.03±3.54毫米，平均水平骨增量为7.18±2.00毫米，平均植骨长度为28.19±11.01毫米。在增量区域共植入了217颗种植体。在种植体水平上，测量到平均垂直骨增量为10.44±3.44毫米，平均水平骨增量为6.54±1.86毫米。在43个月的观察期内，近中边缘骨吸收和远中边缘骨吸收平均分别为0.44±0.92毫米和0.49±1.05毫米。8颗种植体被诊断为种植体周围炎，导致4颗种植体丢失，而未报告早期种植体丢失情况。
在本研究的局限性范围内，发现髂嵴块状植骨进行垂直骨移植是牙种植体植入的可靠治疗选择，并且在骨轮廓外放置块状植骨不会导致较差的结果。
