implants - international magazine of oral implantology International Edition

site.Ithasbeendescribedthatthevolumeishalfofwhat can be achieved from the mandibular symphysis.13 The dense structure of cortical portion of the grafts offers the benefit of improved implant stability during place- ment and healing and may even improve interfacial stresstransmissiononimplantloading.5, 30, 42 Theaimofthisstudywastoreportclinicalresultsof alveolarridgeaugmentationinpartiallyedentulouspa- tients prior to implant placement, using bone blocks fromtheretromolarregionandfirmlysecuredtothere- cipient site with osteosynthesis screws with the use of barrier membranes. The clinical indication for the pro- cedurewasthelackofsufficientalveolarbone,asitua- tion that could interfere with the correct placement of implantsofthedesiredlength. In this retrospective study, the data reported were readilycollectedfromtheauthorsafterthepostopera- tive phase. The sample studied was small and the aug- mented sites differed in location and type of defect. In the absence of a control group, the statistical signifi- cance of the means calculated was not tested. A new surgical devise with piezoelectric ultrasonic generator (Mectron,DeutschlandVertriebsGmbH)recentlydevel- oped,offersanalternativewayofsafelyremovinghard tissuewithoutdamagingsofttissueandisausefultool ofharvestingproceduresfromtheramus. Barriermembraneshavebeenusedtoachievealve- olarridgeaugmentationinimplantsurgeryinastaged approach, or at the same time as implant place- ment.6, 10, 43 The use of barrier membranes in combina- tion with particulate grafts and implants to augment the alveolar ridge and obtain ideal positioning of im- plants is reported to be an effective procedure in both humansandexperimentalanimals.6, 31, 44 Theuseofbar- rier membranes over particulate bone grafts seems to reduce the tendency for bone graft to be reabsorbed duringthehealingphase.Itmustbepointedoutthatthe tendency of bone grafts to resorb during the healing phase also occurs if the graft is protected by a mem- brane and no complications arise.6 However, the use of barrier membranes generally may be followed by soft tissuedehiscence,membraneexposureandplaquecol- onizationand,inveryfewcases,bytheneedtoremove thebarrier.Thiscomplicationjeopardizesthewholepro- cedure.45-46 According to Buser et al (1996), if a staged approach is used, complications involving membrane exposure, suture dehiscence and loss of the graft are minimal.6 Fixationofanonlaygrafttotherecipientsitecanin- fluence the revascularization of a graft.47 A loose graft may become nonunioned and encapsulated. Fixation screwsfortheonlaygraftshouldbetightenedtoensure close adaption. Infection is usually a consequence of poor aseptic control of the surgical field. Rinsing with chlorhexidinebeforesurgeryisapreventivemeasureto reducetheriskofinfection.Tension-freeflapclosureis essential so exposure of the membrane or fixation screwscanbeprevented.48 Thelimitsoftheretromolarareaaredictatedbyclin- icalaccess,aswellasthecoronoidprocess,molarteeth, andinferioralveolarcanal.Arectangularpieceofbone upto4mminthicknessmaybeharvestedfromthera- mus. This morphology conforms especially well as a vennergrafttogainadditionalridgewidth.49 A vestibular incision that extends well beyond the mucogingival junction creates easier access but pro- duces more soft tissue bleeding and intraoral scar for- mation. Haemostatic materials are placed into areas of osseousbleeding,andpostoperativepressuredressings reducethedevelopmentofhaematomaformation,inci- sionlinedehiscenceandinfection.Theuseofglucocor- ticoidsishelpfulinreducingpostoperativeoedema.50-52 The ramus graft patients appeared to have fewer diffi- cultiesinmanagingpostoperativeoedemaandpain. Painisalsoreducedinthefirstdayaftersurgery.No adverse effects for single dose or a negative effect on research I Table 3_Etiology of tooth lost. Table 4_Distribution of alveolar ridge situation and jaw separation prior to implant placement. Table 5_Type and number of post- surgical complications in donor sites. I 09implants4_2013 Etiology N Caries/Periodontitis 97 Trauma 3 Hypodonty 4 Total 104 Alveolar ridge Situation/ jaw Maxilla Mandibula Summary Free-end situation 7 30 37 Multiple teeth gap 12 16 28 Single tooth gap 3 36 39 Summary 22 82 104 Type of complication N Wound infection with pus 1 Swelling/abscess 2 Hypoesthesia N.mental 11 Hypoesthesia N.mental and lingual 3 Postoperative bleeding 1 Total 18