• The Journal of the Korean dental association
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• v.50 no.6
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• pp.329-338
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• 2012

Introduction: The purpose of this study is to evaluate the clinical results of vertical alveolar ridge augmentation using autogenous block bone graft, especially resorption rate, and outcomes of dental implants placed in the grafted site. Patients and Methods: Medical records and radiographs were reviewed. Twenty-seven patients who have been received the autogenous block bone graft which harvested from chin, ramus, and ilium, and the implant installation on 31 areas(22 maxillas and 9 mandibles) were included. Eight implants were installed simultaneously at the time of bone graft in 4 patients, and 65 implants were installed after 4.9 months(range 2~18 months) of autogenous block bone graft in 23 patients. The resorption amount and rate of augmented bone, and the success and survival rates implants were evaluated. Results: Mean height of the augmented block bone was $5.9{\pm}2.3mm$(range from 2.5 to 13.0 mm). Mean follow-up period after block bone graft was 30.4 months(range from 16 to 55 months). Mean resorption of the augmented block bone was $2.0{\pm}1.5mm$ (range from 0.5 to 7.24 mm). The success and survival rates of the implants were 78.1 % and 98.6%, respectively. Conclusion: This study indicates that the autogenous block bone graft is a useful and stable method for alveolar ridge augmentation for dental implant. And more augmentation is needed to compensate the resorption of the grafted bone.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.1
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• pp.46-52
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• 2009

The maxillary posterior edentulous region presents unique and challenging conditions in implant dentistry. The height of the posterior maxilla is reduced greatly as a result of dual resorption from the crest of the ridge and pneumatization of the maxillary sinus after the loss of teeth. Materials previously used for sinus floor grafting include autogenous bone, allogeneic bone, xenogenic bone and alloplastic materials. Autogenous bone is the material of choice, but its use is limited by donor-site morbidity, complications, sparse availability, uncontrolled resorption and marked volume loss. One way to overcome this problem would be to use bone substitutes alone as a osteoconductive scaffold for bone regeneration from the residual bone or in combination with allogeneic bone, which also has osteoinductive properties. The purpose of this article is to describe a double layers technique of demineralized and mineralized bone graft materials instead of autogenous bone in sinus floor augmentation of deficient posterior maxillary alveolar process and to report our experience with this technique. Our results show that maxillary sinus augmentation using mineralized and demineralized bone materials, when installed simultaneously with the implant or not, is good results for bone healing.

• Journal of Korean Dental Science
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• v.17 no.2
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• pp.64-74
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• 2024

This case report presents the long-term radiographic outcomes of a novel approach for simultaneous lateral augmentation and implant surgery. A 60-year-old male patient who required tooth extraction of the maxillary central and lateral incisors due to trauma visited the clinic. After tooth extraction, severe horizontal and vertical deficiencies occurred owing to atrophy of the alveolar ridge, and a simultaneous guided bone regeneration (GBR) procedure was planned along with the installation of two implants. In the present case, a modification of the conventional 'sandwich technique' was used by placing the mixture of autogenous bone chips and xenografts at the outermost layer to maximize the osteogenic potential at the coronal part of augmentation while applying solely xenografts at the inner layer. To enhance volumetric stability, an autogenous block of periosteum harvested from the maxillary tuberosity was incorporated between the two layers. Cone-beam computed tomography was performed at baseline and 3 years after the surgery to compare radiographic outcomes. Dehiscence after fixture installation was successfully observed at the re-entry of the surgery site. Three years after the surgery, average horizontal bone gains of 6.11 mm and 4.12 mm were observed in the maxillary central and lateral incisor areas, respectively. Healthy peri-implant mucosa and well maintained marginal bone levels were observed 8 years after the surgery, meeting the criteria for implant success. The findings of this case suggest that a substantial amount of horizontal bone gain can be obtained with a layered approach using autogenous bone materials and xenografts, highlighting the advantages of incorporating autogenous blocks into the simultaneous GBR procedure.

• The Journal of Korean Academy of Prosthodontics
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• v.48 no.3
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• pp.202-208
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• 2010

