Vertical Ridge Augmentation Using Deproteinized Bovine Bone Material Without Covering With a Membrane: A Tunnel Pouch Technique—4-Year Follow-up—A Pilot Clinical Study
The present pilot clinical trial was planned to evaluate the effect of particulate deproteinized bovine bone graft mixed with blood used as a vertical ridge augmentation material without covering with any form of collagen membrane in a tunnel pouch technique, resulting in sufficient bone formation to allow placement of dental implants with maintenance of the newly formed bone after final restoration. Eight patients (3 males and 5 females) were selected for this procedure and treated between February 2016 and December 2017. All these patients had a deficient vertical height of the posterior mandibular alveolar bone above the inferior alveolar canal. The particulate deproteinized organic bovine bone graft (Bio-Oss) mixed with blood was placed through the tunnel in the defected area and compacted firmly to form a dense pack. The average gain of alveolar bone in the first implant site immediately postoperative was 13.51 ± 0.85 and in the second implant site was 13.84 ± 0.62. Histomorphometric analysis showed that about 70.31% of the area analyzed was occupied by the vital bone, the newly formed bone, whereas only 29.69% of the residual graft remained. In the present pilot study, the deproteinized bovine bone graft placed to enhance vertical and horizontal bone gain showed positive results in regaining the bone needed to place implants and maintaining the bone around restored implants for 4 years of follow-up.
Buccal incision for the tunnel pouch technique for insertion of the bone graft.
Preclinical and postclinical picture (AE), orthopantomogram image (BF), cross-section of the alveolar bone with and without bone graft (CH), and 3D constructed image of the nongrafted and grafted region of the posterior mandible (DI).
Cone beam computerized tomography cross-section images of a particular region, pregrafted (A1), grafted (B1), and grafted sight after 4 months (C1) with the amount of bone gain vertically and horizontally.
Postimplant placement clinical picture, orthopantomogram image, cross-section of the alveolar bone with and without bone graft and 3D constructed image of the nongrafted and grafted region of the posterior mandible.
Postimplant placement after 4 years clinical picture orthopantomogram image and intraoral periapical radiograph showing the measurement of marginal bone loss.
Periapical radiograph showing baseline, after loading, 1-year follow up, and 4-year follow up.
Orthopantomogram (OPG) showing implants placed and loaded after 9 months of grafting and OPG showing 4 years of follow-up.
Photomicrograph shows close association of the newly formed bone and the grafted bone.
Photomicrograph shows new bone forming in the vicinity of the grafted bone with osteoblasts noted lining the new bone.
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