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EAO-464 / OC-SU-004 | The stability of 3D reconstructed bone in aesthetic area: a 10-years study
Clinical Oral Implants Research ( IF 4.3 ) Pub Date : 2021-12-28 , DOI: 10.1111/clr.42_13855


Stefano Trasarti1,*; Daniela marroni2

1Dipartimento Studi Europei Jean Monnet Lugano, Dipartimento Studi Europei Jean Monnet, Lugano, Switzerland; 2Studio Dentistico, Teramo, Italy

Background: The treatment in the aesthetic area has always represented a challenge in implant treatment for both the patient and the operator. When we are facing cases in the aesthetic area that require a restoration of bone volumes in the 3 dimensions, the treatment is more demanding and difficult because the correct implant placement in the three dimensions needs adequate bone volumes of hard and soft tissues. This study presents a report of 35 cases treated in the aesthetic area and followed up to 10 years

Aim/Hypothesis: The present research evaluated the results of 35 cases of 3D bone augmentations in the anterior maxilla and mandible recreated according to the Khoury's biologic concept with the “split bone block technique”.

Material and Methods: All the cases were analysed with preliminary photos and models and using the recent software (Simplant, Dentsply Sirona) to reproduce the bone atrophy and to simulate the reconstruction of the defects. In this way we were able to register the anatomical landmarks and to estimate approximately the volume that must be repristinate. All the bone blocks were harvested from the mandibular retromolar area with the Microsaw under antibiotic prophylaxis and then splitted into two blocks. Bone chips were gained by scraping the blocks using a Safescraper Twist (Meta) until a thickness of 1 mm. The blocks were screwed on distance to remaining crest using a micro screw of 1 mm diameter (Meisinger, Germany). The space between the residual bone and the blocks was filled with the only bone chips of autogenous bone. 3 to 4 months after the bone augmentation the implants were inserted and after other 3 months, we proceed to the second stage surgery with soft tissue management.

Results: 35 patients (21female, 14 male) were treated with this procedure in the anterior area of the maxilla and in the mandible. The median vertical bone augmentation was 6 mm varying from 3 mm to 14 mm. It was created like a box and the cortical lamina were fixed with microscrew. In the second stage surgery no additional bone graft was necessary. In only 5 cases we needed to improve the vertical bone during the implantation using the carrot technique. In the remaining cases no vertical resorption as in the vertical as in the horizontal area around the micro screw was recorded. The quality of this bone was really good after four months permitting the insertion of all the implants in the correct position with excellent quality of the bone. We registered the bone primary stability. In only 1 case, a heavy smoker young patient, we restarted with a new augmentation. All the implants inserted after 4 months showed during the second stage surgery a good integration and they were restored after 2 months.

Conclusion and Clinical implications: The patients were systematically controlled each year until 10 years without any implant failure. Two patients drop out after 7years, although they were be followed by other colleagues. All the patients presented a satisfied functional and aesthetics result. The radiographic control documented the stability of the grafted and regenerated bone over the years. Patients with 3D bone defects treated with autogenous bone blocks according to the biological concept showed unchanging results up to 10 years

Disclosure of Interest: None Declared

Keywords: aesthetic zone, bone graft, bone regeneration



中文翻译:

EAO-464 / OC-SU-004 | 美学领域3D重建骨的稳定性:10年研究

斯特凡诺·特拉萨蒂1,* ; 丹妮拉·马罗尼2

1 Dipartimento Studi Europei Jean Monnet Lugano,Dipartimento Studi Europei Jean Monnet,瑞士卢加诺;2 Studio Dentistico, Teramo, 意大利

背景:美容领域的治疗一直是对患者和操作者进行种植体治疗的挑战。当我们面临美学领域需要在三维空间恢复骨量的情况时,治疗要求更高,难度更大,因为在三维空间中正确放置种植体需要足够的硬组织和软组织的骨量。本研究报告了 35 例在美容领域接受治疗并随访长达 10 年的病例

目的/假设:本研究评估了 35 例根据 Khoury 的生物学概念使用“分裂骨块技术”重建的前上颌骨和下颌骨 3D 骨增强的结果。

材料与方法:所有病例均使用初步照片和模型进行分析,并使用最近的软件(Simplant、Dentsply Sirona)再现骨萎缩并模拟缺损的重建。通过这种方式,我们能够配准解剖标志并大致估计必须重新生成的体积。在抗生素预防下,用显微锯从下颌磨牙后区域采集所有骨块,然后分成两块。通过使用 Safescraper Twist (Meta) 刮块直到 1 mm 的厚度来获得骨碎片。使用直径为 1 mm 的微型螺钉(Meisinger,德国)将块体与剩余牙冠保持一定距离。残骨和块体之间的空间充满了唯一的自体骨骨碎片。

结果:35 名患者(21 名女性,14 名男性)在上颌骨前部和下颌骨接受了该手术。中位垂直骨增量为 6 毫米,从 3 毫米到 14 毫米不等。它像一个盒子一样被创造出来,皮质层用微螺钉固定。在第二阶段手术中,不需要额外的骨移植。仅在 5 个案例中,我们需要使用胡萝卜技术在植入过程中改善垂直骨骼。在其余情况下,没有记录到微型螺钉周围的垂直区域和水平区域的垂直吸收。四个月后,这块骨头的质量非常好,允许将所有植入物插入到正确的位置,骨头质量非常好。我们记录了骨骼的初级稳定性。仅在 1 例中,一名重度吸烟的年轻患者,我们重新开始了新的扩充。4个月后植入的所有种植体在二期手术中均显示出良好的整合,并在2个月后恢复。

结论和临床意义:患者每年都得到系统控制,直到 10 年没有任何种植失败。两名患者在 7 年后退出,尽管他们被其他同事跟踪。所有患者均呈现满意的功能和美学效果。射线照相控制记录了多年来移植和再生骨的稳定性。根据生物学概念用自体骨块治疗的 3D 骨缺损患者显示出长达 10 年不变的结果

利益披露:无申报

关键词: 美学区, 植骨, 骨再生

更新日期:2021-12-29
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