Skip to main content
PMC home page
Acta Stomatologica Croatica logoLink to Acta Stomatologica Croatica
. 2021 Dec;55(4):406–417. doi: 10.15644/asc55/4/8

Volumetric Changes of a Customized Allogeneic Bone Block Measured by Two Image Matching Tools: Introduction of a Novel Assessment Technique for Graft Resorption

Oliver Blume 1, Phil Donkiewicz 2,✉, Daniel Palkovics 4, Werner Götz 3, Péter Windisch 4
PMCID: PMC8734454  PMID: 35001936

Abstract

Objective

The purpose of this case report was to present a method for the assessment of volumetric changes of bone blocks during healing and demonstrate its practicability by analysing the resorption of a pre-shaped allogeneic bone block used for the reconstruction of a complex maxillary defect.

Materials and methods

CBCT-scans of a 19-year-old male treated with an allogeneic bone block were recorded pre-OP, post-OP, and following six months of healing. Graft shrinkage was assessed via two image matching tools, namely coDiagnostiX® and Slicer. A biopsy specimen was harvested along the implant canal at the time of implantation.

Results

The osseous defect was successfully restored and advanced graft remodelling was found upon re-entry as confirmed by the histomorphometric and histologic analysis. The initial volumes of the graft determined via coDiagnostiX® and Slicer were 0.373 mL and 0.370 mL., respectively, while graft resorption after six months of healing was 0.011 mL (3.00%) and 0.016 mL (4.33%).

Conclusions

The avoidance of bone harvesting and reduction of invasiveness display an important issue in dentoalveolar restorations. However, before grafting materials can be considered a safe alternative, understanding their clinical performance, especially resorption stability, is pivotal. The present case report demonstrates a limited resorption of the allogeneic bone block and further emphasizes the practicability of determining bone resorption by the here introduced method. As our investigation comprises solely one subject, the results should be considered with care and substantiated by further studies.

Key words: Allogeneic Bone Graft, Allograft, Bone Block, Graft Resorption, Biomaterials, Bone Grafting, Freeze-dried Bone Allograft (FDBA)

Keywords: MeSH terms: Bone Transplantation, Allografts, Bone Substitutes

Introduction

Dental implants are an integral part of modern dentistry and represent the benchmark regarding esthetics, and consequently patient satisfaction (1, 2). Since edentulism, which may occur due to traumata or disease, severely affects the jaw’s morphology by causing ongoing bone resorption, various techniques and materials have been added to the surgeon’s portfolio for the regeneration of the alveolar crest (3-6). The authors of an analysis of 10158 implants who found a grafting frequency of 58.2% emphasized the important role of bone grafting in modern dentistry (7).

While contained and minor bone defects are predictably restorable with a broad selection of bone substitute materials, extensive defects require additional means for graft stabilization, which may either be maintained by barrier membranes, titanium meshes, bone shells or solid bone blocks (8-10). Complex augmentations within the esthetic zone are especially challenging since high long-term volume stability of the grafting material is required to ensure an esthetic appearance. While autogenous bone grafts are considered the gold standard in bone grafting, several authors have reported similar rates in bone gain, especially regarding horizontal dimensions grafting success and implant survival for allogeneic bone blocks (11-15). Several studies have demonstrated that patients prefer surgery with lower invasiveness, had lower acceptance for extra- as compared to intraoral bone harvesting, and were more willing to undergo a secondary bone augmentation with allogeneic than with autogenous bone blocks (16, 17). Additionally, the authors demonstrated comparable success rates and pink esthetic scores for both treatment groups (18). These encouraging findings have led to a greater acceptance of allogeneic bone grafts in oral surgery regarding both surgeons and patients (19, 20).

Allografts are categorized into fresh-frozen bone (FFBA), freeze–dried bone (FDBA) and demineralized freeze–dried bone allografts (DFDBA), (21). FDBA and DFDBA are considered a safe alternative to autogenous bone grafts, whereas immunization and disease transmission associated with the application of FFBA has previously been reported (22-24). In this context, a literature review carried out by the World Health Organization found no reports of disease transmission associated with wet-chemically processed allografts, and also no reports of disease transmission associated with FFBA after the introduction of nucleic-acid testing (25). Various authors have demonstrated low graft resorption acompanied by high grafting success and implant survival rates (26-29).

The computer-aided design/ computer-aided manufacturing (CAD/ CAM) technology has enabled the manufacturing of individualized dental materials such as polymethyl methacrylate or allogenic bone blocks via cone beam computed tomography (CBCT) datasets (30-32). A bone mortiser is then used to mill the bone in accordance with the digital design, so that the block matches the defect’s morphology precisely. The accuracy of this manufacturing process renders manual adjustments of bone blocks largely unnecessary, and consequently lowers the risk of complications and graft contamination (19, 33). In addition, the customization process minimizes the space between the allogeneic block graft and the host bone which promotes trophic support and graft vascularization (20, 34, 35).