Purpose: This study was aimed to evaluate the effect of rhPMP-2 coated implants on alveolar ridge augmentation in dogs. Materials and methods: Six Beagle dogs were used in this study. Six 8.0 mm long anodized surface titanium implants were placed 5 mm into the mandibular alveolar ridge following 6 month of healing period after extraction. Each animal received three implants coated with rhBMP-2 and three uncoated control implants using the randomized split-mouth design. Radiographic examinations were undertaken immediately at implant placement (baseline), at weeks 4 and 8 after implant placement. The amount of bone augmentation was evaluated by measuring the distance from the uppermost point of the coverscrew to the marginal bone. Implant Stability Quotient (ISQ) values were measured immediately at implant placement and 8 weeks after implant placement. For the statistical analysis, Man-Whitney ranksum test and Wilcoxon signed rank test of SPSS 12.0 software were used (P=.05). Results: The BMP group exhibited radiographic vertical bone augmentation about $0.6{\pm}0.7$ mm at 8 weeks later while controls showed bone loss about $0.4{\pm}0.6$ mm. There was significant difference among the rhBMP-2 group and controls in bone level change (P<.05). The ISQ values were significantly higher in the BMP-2 group than the control group at 8 weeks later (P<.05), while there was no significant difference at surgery. Conclusion: Within the limitation of this study, the rhBMP-2 coated on anodized implant could stimulate vertical alveolar bone augmentation, which may increase implant stability significantly on completely healed alveolar ridge.

• The korean journal of orthodontics
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• v.46 no.6
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• pp.379-385
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• 2016

Objective: Forced eruption has been proposed for the reconstruction of deficient bone and soft tissue. The aim of this study was to examine the changes in the alveolar ridge width and the vertical levels of the interproximal bone and papilla following forced eruption. Methods: Patients whose hopeless maxillary anterior teeth were expected to undergo severe bone resorption and soft tissue recession upon extraction were recruited. In addition, patients whose maxillary anterior teeth required forced eruption for restoration due to tooth fracture or dental caries were included. Before and after forced eruption, the interproximal bone height was measured by radiographic analysis, and changes in the alveolar ridge width and the interproximal papilla height were measured with an acrylic stent. Results: This prospective study demonstrated that the levels of the interproximal alveolar bone and papilla were significantly increased by 1.36 mm and 1.09 mm, respectively, in the vertical direction. However, the alveolar ridge width was significantly reduced by an average of 0.67 mm in the buccolingual direction. The changes in the level of the interproximal alveolar bone and papilla were positively correlated. Conclusions: Although the levels of the interproximal bone and papilla were significantly increased, the alveolar ridge width was significantly decreased following forced eruption. There was a modest positive and significant correlation between the changes in the height of the interproximal alveolar bone and the papilla. Based on our findings, modification of vertical forced eruption should be considered when augmentation of the alveolar ridge width is required.

• Journal of Periodontal and Implant Science
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• v.47 no.1
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• pp.51-63
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• 2017

Purpose: Following tooth extraction, alveolar ridge preservation (ARP) can maintain the dimensions of ridge height and width. Although previous studies have demonstrated the effects of ARP, few if any studies have investigated the compressive force applied during grafting. The aim of this study was to determine the effects of different compressive forces on the graft materials during ARP. Methods: After tooth extraction, sockets were filled with deproteinized bovine bone mineral with 10% porcine collagen and covered by a resorbable collagen membrane in a double-layered fashion. The graft materials were compressed using a force of 5 N in the test group (n=12) and a force of 30 N in the control group (n=12). A hidden X suture was performed to secure the graft without primary closure. Cone-beam computed tomography (CBCT) was performed immediately after grafting and 4 months later, just before implant surgery. Tissue samples were retrieved using a trephine bur from the grafted sites during implant surgery for histologic and histomorphometric evaluations. Periotest values (PTVs) were measured to assess the initial stability of the dental implants. Results: Four patients dropped out from the control group and 20 patients finished the study. Both groups healed without any complications. The CBCT measurements showed that the ridge volume was comparably preserved vertically and horizontally in both groups (P>0.05). Histomorphometric analysis demonstrated that the ratio of new bone formation was significantly greater in the test group (P<0.05). The PTVs showed no significant differences between the 2 groups (P>0.05). Conclusions: The application of a greater compressive force on biomaterials during ARP significantly enhanced new bone formation while preserving the horizontal and vertical dimensions of the alveolar ridge. Further studies are required to identity the optimal compressive force for ARP.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.22 no.1
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• pp.47-55
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• 2013

There have been a great number of developments in clinical techniques and dental materials in dentistry to date. Looking at these developments, while it could be seen that functional elements such as mastication were prioritized rather than aesthetic aspect in the past, aesthetic needs of patients have steadily increased over time and accordingly the aesthetic has become considered a priority in the development of dentistry. Although the first to be considered in discussing the aesthetic in clinical dentistry will be the white aesthetic that is the tooth part of prosthesis, the pink aesthetic that refers to the harmony of such prosthesis with gingiva can be an important consideration not to be ignored aesthetically. However, the harmony with the gingiva often cannot be obtained only by the beautiful prosthesis, and in particular, the pontic and implant areas have poor conditions to achieve the gingival (pink) aesthetic due to the absorption of alveolar ridge compared to natural teeth. Among the most important elements of the gingival aesthetic are the gingival level and the interproximal papilla height. It is very difficult to make the gingival aesthetic in the case of insufficient alveolar ridge, and the recovery of ridge volume and contour is necessary in order to overcome this condition. To this end, the most widely used method is the "connective tissue graft". Many techniques of the connective tissue graft have already been introduced for the ridge augmentation, and each technique has different purposes, and advantages and disadvantages. Rather, due to the excessive amount of techniques, there is confusion about selecting the right technique at a certain time. However, the goal is clear. Ways to increase the success rates must be found, and at the same time, a more favorable way to the gingival aesthetic is to be chosen. Thus, in this study, considerations for the gingival aesthetic that makes harmony and the techniques to achieve it are discussed.

