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alt5/ziy-id/ziy-id/ziy00410/ziy3108-10z xppws S1 5/24/10 8:21 Art: ID200361 Input-pja<br />

IMPLANT DENTISTRY /VOLUME 19, NUMBER 4 2010 1<br />

AQ: 1<br />

<strong>Retrospective</strong> <strong>Study</strong> <strong>of</strong> <strong>Bone</strong> <strong>Grafting</strong><br />

<strong>Procedures</strong> <strong>Before</strong> <strong>Implant</strong> Placement<br />

Gustavo Davi Rabelo, DDS,* Priscila Marani de Paula, DDS,† Flaviana Soares Rocha, DDS,‡<br />

Cláudia Jordão Silva, DDS, MSc, PhD,§ and Darceny Zanetta-Barbosa, DDS, MSc, PhD<br />

Dental rehabilitation <strong>of</strong> partially<br />

or totally edentulous patients<br />

with oral implants has become<br />

common practice with reliable longterm<br />

results. 1 However, unfavorable local<br />

conditions <strong>of</strong> the alveolar ridge,<br />

because <strong>of</strong> atrophy, periodontal disease,<br />

and trauma sequelae, may cause insufficient<br />

bone volume, which may render<br />

implant placement impossible. 2 When<br />

the alveolar ridges lack the appropriate<br />

bone volume, additional surgical reconstructive<br />

procedures are required.<br />

Researchers continuously strive to<br />

improve on current bone grafting techniques<br />

and provide faster and denser<br />

bone regeneration. A variety <strong>of</strong> autogenous,<br />

3 allogenous, 4 xenogenous, 5 and alloplastic<br />

6,7 grafts, alone or in different<br />

combinations, have been used to provide<br />

sufficient ridge width or high for<br />

proper positioning <strong>of</strong> endosseous implants.<br />

8–10 Additionally, the use <strong>of</strong><br />

platelet-rich plasma (PRP) <strong>of</strong>fers a potentially<br />

useful adjunct to bone grafts 11<br />

due to osteoinductive properties <strong>of</strong><br />

PRP. 12,13<br />

Aim: The aim <strong>of</strong> this retrospective<br />

study was to evaluate morbidity<br />

and possible complications in augmentation<br />

procedures before implant<br />

placement.<br />

Methods: Records from 93 consecutive<br />

patients with indication for<br />

autogenous bone grafting before implant<br />

placement, treated at Department<br />

<strong>of</strong> Oral and Maxill<strong>of</strong>acial Surgery<br />

and <strong>Implant</strong>ology <strong>of</strong> Uberlândia Federal<br />

University, in a 7-year period<br />

(July 2000 until July 2007), were reviewed.<br />

The need for bone grafting<br />

was defined by the impossibility <strong>of</strong> installing<br />

implants <strong>of</strong> adequate length or<br />

diameter to fulfill prosthetic requirements<br />

or for aesthetic reasons.<br />

Results: A total <strong>of</strong> 136 bone grafting<br />

procedures were performed. The<br />

mandibular external oblique line and<br />

ascending ramus were the most frequently<br />

used donor areas (59.64%)<br />

and block grafts (67.64%) were the<br />

most frequently used type <strong>of</strong> graft,<br />

frequently from the mandibular external<br />

oblique line/ascending ramus (52.18%).<br />

Platelet-rich plasma was used in 20.1%<br />

<strong>of</strong> all procedures, usually associated<br />

with particulate bone grafts. Maxillary<br />

procedures represented the majority <strong>of</strong><br />

surgeries (75%), but with fewer complications<br />

compared with the mandible. Sinus<br />

mucosa perforation was the most<br />

frequent complication in maxillary<br />

procedures, whereas graft exposure<br />

was the most common complication<br />

in mandible.<br />

Conclusions: Alveolar reconstruction<br />

using autogenous bone<br />

followed by implant placement is a<br />

reliable treatment for patients with insufficient<br />

bone. Complications and<br />

morbidity were frequently observed.<br />

However, in only 6.6% <strong>of</strong> all procedures,<br />

the final rehabilitation with<br />

dental implants was not possible.<br />

(<strong>Implant</strong> Dent 2010;19:1–000)<br />

Key Words: bone graft, implant, surgery,<br />

complications<br />

AQ: 3<br />

*Master Student, School <strong>of</strong> Dentistry, Uberlândia Federal<br />

University, Minas Gerais, Brazil.<br />

†Dental Surgeon, School <strong>of</strong> Dentistry, Uberlândia Federal<br />

University, Minas Gerais, Brazil.<br />

‡Master Student, School <strong>of</strong> Dentistry, Uberlândia Federal<br />

University, Minas Gerais, Brazil.<br />

§Assistant Pr<strong>of</strong>essor, Oral & Maxill<strong>of</strong>acial Surgery and<br />

<strong>Implant</strong>ology Department, Uberlândia Federal University, Minas<br />

Gerais, Brazil.<br />

Full Pr<strong>of</strong>essor, Oral & Maxill<strong>of</strong>acial Surgery and <strong>Implant</strong>ology<br />

