Augmentation Stability of Guided Bone Regeneration for Peri-Implant Dehiscence Defects with L-shaped Porcine-Derived Block Bone Substitute
Abstract
:1. Introduction
2. Materials and Methods
2.1. Ethical Statements
2.2. Participants
- Presence of peri-implant buccal dehiscence defects (≥1 mm);
- Re-entry surgery within 4–6 months;
- Healthy or mild systemic diseases(American Society of Anesthesiologists physical status classification I/II);
- Good or acceptable oral hygiene(full-mouth bleeding score on probing and full-mouth plaque score < 25%).
- Implant surgery with GBR within 1 month after tooth extraction;
- Heavy smokers (≥10 cigarettes/day);
- Uncontrolled diabetes mellitus or bone metabolic diseases.
2.3. Surgical Procedure
2.4. Re-Entry Sugery
- L-shaped DPBM-C group: DPBM-C (Legograft®, Purgo Biologics, Seongnam, Korea), which was composed of a porcine-derived bone mineral matrix from cancellous bone and 10% atelocollagen from porcine tendon, was directly trimmed to an L-shape using a #15 blade. DPBM-C was manually adapted to the peri-implant dehiscence defect without using additional fixation devices (e.g., bone screws, pins, bone tack, or titanium mesh), and the defect was augmented to ≥1 mm of the buccal and occlusal aspects. The peri-implant dehiscence defect was augmented to ≥1 mm of the buccal and occlusal aspects. The L-shaped DPBM-C was covered with an absorbable native bilayer collagen membrane (NBCM, Geistlich Bio-Gide®, Geistlich Pharma AG, Wolhusen, Switzerland).
- L-shaped DBBM-C group: DBBM-C (Geistlich Bio-Oss® Collagen, Geistlich Pharma AG, Wolhusen, Switzerland) was appropriately trimmed to an L-shape and applied to the peri-implant dehiscence defect. DBBM-C was manually adapted to the peri-implant dehiscence defect without using additional fixation devices, and the defect was augmented to ≥1 mm of the buccal and occlusal aspects. The defects were augmented to achieve a ≥1 mm over-contour for both the buccal and occlusal aspects. Subsequently, the L-shaped DBBM-C was covered with the NBCM.
2.5. Radiograhic Analysis
2.6. Volumetric Analysis
2.7. Self-Reported Questionnaire and Clinical Analysis
2.8. Outcome Variables
- Primary outcome: To measure the horizontal thickness of the augmented hard tissue, lines perpendicular to the long axis of the fixture at its shoulder (HT0h) and 2 mm (HT2h) and 4 mm (HT4h) below it were drawn on the sagittal CBCT images.
- Secondary outcomes: (a) The vertical thickness (VT) of the augmented hard tissue following the long axis of the implant and the 45° vertical thickness (45-VT) at a 45° positive angle relative to the long axis of the fixture were measured on the sagittal CBCT images. (b) The horizontal thickness of the augmented volume was measured on the cross-sectional images of the STL products. The ROI was limited by the mid-point of the facial cementoenamel junction of the mesial and distal teeth and extended 4 mm apically. At the cross-section of the baseline, the lines parallel to the occlusal plane were drawn at the buccal crest (HT0s) and 2 mm (HT2s) and 4 mm (HT4s) below it. (c) Subjective postoperative discomfort and the early wound healing outcomes were assessed using a self-report questionnaire and based on the clinical evaluation during the suture removal. (d) The stability of the implants (PTVs) were measured during the re-entry surgery.