Previous authors have reported bone resorption of 3.9 ± 5.6% and 4.2 ± 5.5% for manually adapted monocortical autogenous and allogeneic bone blocks, respectively. In these studies, dimensional changes were assessed by geometrical measurements (36). Nevertheless, limited literature is available on the initial resorption and remodeling capacity of allogenic bone blocks. The purpose of this case report was to present a two-factor method for digitally assessing the volumetric changes of bone grafts during graft consolidation as demonstrated by a customized allogeneic bone block, which was applied for the augmentation of a complex osseous defect in the maxillary esthetic zone.

Case Presentation and Surgical Procedure

A 19–year–old male suffering from Hirschsprung’s disease (HSCR) and attention deficit hyperactivity disorder (ADHD) presented with the desire for a fixed prosthetic rehabilitation of the congenitally missing permanent tooth #7 (ADA Dental Terminology 2011–2012) in the maxillary esthetic zone (Figure 1 A). During the clinical and radiographic examination of the jaw, an extensive bone deficit was identified in the edentulous area which required bone augmentation prior to implantation. The patient was a non-smoker with healthy soft tissue and good oral hygiene so that the overall health status did not contraindicate alveolar bone grafting. As the patient opposed intraoral bone harvesting, a CAD/CAM manufactured bone block (maxgraft bonebuilder®, botiss biomaterials GmbH, Zossen, Germany) made of cancellous freeze-dried bone allograft was applied (Figure 1 B, C). The graft was obtained from femoral heads of living donors who underwent arthroplastic surgery. Prior to treatment, the patient gave his informed consent for the inclusion into scientific publications.

Figure 1.

Figure 1

Open in a new tab

Initial defect situation and digital planning of the allogeneic bone block. Clinical demonstration of the area of missing tooth #7 (A). Digital planning of the implant and crown position (B) and the allogeneic bone block (C). Dashed black line indicated the incision line.

The bone augmentation procedure was conducted under general anesthesia upon the patient's request. Prior to bone augmentation, platelet–rich plasma (PRP) matrices were generated from the patient's blood and 600 mg of Clindamycin were intravenously administered for antibiotic prophylaxis (37). An incision design recently introduced by our group termed the "semi-pillar incision" was applied to enter the defect site (35, 38). Instead of a mid-crestal position, the horizontal incision was placed about 20 mm to the buccal site within the flexible mucosa and only one vertical releasing incision was added at the distal end of the horizontal incision line. Subsequently, the vestibular mucosal flap was carefully mobilized, and the periosteum was elevated from the maxillary bone so that the keratinized mucosa above the defect remained undamaged (Figure 2 A). This approach facilitates tension-free covering of grafts with extensive volumes and, consequently lowers the risk of wound dehiscences and associated complications.

Figure 2.

Figure 2

Open in a new tab

Conduct of the surgical intervention. Defect projection using the semi-pillar incision design (A). Sterile FDBA block hydrated with saline solution (B). Bone block mounted onto the alveolar ridge by a fixation screw (C). PRP matrix covering the bone graft (D). Saliva-tight and tension-free wound closure (E).

Before the insertion of the allogeneic bone block, the cortical layer of the recipient site was perforated multiple times by means of a diamond burr to induce bleeding and enhance graft vascularization (34). The block was hydrated in exudate serum which was obtained during production of the PRP matrices (Figure 2 B). Since the block matched the defect’s geometry exactly, no additional adjustments were required. Additionally, due to the optimal fit of the block within the recipient site, a single 9 mm titanium osteosynthesis screw with a diameter of 1.5 mm was sufficient for graft fixation (Figure 2 C). For the prevention of pressure exerted by the screw-head and the concomitant graft resorption, a countersink for the screw head was created. Due to a pronounced over-contouring, which was planned intentionally though, a thin layer on the vestibular site of the block was abraded and then covered with a resorbable collagen membrane made of porcine pericardium (Jason® membrane, botiss biomaterials GmbH, Zossen, Germany), which was fixated with titanium pins. Finally, a PRP matrix was positioned over the grafting site with the intention of enhancing soft tissue healing (Figure 2 D). The flap was sutured saliva-tight and tension-free by single button pulley seams with absorbable 4.0 suture material (Figure 2 E).

