Chinese Journal of Oral Implantology

Preface for the key column “bone augmentation”

Editorial Board of Chinese Journal of Oral Implantology

2024, 29(5): 398-399. DOI: 10.12337/zgkqzzxzz.2024.10.001

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Management of vertical bone deficiency in the posterior mandibular region

Qiu Lixin, Niu Lixuan

2024, 29(5): 400-406. DOI: 10.12337/zgkqzzxzz.2024.10.002

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Vertical bone augmentation in the posterior mandibular region is technically demanding and prone to frequent complications. There is no consensus, either domestically or internationally, on the optimal technique. Furthermore, there is a lack of large-scale, high-quality clinical studies on the long-term outcomes of vertical bone augmentation followed by implant-supported restorations. This article provides a systematic review of complications and long-term outcomes of various vertical bone augmentation techniques, drawing on the authors' clinical expertise to provide information on decision-making.

Application of bone blocks harvested from the lateral wall of the maxillary sinus in horizontal alveolar ridge augmentation using the tenting technique

Zhou Danhong, Hu Ling, Zhou Guodong, Qiu Yuesheng, Jiang Zhiwei, Yang Guoli

2024, 29(5): 407-412. DOI: 10.12337/zgkqzzxzz.2024.10.003

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Objective To explore the clinical effect of bone blocks harvested from the lateral wall of the maxillary sinus on horizontal alveolar ridge augmentation using the tenting technique. Methods This study reviewed patients with dental defects who underwent horizontal tenting technique in the maxillary posterior region using bone blocks harvested from the lateral wall of the maxillary sinus at the Stomatology Hospital of Zhejiang University School of Medicine from November 2018 to March 2023. The width of the alveolar ridge in the grafted area was compared using cone beam computer tomography (CBCT) images taken preoperatively, immediately postoperatively, and 6 months postoperatively. Patients were also followed up clinically. Results There was a statistically significant increase in bone width at 0mm and 3mm from the top of the alveolar ridge in the immediate postoperative period compared to the preoperative period (P<0.05). 6 months postoperatively, the increase in horizontal bone width at the top of the alveolar ridge was (3.60±2.29) mm compared to preoperative measurements (P>0.05). The increase in horizontal bone width at 3 mm from the top of the alveolar ridge was (2.85±1.54) mm compared to preoperative measurements, and the difference was statistically significant (P<0.05). And compared to the immediate postoperative period, the bone augmentation at different distances from the top of the alveolar ridge remained basically stable 6 months postoperatively, with no significant bone resorption observed (P>0.05). Conclusion Bone blocks harvested from the lateral wall of the maxillary sinus show effective bone augmentation and favorable clinical outcomes when used in the horizontal alveolar ridge augmentation using the tenting technique. It provides a new surgical method for cases with insufficient alveolar ridge width in the maxillary posterior region, especially when combined with severe bone height deficiency requiring lateral window technique for sinus floor elevation.

Evaluation of micro crestal flap-alveolar ridge preservation in maxillary molar extraction for severe periodontitis: a retrospective study

Wei Yiping, Zhang Haoyun, Hu Wenjie, Xu Tao, Li Liman, Zhao Liping

2024, 29(5): 413-419. DOI: 10.12337/zgkqzzxzz.2024.10.004

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Objective This retrospective clinical study aimed to investigate the effects of micro crestal flap-alveolar ridge preservation (MCF-ARP) following maxillary molar extraction in patients with severe periodontitis. Methods A total of 95 maxillary molars from 80 patients were included, with the teeth extracted and then either left to heal naturally or treated with MCF-ARP before implant placement. Changes in bone height, bone width, and maxillary sinus pneumatization were evaluated using imaging. Additionally, the proportion of patients requiring bone augmentation surgery during implant placement was recorded. Results After healing, the bone height at the center of the alveolar socket increased by 4.94 mm in the MCF-ARP group and 2.20 mm in the natural healing group. The bone width 1 mm below the crest of the ridge increased by about 4 mm in the MCF-ARP group, while it decreased by about 1 mm in the natural healing group. The maxillary sinus pneumatization was (0.50 ± 0.35) mm in the natural healing group compared to (0.23 ± 0.44) mm in the MCF-ARP group (P=0.003). The proportion of patients requiring bone augmentation during implant placement was 67.6% in the natural healing group compared to 29.5% in the MCF-ARP group. Conclusion In patients with severe periodontitis, MCF-ARP can improve alveolar bone height and width, as well as reduce maxillary sinus pneumatization. This technique decreases the need for bone augmentation surgery during implant placement, thereby reducing the trauma and complexity of the implant procedure.