Department, Uberlândia Federal University, Minas Gerais, Brazil.<br />

Reprint requests and correspondence to: Darceny Zanetta-<br />

Barbosa, DDS, MSc, PhD, Avenida Pará s/n°, Campus<br />

Umuarama, Bloco 4T, Departamento de Cirurgia e<br />

Traumatologia Buco-Maxilo-Facial, Bairro Umuarama,<br />

Uberlândia, Minas Gerais, Brazil, CEP: 38.400–902, Fax<br />

and Telephone: 55-34-3218-2636, E-mail: ctbmf@<br />

umuarama.ufu.br or zanetta@foufu.ufu.br<br />

ISSN 1056-6163/10/01904-001<br />

<strong>Implant</strong> Dentistry<br />

Volume 19 • Number 4<br />

Copyright © 2010 by Lippincott Williams & Wilkins<br />

DOI: 10.1097/ID.0b013e3181e416f9<br />

The use <strong>of</strong> autogenous bone grafts<br />

from intra- 14 or extraoral 15 donor sites<br />

has been considered to be the gold standard<br />

in comparison with new bone graft<br />

materials due to their biological properties<br />

and the lack <strong>of</strong> possibility <strong>of</strong> disease<br />

transmission or host rejection. 14,16,17<br />

Complications after grafting procedures<br />

are relatively rare 11 ; however,<br />

every surgical procedure presents advantages<br />

and disadvantages, which must<br />

be carefully evaluated before surgery.<br />

The clinician must make the appropriate<br />

selection <strong>of</strong> the graft material and technique<br />

based on the size, shape, and dimensions<br />

<strong>of</strong> the defect and its location<br />

in the mouth. 18 A guideline for surgical<br />

decision in reconstruction for oral rehabilitation<br />

with implants may help prevention<br />

<strong>of</strong> possible failures.<br />

The aim <strong>of</strong> this retrospective study<br />

was to evaluate morbidity and possible<br />

complications in augmentation procedures<br />

before implant placement.<br />

PATIENTS AND METHODS<br />

The records <strong>of</strong> all patients submitted<br />

to implant-supported rehabilitation<br />

at Department <strong>of</strong> Oral and Maxill<strong>of</strong>a-<br />

• •


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2 BONE GRAFTING PROCEDURES BEFORE IMPLANT PLACEMENT •RABELO ET AL<br />

cial Surgery and <strong>Implant</strong>ology <strong>of</strong> Federal<br />

University <strong>of</strong> Uberlândia, from<br />

July 2000 to July 2007, were reviewed<br />

and those who underwent bone reconstruction<br />

procedures were included in<br />

the current retrospective study.<br />

The need for bone grafting was defined<br />

by the impossibility <strong>of</strong> installing<br />

implants <strong>of</strong> adequate length or diameter<br />

to fulfill prosthetic requirements or by<br />

aesthetic reasons. The following situations<br />

were considered for augmentation<br />

procedures:<br />

1. Less than 5 mm <strong>of</strong> bone bellow<br />

maxillary sinus.<br />

2. Less than 4 mm <strong>of</strong> width in posterior<br />

areas.<br />

3 Vertical defects <strong>of</strong> more than 3 mm<br />

in aesthetic area.<br />

All patients should be in good<br />

healthy conditions, without any disease<br />

that would contraindicate surgery. All<br />

surgeries were performed by trainee implantologists<br />

and supervised by a Pr<strong>of</strong>essor<br />

<strong>of</strong> Oral and Maxill<strong>of</strong>acial Surgery<br />

and <strong>Implant</strong>ology Department.<br />

The pertinent data <strong>of</strong> the surgical<br />

procedure were organized as follows:<br />

1. Donor areas: symphysis, mandibular<br />

external oblique line/ascending<br />

ramus, implant area, calvaria, and<br />

iliac crest.<br />

2. Use or not <strong>of</strong> PRP.<br />

3. Type <strong>of</strong> graft: block graft and particulate<br />

bone graft.<br />

4. Transsurgical complications: graft<br />

fracture, sinus mucosa perforation,<br />

insufficient bone at time <strong>of</strong> implant<br />

installation, graft displacement, implant<br />

instability, and fracture <strong>of</strong> fixation<br />

screw.<br />

5. Postsurgical complications: pain,<br />

bleeding, infection, graft or implant<br />

exposure, graft or implant loss, sinusitis,<br />

paresthesia, and hematoma.<br />

All patients with transsurgical or<br />

postsurgical complications received<br />

appropriate treatment. The data <strong>of</strong> all<br />

patients were analyzed and presented<br />

in tables.<br />

RESULTS<br />

In the 7-year period <strong>of</strong> the current<br />

study, 136 bone grafting procedures<br />

were performed in 93 patients and the<br />

mandibular external oblique line/<br />

ascending ramus was the most frequently<br />

used donor area (59.64%) followed<br />

by chin (20.17%) and implant<br />

area (10.52%) as shown in Table 1.<br />

Block graft were the most frequently<br />

used type <strong>of</strong> graft (67.64%)<br />

and particulate grafts represented<br />

32.34% <strong>of</strong> the procedures. PRP was<br />

Table 1. Donor Areas<br />

Number <strong>of</strong><br />

Area <strong>Procedures</strong> (%)<br />

Chin 23 (20.17)<br />

Mandibular external 68 (59.64)<br />

oblique line/<br />

ascending ramus<br />

<strong>Implant</strong> area 12 (10.52)<br />

Calvaria 9 (7.89)<br />

Iliac crest 2 (1.75)<br />

Total 114 (100)<br />

*A total <strong>of</strong> 114 donor areas were use for 136 bone grafting<br />

