J Periodontal Implant Sci.  2014 Feb;44(1):33-38. 10.5051/jpis.2014.44.1.33.

Alveolar ridge augmentation with the perforated and nonperforated bone grafts

• de Avila E
• Filho JS
• de Oliveira Ramalho LT
• Real Gabrielli MF
• Pereira Filho VA

• KMID: 1845880
• DOI: http://doi.org/10.5051/jpis.2014.44.1.33

Abstract

PURPOSE
Autogenous bones are frequently used because of their lack of antigenicity, but good osteoconductive and osteoinductive properties. This study evaluated the biological behavior of perforated and nonperforated cortical block bone grafts.
METHODS
Ten nonsmoking patients who required treatment due to severe resorption of the alveolar process and subsequent implant installation were included in the study. The inclusion criteria was loss of one or more teeth; the presence of atrophy of the alveolar process with the indication of reconstruction procedures to allow rehabilitation with dental implants; and the absence of systemic disease, local infection, or inflammation. The patients were randomly divided into two groups based on whether they received a perforated (inner surface) or nonperforated graft. After a 6-month healing period, a biopsy was performed and osseointegrated implants were installed in the same procedure.
RESULTS
Fibrous connective tissue was evident at the interface in patients who received nonperforated grafts. However, full union between the graft and host bed was visible in those who had received a perforated graft.
CONCLUSIONS
We found that cortical inner side perforations at donor sites increased the surface area and opened the medullary cavity. Our results indicate an increased rate of graft incorporation in patients who received such perforated grafts.

Keyword

Alveolar ridge; Autografts; Dental implants; Oral surgery

MeSH Terms

Alveolar Process*
Alveolar Ridge Augmentation*
Atrophy
Autografts
Biopsy
Connective Tissue
Dental Implants
Humans
Inflammation
Rehabilitation
Surgery, Oral
Tissue Donors
Tooth
Transplants*
Dental Implants

Figure

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  Figure 1 Receptor site before reconstruction.

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  Figure 2 Perforation of the graft's inner surface.

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  Figure 3 Nonperforated grafts fixed to the host bed.

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  Figure 4 On the inner side of the nonperforated bone graft, observations of immature bone, large trabecular spaces, and some areas of newly formed bone is possible (H&E, ×250). Black asterisks indicate the inner side of nonperforated bone graft and the presence of osteoclasts and bone resorption characterized by the presence of innumerous inflammatory cells like macrophages. Red asterisks indicate recently formed connective tissue with innumerous blood vessels.

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  Figure 5 Nonperforated bone graft interface and the host bed with immature tissue (H&E, ×250). Black asterisk indicates the nonperforated bone graft with osteoclasts present. Red asterisk indicates the immature connective tissue interface in the supracrestal region.

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  Figure 6 The inner side of the perforated bone graft with the perforated region created by cylindrical burs. Neoformed bone tissue characterized by the presence of innumerous osteocytes and medullary space and remodeling bone tissue with various osteoclasts are also present (H&E, ×250).

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  Figure 7 Perforated region of the bone graft and host bed with a slight presence of connective tissue (H&E, ×250). Black asterisk indicates bone tissue from the receptor bed with innumerous osteocytes. Red asterisk indicates the inner side of the perforated bone tissue with meduallary spaces, osteoclasts, and osteocytes.

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