Safe and Predictable Hard Tissue Augmentation Modalities and Their Proper Use
To prevent recession of the marginal soft tissue after installation of the implant superstructure, a hard tissue thickness of 2 mm or more is required on the buccal (cheek) side of the implant. Therefore, if the remaining bone lacks thickness, some hard tissue augmentation is required.Conventionally...
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| Published in | Journal of Japanese Society of Oral Implantology Vol. 33; no. 3; pp. 266 - 274 |
|---|---|
| Main Authors | , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japanese Society of Oral Implantology
30.09.2020
公益社団法人 日本口腔インプラント学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0914-6695 2187-9117 |
| DOI | 10.11237/jsoi.33.266 |
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| Abstract | To prevent recession of the marginal soft tissue after installation of the implant superstructure, a hard tissue thickness of 2 mm or more is required on the buccal (cheek) side of the implant. Therefore, if the remaining bone lacks thickness, some hard tissue augmentation is required.Conventionally, block bone grafting has been recommended for highly atrophied ridges. However, adaptation of the block bone to the recipient site, the surface morphology of which is usually irregular and complex, is problematic. This can lead to poor prognosis of the engraftment.Under these circumstances, Dr. Urban introduced "a sausage technique", in which a bone graft composed of a mixture of granular autogenous bone and slow-resorbing xenogenous bone (deproteinized bovine bone mineral) is covered and immobilized at the recipient site with a resorbable collagenous membrane that is secured using fixation pins. This technique allows high adaptability of the graft to the recipient site as it uses granular bone, and is relatively safe because it uses a resorbable membrane with a low wound dehiscence rate.However, large bone resorption, especially on the buccal (cheek) side of the alveolar ridge shoulder where the external pressure is markedly concentrated, is a major drawback and often requires additional GBR during implant placement. Moreover, the space-making capacity in the vertical direction is relatively poor.Therefore, in cases where a vertical and even horizontal hard tissue augmentation at the alveolar ridge shoulder is desired, a titanium-reinforced non-resorbable membrane is preferable. |
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| AbstractList | To prevent recession of the marginal soft tissue after installation of the implant superstructure, a hard tissue thickness of 2 mm or more is required on the buccal (cheek) side of the implant. Therefore, if the remaining bone lacks thickness, some hard tissue augmentation is required.Conventionally, block bone grafting has been recommended for highly atrophied ridges. However, adaptation of the block bone to the recipient site, the surface morphology of which is usually irregular and complex, is problematic. This can lead to poor prognosis of the engraftment.Under these circumstances, Dr. Urban introduced "a sausage technique", in which a bone graft composed of a mixture of granular autogenous bone and slow-resorbing xenogenous bone (deproteinized bovine bone mineral) is covered and immobilized at the recipient site with a resorbable collagenous membrane that is secured using fixation pins. This technique allows high adaptability of the graft to the recipient site as it uses granular bone, and is relatively safe because it uses a resorbable membrane with a low wound dehiscence rate.However, large bone resorption, especially on the buccal (cheek) side of the alveolar ridge shoulder where the external pressure is markedly concentrated, is a major drawback and often requires additional GBR during implant placement. Moreover, the space-making capacity in the vertical direction is relatively poor.Therefore, in cases where a vertical and even horizontal hard tissue augmentation at the alveolar ridge