procedures performed.<br />

Table 2. Type <strong>of</strong> Graft and PRP Use<br />

Type<br />

Quantity<br />

(%)<br />

Yes<br />

PRP<br />

No<br />

Block graft 92 (67.64) 11 81<br />

Particulate 44 (32.34) 17 27<br />

graft<br />

Total 136 (100) 28 108<br />

Table 3. Donor Areas and Type <strong>of</strong> Graft<br />

used in 28 procedures, representing<br />

20.1% <strong>of</strong> the total, usually associated<br />

with particulate bone grafts as demonstrated<br />

in Table 2.<br />

Block grafts were most frequently<br />

originated from mandibular external<br />

oblique line/ascending ramus (52.18%)<br />

followed by calvaria (20.65%) and chin<br />

(19.56%). Particulate grafts were most<br />

frequently originated from mandibular<br />

external oblique line/ascending ramus<br />

(54.54%) followed by implant area<br />

(27.28%) and chin (13.64%) as shown<br />

in Table 3.<br />

The incidence <strong>of</strong> complications<br />

among the donor sites was more significant<br />

for mandibular external<br />

oblique line/ascending ramus followed<br />

by chin. <strong>Bone</strong> grafts from implant<br />

area and iliac crest did not have<br />

complications (Table 4). Maxillary<br />

augmentation procedures were the<br />

majority <strong>of</strong> surgeries (102 procedures<br />

representing 75% <strong>of</strong> all), but<br />

with fewer complications compared<br />

with the mandible. Sinus mucosa<br />

perforation was the most frequent<br />

complication in maxillary procedures,<br />

whereas graft exposure was<br />

the most common complication in<br />

the mandible. Despite the complications,<br />

a significantly higher loss <strong>of</strong><br />

implants was not found. The results<br />

are presented in Table 5.<br />

Area Block Graft Particulate Graft<br />

Chin 18 (19.56) 6 (13.64)<br />

Mandibular external oblique 48 (52.18) 24 (54.54)<br />

line/ascending ramus<br />

<strong>Implant</strong> area 0 (0) 12 (27.28)<br />

Calvaria 19 (20.65) 2 (4.54)<br />

Iliac crest 7 (7.61) 0 (0)<br />

Total 92 (100) 44 (100)<br />

Table 4. Number and Type <strong>of</strong> Transsurgical and Postsurgical Complications in<br />

Donor Areas<br />

Quantity and Type<br />

<strong>of</strong> Complications<br />

Area (Quantity)<br />

Chin (n 23)<br />

2 hematoma<br />

Mandibular external oblique line/<br />

ascending ramus (n 68)<br />

<strong>Implant</strong> area (n 12) 0<br />

Calvaria (n 9)<br />

1 pain<br />

Iliac crest (n 2) 0<br />

Total 114 8<br />

3 paresthesia; 1 bleeding;<br />

1 hematoma<br />

T2<br />

T1,AQ:2<br />

T3<br />

T4<br />

T5


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IMPLANT DENTISTRY /VOLUME 19, NUMBER 4 2010 3<br />

T6<br />

Table 5. Number and Type <strong>of</strong> Transsurgical and Postsurgical Complications in<br />

Receptor Areas After <strong>Bone</strong> <strong>Grafting</strong> <strong>Procedures</strong><br />

Area (Quantity) Specific Area (Quantity) Quantity and Type <strong>of</strong> Complications<br />

Mandible<br />

(n 34)<br />

Anterior mandible (n 5) 0<br />

Posterior mandible 5 graft exposure; 2 graft loss; 1 break <strong>of</strong><br />

(n 29)<br />

fixation screw; 2 implant exposure; 1<br />

graft displacement; 1 infection<br />

2 graft displacement; 2 implant loss;<br />

Maxila (n 102) Anterior maxila (n 40)<br />

Posterior maxila<br />

(n 62)<br />

Cases where installation <strong>of</strong> the<br />

implants and rehabilitation were not<br />

possible, even with bone grafting procedures<br />

and appropriate treatment for<br />

all complications are presented in Table<br />

6. In 6.61% <strong>of</strong> all cases, implant<br />

installation was not possible due to<br />

insufficient bone after augmentation<br />

procedures.<br />

DISCUSSION<br />

<strong>Implant</strong>-supported fixed or removable<br />

prostheses provide a proper<br />

treatment modality. 1 Nevertheless, the<br />

use <strong>of</strong> endosseous implants may be<br />

limited by insufficient quality and<br />

quantity <strong>of</strong> available bone. Several<br />

grafting procedures have been described<br />

to create sufficient volume <strong>of</strong><br />

bone for implant placement. 19 Autogenous<br />

grafts still remain the “gold<br />

standard” in reconstructive surgeries<br />

due to their osteoinductive, osteoconductive,<br />

and osteogenic potential 14,16,17<br />

essential for bone morphogenesis. 16,17<br />

Serra e Silva et al 14 conclude that autogenous<br />

bone grafts are the best option<br />

compared with allografts and<br />

1 infection<br />

4 sinus mucosa perforation; 2 insufficient<br />

bone during implant placement; 2<br />

implant exposure; 1 fracture; 2<br />

implant loss; 1 pain<br />

Total 136 29<br />

Table 6. Reconstructed Areas<br />

Where Rehabilitation Was Not<br />

Possible (n 136)<br />

Reason <strong>of</strong> the<br />

Noninstallation <strong>of</strong><br />

the <strong>Implant</strong> Quantity (%)<br />

Personal/financial/ 10 (7.35)<br />

other reasons<br />

Referred to orthodontist 3 (2.20)<br />

Nonrehabilitation due to 9 (6.61)<br />

insufficient bone<br />

Total 22 (16.17)<br />

xenografts due to its properties and<br />

constitute a viable form <strong>of</strong> treatment<br />

for patients with alveolar bone loss. 19<br />

Autogenous bone can be harvested<br />

from intra- or extraoral donor<br />

sites. Schwartz-Arad and Levin 20 concluded<br />

that the intraoral bone block<br />

grafting is a predictable operation with<br />

a high success rate for long-span augmentation.<br />

In this study, the predilection<br />

for intraoral donor areas was based on<br />

advantages like lower morbidity, lower<br />

operatory cost, and easier access during<br />

surgery. 20 Other advantages include the<br />

use <strong>of</strong> local anesthesia instead <strong>of</strong> general<br />

