Трехлетний результат латеральной аугментации с использованием аллогенных костных блоков перед имплантационной стоматологией

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1 Трехлетний результат латеральной аугментации с использованием аллогенных костных блоков перед имплантационной стоматологией Three year results of lateral augmentations using human allogen bone blocks before implant dentistry Доктор И. Счау, Виттен/Хердеке Университет, Германия, Центр Имплантологии Детмоль дпрофессор В.Д. Гримм, Ставрополь, Россия, Виттен/Хердеке Университет, Германия Wolf-D. Grimm University of Witten/Herdecke, Faculty of Health, Department of Dental Medicine, Periodontology UW/H 1 Praxisteam Hasslinghausen

2 2nd International Symposium Age of Regenerative Medicine Stavropol State Medical University, Russian Federation 3-year results of lateral augmentations using human allogenic bone blocks before dental implant placement Ingmar Schau Executive Chair: Prof. Dr. Wolf-D. Grimm

3 Background: allogenic bone blocks are an alternative grafting material, when autogenous bone is not available no donor-site surgery, no donor-site morbidity high availability BUT: evidence is still missing

4 scientific data in 2007 (n=82) Int J Periodontics Restorative Dent 2006;26:

5 scientific data in 2007 Case Reports: Leonetti et Koup 2003 (n=1) Lyford et al (n=5) Keith 2004 (n=1) Jacotti 2006 (technical note)

6 solution: prospective multi-center clinical and histologic study allogenic bone block grafting and subsequent implant placement / radiologic and clinical evaluation of IMPLANT SUCCESS 5 centers throughout Germany approved by the Ethics-Commission of the University of Münster / Germany

7 material:

8 Indication all kinds of gaps or edentulous jaws insufficient bone height, bone width or both prior to dental implant placement golden standard : allogenic block

9 Hypothesis allogenic bone block = non-vital material scenario 1: no tissue integration: graft failure, infection, fibrous regeneration scenario 2: incomplete integration: high resorption / chronical inflammation / periimplantitis scenario 3: high initial resorption: vascularisation / substitution / intact bone / physiological peri-implant bone loss 1 year / 3 years

10 time-table of the study t(-1): allogenic block augmentation t0: implant insertion after 4 months t1: prosthetic rehabilitation after 4 months t2-t3: clinical and radiological examinations after 12 and 36 months

11 examination parameters radiographs after implant placement (t0), loading (t1), 1 year (t2), 3 years (t3) clinical parameters after 1 year (t2) and 3 years (t3) foto documentation

12 clinical parameters probing depth bleeding on probing plaque index with of keratinized gingiva periotest-values peri-implant tissue

13 comparison with recent literature - success criteria for implants in general - peri-implant bone loss after different augmentation procedures

14 available scientific data 2015 NCBI PubMed search for Allogeneic+Bone+Block 25 hits in DENTAL JOURNALS 1 systematc review: Waasdorp et Reynolds further syst. Rev. after advanced search: Monje et al Araujo et al. 2013

15 Monje A, Pikos MA, Chan HL, Suarez F, Gargallo-Albiol J, Hernandez- Alfaro F, Galindo-Moreno P, Wang HL. On the Feasibility of Utilizing Allogeneic Bone Blocks for Atrophic Maxillary Augmentation. Biomed Res Int 2014; (Epub 2014 Sep 11) Review Article: 15 publications 361 allogeneic block grafts / follow-up 4 9 months / 2.4% failed mean bone gain: 4.79 mm 228 implants / mean follow-up 23.9 months 96.9% cumulative survival rate (95%CI: %)

16 peri-implant bone loss after allogenic bone block augmentation: no data available 3/2015

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21 missing histological specimen histological samples were not collected: weakening of implant bed lack of space risk of graft mobilization

22 missing histological specimen allogenic block graft implant insertion after 4 months

23 missing histological specimen multiple allogenic block augmentation implant insertion after 4 months

24 collected data for analysis: radiological and clinical data over 36 months identical surgeon identical implant system (MIS Seven) identical prosthodontist completion of follow-up period (36 months)

25 number of cases Test-group ( ) 14 patients 40 allogenic bone-blocks 60 implants control-group: ( ) 14 patients no augmentation / sufficient bone volume 53 implants

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27 computer-assisted measurement of radiologic bone loss t1 t2 t3 screen shots: Messung radiologischer Knochenabbau Zeitpunkte t1, t2, t3 Software: ImageJ 1.46r (NIH, Wayne Rasband)

28 computer-assisted measurement of radiologic bone loss Kalibrierung und metrisches Maß

29 computer-assisted measurement of radiologic bone loss

30 results: with reference to the single implant 2 primary outcomes: - 3 years after loading comparing groups - years 2+3 after loading comparing groups secondary outcomes: - 1 year after loading comparing groups - maxilla vs. mandible test-group number of implants suffering from pathologic bone loss

31 Statistics categorial data (age, gender): cross-table, percentages; exact test (Fisher) for comparison between groups continuous data (radiologic bone-loss, probing depth): medians / quartiles; boxplots; Wilcoxon-test for comparing groups level of significance: α=0.05/4=0.0125

32 Results socio-demografic data (gender)

33 Test-group Median 57 years (21-77) Control-group Median 49.5 years (29-70) p=0.403 Results sociodemografic data (age)

34 Results radiological bone-loss

35 Resultats clinical data

36 Summary and Conclusion» implants after allogenic block onlaygrafting suffer higher crestal bone loss than implants placed into native bone» peri-implant bone loss is within the physiological range of < 1mm after 12 months and <1.4mm after 36 months» median crestal bone loss was 0.35mm after 12 months and 0.72mm after 36 months 36

37 Summary and Conclusion» probing depth, plaque index and bleeding index show no significant differences between groups» width of keratinized tissue is significantly lower in the test-group 37

38 » clinical and radiological data suggest good graft incorporation, substitution and remodeling of newly formed bone» allogenic bone block onlay-graftig seems to be predictable and successful with regard to the long-term success of dental implants» further investigation has to be done, histological examinations must proof good graft incorporation 38

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40 allogenic monocortical bone block

41 3 allogenic bone blocks

42 allogenic bone block

43 allogenic bone block

44 Thank You for Your kind Attention! Ingmar Schau, Detmold, Germany 44