Barbell Technique: A Novel Approach for Bidirectional Bone Augmentation: Clinical and Tomographic Study
Horizontal bone augmentation is a common surgical procedure used in implant therapy to achieve adequate bone volume to permit dental implant placement. However, most current techniques are focused on unidirectional bone reconstruction (grafting only on the buccal side). This study was carried out to validate a new device that will permit bidirectional bone augmentation. Ten patients of both sexes (7 women and 3 men), with ages ranging from 29 to 62 years, who needed a bidirectional horizontal bone augmentation in maxilla were separated in accordance with the horizontal alveolar change (HAC) classification published by Pelegrine et al (2018). The patients classified as HAC 3 (ie, containing remaining cancellous bone at the recipient bed) received the Barbell device with xenogeneic biomaterial and a collagen membrane, whereas HAC 4 patients (ie, with no remaining cancellous bone at the recipient bed) received the Barbell device with a mixture of autogenous bone chips and xenogeneic biomaterial covered by a collagen membrane. For each patient, two computerized tomography scans were performed (T0 at baseline and T1 at 6 months postoperative examinations). Mean bone thickness (T0) in the studied sites were 3.25 ± 0.35 in HAC 3 and 1.98 ± 0.5 in HAC 4 patients. The mean bone thickness achieved after 6 months was 7.70 ± 0.89 mm and 8.62 ± 0.89 in HAC 3 and 4, respectively. All grafted sites were able to receive dental implants in adequate prosthetic positions. Based on these results, the use of this novel device permits bidirectional horizontal bone augmentation.

CT scan of a HAC 4 clinical situation (no cancellous bone) at baseline. Note the lack of bone thickness to allow implant placement. CT indicates computerized tomography; HAC, horizontal alveolar change.

(a) Titanium Barbell screw and PEEK capsules. (b) Barbell Technique surgical kit. PEEK indicates polyether ether ketone.

Barbell Technique: sequence of screw insertion, PEEK caps installation, and bone graft material.

Recipient bed after cortical perforations and Barbell titanium screw fixation.

Mixture of autogenous bone and xenogeneic biomaterial used in HAC 4 clinical cases.

Barbell screw installed and PEEK capsules fixed in accordance with needs for bone gain.

Bone graft (mixture of autogenous and xenogeneic biomaterial) covering the bone defect in buccal and palatal sides.

Hydrophilic collagen membrane covering the bone graft.

CT scan after 6 months showing the outcomes of bone augmentation with Blue Sky Bio software.

Clinical aspect of bone augmentation in a bidirectional manner after 6 months.

Indicator pins of the implant positions in accordance with the prosthetic guide.
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