shoulder is desired, a titanium-reinforced non-resorbable membrane is preferable. To prevent recession of the marginal soft tissue after installation of the implant superstructure, a hard tissue thickness of 2 mm or more is required on the buccal (cheek) side of the implant. Therefore, if the remaining bone lacks thickness, some hard tissue augmentation is required.Conventionally, block bone grafting has been recommended for highly atrophied ridges. However, adaptation of the block bone to the recipient site, the surface morphology of which is usually irregular and complex, is problematic. This can lead to poor prognosis of the engraftment.Under these circumstances, Dr. Urban introduced “a sausage technique”, in which a bone graft composed of a mixture of granular autogenous bone and slow-resorbing xenogenous bone (deproteinized bovine bone mineral) is covered and immobilized at the recipient site with a resorbable collagenous membrane that is secured using fixation pins. This technique allows high adaptability of the graft to the recipient site as it uses granular bone, and is relatively safe because it uses a resorbable membrane with a low wound dehiscence rate.However, large bone resorption, especially on the buccal (cheek) side of the alveolar ridge shoulder where the external pressure is markedly concentrated, is a major drawback and often requires additional GBR during implant placement. Moreover, the space-making capacity in the vertical direction is relatively poor.Therefore, in cases where a vertical and even horizontal hard tissue augmentation at the alveolar ridge shoulder is desired, a titanium-reinforced non-resorbable membrane is preferable. 上部構造装着後の辺縁軟組織の退縮を抑止するためには，インプラント体の唇（頬）側に2mm以上の厚みの硬組織が必要とされている．そのため，既存骨の厚みが薄い場合は，何かしらの硬組織増生術が必要とされる．従来，高度に萎縮した顎堤に対してはブロック骨移植が推奨されてきたが，いびつで複雑な表面形態をしている母床骨に，ブロック骨を適合させることは容易ではない．また，ブロック骨の適合が不良の場合は，生着不良を引き起こすことがあることも問題であった．そのようななか，Dr. URBANは粉砕自家骨と吸収スピードの遅い骨補填材（脱タンパク化ウシ骨ミネラル）を混合した移植材を，吸収性メンブレンとピンで固定するソーセージテクニックを発表した．このテクニックは，顆粒状の混合補填材を用いるため母床骨との適合を心配する必要がなく，メンブレンは創裂開率が低い吸収性メンブレンを用いているため，比較的安全な術式であると考えられる．しかし，増生後のグラフト吸収量が多いことが難点であり，特に外側からの圧が集中する唇（頬）側歯槽堤のショルダー部分での吸収が顕著なため，インプラント体埋入時に追加の骨再生誘導法（Guided Bone Regeneration：GBR）が必要になる場合も多い．また，垂直的なスペース保持能力が乏しいことから，垂直的な増生を目的にする場合や，水平的な増生においても歯槽堤のショルダー部分に十分な厚みの硬組織を構築したい場合は，チタンフレーム付き非吸収性メンブレンの使用が望ましいと考えられる． |
| Author | KUBOKI, Takuo ODA, Norimi SONOYAMA, Wataru |
| Author_FL | 小田 師巳 園山 亘 窪木 拓男 |
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| References | 21) 石原和幸，今井健一，小川知彦，ほか編著．細菌学総論 細菌の構造と形態 細菌の細胞形態．口腔微生物学．第6版．東京：学建書院，2018 32) Hasegawa H, Kaneko T, Kanno C, et al. Evaluation of a newly designed microperforated titanium membrane with beta-tricalcium phosphate for guided bone regeneration in dog mandibles. Int J Oral Maxillofac Implants 2019;34:1132-1142. 11) Cordaro L, Amadé DS, Cordaro M. Clinical results of alveolar ridge augmentation with mandibular block bone grafts in partially edentulous patients prior to implant placement. Clin Oral Implants Res 2002;13:103-111. 5) Becker J, Al-Nawas B, Klein MO, et al. Use of a new crosslinked collagen membrane for the treatment of dehiscencetype defects at titanium implants : a prospective, randomizedcontrolled double-blinded clinical multicenter study. Clin Oral Implants Res 2009;20:742-749. 29) Rasia-dal Polo M, Poli PP, Rancitelli D, et al. Alveolar ridge reconstruction with titanium meshes : a systematic review of the literature. Med Oral Patol Oral Cir Bucal 2014;19:e639-e646. 2) Mordenfeld A, Aludden H, Starch-Jensen T. Lateral ridge augmentation with two different ratios of deproteinized bovine bone and autogenous bone : A 2-year follow-up of a randomized and controlled trial. Clin Implant Dent Relat Res 2017;19:884-894. 18) Hämmerle CH, Jung RE. Bone augmentation by means of barrier membranes. Periodontol 2000 2003;33:36-53. 6) Jung RE, Fenner N, Hämmerle CH, et al. Long-term outcome of implants placed with guided bone regeneration (GBR) using resorbable and non-resorbable membranes after 12-14 years. Clin Oral Implants Res 2013;24:1065-1073. 