anesthesia, relatively short operating<br />

time and no need <strong>of</strong> postoperative hospitalization.<br />

19 Nevertheless, complications<br />

with intraoral donor sites can<br />

occasionally occur 14 and include altered<br />

sensation <strong>of</strong> teeth, mucosa and skin, limited<br />

mouth opening, bleeding, swelling,<br />

pain, contour changes in donor areas,<br />

and postoperative infections. 21,22 When a<br />

large amount <strong>of</strong> autologous bone is required<br />

for reconstruction, other areas<br />

such as the calvaria or iliac crest, should<br />

be considered as an alternative. 15<br />

Studies to determine which donor<br />

sites provide sufficient bone with the<br />

least patient discomfort and risk <strong>of</strong><br />

complications are needed. 23 The risks<br />

and morbidity <strong>of</strong> harvesting autogenous<br />

bone from intraoral sites can be<br />

associated with some complications, 14<br />

which do not significantly compromise<br />

rehabilitation when appropriate<br />

treatment is established. The same authors<br />

also revealed that mandibular<br />

symphysis is the intraoral donor site<br />

with the highest prevalence <strong>of</strong> complications<br />

compared with other intraoral<br />

donor sites. This was not confirmed in<br />

our study. According to Freih<strong>of</strong>er et<br />

al, 24 the mandibular symphysis is an<br />

attractive donor site as the patients are<br />

reported to have lesser pain and discomfort.<br />

The main criticism for the<br />

use <strong>of</strong> mandibular symphysis as a graft<br />

is the limited volume <strong>of</strong> bone available<br />

for grafting, 25 thus they are not suitable<br />

for larger bone defects.<br />

The mandibular external oblique<br />

line/ascending ramus are common sites<br />

for cortical bone harvesting 21 but the<br />

risk <strong>of</strong> damaging the inferior alveolar<br />

nerve is <strong>of</strong> great concern when using<br />

this technique. In our study, 3 cases <strong>of</strong><br />

temporary nerve paresthesia were<br />

found. However, the number <strong>of</strong> procedures<br />

in this area was high (68), and the<br />

incidence <strong>of</strong> this complication (4.4%)<br />

may be considered to be low even<br />

among the trainee implantologists.<br />

Small amounts <strong>of</strong> particulate<br />

bone grafts may be collected from<br />

the implant area during implant site<br />

preparation, and the resulting bone<br />

chips can then be used to fill small<br />

defects or be mixed with other graft<br />

materials. Collection <strong>of</strong> bone chips<br />

during drilling for implant placement<br />

is done under copious irrigation.<br />

The main disadvantage <strong>of</strong> this<br />

technique is the contamination with<br />

oral bacteria. Therefore, it is suggested<br />

to use 2 surgical aspirators:<br />

one <strong>of</strong> them only for saliva and another<br />

directly applied to the drilling<br />

site, collecting only bone and saline<br />

solution, thus reducing the risk <strong>of</strong><br />

excessive bacterial contamination. 26<br />

In accordance with Chiapasco et<br />

al, 2 we found that the block graft was<br />

used in the majority <strong>of</strong> cases. Particulated<br />

bone was associated with bone<br />

blocks in case <strong>of</strong> simultaneous sinus<br />

grafting procedures or as a filling material<br />

around or between bone blocks.<br />

Only bone blocks maintain the architecture<br />

<strong>of</strong> bone and appear to adapt<br />

easily to the receptor area, whereas<br />

particulate bone grafts must be placed<br />

into cavities or associated with block<br />

grafts, which limits its use for specific<br />

clinical situations.<br />

Higher implant failure rates have<br />

been reported when implants are<br />

placed into grafted sites. 27 However,<br />

in this study, despite the number <strong>of</strong>


alt5/ziy-id/ziy-id/ziy00410/ziy3108-10z xppws S1 5/24/10 8:21 Art: ID200361 Input-pja<br />

4 BONE GRAFTING PROCEDURES BEFORE IMPLANT PLACEMENT •RABELO ET AL<br />

complications, rehabilitation with oral<br />

implants was not possible in only<br />

6.6% <strong>of</strong> all bone grafting procedures.<br />

Aghaloo and Moy 18 have already indicated<br />

similar success rates between<br />

implants placed into grafted sited<br />

compared with implants placed into<br />

native bone.<br />

Maxillary procedures represented<br />

the majority <strong>of</strong> surgeries and presented<br />

few complications, which could be related<br />

to the best donor site irrigation.<br />

Sinus mucosa perforations occurred<br />

during sinus floor elevation procedures,<br />

mainly due to technical difficulties.<br />

However, they were not related to<br />

significantly higher loss <strong>of</strong> implants.<br />

The morbidity and complication rate<br />

<strong>of</strong> maxillary sinus augmentation reported<br />

in the literature is very low. 28<br />

Raghoebar et al 22 concluded that maxillary<br />

sinus bone grafting with autogenous<br />

bone for the insertion <strong>of</strong><br />

implants is a reliable treatment modality<br />

with good long-term results.<br />

The highest incidence <strong>of</strong> complications<br />

occurred in the mandible.<br />

Temporary sensory disturbances and<br />

graft exposures were the most common<br />

complications. None <strong>of</strong> them<br />

significantly influenced the success<br />

<strong>of</strong> rehabilitation.<br />

When grafts are loaded and<br />

stimulated, significant resorption<br />

during the initial 6 months <strong>of</strong> healing<br />

is relatively common. 9 One-stage<br />

surgery reduces the number <strong>of</strong> surgical<br />

interventions and the healing<br />

time. However, some authors have<br />

reported better results with the<br />

2-stage than with the 1-stage approach.<br />

8,29 In this study, all cases<br />

were treated by 2-staged surgeries,<br />

allowing revascularization and incorporation<br />

<strong>of</strong> the graft 22 in a first<br />

moment, followed by osseointegration<br />

<strong>of</strong> the implant before prosthetic<br />

rehabilitation, which could have<br />

contributed to the high success rates<br />

found. Delayed placement also permits<br />

proper angulation and precise<br />

positioning compared with implants<br />

placed at the time <strong>of</strong> bone grafting. 30<br />

CONCLUSION<br />

Reconstruction using autogenous<br />

bone followed by implant<br />

placement is a reliable treatment<br />

with high success rates. Complications<br />

and morbidity were noted in<br />

many cases. In 6.61% <strong>of</strong> all cases,<br />

implant installation was not possible.<br />

This retrospective study <strong>of</strong> bone<br />

grafting surgeries can serve as a<br />

guide in the prevention <strong>of</strong> possible<br />

failures and consequently improve<br />

the quality <strong>of</strong> future procedures.<br />

ACKNOWLEDGMENT<br />

The authors claim to have no<br />

financial interest in any company or<br />

any <strong>of</strong> the products mentioned in this<br />

article.<br />

REFERENCES<br />

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Mayfield LJ, et al. Consensus statements<br />

