J Korean Assoc Oral Maxillofac Surg.  2015 Oct;41(5):232-239. 10.5125/jkaoms.2015.41.5.232.

Volumetric stability of autogenous bone graft with mandibular body bone: cone-beam computed tomography and three-dimensional reconstruction analysis

• Lee HG
• Kim YD

• KMID: 2070436
• DOI: http://doi.org/10.5125/jkaoms.2015.41.5.232

Abstract

OBJECTIVES
The purpose of this study was to estimate the volumetric change of augmented autobone harvested from mandibular body cortical bone, using cone-beam computed tomography (CBCT) and three-dimensional reconstruction. In addition, the clinical success of dental implants placed 4 to 6 months after bone grafting was also evaluated.
MATERIALS AND METHODS
Ninety-five patients (48 men and 47 women) aged 19 to 72 years were included in this study. A total of 128 graft sites were evaluated. The graft sites were divided into three parts: anterior and both posterior regions of one jaw. All patients included in the study were scheduled for an onlay graft and implantation using a two-stage procedure. The dental implants were inserted 4 to 6 months after the bone graft. Volumetric stability was evaluated by serial CBCT images.
RESULTS
No major complications were observed for the donor sites. A total of 128 block bones were used to augment severely resorbed alveolar bone. Only 1 of the 128 bone grafts was resorbed by more than half, and that was due to infection. In total, the average amount of residual grafted bone after resorption at the recipient sites was 74.6%+/-8.4%.
CONCLUSION
Volumetric stability of mandibular body autogenous block grafts is predictable. The procedure is satisfactory for patients who want dental implants regardless of atrophic alveolar bone.

Keyword

Alveolar bone grafting; Augment bone graft; Dental implant

MeSH Terms

Alveolar Bone Grafting
Bone Transplantation
Cone-Beam Computed Tomography*
Dental Implants
Humans
Inlays
Jaw
Male
Tissue Donors
Transplants*
Dental Implants

Figure

• 

  Fig. 1 A. Cortical bone after sawing targeted bone. B. Donor site after harvesting cortical bone. C. Harvested cortical bone. D. Particulate bone from cortical bone.

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  Fig. 2 A. Fixed block bone using the "lag screw" technique. B. Particulate bone surrounding block bone with Tisseel (Baxter Healthcare GmbH, Wien, Austria). C. Membrane materials covering block and particulate bone.

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  Fig. 3 A. Evaluating adjacent cortical bone not harvested with the grayscale range. B. Enclosing grafted bone in a rectangular parallelepiped by using an evaluated grayscale range. C. Calculating grafted bone in the Ez3D2009 program (Vatech, Yongin, Korea) setting.

• 

  Fig. 4 A. Cross-section of grafted bone 1 day after grafting surgery. B. Cross-section of grafted bone 4.2 months after grafting surgery. Hyeong-Geun Lee et al: Volumetric

Reference

1. Adell R, Eriksson B, Lekholm U, Brånemark PI, Jemt T. Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws. Int J Oral Maxillofac Implants. 1990; 5:347–359. PMID: 2094653.

2. Jemt T, Lekholm U, Adell R. Osseointegrated implants in the treatment of partially edentulous patients: a preliminary study on 876 consecutively placed fixtures. Int J Oral Maxillofac Implants. 1989; 4:211–217. PMID: 2700745.

3. McAllister BS, Haghighat K. Bone augmentation techniques. J Periodontol. 2007; 78:377–396. PMID: 17335361.

4. Barone A, Covani U. Maxillary alveolar ridge reconstruction with nonvascularized autogenous block bone: clinical results. J Oral Maxillofac Surg. 2007; 65:2039–2046. PMID: 17884536.

5. Sjöström M, Lundgren S, Sennerby L. A histomorphometric comparison of the bone graft-titanium interface between interpositional and onlay/inlay bone grafting techniques. Int J Oral Maxillofac Implants. 2006; 21:52–62. PMID: 16519182.

6. Reinert S, König S, Bremerich A, Eufinger H, Krimmel M. Stability of bone grafting and placement of implants in the severely atrophic maxilla. Br J Oral Maxillofac Surg. 2003; 41:249–255. PMID: 12946668.

7. Zouhary KJ. Bone graft harvesting from distant sites: concepts and techniques. Oral Maxillofac Surg Clin North Am. 2010; 22:301–316. PMID: 20713264.

8. Brugnami F, Caiazzo A, Leone C. Local intraoral autologous bone harvesting for dental implant treatment: alternative sources and criteria of choice. Keio J Med. 2009; 58:24–28. PMID: 19398881.