31) 長谷川 博，増井誠一郎，石幡浩志，ほか．新規骨再生誘導法用メンブレンの開発．Bio Industry 2017；33：59-69 15) Urban IA, Nagursky H, Lozada JL. Horizontal ridge augmentation with a resorbable membrane and particulated autogenous bone with or without anorganic bovine bone-derived mineral : a prospective case series in 22 patients. Int J Oral Maxillofac Implants 2011;26:404-414. 14) Chappuis V, Cavusoglu Y, Buser D, et al. Lateral ridge augmentation using autogenous block grafts and guided bone regeneration : a 10-year prospective case series study. Clin Implant Dent Relat Res 2017;19:85-96. 27) Lizio G, Corinaldesi G, Marchetti C. Alveolar ridge reconstruction with titanium mesh : a three-dimensional evaluation of factors affecting bone augmentation. Int J Oral Maxillofac Implants 2014;29:1354-1363. 10) Antoun H, Sitbon JM, Martinez H, et al. A prospective randomized study comparing two techniques of bone augmentation : onlay graft alone or associated with a membrane. Clin Oral Implants Res 2001;12:632-639. 3) Annen BM, Ramel CF, Hämmerle CH, et al. Use of a new cross-linked collagen membrane for the treatment of peri-implant dehiscence defects : a randomised controlled doubleblinded clinical trial. Eur J Oral Implantol 2011;4:87-100. 13) von Arx T, Buser D. Horizontal ridge augmentation using autogenous block grafts and the guided bone regeneration technique with collagen membranes : a clinical study with 42 patients. Clin Oral Implants Res 2006;17:359-366. 1) Mordenfeld A, Johansson CB, Albrektsson T, et al. A randomized and controlled clinical trial of two different compositions of deproteinized bovine bone and autogenous bone used for lateral ridge augmentation. Clin Oral Implants Res 2014;25:310-320. 9) Urban IA, Montero E, Monje A, et al. Effectiveness of vertical ridge augmentation interventions : A systematic review and meta-analysis. J Clin Periodontol 2019;46(Suppl 21):319-339. 24) Esposito M, Grusovin MG, Felice P, et al. The efficacy of horizontal and vertical bone augmentation procedures for dental implants - a Cochrane systematic review. Eur J Oral Implantol 2009;2:167-184. 4) Wessing B, Lettner S, Zechner W. Guided bone regeneration with collagen membranes and particulate graft materials : a systematic review and meta-analysis. Int J Oral Maxillofac Implants 2018;33:87-100. 16) Urban IA, Nagursky H, Lozada JL, et al. Horizontal ridge augmentation with a collagen membrane and a combination of particulated autogenous bone and anorganic bovine bone-derived mineral : a prospective case series in 25 patients. Int J Periodontics Restorative Dent 2013;33:299-307. 28) Uehara S, Kurita H, Shimane T, et al. Predictability of staged localized alveolar ridge augmentation using a micro titanium mesh. Oral Maxillofac Surg 2015;19:411-416. 7) Cordaro L, Torsello F, Miuccio MT, et al. Mandibular bone harvesting for alveolar reconstruction and implant placement : subjective and objective cross-sectional evaluation of donor and recipient site up to 4 years. Clin Oral Implants Res 2011;22:1320-1326. 19) Greenstein G, Carpentieri JR. Utilization of d-PTFE barriers for post-extraction bone regeneration in preparation for dental implants. Compend Contin Educ Dent 2015;36:465-473. 25) Fontana F, Maschera E, Rocchietta I, et al. Clinical classification of complications in guided bone regeneration procedures by means of a nonresorbable membrane. Int J Periodontics Restorative Dent 2011;31:265-273. 30) Briguglio F, Falcomatà D, Marconcini S, et al. The use of titanium mesh in guided bone regeneration : A systematic review. Int J Dent 2019;2019:9065423. 20) Tripathy A, Sen P, Su B, et al. Natural and bioinspired nanostructured bactericidal surfaces. Adv Colloid Interface Sci 2017;248:85-104. 26) Cucchi A, Vignudelli E, Napolitano A, et al. Evaluation of complication rates and vertical bone gain after guided bone regeneration with non-resorbable membranes versus titanium meshes and resorbable membranes. A randomized clinical trial. Clin Implant Dent Relat Res 2017;19:821-832. 