Clinical results of autologous bone augmentation harvested from the mandibular ramus prior to implant placement. An analysis of 104 cases
Identifieur interne : 002C62 ( Pmc/Curation ); précédent : 002C61; suivant : 002C63Clinical results of autologous bone augmentation harvested from the mandibular ramus prior to implant placement. An analysis of 104 cases
Auteurs : Andreas Sakkas [Allemagne] ; Konstantinidis Ioannis [Allemagne] ; Karsten Winter [Allemagne] ; Alexander Schramm [Allemagne] ; Frank Wilde [Allemagne]Source :
- GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW [ 2193-8091 ] ; 2016.
Abstract
Url:
DOI: 10.3205/iprs000100
PubMed: 27785390
PubMed Central: 5061514
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<author><name sortKey="Sakkas, Andreas" sort="Sakkas, Andreas" uniqKey="Sakkas A" first="Andreas" last="Sakkas">Andreas Sakkas</name>
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<affiliation wicri:level="1"><nlm:aff id="A2">Department of Oral and Plastic Maxillofacial Surgery, Military Hospital, Ulm, Germany</nlm:aff>
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<author><name sortKey="Ioannis, Konstantinidis" sort="Ioannis, Konstantinidis" uniqKey="Ioannis K" first="Konstantinidis" last="Ioannis">Konstantinidis Ioannis</name>
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<author><name sortKey="Winter, Karsten" sort="Winter, Karsten" uniqKey="Winter K" first="Karsten" last="Winter">Karsten Winter</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Clinical results of autologous bone augmentation harvested from the mandibular ramus prior to implant placement. An analysis of 104 cases</title>
<author><name sortKey="Sakkas, Andreas" sort="Sakkas, Andreas" uniqKey="Sakkas A" first="Andreas" last="Sakkas">Andreas Sakkas</name>
<affiliation wicri:level="1"><nlm:aff id="A1">Department of Oral and Maxillofacial Surgery, University Hospital Ulm, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Department of Oral and Maxillofacial Surgery, University Hospital Ulm</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="A2">Department of Oral and Plastic Maxillofacial Surgery, Military Hospital, Ulm, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Department of Oral and Plastic Maxillofacial Surgery, Military Hospital, Ulm</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Ioannis, Konstantinidis" sort="Ioannis, Konstantinidis" uniqKey="Ioannis K" first="Konstantinidis" last="Ioannis">Konstantinidis Ioannis</name>
<affiliation wicri:level="1"><nlm:aff id="A3">Department of Prosthodontics, University of Dresden, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Department of Prosthodontics, University of Dresden</wicri:regionArea>
</affiliation>
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<author><name sortKey="Winter, Karsten" sort="Winter, Karsten" uniqKey="Winter K" first="Karsten" last="Winter">Karsten Winter</name>
<affiliation wicri:level="1"><nlm:aff id="A4">Institute of Anatomy, Medical Faculty, University of Leipzig, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Institute of Anatomy, Medical Faculty, University of Leipzig</wicri:regionArea>
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<author><name sortKey="Schramm, Alexander" sort="Schramm, Alexander" uniqKey="Schramm A" first="Alexander" last="Schramm">Alexander Schramm</name>
<affiliation wicri:level="1"><nlm:aff id="A1">Department of Oral and Maxillofacial Surgery, University Hospital Ulm, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Department of Oral and Maxillofacial Surgery, University Hospital Ulm</wicri:regionArea>
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<affiliation wicri:level="1"><nlm:aff id="A2">Department of Oral and Plastic Maxillofacial Surgery, Military Hospital, Ulm, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Department of Oral and Plastic Maxillofacial Surgery, Military Hospital, Ulm</wicri:regionArea>
</affiliation>
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<author><name sortKey="Wilde, Frank" sort="Wilde, Frank" uniqKey="Wilde F" first="Frank" last="Wilde">Frank Wilde</name>
<affiliation wicri:level="1"><nlm:aff id="A1">Department of Oral and Maxillofacial Surgery, University Hospital Ulm, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Department of Oral and Maxillofacial Surgery, University Hospital Ulm</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="A2">Department of Oral and Plastic Maxillofacial Surgery, Military Hospital, Ulm, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Department of Oral and Plastic Maxillofacial Surgery, Military Hospital, Ulm</wicri:regionArea>
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<series><title level="j">GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW</title>