and recommended clinical procedures regarding<br />

implant survival and complications.<br />

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19(suppl):150-154.<br />

2. Chiapasco M, Zaniboni M, Boisco<br />

M. Augmentation procedures for the rehabilitation<br />

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oral implants. Clin Oral <strong>Implant</strong>s Res.<br />

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al. Long-term evaluation <strong>of</strong> osseointegrated<br />

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4. Friedmann A, Strietzel FP, Maretzki<br />

B, et al. Histological assessment <strong>of</strong> augmented<br />

jaw bone utilizing a new collagen<br />

barrier membrane compared to a standard<br />

barrier membrane to protect a granular<br />

bone substitute material. Clin Oral <strong>Implant</strong>s<br />

Res. 2002;13:587-594.<br />

5. Araujo MG, Sonohara M, Hayacibara<br />

R, et al. Lateral ridge augmentation<br />

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bone or a biomaterial. An experimental<br />

in the dog. J Clin Periodontol. 2002;29:<br />

1122-1131.<br />

6. Barone A, Crespi R, Aldini NN, et<br />

al. Maxillary sinus augmentation: Histologic<br />

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J Oral Maxill<strong>of</strong>ac <strong>Implant</strong>s. 2005;20:519-<br />

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7. Meyer C, Chatelain B, Benarroch M,<br />

et al. Massive sinus-lift procedures with<br />

beta-tricalcium phosphate: Long-term results.<br />

Rev Stomatol Chir Maxill<strong>of</strong>ac. 2009;<br />

110:69-75.<br />

8. Barone A, Covani U. Maxillary alveolar<br />

ridge reconstruction with nonvascularized<br />

autogenous block bone: Clinical<br />

results. J Oral Maxill<strong>of</strong>ac Surg. 2007;65:<br />

2039-2046.<br />

9. Block MS, Kent JN, Kallukaran FU,<br />

et al. <strong>Bone</strong> maintenance 5 to 10 years after<br />

sinus grafting. J Oral Maxill<strong>of</strong>ac Surg.<br />

1998;56:706-715.<br />

10. Chiapasco M, Colletti G, Romeo E,<br />

et al. Long-term results <strong>of</strong> mandibular reconstruction<br />

with autogenous bone grafts<br />

and oral implants after tumor resection.<br />

Clin Oral <strong>Implant</strong>s Res. 2008;19:1074-<br />

1080.<br />

11. Meraw SJ, Eckert SE, Yacyshyn<br />

CE, et al. <strong>Retrospective</strong> review <strong>of</strong> grafting<br />

techniques utilized in conjunction with<br />

endosseous implant placement. Int<br />

J Oral Maxill<strong>of</strong>ac <strong>Implant</strong>s. 1999;14:744-<br />

747.<br />

12. Kim E, Park E, Choung P. Platelet<br />

concentrates and its effect on bone formation<br />

in calvarial defects: An experimental<br />

study in rabbits. J Prosth Den. 2001;86:<br />

428-433.<br />

13. Kim SG, Kim WK, Park JC, et al. A<br />

comparative study <strong>of</strong> osseointegration <strong>of</strong><br />

Avana implants in a demineralized freezedried<br />

bone alone or with platelet-rich<br />

plasma. J Oral Maxill<strong>of</strong>ac Surg. 2002;60:<br />

1018-1025.<br />

14. Serra e Silva FM, Cortez ALV,<br />

Moreira RWF, et al. Complications <strong>of</strong> intraoral<br />

donor site for bone grafting prior to<br />

implant placement. <strong>Implant</strong> Dentistry.<br />

2006;15:420-426.<br />

15. Smolka W, Bosshardt DD,<br />

Mericske-Stern R, et al. Reconstruction <strong>of</strong><br />

the severely atrophic mandible using calvarial<br />

split bone grafts for implantsupported<br />

oral rehabilitation. Oral Surg<br />

Oral Med Oral Pathol Oral Radiol Endod.<br />

2006;101:35-42.<br />

16. Lohmann H, Grass G, Rangger C,<br />

et al. Economic impact <strong>of</strong> cancellous bone<br />

grafting in trauma surgery. Arch Orthop<br />

Trauma Surg. 2007;127:345-348.<br />

17. Lye KW, Deatherage JR, Waite PD.<br />

The use <strong>of</strong> demineralized bone matrix for<br />

grafting during Le Fort I and chin<br />

osteotomies: Techniques and complications.<br />

J Oral Maxill<strong>of</strong>ac Surg. 2008;66:<br />

1580-1585.<br />

18. Aghaloo TL, Moy PK. Which hard<br />

tissue augmentation techniques are the<br />

most successful in furnishing bony support<br />

for implant placement? Int J Oral<br />

Maxill<strong>of</strong>ac <strong>Implant</strong>s. 2007;22(Suppl):<br />

49-70.<br />

19. Sant’Ana E. Short-term survival <strong>of</strong><br />

osseointegrated implants installed in alveolar<br />

ridge reconstructed with autogenous<br />

graft (Thesis submitted to obtain PhD).<br />

Bauru School <strong>of</strong> Dentistry, São Paulo University,<br />

1997.<br />

20. Schwartz-Arad D, Levin L. Intraoral<br />

autogenous block onlay bone grafting for<br />

extensive reconstruction <strong>of</strong> atrophic maxillary<br />

alveolar ridges. J Periodontol. 2005;<br />

76:636-641.<br />

21. Misch CM. Comparison <strong>of</strong> intraoral


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IMPLANT DENTISTRY /VOLUME 19, NUMBER 4 2010 5<br />

donor sites for onlay grafting prior to implant<br />

placement. Int J Oral Maxill<strong>of</strong>ac <strong>Implant</strong>s.<br />