The influence of bioabsorbable collagen membrane fixation protocols on horizontal ridge augmentation in the maxillary anterior region

Zhang Shuo, Liu Chang, Xiao Hanyu, Zhang Weifeng, Deng Huanze, Zhang Jian

2024, 29(5): 420-428. DOI: 10.12337/zgkqzzxzz.2024.10.005

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Objective To evaluate the influence of bioabsorbable collagen membrane fixation protocols on horizontal ridge augmentation in the maxillary anterior region. Methods A total of 36 patients were enrolled in this retrospective study. One implant was placed in the maxillary anterior region, and simultaneous guided bone regeneration (GBR) surgery was performed. Participants were divided into 3 groups based on different bioabsorbable collagen membrane fixation protocols. Group 1: fixation with titanium pins; Group 2: fixation with absorbable sutures; Group 3: fixation with titanium pins and absorbable sutures. Cone beam computed tomography (CBCT) was performed immediately after surgery (T1) and at six months post-surgery (T2), respectively. The horizontal bone width of the augmented region was analyzed at the implant shoulder (H₀) and 2, 4, 6 mm apical to the implant shoulder (H₂, H₄, H₆). Changes in labial bone width during bone healing were calculated as absolute values (mm) and relative values (%). The incidence of postoperative complications was recorded. Results After six months of bone healing, all groups showed significant bone loss at H₀-H₆ compared to immediate post-surgery results (P<0.05). At H₂, horizontal bone loss in Group 1 was significantly less than in Group 2 (P<0.05). Group 3 exhibited significantly less horizontal bone loss compared to Group 1 at H₀ (P<0.05), and Group 3 showed significantly less bone loss than Group 2 at H₀-H₄ (P<0.05). There were no significant differences in the incidence of hematoma, wound bleeding, wound dehiscence, or infection among the groups (P>0.05). Conclusion When implant placement with simultaneous horizontal ridge augmentation was performed in the maxillary anterior region, membrane fixation with titanium pins demonstrated superior results of the augmented region near the implant shoulder compared to fixation with absorbable sutures. However, the combined use of pins and absorbable sutures contributed to achieving better bone augmentation results compared to using either method alone.

Clinical retrospective study of bone ring technique for 3-dimensional bone augmentation in implant restoration

Chen Gang

2024, 29(5): 429-434. DOI: 10.12337/zgkqzzxzz.2024.10.006

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Objective To evaluate the efficacy and key points of the bone ring technique for three-dimensional bone augmentation with simultaneous implant placement in cases of single-tooth loss with bone defects. Methods A retrospective review of cases from August 2010 to February 2023 at the Department of Dentistry, Peking University Shenzhen Hospital, and U-dental Clinic in Shenzhen, where patients with single-tooth vertical bone defects were treated using the autogenous bone ring technique with simultaneous implant placement. Second-stage surgeries were performed 6 months postoperatively for final restorations. Complications, bone augmentation outcomes, implant failures, and postoperative bone resorption were assessed through clinical and radiographic evaluations. Results 167 teeth were treated with the bone ring technique. 2 implants failed before restoration, and 4 bone rings failed during the healing period. No further implant failures were observed after restoration. Of the 36 patients with complete CBCT data, the average vertical bone gain was (4.52±0.81) mm. Average vertical bone resorption was (0.25±0.11) mm at 6 months post-surgery and (0.52±0.23) mm at 1 year after final restoration. Conclusion The bone ring technique, when applied to cases with sufficient basal bone and vertical bone defects, is an effective method for achieving vertical bone augmentation with simultaneous implant placement. It demonstrates a high implant success rate and low complication rate.