<idno type="eISSN">2193-8091</idno>
<imprint><date when="2016">2016</date>
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<front><div type="abstract" xml:lang="en"><p><bold>Background:</bold>
The aim of this study was the evaluation of the clinical success and complication rates associated with autologous bone grafts harvested from the mandibular ramus for alveolar ridge augmentation and the identification of possible risk factors for graft failure. </p>
<p><bold>Methods:</bold>
In a consecutive retrospective study 86 patients could be included. In these patients a total of 104 bone grafts from the mandibular ramus were harvested for alveolar ridge augmentation. Medical history, age of patient, smoking status, periodontal status and complications were recorded. The need for bone grafting was defined by the impossibility of installing dental implants of adequate length or diameter to fulfill prosthetic requirements, or for aesthetic reasons. The surgical outcome was evaluated concerning complications at the donor or at the recipient site, risk factors associated with the complications and graft survival. All patients were treated using a two-stage technique. In the first operation bone blocks harvested from the retromolar region were placed as lateral or vertical onlay grafts using augmentation templates and were fixed with titanium osteosynthesis screws after exposure of the deficient alveolar ridge. After a healing period of 3–5 months computed tomography scans were performed followed by virtual implant planning and the implants were inserted using guided dental implantation. </p>
<p><bold>Results:</bold>
97 of the 104 onlay bone grafts were successful. In only 7 patients a graft failure occurred after a postsurgical complication. No long-term nerve damage occurred. Postoperative nerve disturbances were reported by 11 patients and had temporary character only. After the healing period between 4 to 5 months, 155 implants were placed (39 in the maxilla, 116 in the mandible). A final rehabilitation with dental implants was possible in 82 of the 86 patients. Except the 7 graft failures, all recorded complications were minor complications which could be easily treated successfully without any long-term problems. Complications at the donor site were recorded in 3 patients and 17 patients experienced complications at the recipient site. Three of 7 patients with graft failure, were secondarily augmented with a new retromolar graft, harvested from the contra-lateral site and dental implants could be successfully inserted later. No association between complications and smoking habit, age of patient, jaw area, and dental situation (tooth gap or free dental arch) could be detected. </p>
<p><bold>Conclusions:</bold>
Retromolar bone grafts are an effective and safe method for the reconstruction of small- to medium-sized alveolar defects of the maxilla and mandible prior to dental implantation and show a low graft failure rate.</p>
</div>
</front>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">GMS Interdiscip Plast Reconstr Surg DGPW</journal-id>
<journal-id journal-id-type="iso-abbrev">GMS Interdiscip Plast Reconstr Surg DGPW</journal-id>
<journal-id journal-id-type="publisher-id">GMS Interdiscip Plast Reconstr Surg DGPW</journal-id>
<journal-title-group><journal-title>GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW</journal-title>
</journal-title-group>
<issn pub-type="epub">2193-8091</issn>
<publisher><publisher-name>German Medical Science GMS Publishing House</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">27785390</article-id>
<article-id pub-id-type="pmc">5061514</article-id>
<article-id pub-id-type="publisher-id">iprs000100</article-id>
<article-id pub-id-type="doi">10.3205/iprs000100</article-id>
<article-id pub-id-type="publisher-id">Doc21</article-id>
<article-id pub-id-type="other">urn:nbn:de:0183-iprs0001007</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Clinical results of autologous bone augmentation harvested from the mandibular ramus prior to implant placement. An analysis of 104 cases</article-title>
<trans-title-group xml:lang="de"><trans-title>Klinische Ergebnisse prä-implantologischer Kieferkammaugmentation mit autologen Knochentransplantaten aus dem Ramus mandibulae. Eine Analyse von 104 Fällen</trans-title>
</trans-title-group>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Sakkas</surname>
<given-names>Andreas</given-names>
</name>
<xref ref-type="corresp" rid="COR1">*</xref>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ioannis</surname>
<given-names>Konstantinidis</given-names>
</name>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Winter</surname>
<given-names>Karsten</given-names>
</name>