Since the healing process was uneventful, the sutures were removed 14 days after surgery. Six months later (Figure 3 A), the re–entry was carried out under general anesthesia and oral antibiotic prophylaxis with 2000 mg amoxicillin was applied by the same surgeon. This time, a crestal incision was placed to access the augmented site (Figure 3 B). Following the removal of the fixation screw, a drilling mark was created with the help of a surgical drilling guide (Figure 3 C), which was also used to aid harvesting a cylindrical bone core biopsy by means of a trephine drill (diameter: 3.0 mm, Fig. 3 D) and for guidance of the subsequent implant drills with a diameter of 3.4 mm and 3.8 mm. Finally, a dental implant (Xive, Dentsply Sirona, Bensheim, Deutschland) with a diameter of 3.8 mm and length of 11 mm was inserted in position #7 with a torque of 45 N·cm (Figure 3 E). The surgical site was closed by single button pulley sutures with an absorbable 6.0 suture material, which was removed one week later. A panoramic radiograph was recorded after implantation to examine the implant position (Figure 3 G), and again after three months at the time of implant uncovering, whereby the final prosthetic restoration was inserted four months later (Figure 3 H). The patient received a provisional crown during the implant’s healing course.

Figure 3.

Figure 3

Open in a new tab

Re-entry and implantation procedure: Clinical situation after six months with view onto the alveolar ridge (A). Projection of the implantation site via a mid-crestal incision line (B). Drilling mark with a surgical drilling guide (C). Specimen extraction for histological and histomorphometrical analysis (D). Implantation (E) and final situation before suturing (F). Orthopantogram to control implant position (G). Final prosthetic restauration (H).

CBCT scans (KaVo 3D eXam, KaVo Dental, Biberach an der Riß, Germany; voxel size: 0.3 mm; field of view: 16.5 cm (diameter) x 13.50 cm (max. hight); tube voltage: 120 kV; tube current: 3–7 mA were recorded at three different time points; before the augmentation procedure, a baseline scan (#1) was conducted to assess the initial defect morphology for the virtual planning and customization of the bone block (Figure 3). A second scan (#2) was recorded immediately after bone augmentation to control for correct positioning of the bone block, and a third scan (#3) was done after six months to assess the vertical and horizontal hard tissue dimensions at the surgical site prior to implantation, and to examine the volume stability of the allogeneic bone block. For determination of the graft shrinkage during the healing course of six months, two different imaging tools for image matching were applied (coDiagnostiX®, Version 10.2.0.15659, Dental Wings Inc., Montreal, Canada; Slicer, open source software platform, https://www.slicer.org).

While alignment of scans in coDiagnostiX® was performed via manually selected reference points. The Slicer uses an intensity–based medical image registration algorithm (Elastix®, PerkLab, Queens University, Kingston, Canada) for this purpose. To calculate the block volumes, the coDiagnostiX® superimposed the aligned virtual models created from CBCT scans and measured the difference (Figure 4), whereas the Slicer automatically computed the entire volume of the virtual models (cm3) and subtracted them (Figure 5). With this method the software was able to calculate the initial block volume V1 by superimposing the #1 and #2 CBCT scan and the final block volume V2 by superimposing scans #1 and #3. Subsequently, the graft resorption was calculated by subtracting V2 from V1. To test the robustness of both imaging analyses and assess intra-and inter-investigator as well as inter-software variance, three investigators (OB, DP, KM) performed the measurements independently for three individual times. The results obtained by the individual investigators and software are shown below (Table. 1-3).

Figure 4.

Figure 4

Open in a new tab

Resorption analysis with coDiagnostiX®. Three-dimensional superimposition of the blocks from CBCT scans #2 (green) and #3 (A). Sagittal two-dimensional superimposition of all three CBCT scans #1 (blue line), #2 (green line) and #3 (red line). The red plane demonstrates the area of the block between the blue line (CBCT scan #1) and the red line (CBCT scan #3) (B). Axial two-dimensional superimposition of all three CBCT scans: #1 (blue line), #2 (green line), and #3 (red line) (C).

Figure 5.

Figure 5

Open in a new tab

Resorption analysis with Slicer: Axial two-dimensional superimposition of all three CBCT scans, #1 (yellow line), #2 (red line) and #3 (beige line) (A). Sagittal two-dimensional superimposition of all three CBCT scans: #1 (yellow line), #2 (red line) and #3 (beige line) (B). Three-dimensional superimposition of the blocks from CBCT scan #2 (red) and #3 (green) (C).

The mean volume of the allogeneic bone block immediately after insertion (V1) assessed by CoDiagnostiX®, and Slicer was 0.373 ± 0.00002 mL and 0.370± 0.00006 cm3 (Table 1), respectively, which decreased to 0.362 ± 0.00006 mL and 0.354 ± 0.00008 cm3 (Table 2) during the six months of healing (V2). The absolute volume loss assessed by the two imaging tools was 0.011 ± 0.00008 mL and 0.016 ± 0.00012 cm3, which corresponds to 3.00 ± 0.02% graft resorption assessed by the CoDiagnostiX® and 4.33 ± 0.03% quantified with the Slicer software (Table 3).