Clinical and histologic evaluation of autogenous dentin blocks for alveolar ridge augmentation

Gao Ming, Niu Lixuan, Zhu Yibo

2024, 29(5): 435-439. DOI: 10.12337/zgkqzzxzz.2024.10.007

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Severe bone defects in the alveolar ridge of edentulous areas pose significant challenges for prosthetically-driven implant placement. Although there are currently several reliable techniques for alveolar ridge augmentation, they present certain limitations, such as high technical sensitivity, significant trauma, prolonged treatment periods, and high costs. The patient in this case presented with multiple missing teeth in both the upper and lower jaws, with a severe horizontal bone defect in the left lower posterior area. Autogenous dentin block augmentation was performed using her wisdom tooth. Two and a half years postoperatively, satisfactory alveolar bone width was achieved, allowing for the placement of a 5 mm diameter implant in dense alveolar bone with good primary stability. Intraoperative histological analysis of tissue specimens showed no abnormalities. One year after the final restoration, marginal bone stability was maintained. In this case, the application of autogenous dentin blocks for alveolar ridge augmentation effectively reconstructed the width of the alveolar ridge, with stable clinical outcomes observed nearly 4 years postoperatively.

Therapeutic strategy of staged bone augmentation in the esthetic zone combined with microsurgical apical surgery on adjacent teeth: clinical diagnosis and treatment process and case study

Du Aobo, Man Yi

2024, 29(5): 440-444. DOI: 10.12337/zgkqzzxzz.2024.10.008

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In implant surgery in the esthetic zone of anterior teeth, different degrees of bone augmentation are often necessary to achieve an ideal anterior dental arch contour and soft tissue harmony. However, chronic periapical inflammation of adjacent teeth at the implant site may become a potential source of infection, leading to early failure of bone augmentation or further affecting the root of the implant, potentially resulting in retrograde peri-implantitis. This report presents a typical case involving an anterior dental bone defect with periapical lesions of adjacent teeth. Staged bone augmentation and implant restoration were performed by combining the dentin shell technique with microsurgical apical surgery. This approach avoided the trauma of harvesting autologous bone from a second surgical site during bone augmentation, offering a minimally invasive option for bone defects involving non-functional natural teeth, such as impacted teeth. Additionally, the potential source of infection from adjacent teeth was addressed during implant surgery, ensuring the long-term predictability of the treatment outcome.

A 5-year clinical observation on the application of non-resorbable membranes for bone augmentation in the aesthetic zone

Wan Peng

2024, 29(5): 445-452. DOI: 10.12337/zgkqzzxzz.2024.10.009

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This case report describes the use of guided bone regeneration (GBR) combined with soft tissue augmentation for implant restoration in an extended edentulous space in the esthetic zone, employing heterogeneous bone and dense polytetrafluoroethylene (dPTFE) membranes with double-layered coverage using a pig-derived non-crosslinked collagen membrane (Bio-Gide). The patient presented with multiple teeth missing in the maxillary anterior region due to trauma sustained at a young age, accompanied by severe horizontal bone loss and slight vertical bone loss. Clinical treatment involved the simultaneous guided placement of implants with GBR using deproteinized bovine bone mineral (DBBM), dPTFE, and Bio-Gide membranes. After 6 months, soft tissue augmentation was performed in two stages: first using the tunneling technique with allogeneic de-epithelialized dermal matrix (AlloDerm), followed by a modified tunneling technique using a connective tissue graft (CTG). Gingival shaping was achieved with temporary restorations, followed by final aesthetic restoration to restore function and appearance. A 5-year clinical follow-up demonstrated that GBR with DBBM, dPTFE, and Bio-Gide achieved ideal bone volume gain, while AlloDerm/CTG with the tunneling technique produced satisfactory soft tissue augmentation, contributing to excellent aesthetic outcomes.

Alveolar ridge preservation in inflammatory extraction sites and implant surgery

Shao Zhiwen, Zhu Hanjiu, Song Yingliang

2024, 29(5): 453-458. DOI: 10.12337/zgkqzzxzz.2024.10.010

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Alveolar ridge preservation after tooth extraction can reduce or even prevent alveolar bone resorption and soft tissue collapse during the healing process. This helps avoid complex soft and hard tissue augmentation procedures and provides good soft and hard tissue conditions for implant surgery. While conventional alveolar ridge preservation techniques have been widely applied and have shown predictable outcomes, there is still no standardized protocol for alveolar ridge preservation in cases where teeth are extracted due to periodontitis or periapical inflammation. To improve the success rate of alveolar ridge preservation in these inflammatory extraction sites, it is necessary to understand the various influencing factors of alveolar ridge preservation. This review discusses the indications for alveolar ridge preservation in inflammatory extraction sites, the impact of inflammation on alveolar ridge preservation, the key steps of this technique, and the timing of implant placement. It also shares experiences and techniques to optimize treatment outcomes.

