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implants international magazine of oral implantology

I research _In the previous issues of implants international magazineoforalimplantology(implants1/2014)theauthors gave a detailed introduction to their topic. In this is- sue, their report is completed. At the time of implant placement, usually four monthsafterthegraftingprocedure,theremodelling process is still underway. Even seven months after grafting, significant amounts of non-vital bone can be found.8 Certain factors may influence the efficacy of the regeneration process. Revascularisation of the graft is crucial to tissue nutrition and regeneration. Revascularisation of a cancellous bone graft is ten- fold faster than that of a cortical bone graft.9 The re- generative potential of the residual ridge is also an important factor. Highly atrophied ridges usually consist of cortical bone that is not well vascularised and does not provide many cells.10 These factors can influence the time needed for remodelling of the graft. Clinically, poor bone regeneration can be visu- ally established from poor bleeding because of an in- adequate blood supply, or from an inhomogeneous structure. Sometimes, even a clear border between the grafted bone and residual ridge can be observed.5 Inmostcases,thescrewhastoberemovedbeforeim- plantscanbeplacedafterbonegrafting.Ifthegraftis not properly integrated, implant placement can loosenthegraft.Mechanicalstabilityofthegraftisan important factor for proper bone regeneration and integration. It is well known that osteoblasts differ- entiate into fibroblasts under mechanical overload.10 If mobility of the graft is observed, soft tissue has to beremoved,bleedingshouldbeprovokedandmobile fragments have to be recured with the screws to al- low the tissue to heal for another three or four months.5 Another reason for insufficient integration 16 I implants3_2014 Ridge augmentation for an atrophied posterior mandible using NanoBone block Part II:Treatment outcome of clinical complications Authors_Dr Omar Soliman & Prof. Dr Dr Mohamed Nassar, Egypt Fig. 1a Fig. 1b Fig. 2 Fig. 3 Fig. 4a Fig. 4b Fig. 5a Fig. 5b

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