Table 1. Volume of the allogeneic bone block (mL/cm3) after insertion. Numbers (#1-3) indicate repetitive measurements by the respective investigator.

coDiagnostiX
Investigator #1 #2 #3 Mean SD
OB* 0.37342 0.37345 0.37341 0.37343 0.00001
DP* 0.37367 0.37362 0.37366 0.37365 0.00002
KM* 0.37325 0.37330 0.37323 0.37326 0.00003
0.37345 0.00002
Slicer
Investigator #1 #2 #3 Mean SD
OB* 0.37065 0.37051 0.37063 0.37060 0.00005
DP* 0.37031 0.37046 0.37044 0.37040 0.00006
KM* 0.36985 0.37001 0.36992 0.36993 0.00006
0.37031 0.00006
Open in a new tab

*investigator initials

Table 2. Volume of the allogeneic bone block (mL/cm3) following six months of healing. Numbers (#1-3) indicate repetitive measurements by the respective investigator.

coDiagnostiX
Investigator #1 #2 #3 Mean SD
OB* 0.36239 0.36241 0.36252 0.36244 0.00005
DP* 0.36196 0.36205 0.36192 0.36198 0.00005
KM* 0.36218 0.36231 0.36244 0.36231 0.00009
0.36224 0.00006
Slicer
Investigator #1 #2 #3 Mean SD
OB* 0.35416 0.35427 0.35409 0.35417 0.00006
DP* 0.35401 0.35374 0.35411 0.35395 0.00014
KM* 0.35473 0.35462 0.35466 0.35467 0.00004
0.35427 0.00008
Open in a new tab

Table 3. Volume loss of the bone block (mL/cm3 and %) during six month healing course. Numbers (#1-3) indicate repetitive measurements by the respective investigator.

coDiagnostiX
Investigator #1 #2 #3 Mean SD
OB* 0.01103
(2.95%)		 0.01104
(2.96%)		 0.01089
(2.92%)		 0.01099
(2.94%)		 0.00006
(0.02%)
DP* 0.01171
(3.13%)		 0.01157
(3.10%)		 0.01174
(3.14%)		 0.01167
(3.12%)		 0.00006
(0.02%)
KM* 0.01107
(2.97%)		 0.01099
(2.94%)		 0.01079
(2.89%)		 0.01095
(2.93%)		 0.00010
(0.03%)
0.01120
(3.00%) 		0.00008
(0.02%)
Slicer
Investigator #1 #2 #3 Mean SD
OB* 0.01649
(4.45%)		 0.01624
(4.38%)		 0.01654
(4.46%)		 0.01642
(4.43%)		 0.00011
(0.03%)
DP* 0.01630
(4.40%)		 0.01672
(4.51%)		 0.01633
(4.41%)		 0.01645
(4.44%)		 0.00017
(0.04%)
KM* 0.01512
(4.09%)		 0.01539
(4.16%)		 0.01526
(4.13%)		 0.01526
(4.12%)		 0.00010
(0.03%)
0.01604
(4.33%) 		0.00012
(0.03%)
Open in a new tab

The biopsy specimen was fixated in 4% neutral buffered formalin for 24 hours, decalcified in 10% Tris-buffered EDTA at 37°C for 15 days and then treated with solutions of ethanol in ascending concentration followed by a solution containing xylol. After embedding of the biopsies in paraffin, a microtone was used for cutting sections with a thickness of 3-5 µm. Slides were processed by means of hematoxylin-eosin stain for histological analysis. The histological examination included an analysis of the following parameters: graft integration, fibrosis, hemorrhage, necrosis, vascularization and the presence of lymphocytes, macrophages, osteoclasts, osteoblasts, and osteocytes. Randomly chosen light-microscopic images of defined size were captured from four sections of the specimen (original magnification x10, microscope: Axioskope 2, Carl Zeiss, Germany; camera: AxioCam MRC, Carl Zeiss). In each image, the areas of newly formed bone, residual bone grafting material, and soft tissue were analyzed and calculated as function of the total tissue using the AxioVision digital image processing software (Carl Zeiss). Area measurements were performed by two investigators and processed automatically by the software after defining the respective thresholds. Mean values of relative amounts were calculated.

The histological analysis revealed the following findings (Figure 6): The framework of the cancellous allogeneic bone block with trabeculae of varying thickness of lamellar bone with empty osteocyte lacunae and anchoring peri-trabecular ossification with varying width of woven bone, which exhibited occasional (crestal) remodeling processes into lamellar bone, were observed. Furthermore, transverse trabeculae of newly formed bone covered by tight connective tissue (propria) with loose infiltrates and allogenic bone fragments along with fragmented multi–layered squamous epithelium, partly adherent to the bone fragments, were identifiable at the crestal site of the specimen. The histomorphometric analysis demonstrated that the specimen was composed of 41, 5%, 29, 3 and 29, 2% newly formed bone, soft tissue, and residual grafting material, respectively.

