IMPLANT INFORMATION: Oral Bone

 
What … for? (Indications)
Implanted oral bone serves as reconstruction of the alveolar (jaw) bone to enable dental implants and/or dentures.		 dental implant bone 04 Bio-Oss
bone structure
Numbers
There are no specific numbers available. Suspected 25% of all dental implant procedures go with an augmentation procedure using bone substitutes.
Times
Healing, restructuring times are necessary, before implanted bone structure may be loaded. Usually it takes 3-6 month. In special circumstances shorter or longer healing times are possible.
Contraindication behavioral Systemic bone diseases, poor oral hygiene, smoking, parafunction, no aftercare possible.
   
medical Diabetes mellitus, infectious diseases, certain systemic/metabolism diseases, low ability for surgery.
 
pharmaceutical Biphosphonates, chemotherapy, drugs, alcohol, corticosteroids, immune suppression
 
Risks at surgery Tissue injury, swallowing/inhaling parts, bone fracture, injury or structures/nervs, ceasing of the surgery.
 
short term Inflammation, foreign body reactions, allergic reactions, rejection, wound opening with loss of implanted material and even more bone surrounding the infected area.
long term Slow degradation, dislocation, chronic inflammation, chronic pain, reoperation, implant loss.
Failures Risks depend from several preconditions like bone volume, material and reasons in connection with the above contraindications.
 
Materials autologous same individual core drilling blocks, resection, granules, transplantation
 
special techniques bone collected in cultures distraction osteogenesis
stem cell
isologous twin as donator
allogenic same species (human) granules
blocks
stem cell
xenogenous different species (bovine, porcine, equine) granules
blocks
bone morpho-genetic proteins
alloplastic anorganic tricalciumphophate (TCP)
  hydroxyapatite (HA)
  hybrid materials
Statistics No specific long-term data available
Nyström E et al.: Bone graft remodelling and implant success rate in the treatment of the severely resorbed maxilla: a 5-year longitudinal study. Int J Oral Maxillofac Surg. 2002 Apr;31(2):158-64

More than half of upper posterior implants had sinus lifting Seong WJ 2013
 
Literature – Basic Buser D et al.: Localized ridge augmentation with autografts and barrier membranes. Periodontol 2000. 1999;19:151-63
Esposito M et al.: The efficacy of various bone augmentation procedures for dental implants: a Cochrane systematic review of randomized controlled clinical trials. See comment in PubMed Commons belowInt J Oral Maxillofac Implants. 2006 Sep-Oct;21(5):696-710   

Seth J et al. : Bone Augmentation Materials : A Literature Review J Dent Fac Sci 2013, 2(3) : 1-6

Schwartz-Arad D et al. : Success of Dental Implants Placed in Intraoral Block Bone Grafts, Journal of Periodontology 78(1):18-21 · February 2007

Von ArxT, Buser D: Clin Oral Implants Res 2006; 17(4): 359-66
 
– Problems Pommer B et al.: To Graft or Not to Graft? Evidence-Based Guide to Decision Making in Oral Bone Graft Surgery, Bone Grafting (2012)
– Science/Future 3D-printed blocks, gentech
Medical Societies see here
Most implantologic societies also concern augmentation surrounding dental implants – see there. Very different worldwide dentists, oral surgeons and maxillofacial surgeons work together or not, having borderlines at very different levels or not, having borderlines at very different levels or even no borderlines. In some countries dentists do the whole job and in others here are dentists do the whole job and in others here are restrictions who´s got to do what. However, in more severe cases a trained surgeon might be helpful, who is found among oral surgeons and/or maxillofacial surgeons.
 
Criticism There are two opposite opinions: Bone may continue getting lost or bone will be stabilized through function, means dental implants in function. The latter may require all parameters to be ok, like orthofunction, general health, oral hygiene, dental prosthetics.
 
Selected Patient Information CTMAX: On bone grafting

Geistlich: On bone augmentation
Register for Patients n/a  Materials are marked comprehensible and should be comprehensible documented in an implant-passport.
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