• Journal of Periodontal and Implant Science
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• v.48 no.3
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• pp.193-200
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• 2018

Purpose: The present study describes 3 patients with chronic periodontitis and consequent vertical resorption of the alveolar ridge who were treated using implant-based restoration with guided bone regeneration (GBR). Methods: After extraction of a periodontally compromised tooth, vertical bone augmentation using a K-incision was performed at the healed, low-level alveolar ridge. Results: The partial-split K-incision enabled soft tissue elongation without any change in buccal vestibular depth, and provided sufficient keratinized gingival tissue during GBR. Conclusions: Within the limits of this study, the present case series demonstrated that the novel K-incision technique was effective for GBR and allowed normal implant-based restoration and maintenance of a healthy periodontal condition. However, further long-term follow-up and a large-scale randomized clinical investigation should be performed to evaluate the feasibility of this technique.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.41.1-41.6
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• 2016

Background: The goal of this study was to retrospectively evaluate the prognosis of minimal invasive horizontal ridge augmentation (MIHRA) technique using small incision and subperiosteal tunneling technique. Methods: This study targeted 25 partially edentulous patients (10 males and 15 females, mean age $48.8{\pm19.7years$) who needed bone graft for installation of the implants due to alveolar bone deficiency. The patients took the radiographic exam, panoramic and periapical view at first visit, and had implant fixture installation surgery. All patients received immediate or delayed implant surgery with bone graft using U-shaped incision and tunneling technique. After an average of 2.8 months, the prosthesis was connected and functioned. The clinical prognosis was recorded by observation of the peri-implant tissue at every visit. A year after restoration, the crestal bone loss around the implant was measured by taking the follow-up radiographs. One patient took 3D-CT before bone graft, after bone graft, and 2 years after restoration to compare and analyze change of alveolar bone width. Results: This study included 25 patients and 39 implants. Thirty eight implants (97.4 %) survived. As for postoperative complications, five patients showed minor infection symptoms, like swelling and tenderness after bone graft. The other one had buccal fenestration, and secondary bone graft was done by the same technique. No complications related with bone graft were found except in these patients. The mean crestal bone loss around the implants was 0.03 mm 1 year after restoration, and this was an adequate clinical prognosis. A patient took 3D-CT after bone graft, and the width of alveolar bone increased 4.32 mm added to 4.6 mm of former alveolar bone width. Two years after bone graft, the width of alveolar bone was 8.13 mm, and this suggested that the resorption rate of bone graft material was 18.29 % during 2 years. Conclusions: The bone graft material retained within a pouch formed using U-shaped incision and tunneling technique resulted with a few complications, and the prognosis of the implants placed above the alveolar bone was adequate.

• The Journal of Korean Academy of Prosthodontics
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• v.27 no.1
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• pp.181-192
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• 1989

Loss of teeth causes the inevitable reduction of residual ridge. Among the various methods solving this problem, hydroxyapatite proved to be useful for correction of ridge defect and irregularity. The purpose of this study is to evaluate the tissue responses of two types Of hydroxyapatites and resin polymer. Calcitite 2040 (Calcitek Inc.), Interpore 200 (Interpore Int.), and HTR polymer (HTR Sciences) were implanted into the jaw of an adult dog. The procedure was designed to obtain the results of 1 week, 2 week, 4 week, and 12 week-intervals. And after 12 weeks from the first operation day, the dog was sacrificed and evaluated histologically by light microscope. The results were as follows : 1. The mucosa was healed after two weeks. 2. After 1 week, there were acute inflammatory cells, but diminished after 2 weeks and were not seen after 12 weeks. 3. The hydroxyapatites implanted in soft tissues were surrounded by fibrous connective tissue. And some foreign body giant cells were found. 4. Calcitite and Interpore particles implanted subperiosteally were surrounded by newly formed bone after 12 months. And direct contact between bone and particles was noted. 5. The HTR particles implanted in soft tissues were encapsulated by fibrous connective tissues. The sample where the particles contacted directly to bone could not obtained by some probable insufficiencies of surgical technique or care of the animal. And the residue of HTR particles was digested by macrophage.