Figure 6.

Figure 6

Open in a new tab

Histological analysis. Overview of the histological section (left = apical, right = crestal) (A). Active remodeling and osteogenesis identifiable by newly formed bone trabecula (star), osteoblasts (circle), osteoclasts (open arrow) and transition zone between allogenic block and newly formed bone (arrows) (B, C).

Discussion

The present case emphasizes the feasibility of successfully rehabilitating extensive bone defects in the maxillary esthetic zone by means of customized allogeneic bone blocks. The assessment of the volumetric changes of the block during healing was easily conductible with both imaging tools. Although the initial graft volume calculated via Slicer was lower and the absolute resorption was increased as compared to the respective values obtained via coDiagnostiX®, the calculated resorption of 3.00 ± 0.02% (coDiagnostiX®) and 4.33 ± 0.03% (Slicer) was within a comparable range. However, a bigger cohort with more blocks requires assessment via this method in order to precisely evaluate a potential inter-software measuring bias. The mean resorption of 3.67 ± 0.03%, which we found during the six months, is slightly below compared with those reported for manually adapted cancellous FDBA blocks by another study (36). A slightly lower resorption observed in this case may have resulted from the optimal fit of the block which enhanced the contact between the graft and the host bone, but also from the defect geometry, which provided a cavity for the block to be positioned in (20).

Both imaging tools indicated that the volume loss occurred on the labial side, whereas the block remained stable in vertical dimensions. While the defect’s geometry supported the vertical stability of the graft, leaving the periosteum on the crestal site undamaged, the application of the semi-pillar incision may have further reduced vertical resorption (39, 40). Although the evidence on the beneficial effects of barrier membranes in counteracting graft resorption remains elusive, a previous randomized controlled trial reported significantly lower bone resorption for cortico-cancellous allogeneic bone granules covered by a collagen membrane as compared to augmentation sites left uncovered (41-48). Consequently, the application of a barrier membrane is likely to have contributed to the low graft resorption we observed. The greatest tension, and hence pressure is located on the labial site of the graft, which also holds the greatest distance from the host bone, so that especially this area is at risk to be subjected to resorption before remodeling is completed (41, 42).

One concern associated with allogeneic bone blocks is the occurrence of complications including wound dehiscences and subsequent graft exposure. This primarily affects vertical bone augmentations since a previous study carried out with CAD/CAM manufactured allogeneic bone blocks reported widely unfavorable results (43). However, the risk of exposure is not specifically associated with the allogeneic bone graft, but rather with improper soft-tissue management. In a study analyzing complications in 137 cancellous allogeneic bone grafts, Chaushu and others have found high frequency of complications, which was not associated with the bone graft itself but rather with the soft tissue situation and management (46). Additionally, the manual adjustment of bone blocks displays a certain potential for graft contamination from oral fluids, surgical instruments, the surgeon's gloves and other external factors (33). The combination of CAD/CAM milled bone blocks with the semi-pillar incision in the flexible mucosa lowers both the risk of graft contamination and wound dehiscence while also reducing the surgical time by avoiding bone harvesting and adaptation.

The histological analysis demonstrated the active remodeling and integration process of the allogeneic bone block, which was supported by the histomorphometric evaluation. We found an advanced osteogenesis within the allogenic bone matrix, whereby crestal mucosal remnants on the basal edge were accompanied by moderate signs of immunologic cell infiltration, and hence inflammation. As a previous study demonstrated that graft turnover and new bone formation associated with cancellous allogeneic bone blocks in the anterior maxilla of patients aged 39 and below was increased as compared to older patients, the young age of the included patient may have contributed to our favorable results (47, 48). Additionally, with a mean of 38.6% of new bone found in specimens harvested from the anterior maxilla, the results obtained by the authors of that study were similar to ours.

Conclusions

Overall, our preliminary results demonstrate low resorption with advanced graft turnover and hence, the successful restoration of an extensive maxillary bone defect with an allogeneic bone block, which demonstrates the advantages of the customization process and emphasizes the feasibility of reliable volume quantification and assessment of bone resorption via the two applied imaging tools. Nevertheless, the validity of these findings is limited, as only one subject was included in the present report. Hence, further controlled studies with a much larger sample size are required to corroborate these promising initial results.

Acknowledgments:

We would like to thank Daniel Palkovics, Branko Trajkovski and Bálint Molná for aiding the writing and editing process. Furthermore, we would like to thank Goran Nikoloski for the virtual design of the allogeneic bone block.

Footnotes

Conflict of interest

Phil Donkiewicz is currently employed as a Key Account Manager for the Straumann Group and simultaneously enrolled as a doctoral student at the Witten/Herdecke University. We received no financial support and no free materials from Straumann or any other company for this study. All surgical procedures were conducted within the regular practice plan. We confirm that the associations with the Straumann group had no impact on the here demonstrated results.

