hrvatski

Inovativna tehnika horizontalne augmentacije alveolarnoga nastavka primjenom autolognoga zuba - pilot klinička studija

A recent series of experimental animal studies have investigated the effectiveness of extracted tooth roots for the purpose of horizontal augmentation of the alveolar ridge and subsequent placement of dental implants in such augmented area. The roots used in this technique were obtained from healthy, endodontically treated, uninfected, or periodontally compromised upper premolars and used as an autologous block graft to augment the horizontal defects of the alveolar ridge. Histological, immunohistochemical and tomographic analyses of the samples had not revealed significant differences in the augmentation quality between the tooth root graft and autologous bone grafts for lateral alveolar ridge augmentation. The aim of this pilot clinical study was to evaluate the efficacy and safety of autologous tooth roots for horizontal augmentation of the alveolar ridge in preparation for the subsequent dental implants placement. Ten patients were included in the study, all of whom were candidates for horizontal augmentation of the alveolar ridge due to insufficient bone width at the site of planned implant placement. Preoperative CBCT was performed for each patient and measurements were made prior to surgery. Patients had to fully understand the nature of the proposed procedure and signed an informed consent form. After removal of the impacted tooth or a periodontally compromised tooth, the crown of the tooth was separated at the enamel-cement junction using a rotating carbide drill and the dental pulp preserved. The separated tooth root was adjusted to the size and shape of the defect. To achieve ankylosis between the graft and the surgical site, the cement layer of the root was carefully removed with a diamond drill, until the dentin was fully exposed. For better root and defect contact, the alveolar extension was prepared by gentle decortication and preparation of the cortical hole defects. Grafts were fixed using a single osteosynthetic screw (1.5 × 9.5 mm, Helmut Zepf, Germany). After supraperiosteal releasement, the mucoperiosteal flaps were coronally positioned and fixed with vertical double sutures to ensure primary wound healing. All patients were prescribed with perioperative antibiotics (1 × amoxicillin with clavulanic acid 2 g) as well as peri- and erative (2 days) antiphlogistic prophylaxis (dexamethasone, 16 mg total). Analgesics (ibuprofen 600 mg) were prescribed and administered as needed. The suture was removed on the 10th postoperatively. After 6 months of healing, a mucoperiosteal flap was raised to reveal the target site and, after gentle removal of osteosynthesis screws, titanium implants placed (BL® taperd®, Institut Straumann AG, Basel, Switzerland). After 6 months, CBCT showed no signs of graft separation from the alveolar ridge. Clinical re-entry confirmed the homogeneous integration of tooth roots in the area of the previous defect, which was confirmed by a firm root-bone connection and circumferential hard tissue formation. Within its limitations, this pilot clinical study confirmed that tooth roots can serve as an adequate minimally invasive alternative for horizontal augmentation of the alveolar ridge prior to dental implant placement.

koštana regeneracija ; augmentacija alveolarnog grebena ; koštani nadomjestni materijali

nije evidentirano

engleski

Innovative horizontal augumentation technique of the alveolar ridge with autologous tooth – a pilot clinical study

A recent series of experimental animal studies have investigated the effectiveness of extracted tooth roots for the purpose of horizontal augmentation of the alveolar ridge and subsequent placement of dental implants in such augmented area. The roots used in this technique were obtained from healthy, endodontically treated, uninfected, or periodontally compromised upper premolars and used as an autologous block graft to augment the horizontal defects of the alveolar ridge. Histological, immunohistochemical and tomographic analyses of the samples had not revealed significant differences in the augmentation quality between the tooth root graft and autologous bone grafts for lateral alveolar ridge augmentation. The aim of this pilot clinical study was to evaluate the efficacy and safety of autologous tooth roots for horizontal augmentation of the alveolar ridge in preparation for the subsequent dental implants placement. Ten patients were included in the study, all of whom were candidates for horizontal augmentation of the alveolar ridge due to insufficient bone width at the site of planned implant placement. Preoperative CBCT was performed for each patient and measurements were made prior to surgery. Patients had to fully understand the nature of the proposed procedure and signed an informed consent form. After removal of the impacted tooth or a periodontally compromised tooth, the crown of the tooth was separated at the enamel-cement junction using a rotating carbide drill and the dental pulp preserved. The separated tooth root was adjusted to the size and shape of the defect. To achieve ankylosis between the graft and the surgical site, the cement layer of the root was carefully removed with a diamond drill, until the dentin was fully exposed. For better root and defect contact, the alveolar extension was prepared by gentle decortication and preparation of the cortical hole defects. Grafts were fixed using a single osteosynthetic screw (1.5 × 9.5 mm, Helmut Zepf, Germany). After supraperiosteal releasement, the mucoperiosteal flaps were coronally positioned and fixed with vertical double sutures to ensure primary wound healing. All patients were prescribed with perioperative antibiotics (1 × amoxicillin with clavulanic acid 2 g) as well as peri- and erative (2 days) antiphlogistic prophylaxis (dexamethasone, 16 mg total). Analgesics (ibuprofen 600 mg) were prescribed and administered as needed. The suture was removed on the 10th postoperatively. After 6 months of healing, a mucoperiosteal flap was raised to reveal the target site and, after gentle removal of osteosynthesis screws, titanium implants placed (BL® taperd®, Institut Straumann AG, Basel, Switzerland). After 6 months, CBCT showed no signs of graft separation from the alveolar ridge. Clinical re-entry confirmed the homogeneous integration of tooth roots in the area of the previous defect, which was confirmed by a firm root-bone connection and circumferential hard tissue formation. Within its limitations, this pilot clinical study confirmed that tooth roots can serve as an adequate minimally invasive alternative for horizontal augmentation of the alveolar ridge prior to dental implant placement.

bone regeneration ; alveolar ridge augmentation ; bone substitutes

nije evidentirano