Horizontal Bone Reconstruction on sites with different amounts of native bone: a retrospective study

Abstract: The lack of guidelines for bone augmentation procedures might compromise decision making in implantology. The objective of this study was to perform a retrospective study to verify the outcomes of horizontal bone reconstruction in implant dentistry with different types of materials and amounts of native bone in the recipient bed to allow for a new guideline for horizontal bone reconstruction. One hundred preoperative CT scans were retrospectively evaluated and categorized in accordance to horizontal bone defects as presence (Group P) or absence (Group A) of cancellous bone in the recipient bed. Different approaches were used to treat the edentulous ridge and the outcomes were defined either as satisfactory or unsatisfactory regarding the possibility of implant placement. The percentage distribution of the patients according to the presence or absence of cancellous bone was 92% for Group P and 8% for Group A. In Group P, 98% of the patients had satisfactory outcomes, and the use of autografts had 100% of satisfactory outcomes in this group. In Group A, 37.5% of the patients had satisfactory outcomes, and the use of autografts also yielded 100% of satisfactory outcomes. The use of allografts and xenografts in Group A had 0% and 33.3% of satisfactory outcomes, respectively. Therefore, it seems reasonable to speculate that the presence of cancellous bone might be predictive and predictable when the decision includes bone substitutes. In cases of absence of cancellous bone in the recipient bed, the use of a vitalized graft seems to be mandatory.

摘要：骨增量手术缺乏统一规范指南，或对种植学（Implantology）中的临床决策造成不利影响。本研究旨在开展一项回顾性研究，验证口腔种植学中不同材料及受植床（recipient bed）天然骨量条件下水平骨重建术（horizontal bone reconstruction）的疗效，以期为水平骨重建术制定全新的临床指南。本研究回顾性分析了100例术前CT（Computed Tomography）扫描影像，根据受植床是否存在松质骨（cancellous bone）将研究对象分为两组：存在松质骨组（Group P，下称P组）与不存在松质骨组（Group A，下称A组）。研究采用多种术式治疗无牙颌牙槽嵴（edentulous ridge），以种植体植入的可行性作为疗效判定标准，将疗效划分为满意与不满意两类。按松质骨有无分组的患者占比分别为：P组92%，A组8%。P组中98%的患者疗效满意，其中使用自体骨移植物（autograft）的患者疗效满意率达100%。A组中仅37.5%的患者疗效满意，该组中使用自体骨移植物的患者疗效满意率同样为100%；A组中使用同种异体骨移植物（allograft）与异种骨移植物（xenograft）的患者疗效满意率分别为0%与33.3%。据此可合理推断，当临床决策涉及骨替代材料时，受植床是否存在松质骨可作为疗效的预测及预判指标。对于受植床不存在松质骨的病例，使用活性移植物似乎为必需的治疗方案。