12) Maiorana C, Beretta M, Salina S, et al. Reduction of autogenous bone graft resorption by means of bio-oss coverage : a prospective study. Int J Periodontics Restorative Dent 2005;25:19-25. 23) Toscano N, Shumaker N, Holtzclaw D. The art of block grafting, a review of the surgical protocol for reconstruction of alveolar ridge deficiency. J Implant Adv Clin Dent 2010;2:45-66. 8) Jensen SS, Terheyden H. Bone augmentation procedures in localized defects in the alveolar ridge : clinical results with different bone grafts and bone-substitute materials. Int J Oral Maxillofac Implants 2009;24(Suppl):218-236. 17) Soldatos NK, Stylianou P, Koidou VP, et al. Limitations and options using resorbable versus nonresorbable membranes for successful guided bone regeneration. Quintessence Int 2017;48:131-147. 22) Bartee BK. Extraction site reconstruction for alveolar ridge preservation. Part 2 : membrane-assisted surgical technique. J Oral Implantol 2001;27:194-197. |
| References_xml | – reference: 13) von Arx T, Buser D. Horizontal ridge augmentation using autogenous block grafts and the guided bone regeneration technique with collagen membranes : a clinical study with 42 patients. Clin Oral Implants Res 2006;17:359-366. – reference: 27) Lizio G, Corinaldesi G, Marchetti C. Alveolar ridge reconstruction with titanium mesh : a three-dimensional evaluation of factors affecting bone augmentation. Int J Oral Maxillofac Implants 2014;29:1354-1363. – reference: 1) Mordenfeld A, Johansson CB, Albrektsson T, et al. A randomized and controlled clinical trial of two different compositions of deproteinized bovine bone and autogenous bone used for lateral ridge augmentation. Clin Oral Implants Res 2014;25:310-320. – reference: 32) Hasegawa H, Kaneko T, Kanno C, et al. Evaluation of a newly designed microperforated titanium membrane with beta-tricalcium phosphate for guided bone regeneration in dog mandibles. Int J Oral Maxillofac Implants 2019;34:1132-1142. – reference: 7) Cordaro L, Torsello F, Miuccio MT, et al. Mandibular bone harvesting for alveolar reconstruction and implant placement : subjective and objective cross-sectional evaluation of donor and recipient site up to 4 years. Clin Oral Implants Res 2011;22:1320-1326. – reference: 23) Toscano N, Shumaker N, Holtzclaw D. The art of block grafting, a review of the surgical protocol for reconstruction of alveolar ridge deficiency. J Implant Adv Clin Dent 2010;2:45-66. – reference: 19) Greenstein G, Carpentieri JR. Utilization of d-PTFE barriers for post-extraction bone regeneration in preparation for dental implants. Compend Contin Educ Dent 2015;36:465-473. – reference: 2) Mordenfeld A, Aludden H, Starch-Jensen T. Lateral ridge augmentation with two different ratios of deproteinized bovine bone and autogenous bone : A 2-year follow-up of a randomized and controlled trial. Clin Implant Dent Relat Res 2017;19:884-894. – reference: 5) Becker J, Al-Nawas B, Klein MO, et al. Use of a new crosslinked collagen membrane for the treatment of dehiscencetype defects at titanium implants : a prospective, randomizedcontrolled double-blinded clinical multicenter study. Clin Oral Implants Res 2009;20:742-749. – reference: 17) Soldatos NK, Stylianou P, Koidou VP, et al. Limitations and options using resorbable versus nonresorbable membranes for successful guided bone regeneration. Quintessence Int 2017;48:131-147. – reference: 30) Briguglio F, Falcomatà D, Marconcini S, et al. The use of titanium mesh in guided bone regeneration : A systematic review. Int J Dent 2019;2019:9065423. – reference: 21) 石原和幸，今井健一，小川知彦，ほか編著．細菌学総論 細菌の構造と形態 細菌の細胞形態．口腔微生物学．第6版．