9. Misch CM. Maxillary autogenous bone grafting. Oral Maxillofac Surg Clin North Am. 2011; 23:229–238. PMID: 21492798.

10. Greenberg JA, Wiltz MJ, Kraut RA. Augmentation of the anterior maxilla with intraoral onlay grafts for implant placement. Implant Dent. 2012; 21:21–24. PMID: 22228463.

11. Zins JE, Whitaker LA. Membranous versus endochondral bone: implications for craniofacial reconstruction. Plast Reconstr Surg. 1983; 72:778–785. PMID: 6196801.

12. Borstlap WA, Heidbuchel KL, Freihofer HP, Kuijpers-Jagtman AM. Early secondary bone grafting of alveolar cleft defects. A comparison between chin and rib grafts. J Craniomaxillofac Surg. 1990; 18:201–205. PMID: 2387908.

13. Ozaki W, Buchman SR. Volume maintenance of onlay bone grafts in the craniofacial skeleton: micro-architecture versus embryologic origin. Plast Reconstr Surg. 1998; 102:291–299. PMID: 9703062.

14. Rosenthal AH, Buchman SR. Volume maintenance of inlay bone grafts in the craniofacial skeleton. Plast Reconstr Surg. 2003; 112:802–811. PMID: 12960861.

15. Keller EE, Tolman DE, Eckert S. Surgical-prosthodontic reconstruction of advanced maxillary bone compromise with autogenous onlay block bone grafts and osseointegrated endosseous implants: a 12-year study of 32 consecutive patients. Int J Oral Maxillofac Implants. 1999; 14:197–209. PMID: 10212536.

16. Nyström E, Legrell PE, Forssell A, Kahnberg KE. Combined use of bone grafts and implants in the severely resorbed maxilla. Postoperative evaluation by computed tomography. Int J Oral Maxillofac Surg. 1995; 24:20–25. PMID: 7782636.

17. Waitzman AA, Posnick JC, Armstrong DC, Pron GE. Craniofacial skeletal measurements based on computed tomography: part I. Accuracy and reproducibility. Cleft Palate Craniofac J. 1992; 29:112–117. PMID: 1571344.

18. Dasmah A, Thor A, Ekestubbe A, Sennerby L, Rasmusson L. Particulate vs. block bone grafts: three-dimensional changes in graft volume after reconstruction of the atrophic maxilla, a 2-year radiographic follow-up. J Craniomaxillofac Surg. 2012; 40:654–659. PMID: 22137760.

19. Johansson B, Grepe A, Wannfors K, Hirsch JM. A clinical study of changes in the volume of bone grafts in the atrophic maxilla. Dentomaxillofac Radiol. 2001; 30:157–161. PMID: 11420628.

20. Honma K, Kobayashi T, Nakajima T, Hayasi T. Computed tomographic evaluation of bone formation after secondary bone grafting of alveolar clefts. J Oral Maxillofac Surg. 1999; 57:1209–1213. PMID: 10513867.

21. White SC, Pharoah MJ. Oral radiology: principles and interpretation. London: Elsevier Health Sciences;2008.

22. Razi T, Niknami M, Alavi Ghazani F. Relationship between Hounsfield unit in CT scan and gray scale in CBCT. J Dent Res Dent Clin Dent Prospects. 2014; 8:107–110. PMID: 25093055.

23. Iizuka T, Smolka W, Hallermann W, Mericske-Stern R. Extensive augmentation of the alveolar ridge using autogenous calvarial split bone grafts for dental rehabilitation. Clin Oral Implants Res. 2004; 15:607–615. PMID: 15355404.

24. Misch CM. Comparison of intraoral donor sites for onlay grafting prior to implant placement. Int J Oral Maxillofac Implants. 1997; 12:767–776. PMID: 9425757.

25. Smolka W, Eggensperger N, Carollo V, Ozdoba C, Iizuka T. Changes in the volume and density of calvarial split bone grafts after alveolar ridge augmentation. Clin Oral Implants Res. 2006; 17:149–155. PMID: 16584410.

26. Burchardt H. The biology of bone graft repair. Clin Orthop Relat Res. 1983; (174):28–42. PMID: 6339139.

27. 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. PMID: 16907765.

28. Dasmah A, Thor A, Ekestubbe A, Sennerby L, Rasmusson L. Marginal bone-level alterations at implants installed in block versus particulate onlay bone grafts mixed with platelet-rich plasma in atrophic maxilla. a prospective 5-year follow-up study of 15 patients. Clin Implant Dent Relat Res. 2013; 15:7–14. PMID: 21815995.