Application of a new Tent-Peg technique in the reconstruction of severe alveolar bone defects

Wang Mohan, Hu Yinghan, Wu Jing, Zou Duohong

2024, 29(5): 459-466. DOI: 10.12337/zgkqzzxzz.2024.10.011

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Adequate bone volume is crucial for the successful placement and long-term stability of dental implants. Therefore, the reconstruction of severe alveolar bone defects hold significant clinical importance. With the development of guided bone regeneration (GBR) techniques, various GBR approaches have been applied in clinical practice to address alveolar bone defects. Based on the concept of "stability-centered" alveolar bone reconstruction, we developed a series of Tent-Peg medical products and established a new Tent-Peg technique. This technique enables the reconstruction of severe alveolar bone defects without the need for autologous bone, providing a novel solution for both the functional and aesthetic reconstruction of such defects. This innovative method has been successfully validated in clinical practice, and its appeal lies in its "three lows" (low technical sensitivity, low failure rate, and low cost) and "three easies" (easy to operate, promote, and popularize). To enhance clinicians' understanding of this innovative technique, this paper provides a comprehensive overview of the Tent-Peg medical product series and highlights the advantages of the new Tent-Peg technique, supported by clinical case demonstrations. This overview aims to promote the standardized application of this technique in clinical practice.

A survey of the willingness and influencing factors for dental implants among middle-aged and elderly patients with missing teeth in five cities of Liaoning

Chai Haoran, Liu Yi, Wang Zunshuo, Lang Zheyu, Li Chenhui, Zhu Shenghui, Zhang Xuepu, Zhang Yue

2024, 29(5): 467-473. DOI: 10.12337/zgkqzzxzz.2024.10.012

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Objective To investigate the willingness and influencing factors for dental implants among middle-aged and elderly patients with missing teeth in five cities of Liaoning Province. Methods Using population proportionate sampling (PPS) and a three-stage random sampling method, middle-aged and elderly patients with missing teeth in Shenyang, Fushun, Jinzhou, Panjin, and Chaoyang in Liaoning Province were selected as research subjects for a questionnaire survey. T-tests, analysis of variance, and structural equation modeling were used to explore the factors influencing implant willingness. Results There were statistically significant differences in the expected treatment outcomes of dental implants among patients with different educational levels (P<0.05). Media channels used by patients to learn about implants also varied significantly across different income levels (P<0.05). Significant differences were found in implant willingness, expected treatment outcomes, media channels, price barriers, and perceived risks between urban and rural patients (P<0.05). Urban patients had higher scores for implant willingness (3.37), expected treatment outcomes (3.76), and media channels (3.52) compared to rural patients (2.91, 3.35, 3.12, respectively), while rural patients had higher scores for price barriers (2.94) and perceived risks (3.01) compared to urban patients (2.71 and 2.67, respectively). Structural equation modeling revealed that expected treatment outcomes (β=0.185) and media channels (β=0.277) had a significant positive impact on implant willingness, while price barriers (β=-0.212), perceived risks (β=-0.127), and geographical limitations (β=-0.227) had a significant negative impact. Conclusion Price barriers, perceived risks, and geographical limitations are important factors contributing to the low willingness for dental implants among middle-aged and elderly patients with missing teeth in Liaoning Province. Therefore, it is necessary to promote dental implants through coordinated efforts from hospitals, the public, and manufacturers, in order to increase the application of dental implants.

Clinical evaluation of collagen sponge for augmenting keratinized gingiva around dental implants

