Clinical and radiographic outcomes of horizontal auto-augmentation of the anterior mandible using a single-site surgical technique prior to delayed implant placement: a case series
The findings of this preliminary case series suggest that the auto-augmentation technique from the mandibular symphysis is a technically feasible protocol for horizontal ridge augmentation, and achieves adequate bone gain while minimizing donor-site trauma and optimizing patient recovery profiles.
Abstract
Insufficient bone width is a common obstacle when placing dental implants. Numerous methods have been devised to enhance bone thickness. Autogenous bone is considered the benchmark material owing to its superior properties. The split bone block technique showed favorable results in bone gain, although donor site morbidity and the need for a second surgical site were major concerns. The study aimed to assess bone augmentation in the anterior mandible, using the symphysis as both the donor and recipient site, while the original technique required two surgeries. This prospective, single-center, formal consecutive case series study focused on outcomes and involved 11 patients, each having a bone width of less than 4 mm in the anterior mandibular area. Patients underwent a procedure for horizontal ridge augmentation, with implants being placed after a four-month interval. The study assessed the healing of the surgical site, reported complications, and measured pain levels using a visual analogue scale. It evaluated bone gain in width, primary stability, secondary stability of implants, short-term implant success, and augmented bone stability. The current study revealed postoperative swelling occurred in 45.5% of patients, while hematoma and flap dehiscence were each observed twice. Visual Analog Scale pain scores decreased over two weeks (P < 0.001). Mean radiographic bone width increased from (3.27 ± 0.80 mm) preoperatively to (5.88 ± 0.82 mm) at 4 months (P < 0.001). Furthermore, mean implant stability quotient scores improved from 72.80 (3.94) to 88.90 (2.10) (P < 0.001). The short-term implant success was 90.9%, and the mean linear augmented bone stability was 88.41% ± 6.24% (median: 90.57%), with individual values ranging from a minimum of 74.39% to a maximum of 94.57%. The findings of this preliminary case series suggest that the auto-augmentation technique from the mandibular symphysis is a technically feasible protocol for horizontal ridge augmentation. By confining the surgery to a single localized window, it achieves adequate bone gain while minimizing donor-site trauma and optimizing patient recovery profiles. The trial was registered on 12/09/2024 at clinicaltrials.gov (ID: NCT06727591).
Background: Autologous dentin has emerged as a potential grafting material in regenerative oral surgery because of its structural and biological similarities to bone. This technical report describes a modified tooth-shell technique used for horizontal ridge reconstruction with simultaneous implant placement in two clinical cases involving the aesthetic zone. Case Presentation: The first case involved a 29-year-old female patient requiring extraction of a partially impacted, buccally positioned maxillary third molar (tooth 28). The extracted tooth was processed intraoperatively to obtain a dentin shell, which was fixed as a buccal plate during simultaneous implant placement. The remaining defect was filled with sticky bone prepared from biphasic calcium phosphate combined with platelet-rich fibrin. Radiographic evaluations performed at 4 and 6 months demonstrated stable ridge contours, while clinical follow-up continued for 2 years with maintenance of implant function and peri-implant tissue stability. The second case involved a 58-year-old female patient with a previous failure of immediate implantation in the anterior maxilla associated with implant overload, loss of implant stability, and buccal bone deficiency. After soft- and hard-tissue healing, ridge reconstruction was performed using a dentin shell prepared from tooth 18 together with simultaneous implant placement and immediate provisional restoration. Follow-up after 6 months revealed stable peri-implant tissues, a satisfactory aesthetic outcome, and successful prosthetic rehabilitation. Conclusions: The modified tooth-shell technique using autologous dentin provided satisfactory preliminary clinical and radiographic outcomes in both cases. These findings should be considered hypothesis-generating and require confirmation in larger prospective studies with longer follow-up periods.
Jan Łoś, Justyna Szałkowska-Łoś, Michał Pikuła et al.· Journal of Functional Biomat...· 0 citations
Lateral sinus augmentation is a widely used procedure for implant placement in the posterior maxilla with insufficient residual bone height. This study retrospectively described the clinical and radiographic outcomes of lateral sinus augmentation performed using a controlled osteotomy strategy, referred to as the Wedge and Feather (WF) technique, and explored factors potentially associated with vertical bone gain.
This descriptive retrospective case series included consecutive patients who underwent lateral sinus augmentation using the WF technique. Clinical and radiographic data were collected from routine records. Vertical bone gain and complication rates were summarized descriptively. Because of the small sample size and absence of a control group, inferential analyses were considered exploratory and hypothesis-generating.
A total of 38 patients (43 sinus augmentation sites, 55 implants) was included. The mean vertical bone gain measured on postoperative panoramic radiographs was 8.5 ± 2.3 mm (range: 3.8–13.3 mm). Schneiderian membrane perforation occurred in 2 sites (4.7%), intraoperative bleeding in 1 site (2.3%), and postoperative sinusitis in 3 sites (7.0%). No implant failure was observed during the available follow-up period; however, no formal survival analysis was performed.
Because this retrospective case series lacked a control group and postoperative bone gain was measured using panoramic radiographs rather than CBCT, the findings should be interpreted as descriptive and hypothesis-generating. The WF technique was associated with clinically manageable surgical complications and radiographic bone gain in this single-surgeon cohort, but no conclusions regarding superiority or non-inferiority relative to conventional rotary or piezoelectric techniques can be drawn.
The clinical outcome supports current evidence indicating that osseodensification may enhance initial stability and predictability of immediate implants placed in posterior mandibular regions.
Márcio de Carvalho Formiga, Jucielly Santos Lesnik de Souza, Gustavo Dos Santos Coura et al.· Reports· 0 citations
OBJECTIVE
Reconstruction of severe vertical and horizontal alveolar ridge defects remains a clinical challenge in implant dentistry. The Khoury bone plate technique is widely used; however, graft resorption and limited graft containment may affect outcomes. This study aimed to evaluate the clinical outcomes of the Composite Cortical Plate Grafting (CCPG) technique compared with the Khoury bone plate technique. This retrospective comparative clinical study included 64 ridge augmentation procedures performed using either a CCPG technique (n=32) or the Khoury bone plate technique (n=32). The dual-layer approach involved cortical plate fixation, composite grafting with autogenous bone and xenograft, followed by an additional xenograft layer and pericardium membrane coverage. Bone gain was assessed clinically and radiographically. Graft resorption was evaluated based on radiographic observations during follow-up. Implant success was defined by clinical stability and absence of complications. The follow-up period ranged from 6 to 12 months.
RESULTS
The CCPG technique showed greater bone gain and improved graft stability compared with the Khoury technique. Lower graft resorption and higher implant placement success rates were observed in the CCPG group (93.7% versus 75%). Complication rates were lower in the CCPG group.
CONCLUSIONS
The findings suggest that the CCPG technique may provide favorable outcomes in terms of bone gain and graft stability compared with the Khoury technique. This approach represents a modification of established ridge augmentation methods and may be considered in the management of complex alveolar defects.
Unknown authors· The Journal of craniofacial...· 0 citations
While DO provides the greatest vertical bone gain, the GBR techniques might be a more clinically practical option, however, future well-planned RCTs to identify effective vertical bone augmentation techniques are still warranted.
