Incorporation and Remodeling of Bone Block Allografts in the Maxillary Reconstruction: A Randomized Clinical Trial

• Published in: Clinical implant dentistry and related research 2017-02, Vol.19 (1), p.180-194
• Main Authors: Deluiz, Daniel, Santos Oliveira, Luciano, Ramôa Pires, Fábio, Reiner, Teresita, Armada, Luciana, Nunes, Marcus A., Muniz Barretto Tinoco, Eduardo
• Format: Article
• Language: English
• Subjects: Adult; Aged; Allografts; Alveolar bone; Alveolar Bone Loss - pathology; Alveolar Bone Loss - surgery; alveolar ridge reconstruction; Atrophy; Augmentation; bone allograft, bone augmentation; bone grafting; Bone grafts; Bone remodeling; Bone Remodeling - physiology; Bone Resorption; Bone surgery; Bone Transplantation - methods; Clinical trials; Computed tomography; Cone-Beam Computed Tomography; Dehiscence; Dental Implantation, Endosseous - methods; Dental Prosthesis, Implant-Supported - methods; Dentistry; edentulous atrophic maxilla; Female; Grafting; Grafts; Healing; histological analysis; Humans; Imaging, Three-Dimensional; implant survival; Infections; Male; Maxilla; Maxilla - pathology; Maxilla - physiopathology; Maxilla - surgery; Middle Aged; Mouth, Edentulous - physiopathology; Mouth, Edentulous - surgery; Mucosa; Osseointegration - physiology; Osteocytes - pathology; Patients; Perforation; Placement; randomized controlled trial; Reentry; Sinus Floor Augmentation - methods; Surgery; Surgical implants; Survival; Tibia; Time Factors; Transplants & implants
• ISSN: 1523-0899; 1708-8208
• DOI: 10.1111/cid.12441

Background Severe alveolar atrophy often presents a challenge for the implant surgery. The significant lack of bone in the alveolar ridges may compromise the final restorations both from the aesthetic and functional standpoints. Objectives To evaluate the behavior of bone block allografts for the maxillary augmentation and to investigate its incorporation, remodeling, and implant survival rates in two different healing time points. Material and Methods Sixty‐six consecutive patients (52 female/14 male, mean age: 57.95 ± 9.06 years old), presenting 113 atrophic alveolar ridges underwent maxillary augmentation with fresh‐frozen allogeneic bone blocks from tibia. Patients were randomly assigned in two groups: Group 1—patients who would wait 4 months for implant placement after grafting, and Group 2—patients who would wait 6 months. Events of infection, suture dehiscence or mucosal perforation were recorded. Cone‐beam computed tomography scans were compared volumetrically between the time of the grafting surgery and reentry procedure after incorporation. Biopsies were collected and subjected to histological, histomorphometric and immunehistochemical analysis. Results A total of 305 implants were placed in the reconstructed sites. The mean resorption rate in Group 1 (13.98% ± 5.59) was significantly lower than Group 2 (31.52% ± 6.31). The amount of calcified tissue, newly formed bone and remaining graft particles demonstrated no difference between groups. The samples showed evident immunolabeling for the podoplanin protein in both groups. The implants cumulative survival rate was 94.76%. Conclusions The findings of the present study indicate that there is a significant difference regarding the resorption of the grafts when waiting 4 or 6 months before placing the implants, even though no difference was found in the histological, histomorphometric, and immunohistochemical features. Both 4‐month and 6‐months healing times are suitable for the implant placement.