<xref ref-type="aff" rid="A4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Schramm</surname>
<given-names>Alexander</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Wilde</surname>
<given-names>Frank</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>1</label>
Department of Oral and Maxillofacial Surgery, University Hospital Ulm, Germany</aff>
<aff id="A2"><label>2</label>
Department of Oral and Plastic Maxillofacial Surgery, Military Hospital, Ulm, Germany</aff>
<aff id="A3"><label>3</label>
Department of Prosthodontics, University of Dresden, Germany</aff>
<aff id="A4"><label>4</label>
Institute of Anatomy, Medical Faculty, University of Leipzig, Germany</aff>
<author-notes><corresp id="COR1">*To whom correspondence should be addressed: Andreas Sakkas, Department of Oral and Plastic Maxillofacial Surgery, Military Hospital, Oberer Eselsberg 40, 89081 Ulm, Germany, Phone: +49-731-1710-1701, Fax: +49-731-1710-1008, E-mail: <email>ansakkas@yahoo.com</email>
</corresp>
</author-notes>
<pub-date pub-type="epub"><day>06</day>
<month>10</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="collection"><year>2016</year>
</pub-date>
<volume>5</volume>
<elocation-id>Doc21</elocation-id>
<permissions><copyright-statement>Copyright © 2016 Sakkas et al.</copyright-statement>
<copyright-year>2016</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License.</license-p>
</license>
</permissions>
<self-uri xlink:type="simple" xlink:href="http://www.egms.de/en/journals/iprs/2016-5/iprs000100.shtml">This article is available from http://www.egms.de/en/journals/iprs/2016-5/iprs000100.shtml</self-uri>
<abstract><p><bold>Background:</bold>
The aim of this study was the evaluation of the clinical success and complication rates associated with autologous bone grafts harvested from the mandibular ramus for alveolar ridge augmentation and the identification of possible risk factors for graft failure. </p>
<p><bold>Methods:</bold>
In a consecutive retrospective study 86 patients could be included. In these patients a total of 104 bone grafts from the mandibular ramus were harvested for alveolar ridge augmentation. Medical history, age of patient, smoking status, periodontal status and complications were recorded. The need for bone grafting was defined by the impossibility of installing dental implants of adequate length or diameter to fulfill prosthetic requirements, or for aesthetic reasons. The surgical outcome was evaluated concerning complications at the donor or at the recipient site, risk factors associated with the complications and graft survival. All patients were treated using a two-stage technique. In the first operation bone blocks harvested from the retromolar region were placed as lateral or vertical onlay grafts using augmentation templates and were fixed with titanium osteosynthesis screws after exposure of the deficient alveolar ridge. After a healing period of 3–5 months computed tomography scans were performed followed by virtual implant planning and the implants were inserted using guided dental implantation. </p>
<p><bold>Results:</bold>
97 of the 104 onlay bone grafts were successful. In only 7 patients a graft failure occurred after a postsurgical complication. No long-term nerve damage occurred. Postoperative nerve disturbances were reported by 11 patients and had temporary character only. After the healing period between 4 to 5 months, 155 implants were placed (39 in the maxilla, 116 in the mandible). A final rehabilitation with dental implants was possible in 82 of the 86 patients. Except the 7 graft failures, all recorded complications were minor complications which could be easily treated successfully without any long-term problems. Complications at the donor site were recorded in 3 patients and 17 patients experienced complications at the recipient site. Three of 7 patients with graft failure, were secondarily augmented with a new retromolar graft, harvested from the contra-lateral site and dental implants could be successfully inserted later. No association between complications and smoking habit, age of patient, jaw area, and dental situation (tooth gap or free dental arch) could be detected. </p>
<p><bold>Conclusions:</bold>
Retromolar bone grafts are an effective and safe method for the reconstruction of small- to medium-sized alveolar defects of the maxilla and mandible prior to dental implantation and show a low graft failure rate.</p>
</abstract>
<trans-abstract xml:lang="de"><title>Zusammenfassung</title>
<p><bold>Hintergrund:</bold>
Ziel dieser Studie war die Evaluation des klinischen Erfolgs sowie der Komplikationsrate nach Alveolarkammaugmentation mit autologen Knochentransplanten aus dem Ramus mandibulae. Des Weiteren galt es mögliche Risikofaktoren für einen Transplantatverlust zu identifizieren.</p>
