Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2014-11-07, 14:16:52 | version 1.30.01
I research 18 I implants3_2014 of bone grafts is the migration of soft tissue, such as connectivetissue,betweenthegrafts,orbetweenthe graft and the residual ridge.4 There should be proper adaptation of the graft to the defect. All the gaps between the block graft and the residual ridge must be filled with bone chips to prevent ingrowth of the connective tissue. If all of the gaps are sealed with particulate bone, no membrane is needed to prevent theingrowthofsofttissue,buttitaniummeshcanbe useful in some cases to stabilise the grafted material and to hold it in place. If fibrous or granulation tissue is present in the grafted area, it should be removed before grafting.5 Resorption may be identified by the appearance of the fixation screw through the tissue as the soft tissue follows the underlying bone. Regeneration is commonly observed in block grafts.12–14 Dehiscenceleadstoahigherpercentageof resorption.Combiningamembranewithablockgraft has been reported to achieve less bone resorption.15 However, a high complication rate, such as dehis- cence of up to 14%16 or 18%17 with resulting infec- tion or resorption, has been reported in connection with non-resorbable membranes, making this ap- proach less attractive. Titanium mesh may be useful for avoiding resorption and appears to cause less de- hiscence than do other non-resorbable materials.18 _Bone remodelling and resorption after grafting Parallel to the healing of transplanted bone, in- cludingrevascularisationandremodelling,thevol- ume of the grafted area is reduced in the first few months after the surgical procedure. Bone resorp- tion of different forms and intensity is a typical phenomenon after the transplantation of a free bone graft.19 There are different reasons for this boneresorption,dependingonthegrafttechnique, localisation, the type of surgery, soft-tissue pres- sure and muscle function. The bone quality of the graftandoftherecipientsite,theamountofrevas- cularisation and revitalisation, and some genetic parametersinfluencetheintensityofthisbonere- sorption. Resorption of the grafted bone has been found to be influenced by the following parameters:6 1) Bone blocks inside the contours of the alveolar crest for reconstruction of a failed bone wall showed significantly greater and faster resorp- tionthanthosegraftedinsidethecontours.This resorption of the grafted bone outside the con- tours can be influenced by implant insertion into the grafted area, thereby moderating re- sorption. 2) Functional loading of the grafted bone with an implant reduces the amount of bone resorp- tion. When implants had not been inserted in the grafted area, the majority of the bone Fig. 6a Fig. 6b Fig. 7a Fig. 7b Fig. 8a Fig. 8b Fig. 9 Fig. 10 Fig. 11 Fig. 12 Fig. 13 Fig. 14