References

  • 1.Ellis JS, Pelekis ND, Thomason JM. Conventional rehabilitation of edentulous patients: the impact on oral health-related quality of life and patient satisfaction. J Prosthodont. 2007. January-February;16(1):37–42. 10.1111/j.1532-849X.2006.00152.x [DOI] [PubMed] [Google Scholar]
  • 2.Gerritsen AE, Allen PF, Witter DJ, et al. Tooth loss and oral health-related quality of life: a systematic review and meta-analysis. Health Qual Life Outcomes. 2010. November 5;8:126. 10.1186/1477-7525-8-126 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Cawood JI, Howell RA. A classification of the edentulous jaws. Int J Oral Maxillofac Surg. 1988. August;17(4):232–6. 10.1016/S0901-5027(88)80047-X [DOI] [PubMed] [Google Scholar]
  • 4.Karaagaçlioglu L, Ozkan P. Changes in mandibular ridge height in relation to aging and length of edentulism period. Int J Prosthodont. 1994;7(4) [PubMed] [Google Scholar]
  • 5.Buser D, Dahlin C, Schenk RK. Guided bone regeneration. Chicago Quintessence; 1994. [Google Scholar]
  • 6.Boyne PJ. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg. 1980;38:613–6. [PubMed] [Google Scholar]
  • 7.Knöfler W, Barth T, Graul R, Krampe D. Retrospective analysis of 10,000 implants from insertion up to 20 years-analysis of implantations using augmentative procedures. Int J Implant Dent. 2016. December;2(1):25. 10.1186/s40729-016-0061-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Roccuzzo M, Ramieri G, Spada MC, et al. Vertical alveolar ridge augmentation by means of a titanium mesh and autogenous bone grafts. Clin Oral Implants Res. 2004. February;15(1):73–81. 10.1111/j.1600-0501.2004.00998.x [DOI] [PubMed] [Google Scholar]
  • 9.Cha H-S, Kim J-W, Hwang J-H, Ahn K-M. Frequency of bone graft in implant surgery. Maxillofac Plast Reconstr Surg. 2016. March 31;38(1):19. 10.1186/s40902-016-0064-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Pereira E, Messias A, Dias R, et al. Horizontal Resorption of Fresh-Frozen Corticocancellous Bone Blocks in the Reconstruction of the Atrophic Maxilla at 5 Months. Clin Implant Dent Relat Res. 2015 Oct;17 Suppl 2(Suppl 2):e444-58. [DOI] [PMC free article] [PubMed]
  • 11.Sakkas A, Wilde F, Heufelder M, et al. Autogenous bone grafts in oral implantology—is it still a “gold standard”? A consecutive review of 279 patients with 456 clinical procedures. Int J Implant Dent. 2017. December;3(1):23. 10.1186/s40729-017-0084-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Troeltzsch M, Troeltzsch M, Kauffmann P, et al. Clinical efficacy of grafting materials in alveolar ridge augmentation: A systematic review. J Craniomaxillofac Surg. 2016. October;44(10):1618–29. 10.1016/j.jcms.2016.07.028 [DOI] [PubMed] [Google Scholar]
  • 13.Starch-Jensen T, Deluiz D, Tinoco EMB. Horizontal Alveolar Ridge Augmentation with Allogeneic Bone Block Graft Compared with Autogenous Bone Block Graft: a Systematic Review. J Oral Maxillofac Res. 2020. March 31;11(1):e1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Rocchietta I, Ferrantino L, Simion M. Vertical ridge augmentation in the esthetic zone. Periodontol 2000. 2018;77(1):241–55. 10.1111/prd.12218 [DOI] [PubMed] [Google Scholar]
  • 15.Vuletić M, Knežević P, Jokić D, Rebić J, Žabarović D, Macan D. Alveolar Bone Grafting in Cleft Patients: from Bone Defect to Dental Implants. Acta Stomatol Croat. 2014;48(4):250–7. 10.15644/asc48/4/2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Reissmann DR, Dietze B, Vogeler M, et al. Impact of donor site for bone graft harvesting for dental implants on health‐related and oral health‐related quality of life. Clin Oral Implants Res. 2013;24(6):698–705. 10.1111/j.1600-0501.2012.02464.x [DOI] [PubMed] [Google Scholar]
  • 17.Reissmann DR, Poxleitner P, Heydecke G. Location, intensity, and experience of pain after intra-oral versus extra-oral bone graft harvesting for dental implants. J Dent. 2018. December;79:102–6. 10.1016/j.jdent.2018.10.011 [DOI] [PubMed] [Google Scholar]