2.9. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Radiographic and Volumetric Outcomes
3.3. Postoperative Discomfort and Wound Healing Outcomes
3.4. Stability of the Dental Implants
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | L-shaped DPBM-C (n = 20) | L-shaped DBBM-C (n = 22) | Total (n = 42) | p Value |
---|---|---|---|---|
Sex | ||||
Male | 11 (55.0%) | 8 (36.4%) | 19 (45.2%) | 0.231 |
Female | 9 (45.0%) | 14 (63.6%) | 23 (54.8%) | |
Age | ||||
Mean ± SD | 58.9 ± 7.7 | 58.0 ± 13.6 | 58.4 ± 11.1 | 0.797 |
Smoking habits | ||||
Non-smoker | 12 (60.0%) | 13 (59.1%) | 25 (59.5%) | 0.756 |
Former smoker | 3 (15.0%) | 5 (22.7%) | 8 (19.0%) | |
Smoker (<10 cigarettes/day) | 5 (25.0%) | 4 (18.2%) | 9 (21.4%) | |
Diabetes mellitus | ||||
Yes | 6 (30.0%) | 5 (22.7%) | 11 (26.2%) | 0.596 |
Location | ||||
Maxillary anterior | 6 (30.0%) | 8 (36.4%) | 14 (33.3%) | 0.923 |
Maxillary posterior | 3 (15.0%) | 4 (18.2%) | 7 (16.7%) | |
Mandibular anterior | 7 (35.0%) | 7 (31.8%) | 14 (33.3%) | |
Mandibular posterior | 4 (20.0%) | 3 (13.6%) | 7 (16.7%) |
L-shaped DPBM-C (n = 20) | L-shaped DBBM-C (n = 22) | |||||
---|---|---|---|---|---|---|
T0–T1 | T0–T2 | p Value | T0–T1 | T0–T2 | p Value | |
Changes in hard tissue thickness (mm) | ||||||
HT0h | 2.46 ± 1.06 (2.60, (1.60, 3.25)) | 1.63 ± 0.87 (1.42, (0.92, 2.20)) | <0.001 | 2.50 ± 0.85 (2.33, (2.09, 2.98)) | 1.88 ± 0.85 (1.99, (1.21, 2.12)) | <0.001 |
HT2h | 2.19 ± 0.90 (2.20, (1.28, 2.85)) | 1.37 ± 0.75 (1.25, (0.70, 2.09)) | <0.001 | 2.35 ± 0.85 (2.38, (1.85, 2.90)) | 1.71 ± 0.86 (2.01, (0.98, 2.34)) | <0.001 |
HT4h | 2.21 ± 0.87 (2.20, (1.29, 2.85)) | 1.60 ± 0.74 (1.54, (1.04, 2.12)) | <0.001 | 2.58 ± 1.03 (2.61, (1.85, 3.01)) | 1.84 ± 0.94 (1.73, (1.12, 2.23)) | <0.001 |
VT | 2.28 ± 0.89 (2.38, (1.60, 2.95)) | 1.62 ± 0.91 (1.88, (0.69, 2.30)) | <0.001 | 2.57 ± 0.89 (2.20, (2.01, 3.01)) | 1.79 ± 0.70 (1.77, (1.47, 2.04)) | <0.001 |
45-VT | 2.34 ± 1.01 (2.30, (1.41, 2.95)) | 1.64 ± 0.97 (1.48, (0.72, 2.64)) | <0.001 | 2.57 ± 0.75 (2.53, (2.09, 2.98)) | 1.80 ± 0.76 (1.77, (1.19, 2.04)) | <0.001 |
Changes in volume (mm) | ||||||
HT0s | 3.97 ± 0.94 (4.12, (3.31, 4.50)) | 2.55 ± 0.98 (2.33, (2.03, 3.28)) | <0.001 | 4.22 ± 0.86 (4.21, (3.44, 4.63)) | 2.98 ± 0.91 (3.05, (2.30, 3.47)) | <0.001 |
HT2s | 4.03 ± 0.99 (4.12, (3.34, 4.50)) | 2.49 ± 1.11 (2.33, (1.83, 3.35)) | <0.001 | 4.32 ± 1.01 (4.28, (3.85, 5.02)) | 2.86 ± 0.97 (2.93, (2.33, 3.52)) | <0.001 |
HT4s | 4.17 ± 1.10 (4.17, (3.23, 4.90)) | 2.90 ± 1.11 (2.89, (2.15, 3.41)) | <0.001 | 4.28 ± 0.86 (4.17, (3.75, 4.83)) | 2.78 ± 0.97 (2.93, (2.20, 3.14)) | <0.001 |
Variables | L-shaped DPBM-C (n = 20) | L-shaped DBBM-C (n = 22) | p Value |
---|---|---|---|
Subjective pain | |||
Severity (VAS) a | 4.8 ± 1.5 | 4.5 ± 1.6 | 0.501 |
Duration (days) | 4.3 ± 2.5 | 4.9 ± 2.3 | 0.569 |
Subjective swelling | |||
Severity (VAS) a | 4.7 ± 2.0 | 4.2 ± 1.5 | 0.385 |
Duration (days) | 6.9 ± 2.5 | 5.5 ± 2.5 | 0.086 |
Wound dehiscence and membrane exposure | |||
No | 17 (85.0%) | 20 (90.9%) | 0.348 |
Yes | 3 (15.0%) | 2 (9.1%) |
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Lee, J.-H.; Jung, E.-H.; Jeong, S.-N. Augmentation Stability of Guided Bone Regeneration for Peri-Implant Dehiscence Defects with L-shaped Porcine-Derived Block Bone Substitute. Materials 2021, 14, 6580. https://doi.org/10.3390/ma14216580
Lee J-H, Jung E-H, Jeong S-N. Augmentation Stability of Guided Bone Regeneration for Peri-Implant Dehiscence Defects with L-shaped Porcine-Derived Block Bone Substitute. Materials. 2021; 14(21):6580. https://doi.org/10.3390/ma14216580
Chicago/Turabian StyleLee, Jae-Hong, Eun-Hee Jung, and Seong-Nyum Jeong. 2021. "Augmentation Stability of Guided Bone Regeneration for Peri-Implant Dehiscence Defects with L-shaped Porcine-Derived Block Bone Substitute" Materials 14, no. 21: 6580. https://doi.org/10.3390/ma14216580