1997;12:767-776.<br />

22. Raghoebar GM, Timmenga NM,<br />

Reintsema H, et al. Maxillary bone grafting<br />

for insertion <strong>of</strong> endosseous implants: Results<br />

after 12–124 months. Clin Oral Impl<br />

Res. 2001;12:279-286.<br />

23. Esposito M, Grusovin MG,<br />

Coulthard P, et al. The efficacy <strong>of</strong> various<br />

bone augmentation procedures for dental<br />

implants: A Cochrane systematic review <strong>of</strong><br />

randomized controlled clinical trials. Int J Oral<br />

Maxill<strong>of</strong>ac <strong>Implant</strong>s. 2006;21:696-710.<br />

24. Freih<strong>of</strong>er HP, Borstlap WA, Kuijpers-<br />

Jagtman AM, et al. Timing and transplant<br />

materials for closure <strong>of</strong> alveolar clefts. A clinical<br />

comparison <strong>of</strong> 296 cases. J Craniomaxill<strong>of</strong>ac<br />

Surg. 1993;21:143-148.<br />

25. Booij A, Raghoebar GM, Jansma J,<br />

et al. Morbidity <strong>of</strong> chin bone transplants<br />

used for reconstructing alveolar defects in<br />

cleft patients. Cleft Palate Crani<strong>of</strong>ac J.<br />

2005;42:533-538.<br />

26. Blay A, Tunchel S, Sendyk WR. Viability<br />

<strong>of</strong> autogenous bone grafts obtained<br />

by using bone collectors: Histological and<br />

microbiological study. Pesqui Odontol<br />

Bras. 2003;17:234-240.<br />

27. Lorenzoni M, Pertl C, Wegscheider<br />

W, et al. <strong>Retrospective</strong> analysis <strong>of</strong> Frialit-2<br />

implants in the augmented sinus. Int J Periodontics<br />

Restorative Dent. 2000;20:255-<br />

267.<br />

28. Ardekian L, Oved-Peleg E, Mactei<br />

EE, et al. The clinical significance <strong>of</strong> sinus<br />

membrane perforation during augmentation<br />

<strong>of</strong> the maxillary sinus. J Oral Maxill<strong>of</strong>ac<br />

Surg. 2006;64:277-282.<br />

29. Sjöström M, Lundgren S, Sennerby<br />

L. A histomorphometric comparison<br />

<strong>of</strong> the bone graft-titanium interface between<br />

interpositional and onlay/inlay bone<br />

grafting techniques. Int J Oral Maxill<strong>of</strong>ac<br />

<strong>Implant</strong>s. 2006;21:52-62.<br />

30. Bell RB, Blakey GH, White RP,<br />

et al. Staged reconstruction <strong>of</strong> the severely<br />

atrophic mandible with autogenous<br />

bone graft and endosteal implants.<br />

J Oral Maxill<strong>of</strong>ac Surg. 2002;60:1135-<br />

1141.<br />

Abstract Translations<br />

GERMAN / DEUTSCH<br />

AUTOR(EN): Gustavo Davi Rabelo, DDS, Priscila Marani de<br />

Paula, DDS, Flaviana Soares Rocha, DDS, Cláudia Jordão Silva,<br />

DDS, MSc, PhD, Darceny Zanetta-Barbosa, DDS, MSc, PhD<br />

Retrospektive Studie von Knochentransplantierungsabläufen<br />

vor Einsetzung von <strong>Implant</strong>aten<br />

ZUSAMMENFASSUNG: Zielsetzungen: Diese retrospektive<br />

Studie zielte darauf ab, die Sterblichkeit und möglichen<br />

Komplikationen bei Augmentation vor <strong>Implant</strong>ateinpflanzung<br />

zu beurteilen. Materialien und Methoden: Es wurden<br />

die Aufzeichnungen von 93 aufeinander folgenden Patienten<br />

mit einer Indikation für die Transplantierung von autologem<br />

Knochengewebe vor <strong>Implant</strong>atsetzung untersucht, die in<br />

der Abteilung für Gesichts- und Kieferchirurgie undimplantologie<br />

an der staatlichen Universität Uberlândia innerhalb<br />

eines Zeitraums von 7 Jahren (Juli 2000 bis Juli<br />

2007) behandelt wurden. Die Notwendigkeit für eine<br />

Knochentransplantation wurde durch die fehlenden Möglichkeiten<br />

bestimmt, <strong>Implant</strong>ate von ausreichender Länge oder<br />

ausreichendem Durchmesser zur Erfüllung der prothetischen<br />

Erfordernisse einsetzen zu können, oder aber durch ästhetische<br />

Gründe. Ergebnisse: Insgesamt wurden 136 Knochentransplantierungsbehandlungen<br />