<p><bold>Methoden:</bold>
In einer konsekutiven retrospektiven Studie wurden 86 Patienten eingeschlossen. Bei diesen Patienten wurden insgesamt 104 Knochentransplantate aus dem Ramus mandibulae zur Alveolarkammaugmentation entnommen. Anamnese, Patientenalter, Rauchverhalten, Parodontalstatus und Komplikationen wurden dokumentiert. Die Indikation zur Knochentransplantation bestand aufgrund eines zu geringen Knochenangebots zur Insertion von dentalen Implantaten in ausreichender Länge oder ausreichendem Durchmesser. Das chirurgische Ergebnis wurde in Bezug auf auftretende Komplikationen in der Entnahme-- oder Empfängerregion, die Risikofaktoren für postoperative Komplikationen und die Transplantat-Überlebensrate evaluiert. Alle Patienten wurden im Rahmen eines zweizeitigen Vorgehens behandelt. Dabei wurden in der ersten Operation retromolare Knochenblöcke entnommen und nach Darstellung des defizitären Alveolarkamms als laterale oder vertikale Onlay-Transplantate unter Verwendung einer Augmentationsschablone mit Mini-Titan-Osteosyntheseschrauben bedarfsgerecht auf dem Alveolarkamm fixiert. Nach einer Einheilzeit von 4–5 Monaten wurden nach computer-assistierter Implantatplanung basierend auf einer Computertomographie die Implantate schablonengeführt inseriert. </p>
<p><bold>Ergebnisse:</bold>
97 der 104 Knochentransplantate zeigten eine erfolgreiche Einheilung. Bei 7 Patienten kam es aufgrund postoperativer Komplikationen zu einem Transplantatverlust. Eine langfristige Nervenschädigung trat in keinem der Fälle auf. Temporäre postoperative Sensibilitätsstörungen wurden bei 11 Patienten festgestellt. Nach einer Heilungsphase von 4 bis 5 Monaten konnten 155 Implantate inseriert werden (39 im Oberkiefer, 116 im Unterkiefer). Eine Rehabilitation mit dentalen Implantaten war bei 82 der 86 Patienten möglich. Mit Ausnahme der 7 Transplantatverluste konnten alle weiteren Komplikationen ohne Folgen erfolgreich beherrscht werden. Postoperative Komplikationen traten bei 3 Patienten im Bereich der Entnahmestelle und bei 17 Patienten im Bereich der Empfängerstelle auf. Drei der 7 Patienten welche einen Transplantatverlust zu verzeichnen hatten, wurden sekundär mit einem weiteren retromolaren Transplantat aus der kontralateralen Seite augmentiert und konnten in der Folge erfolgreich implantiert werden. Keine der dokumentierten Komplikationen stand statistisch im Zusammenhang mit den Rauchgewohnheiten, dem Patientenalter, der Kieferlokalisation und der dentalen Situation des augmentierten Bereiches (Schaltlücke oder Freiendsituation).</p>
<p><bold>Schlussfolgerungen:</bold>
Die Transplantation von retromolaren Knochenblöcken vor dentaler Implantation erweist sich als eine effektive und sichere Methode zur Rekonstruktion von kleinen bis mittelgroßen Alveolarkammdefekten des Ober- und Unterkiefers bei nur geringem Transplantatverlustrisiko.</p>
</trans-abstract>
<kwd-group><kwd>retromolar bone graft</kwd>
<kwd>autologous bone</kwd>
<kwd>alveolar ridge augmentation</kwd>
<kwd>alveolar atrophy</kwd>
<kwd>dental implants</kwd>
</kwd-group>
</article-meta>
</front>
<floats-group><fig id="T1" position="float"><label>Table 1</label>
<caption><title>Patient characteristics</title>
</caption>
<graphic xlink:href="IPRS-05-21-t-001"></graphic>
</fig>
<fig id="T2" position="float"><label>Table 2</label>
<caption><title>Postoperative complications at the donor and recipient site</title>
</caption>
<graphic xlink:href="IPRS-05-21-t-002"></graphic>
</fig>
<fig id="F1" position="float"><label>Figure 1</label>
<caption><title>The figure is showing the left maxilla with alveolar ridge atrophy in region 24 to 26 (FDI tooth numbering system). A splint with integrated tubes which are indicating the planed implant position (black arrows) is fixed on the remaining dentition [11]. The probe (white arrow) is indicating the position and amount of bone which is needed for later sufficient implant placement.</title>
</caption>
<graphic xlink:href="IPRS-05-21-g-001"></graphic>
</fig>
<fig id="F2" position="float"><label>Figure 2</label>
<caption><title>The cranial cut through the cortex is placed on the lateral aspect of the left ramus and the anterior vertical cut was made in the mandibular body in the third molar region in order to harvest the bone graft.</title>
</caption>
<graphic xlink:href="IPRS-05-21-g-002"></graphic>
</fig>
<fig id="F3" position="float"><label>Figure 3</label>
<caption><title>The bone graft is placed in the bone defect in the maxillary left posterior area and fixed with three titanium osteosynthesis screws (arrow).</title>
</caption>
<graphic xlink:href="IPRS-05-21-g-003"></graphic>
</fig>
</floats-group>
</pmc>
</record>
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