  • 18.Schlee M, Dehner J-F, Baukloh K, et al. Esthetic outcome of implant-based reconstructions in augmented bone: comparison of autologous and allogeneic bone block grafting with the pink esthetic score (PES). Head Face Med. 2014;10:21. 10.1186/1746-160X-10-21 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Jacotti M, Wang H-L, Fu J-H, et al. Ridge augmentation with mineralized block allografts: clinical and histological evaluation of 8 cases treated with the 3-dimensional block technique. Implant Dent. 2012. December;21(6):444–8. 10.1097/ID.0b013e31826f7a67 [DOI] [PubMed] [Google Scholar]
  • 20.Schlee M, Rothamel D. Ridge augmentation using customized allogenic bone blocks: proof of concept and histological findings. Implant Dent. 2013. June;22(3):212–8. 10.1097/ID.0b013e3182885fa1 [DOI] [PubMed] [Google Scholar]
  • 21.Wang W, Yeung KW. Bone grafts and biomaterials substitutes for bone defect repair: A review. Bioact Mater. 2017. June 7;2(4):224–47. 10.1016/j.bioactmat.2017.05.007 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Piaia M, Bub CB, de Menezes Succi G, et al. HLA-typing analysis following allogeneic bone grafting for sinus lifting. Cell Tissue Bank. 2017. March;18(1):75–81. 10.1007/s10561-016-9594-1 [DOI] [PubMed] [Google Scholar]
  • 23.Buck BE, Malinin TI, Grown MD. Bone Transplantation and Human Immunodeficiency Virus: An Estimate of Risk of Acquired Immunodeficiency Syndrome (AIDS). Clin Orthop Relat Res. 1989. March; (240):129–36. 10.1097/00003086-198903000-00015 [DOI] [PubMed] [Google Scholar]
  • 24.Conrad EU, Gretch DR, Obermeyer KR, et al. Transmission of the hepatitis-C virus by tissue transplantation. J Bone Joint Surg Am. 1995;77(2):214–24. 10.2106/00004623-199502000-00007 [DOI] [PubMed] [Google Scholar]
  • 25.Hinsenkamp M, Muylle L, Eastlund T, et al. Adverse reactions and events related to musculoskeletal allografts: reviewed by the World Health Organisation Project NOTIFY. Int Orthop. 2012. March;36(3):633–41. 10.1007/s00264-011-1391-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Monje A, Pikos MA, Chan H-L, et al. On the feasibility of utilizing allogeneic bone blocks for atrophic maxillary augmentation. BioMed Res Int. 2014;2014:814578. 10.1155/2014/814578 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Novell J, Novell-Costa F, Ivorra C. Five-year results of implants inserted into freeze-dried block allografts. Implant Dent. 2012. April;21(2):129–35. 10.1097/ID.0b013e31824bf99f [DOI] [PubMed] [Google Scholar]
  • 28.Nissan J, Mardinger O, Calderon S, et al. Cancellous bone block allografts for the augmentation of the anterior atrophic maxilla. Clin Implant Dent Relat Res. 2011;13:104–11. 10.1111/j.1708-8208.2009.00193.x [DOI] [PubMed] [Google Scholar]
  • 29.Dayan C, Guven MC, Gencel B, Bural C. A Color Stability Comparison of Conventional and CAD / CAM Polymethyl Methacrylate Denture Base Materials. Acta Stomatol Croat. 2019. June;53(2):158–67. 10.15644/asc53/2/8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Knezevic A, Zeljezic D, Kopjar N, Duarte S, Jr, Par M, Tarle Z. Toxicity of Pre-heated Composites Polymerized Directly and Through CAD / CAM Overlay. Acta Stomatol Croat. 2018. September;52(3):203–17. 10.15644/asc52/3/4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Blume O, Donkiewicz P, Back M, Born T. Bilateral maxillary augmentation using CAD/CAM manufactured allogenic bone blocks for restoration of congenitally missing teeth: A case report. J Esthet Restor Dent. 2019. May;31(3):171–8. 10.1111/jerd.12454 [DOI] [PubMed] [Google Scholar]
  • 32.Motamedian SR, Khojaste M, Khojasteh A. Success rate of implants placed in autogenous bone blocks versus allogeneic bone blocks: A systematic literature review. Ann Maxillofac Surg. 2016;6(1):78. 10.4103/2231-0746.186143 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Jacotti M, Barausse C, Felice P. Posterior atrophic mandible rehabilitation with onlay allograft created with CAD-CAM procedure: a case report. Implant Dent. 2014;23:22–8. 10.1097/ID.0000000000000023 [DOI] [PubMed] [Google Scholar]
  • 34.Danesh-Sani SA, Tarnow D, Yip JK, Mojaver R. The influence of cortical bone perforation on guided bone regeneration in humans. Int J Oral Maxillofac Surg. 2017. February;46(2):261–6. 10.1016/j.ijom.2016.10.017 [DOI] [PubMed] [Google Scholar]