durchgeführt. Die externe<br />

abgeschrägte Linie im Unterkiefer sowie der aufsteigende Ast<br />

wurden am häufigsten als Spendebereich (59,64%) eingesetzt<br />

und Blocktransplantate (67,64%) waren die am meisten eingesetzten<br />

Arten von Transplantaten und dies häufig von der<br />

externen schrägen Linie im Unterkiefer / aufsteigendem Ast<br />

(52,18%). Thrombozytreiches Plasma wurde in 20,1% aller<br />

Fälle verwendet, normalerweise in Verbindung mit partikelförmigem<br />

Knochentransplantat. Die meisten chirurgischen<br />

Eingriffe wurden im Oberkiefer abgewickelt (75%). Hierbei<br />

gab es insgesamt trotzdem weniger Komplikationen zu verzeichnen,<br />

als bei Eingriffen im Unterkiefer. Bei den Eingriffen<br />

im Oberkiefer war als häufigste Komplikation eine<br />

Perforation der Sinusschleimhaut festzustellen, während<br />

die Aufdeckung des Transplantats beim Unterkiefer<br />

die am häufigsten auftretende Komplikation darstellte.<br />

Schlussfolgerungen: Eine alveolare Rekonstruktion<br />

unter Verwendung von autogenem Knochengewebe mit<br />

anschließender <strong>Implant</strong>ateinpflanzung stellt eine zuverlässige<br />

Behandlungsalternative für Patienten mit unzureichendem<br />

Knochengewebe dar. Es wurden sehr häufig<br />

Komplikationen und Sterblichkeit beobachtet. Allerdings<br />

was in nur 6,6% aller Fälle die abschließende Wiederherstellung<br />

mit Zahnimplantaten überhaupt nicht möglich.<br />

SCHLÜSSELWÖRTER: Knochentransplantat, <strong>Implant</strong>at,<br />

Chirurgie, Komplikationen<br />

SPANISH / ESPAÑOL<br />

AUTOR(ES): Gustavo Davi Rabelo, DDS, Priscila Marani de<br />

Paula, DDS, Flaviana Soares Rocha, DDS, Cláudia Jordão<br />

Silva, DDS, MSc, PhD, Darceny Zanetta-Barbosa, DDS,<br />

MSc, PhD<br />

Estudio retrospectivo de procedimientos de injerto de hueso<br />

antes de la colocación del implante<br />

ABSTRACTO: Objetivos: El objetivo de este estudio retrospectivo<br />

fue evaluar la morbosidad y posibles complicaciones<br />

en los procedimientos de aumentación antes de la colocación<br />

del implante. Materiales y métodos: Se evaluaron los registros<br />

de 93 pacientes consecutivos con indicación de injerto<br />

autógeno de hueso antes de la colocación del implante, tratados<br />

en el Departamento de Cirugía Oral y Maxil<strong>of</strong>acial e<br />

<strong>Implant</strong>ología de la Universidad Federal Uberlândia, en un<br />

período de 7 años (Julio/2000 hasta Julio/2007). La necesidad


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6 BONE GRAFTING PROCEDURES BEFORE IMPLANT PLACEMENT •RABELO ET AL<br />

del injerto de hueso se definió según la imposibilidad de<br />

colocar implantes de longitud o diámetro adecuado para<br />

cumplir los requisitos prostéticos o por razones estéticas.<br />

Resultados: Se realizaron un total de 136 procedimientos de<br />

injerto de hueso. La zonas de donación usadas con mayor<br />

frecuencia fueron la línea oblicua externa de la mandíbula y<br />

el ramo ascendente (59,64%) y los injertos de bloque<br />

(67,64%) fueron el tipo de injerto usado con mayor frecuencia,<br />

con frecuencia desde la línea oblicua externa de la<br />

mandíbula/ramo ascendente (52,18%). Se usó plasma rico en<br />

plaquetas en un 20,1% de todos los procedimientos, generalmente<br />

asociados con injertos de partículas de hueso. Los<br />

procedimientos en el maxilar representaron la mayoría de las<br />

operaciones (75%), pero con menos complicaciones comparado<br />

con la mandíbula. La perforación de la mucosa del<br />

seno fue la complicación más frecuente en los procedimientos<br />

del maxilar mientras que el contacto con el injerto fue la<br />

complicación más común en la mandíbula. Conclusiones: La<br />

reconstrucción alveolar usando un hueso autógeno seguido<br />

por la colocación del implante es un tratamiento confiable<br />

para los pacientes con hueso insuficiente. Se observaron con<br />

frecuencia complicaciones y morbosidad. Sin embargo, en<br />

solamente un 6,6% de todos los procedimientos, la rehabilitación<br />

final con los implantes dentales no fue posible.<br />

PALABRAS CLAVES: Injerto de hueso, implante, cirugía,<br />

complicaciones<br />

PORTUGUESE / PORTUGUÊS<br />

AUTOR(ES): Gustavo Davi Rabelo, Cirurgião-Dentista,<br />

Priscila Marani de Paula, Cirurgiã-Dentista, Flaviana Soares<br />

Rocha, Cirurgiã-Dentista, Cláudia Jordão Silva, Cirurgiã-<br />

Dentista, Mestre em Ciência, PhD, Darceny Zanetta-Barbosa,<br />

Cirurgiã-Dentista, Mestre em Ciência, PhD<br />

Estudo retrospectivo de procedimentos de enxertamento de<br />

osso antes da colocação de implante<br />

RESUMO: Objetivos: O objetivo deste estudo retrospectivo<br />

foi avaliar a morbidade e possíveis complicações em procedimentos<br />

de aumento antes da colocação de implante. MateriaiseMétodos:<br />

Registros de 93 pacientes consecutivos com<br />

indicação de enxertamento de osso autógeno antes da colocação<br />

de implante, tratados no Departamento de Cirurgia<br />

Oral e Maxil<strong>of</strong>acial e <strong>Implant</strong>ologia da Universidade Federal<br />