Zhong Zhitong, Huang Min, Wang Jing, Shen Qinyuan, Wu Runfa

2024, 29(5): 474-479. DOI: 10.12337/zgkqzzxzz.2024.10.013

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Objective To evaluate the clinical efficacy of collagen sponge in augmenting keratinized gingiva around dental implants. Methods Fourteen patients with 16 surgical sites were randomly assigned to either the collagen sponge group or the free gingival graft group for keratinized gingiva augmentation. The width of keratinized tissue (WKT), soft tissue thickness (ST), color difference, and visual analogue scale (VAS) pain scores were measured at baseline, immediately after surgery, and at 6 weeks and 12 weeks postoperatively. Results At 12 weeks, the WKT was (5.81±0.75) mm and (3.50±0.53) mm (P<0.001), and the change in soft tissue thickness was (0.83±0.44) mm and (0.04±0.07) mm (P<0.05) in the free gingival graft and collagen sponge groups, respectively. The color difference values were 130.86±53.99 and 34.13±31.77 (P<0.05), the VAS pain scores was 5.13±1.25 and 1.88±1.13 (P<0.001), and the operative time was (38.17±4.56) min and (21.17±3.72) min (P<0.01), respectively, showing statistically significant differences. Conclusion Collagen sponge can be used for peri-implant keratinized gingiva augmentation. Compared with free gingival grafts, collagen sponges provide better aesthetic results, reduce operation time, and avoid the additional trauma associated with donor site harvesting.

Research progress on occlusal adjustment combined with laser therapy for peri-implantitis

Fang Li, Chen Zijun, Deng Banglian, Song Yingliang

2024, 29(5): 480-485. DOI: 10.12337/zgkqzzxzz.2024.10.014

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Implant-supported dentures have become the primary choice for patients with partial or complete edentulism. However, excessive occlusal loads and peri-implantitis can lead to bone resorption around implants, potentially causing implant loosening or even failure. Although the mechanism is not clear, studies suggest that excessive occlusal forces may synergistically exacerbate bone resorption in the presence of peri-implantitis. Laser therapy, known for its effective ablation, bactericidal, and bioregulatory properties, plays a significant role in the treatment of peri-implantitis. Combining occlusal adjustment with laser therapy can help control bone resorption around implants and alleviate the symptoms of peri-implantitis. This article reviews the occlusal factors that cause peri-implant bone resorption, the mechanisms through which these factors promote bone loss, and the principles of combining occlusal adjustment with laser therapy for treating peri-implant bone resorption. The aim is to provide treatment suggestions for solving the problem of peri-implant bone resorption.

Current status and research progress in dental implant treatment for alveolar cleft patients

Dai Yuwei, Lan Rong, Wu Yiqun, Wang Feng

2024, 29(5): 486-491. DOI: 10.12337/zgkqzzxzz.2024.10.015

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Cleft lip and palate are common congenital craniofacial anomalies often accompanied by alveolar clefts and missing teeth. Traditional restoration methods for patients with alveolar clefts typically involve fixed or removable partial dentures. Bone grafting and dental implant treatments offer more options for better results. However, there is currently no standardized approach to bone augmentation in alveolar cleft patients, which can affect the success of dental implants. This review will summarize the influence of bone grafting on dental implant restoration in patients with alveolar clefts, the factors affecting the treatment outcomes, as well as the common challenges and clinical effects of implant restoration, to help patients with cleft lip and palate achieve more ideal treatment results.

Research progress on medication-related osteonecrosis of the jaw

Gao Tingting, Bao Yongjie, Lv Xiaoyan, Chen Xian, Liu Yang, Xu Yilei, Lu Huanyou

2024, 29(5): 492-497. DOI: 10.12337/zgkqzzxzz.2024.10.016

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Medication-related osteonecrosis of the jaw (MRONJ) may be induced during the treatment of oral diseases in patients receiving anti-resorptive drugs such as bisphosphonates and denosumab, as well as angiogenesis inhibitors. However, the exact mechanism of MRONJ remains unclear, and although numerous studies have established clinical treatment databases, definitive treatment strategies have yet to be developed. Through a review of the literature, this study discusses the definition, etiology, staging, risk factors, treatment and prevention of MRONJ, providing a reference for clinical practice in oral healthcare.

Exploration and practice of SAC classification in the standardized training of oral implantology

Bai Yi, Chai Jihua, Zhang Xiaoxin, Xia Ting, Zeng Hao

2024, 29(5): 498-501. DOI: 10.12337/zgkqzzxzz.2024.10.017

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Objective To explore the application of SAC classification (simple, advancedand complex classification) in standardized training of oral implantology. Methods According to SAC classification, the content of standardized training in oral implantology was divided into three stages: primary stage, intermediate stage and advanced stage. Students were stratified through a progressive teaching approach. The students' performance was evaluated using a double-blind method. A questionnaire was used to collect students' satisfaction with the teaching. Results Over 92.98% of the students found the course content to be of moderate difficulty and reported significant learning gains. Conclusion The application of SAC classification allows for teaching students according to their abilities and effectively improves their knowledge levels in standardized training of oral implantology, representing a new exploration in dental standardization training.

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