  • 35.Blume O, Hoffmann L, Donkiewicz P, et al. Treatment of Severely Resorbed Maxilla Due to Peri-Implantitis by Guided Bone Regeneration Using a Customized Allogenic Bone Block: A Case Report. Materials (Basel). 2017. October 21;10(10):1213. 10.3390/ma10101213 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Kloss FR, Offermanns V, Kloss‐Brandstätter A. Comparison of allogeneic and autogenous bone grafts for augmentation of alveolar ridge defects—A 12‐month retrospective radiographic evaluation. Clin Oral Implants Res. 2018;29(11):1163–75. 10.1111/clr.13380 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Dohle E, El Bagdadi K, Sader R, et al. Platelet-rich fibrin-based matrices to improve angiogenesis in an in vitro co-culture model for bone tissue engineering. J Tissue Eng Regen Med. 2018. March;12(3):598–610. 10.1002/term.2475 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Blume O, Donkiewicz P, Back M, Born T. Bilateral maxillary augmentation using CAD/CAM manufactured allogenic bone blocks for restoration of congenitally missing teeth: A case report. J Esthet Restor Dent. 2019;31(3):171–8. 10.1111/jerd.12454 [DOI] [PubMed] [Google Scholar]
  • 39.Spin-Neto R, Stavropoulos A, Coletti FL, et al. Remodeling of cortical and corticocancellous fresh-frozen allogeneic block bone grafts a radiographic and histomorphometric comparison to autologous bone grafts. Clin Oral Implants Res. 2015. July;26(7):747–52. 10.1111/clr.12343 [DOI] [PubMed] [Google Scholar]
  • 40.Adeyemo WL, Reuther T, Bloch W, et al. Influence of host periosteum and recipient bed perforation on the healing of onlay mandibular bone graft: an experimental pilot study in the sheep. Oral Maxillofac Surg. 2008;12(1):19–28. 10.1007/s10006-008-0098-4 [DOI] [PubMed] [Google Scholar]
  • 41.Miyamoto I, Funaki K, Yamauchi K, et al. Alveolar ridge reconstruction with titanium mesh and autogenous particulate bone graft: computed tomography‐based evaluations of augmented bone quality and quantity. Clin Implant Dent Relat Res. 2012. April;14(2):304–11. 10.1111/j.1708-8208.2009.00257.x [DOI] [PubMed] [Google Scholar]
  • 42.Dellavia C, Giammattei M, Carmagnola D, et al. Iliac crest fresh-frozen allografts versus autografts in oral pre-prosthetic bone reconstructive surgery: histologic and histomorphometric study. Implant Dent. 2016;25(6):731–8. 10.1097/ID.0000000000000451 [DOI] [PubMed] [Google Scholar]
  • 43.Draenert FG, Kämmerer PW, Berthold M, Neff A. Complications with allogeneic, cancellous bone blocks in vertical alveolar ridge augmentation: prospective clinical case study and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016. August;122(2):e31–43. 10.1016/j.oooo.2016.02.018 [DOI] [PubMed] [Google Scholar]
  • 44.Fu JH, Oh TJ, Benavides E. A randomized clinical trial evaluating the efficacy of the sandwich bone augmentation technique in increasing buccal bone thickness during implant placement surgery: I. Clinical and radiographic parameters. Clin Oral Implants Res. 2014. April;25(4):458–67. 10.1111/clr.12171 [DOI] [PubMed] [Google Scholar]
  • 45.Gielkens PF, Bos RR, Raghoebar GM, Stegenga B. Is there evidence that barrier membranes prevent bone resorption in autologous bone grafts during the healing period? A systematic review. Int J Oral Maxillofac Implants. 2007. May-June;22(3):390–8. [PubMed] [Google Scholar]
  • 46.Chaushu G, Mardinger O, Peleg M, et al. Analysis of complications following augmentation with cancellous block allografts. J Periodontol. 2010;81:1759–64. 10.1902/jop.2010.100235 [DOI] [PubMed] [Google Scholar]
  • 47.Nissan J, Kolerman R, Chaushu L, et al. Age‐related new bone formation following the use of cancellous bone‐block allografts for reconstruction of atrophic alveolar ridges. Clin Implant Dent Relat Res. 2018. February;20(1):4–8. 10.1111/cid.12560 [DOI] [PubMed] [Google Scholar]
  • 48.Dimitriou R, Mataliotakis GI, Calori GM, Giannoudis PV. The role of barrier membranes for guided bone regeneration and restoration of large bone defects: current experimental and clinical evidence. BMC Med. 2012. July 26;10:81. 10.1186/1741-7015-10-81 [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Acta Stomatologica Croatica are provided here courtesy of University of Zagreb: School of Dental Medicine

RESOURCES