de Uberlândia, num período de 7 anos (julho/2000 até julho/<br />

2007), foram revisados. A necessidade de enxertamento ósseo<br />

foi definida pela impossibilidade de instalar implantes de<br />

comprimento ou diâmetro adequado para preencher requisitos<br />

protéticos ou por razões estéticas. Resultados: Um total de<br />

136 procedimentos de enxertamento de osso foi realizado. A<br />

linha mandibular externa oblíqua e o ramo ascendente foram<br />

as áreas doadoras mais frequentemente usadas (59,64%) e os<br />

enxertos em bloco (67,64%) foram o tipo de enxerto mais<br />

frequentemente usado, frequentemente da linha mandibular<br />

externa oblíqua/ramo ascendente (52,18%). Foi usado plasma<br />

rico em plaquetas em 20,1% de todos os procedimentos,<br />

normalmente associado a enxertos de osso particulado. Os<br />

procedimentos maxilares representaram a maioria das cirurgias<br />

(75%), mas com menos complicações em comparação<br />

com a mandíbula. A perfuração da mucosa da cavidade foi a<br />

complicação mais frequente em procedimentos maxilares,<br />

enquanto a exposição do enxerto foi a complicação mais<br />

comum na mandíbula. Conclusões: A reconstrução alveolar<br />

usando osso autógeno seguida por colocação de implante é<br />

um tratamento confiável para pacientes com osso insuficiente.<br />

Complicações e morbidade foram frequentemente<br />

observadas. Contudo, a reabilitação final com implantes<br />

dentários não foi possível em apenas 6,6% de todos os<br />

procedimentos.<br />

PALAVRAS-CHAVE: Enxerto Ósseo, <strong>Implant</strong>e, Cirurgia,<br />

Complicações<br />

RUSSIAN /<br />

: Gustavo Davi Rabelo, <br />

, Priscila Marani de Paula, <br />

, Flaviana Soares Rocha,<br />

, Cláudia Jordão<br />

Silva, , <br />

, <br />

, Darceny Zanetta-Barbosa, <br />

, <br />

, <br />

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. .<br />

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ш <br />

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(Department <strong>of</strong> Oral and Maxill<strong>of</strong>acial Surgery<br />

and <strong>Implant</strong>ology) Uberlândia Federal<br />

University, 7- (2000 .<br />

2007 .). <br />

<br />

<br />

<br />

.<br />

. 136<br />

. <br />

<br />

<br />

(59,64 %), (67,64


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IMPLANT DENTISTRY /VOLUME 19, NUMBER 4 2010 7<br />

%) -<br />

<br />

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(52,18 %). <br />

20,1 % , <br />

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6,6 % <br />

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TURKISH / TÜRKÇE<br />

YAZARLAR: Gustavo Davi Rabelo, DDS, Priscila Marani de<br />

Paula, DDS, Flaviana Soares Rocha, DDS, Cláudia Jordão<br />

Silva, DDS, MSc, PhD, Darceny Zanetta-Barbosa, DDS,<br />

MSc, PhD<br />

İmplant yerleştirme öncesinde kemik greftleme prosedürlerinin<br />

retrospektif bir çalışması<br />

ÖZET: Amaçlar: Bu retrospektif çalışmanın amacı, implant<br />

yerleştirme öncesinde yapılan ogmantasyon prosedürlerinin<br />

olası komplikasyonlarını ve morbiditesini değerlendirmekti.<br />

Gereç veYöntem: Uberlândia Federal Üniversitesinin Oral<br />

ve Maksil<strong>of</strong>asiyal Cerrahi ve İmplantoloji Anabilim Dalında<br />

7 yıllık bir dönemde (Temmuz 2000den Temmuz 2007ye<br />

kadar) tedavi edilen ve implant yerleştirme işlemi öncesinde<br />

otojen kemik greftleme endikasyonu olan art ardına 93 hastanın<br />

kayıtları incelendi. Protez koşullarını karşılamak ya da<br />

estetik nedenlere cevap vermek için yeterli uzunluk ve çapta<br />

implant yerleştirmenin imkansız olması kemik greftleme<br />

gereksinimi olarak tanımlandı. Bulgular: Toplam 136 kemik<br />

greftleme prosedürü yapıldı. En sık kullanılan (%59.64) donör<br />

yerler mandibüler eksternal oblik hat ve asendan ramus<br />

olup, blok greft (%67.64) en sık kullanılan greft türü idi. Bu<br />

greft sıklıkla mandibüler eksternal oblik hat / asendan ramustan<br />

(%52.18) alındı. Prosedürlerin %20.1inde genellikle partikülat<br />

kemik greftleri ile bağlantılı olan trombositten zengin<br />

plazma kullanıldı. Maksiller prosedürler cerrahi işlemlerinin<br />

çoğunluğunu oluşturdu (%75) ve alt çeneye kıyasla daha az<br />

komplikasyona neden oldu. Maksiller prosedürlerde en sık<br />

komplikasyon sinüs mukozasının perforasyonu iken, alt<br />

çenede en yaygın komplikasyonun greftin açığa çıkması<br />

olduğu görüldü. Sonuç: Kemik yetersizliği olan hastalarda<br />

otojen kemik kullanarak alveoler rekonstrüksiyon yapılması<br />

ve ardından implant yerleştirilmesi güvenilir bir tedavi şeklidir.<br />

Komplikasyonlar ve morbidite sık bir şekilde gözlendi.<br />

Ancak, tüm prosedürlerin sadece %6.6’sında dental implant<br />

ile nihai rehabilitasyon sağlanamadı.<br />

ANAHTAR KELİMELER: Kemik grefti, İmplant, Cerrahi,<br />

Komplikasyon<br />

F1–3


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8 BONE GRAFTING PROCEDURES BEFORE IMPLANT PLACEMENT •RABELO ET AL<br />

JAPANESE /<br />

CHINESE /


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IMPLANT DENTISTRY /VOLUME 19, NUMBER 4 2010 9<br />

KOREAN /


JOBNAME: AUTHOR QUERIES PAGE: 1 SESS: 1 OUTPUT: Mon May 24 08:21:29 2010<br />

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AUTHOR QUERIES<br />

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