東京：学建書院，2018． – reference: 14) Chappuis V, Cavusoglu Y, Buser D, et al. Lateral ridge augmentation using autogenous block grafts and guided bone regeneration : a 10-year prospective case series study. Clin Implant Dent Relat Res 2017;19:85-96. – reference: 25) Fontana F, Maschera E, Rocchietta I, et al. Clinical classification of complications in guided bone regeneration procedures by means of a nonresorbable membrane. Int J Periodontics Restorative Dent 2011;31:265-273. – reference: 6) Jung RE, Fenner N, Hämmerle CH, et al. Long-term outcome of implants placed with guided bone regeneration (GBR) using resorbable and non-resorbable membranes after 12-14 years. Clin Oral Implants Res 2013;24:1065-1073. – reference: 16) Urban IA, Nagursky H, Lozada JL, et al. Horizontal ridge augmentation with a collagen membrane and a combination of particulated autogenous bone and anorganic bovine bone-derived mineral : a prospective case series in 25 patients. Int J Periodontics Restorative Dent 2013;33:299-307. – reference: 8) Jensen SS, Terheyden H. Bone augmentation procedures in localized defects in the alveolar ridge : clinical results with different bone grafts and bone-substitute materials. Int J Oral Maxillofac Implants 2009;24(Suppl):218-236. – reference: 12) Maiorana C, Beretta M, Salina S, et al. Reduction of autogenous bone graft resorption by means of bio-oss coverage : a prospective study. Int J Periodontics Restorative Dent 2005;25:19-25. – reference: 20) Tripathy A, Sen P, Su B, et al. Natural and bioinspired nanostructured bactericidal surfaces. Adv Colloid Interface Sci 2017;248:85-104. – reference: 22) Bartee BK. Extraction site reconstruction for alveolar ridge preservation. Part 2 : membrane-assisted surgical technique. J Oral Implantol 2001;27:194-197. – reference: 15) Urban IA, Nagursky H, Lozada JL. Horizontal ridge augmentation with a resorbable membrane and particulated autogenous bone with or without anorganic bovine bone-derived mineral : a prospective case series in 22 patients. Int J Oral Maxillofac Implants 2011;26:404-414. – reference: 4) Wessing B, Lettner S, Zechner W. Guided bone regeneration with collagen membranes and particulate graft materials : a systematic review and meta-analysis. Int J Oral Maxillofac Implants 2018;33:87-100. – reference: 24) Esposito M, Grusovin MG, Felice P, et al. The efficacy of horizontal and vertical bone augmentation procedures for dental implants - a Cochrane systematic review. Eur J Oral Implantol 2009;2:167-184. – reference: 9) Urban IA, Montero E, Monje A, et al. Effectiveness of vertical ridge augmentation interventions : A systematic review and meta-analysis. J Clin Periodontol 2019;46(Suppl 21):319-339. – reference: 10) Antoun H, Sitbon JM, Martinez H, et al. A prospective randomized study comparing two techniques of bone augmentation : onlay graft alone or associated with a membrane. Clin Oral Implants Res 2001;12:632-639. – reference: 26) Cucchi A, Vignudelli E, Napolitano A, et al. Evaluation of complication rates and vertical bone gain after guided bone regeneration with non-resorbable membranes versus titanium meshes and resorbable membranes. A randomized clinical trial. Clin Implant Dent Relat Res 2017;19:821-832. – reference: 3) Annen BM, Ramel CF, Hämmerle CH, et al. Use of a new cross-linked collagen membrane for the treatment of peri-implant dehiscence defects : a randomised controlled doubleblinded clinical trial. Eur J Oral Implantol 2011;4:87-100. – reference: 29) Rasia-dal Polo M, Poli PP, Rancitelli D, et al. Alveolar ridge reconstruction with titanium meshes : a systematic review of the literature. Med Oral Patol Oral Cir Bucal 2014;19:e639-e646. – reference: 18) Hämmerle CH, Jung RE. Bone augmentation by means of barrier membranes. Periodontol 2000 2003;33:36-53. – reference: 11) Cordaro L, Amadé DS, Cordaro M. Clinical results of alveolar ridge augmentation with mandibular block bone grafts in partially edentulous patients prior to implant placement. Clin Oral Implants Res 2002;13:103-111. – reference: 28) Uehara S, Kurita H, Shimane T, et al. Predictability of staged localized alveolar ridge augmentation using a micro titanium mesh. Oral Maxillofac Surg 2015;19:411-416. – reference: 31) 長谷川 博，増井誠一郎，石幡浩志，ほか．新規骨再生誘導法用メンブレンの開発．Bio Industry 2017；33：59-69． |
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| Title | Safe and Predictable Hard Tissue Augmentation Modalities and Their Proper Use |
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