All ETDs from UAB

Advisory Committee Chair

Ramzi Abou-Arraj

Advisory Committee Members

Maninder Kaur

Nico Geurs

Amjad Javed

Maria Geisinger

Document Type

Thesis

Date of Award

2018

Degree Name by School

Master of Dentistry (MDent) School of Dentistry

Abstract

Ridge deficiency is an unfortunate obstacle that obviates the placement of dental implants or results in placing them at an angle that compromises the prosthetic restoration. An ideal volume is essential for implant placement in an optimal three-dimensional position. Several methods for augmenting the alveolar ridge in preparation for implant placement have been described. Autogenous bone grafts, considered to be the “gold standard”, are associated with significant morbidity and require a second surgical site. Guided bone regeneration (GBR), is an alternative technique that use bone-substitute materials as adjuncts to or replacements for autografts in bone augmentation procedures to overcome the limitations related to the use of autografts. Freeze-dried bone allograft (FDBA), of various particle sizes, is commonly used today and has shown success in augmenting deficient ridges. A graft material that promotes a high percentage of new vital bone is beneficial for implant placement and stability. The effect of particle size on the clinical and histological outcomes of lateral ridge augmentation (insufficient edentulous ridge width) has been scarcely studied or reported in the literature. This randomized clinical trial aims to clinically and histologically compare the amount and quality of the bone gained after lateral ridge augmentation procedures performed using small (250-1000μm) versus large (1000-2000μm) particle size cortico-cancellous bone allografts at 6 months following surgical intervention. Twenty-two patients, each presenting with ridge width less than 5mm received a lateral ridge augmentation. The patients were randomly allocated to small and large particle size graft. Trephine bone cores were taken from the 19 augmented sites out of 17 patients who completed the study, 6 months after augmentation for clinical, histologic and histomorphometric analysis. The gain in ridge width at the level of the crest and 4mm apical to the crest, was assessed before grafting and at time of implant placement, using a calibrated surgical caliper and coDiagnostiX software. Large particle size graft (large, 5.1 ± 1.7; small, 3.7 ± 1.3 mm graft size) resulted in greater ridge width gain at the level of the crest and also 4mm apical to the crest (large, 5.9 ± 2.2 small, 5.1 ± 1.8 mm graft size) compared with the small particle size graft. No statistical significance for both outcomes (p=0.0642), (p=0.4480) respectively. Bone samples from both the large and small particle size groups showed evidence of vital bone formation similar to that seen in previous studies, confirming the osteoconductivity of FDBA. Vital bone formation was more extensive in the small particle grafts compared with the large particle grafts ( 41.0 ± 10.1 % vs 31.4 ± 14.8 %, respectively. The most apical zone of the biopsy sample showed the highest percentage of vital bone in both groups. The clinical and radiographic results showed that large particles result in more gain ridge width than small particles FDBA. However no statistical significance found . The histologic results reaffirm the osteoconductive ability of FDBA when used as the sole grafting material in GBR procedures. The histomorphometric results at 6 months revealed an increase in vital bone formation when the small particle size was used. Additional studies should be performed to confirm these result

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