title: A new technique for reconstruction of the atrophied narrow alveolar crest in the maxilla using morselized impacted bone allograft and later placement of dental implants.
abstract: BACKGROUND
  In cases when the alveolar crest is too narrow to host an implant, lateral augmentation is required. The use of autogenous bone blocks harvested from the iliac crest is often demanded. One disadvantage is the associated patient morbidity.
  
  
  OBJECTIVE
  The purpose of this study was to clinically and histologically evaluate the use of morselized impacted bone allograft, a novel technique for reconstruction of the narrow alveolar crest.
  
  
  METHODS
  Two patients with completely edentulous maxillae and one partially edentulous, with a mean age of 77 years (range 76-79 years) were included in the study. The alveolar crest width was <3 mm without possibility to place any implant. Bone grafts were taken from a bone bank in Gävle Hospital. Bone from the neck of femur heads was milled to produce bone chips. The milled bone was partially defatted by rinsing in 37 degrees C saline solution. After compression of the graft pieces with a size of 15 mm (height), 30 mm (length), and 6 mm (width), they were then fit to adapt to the buccal surface of the atrophied alveolar crest. One piece was placed to the right and one to the left side of the midline. On both sides fibrin glue was used (Tisseel, Baxter AG, Vienna, Austria) to stabilize the graft. After 6 months of graft healing, dental implants were placed, simultaneously biopsies were harvested and in one patient two oxidized microimplants were placed. At the time of abutment connection, microimplants were retrieved with surrounding bone for histology. Fixed screw-retained bridges were fabricated in mean of 7 months after implant surgery. Radiographs were taken before and after implant surgery and after 1 year of loading.
  
  
  RESULTS
  Sixteen implants with an oxidized surface were placed (TiUnite, Nobel Biocare AB, Göteborg, Sweden). After 1 year of functional loading, all implants were clinically stable. The marginal bone loss was 1.4 mm (SD 0.3) after 1 year of loading. The histological examination showed resorption and subsequent bone formation on the allograft particles. There were no signs of inflammatory cell infiltration in conjunction with the allograft. The two microimplants showed bone formation directly on the implant surface.
  
  
  CONCLUSIONS
  This study shows that morselized impacted bone allograft can be used to increase the width of the atrophied narrow alveolar crest as a good alternative to autogenous bone grafts in elderly patients. The histological examination of biopsies revealed a normal incorporation process and no signs of an immunological reaction. Further studies with larger samples are of important to be able to conclude if equal results can be obtained using morselized impacted bone allograft as for autogenous bone graft.
authors.affiliation: Clinic for Oral & Maxillofacial Surgery, Gävle Hospital, Gävle, Sweden. Per.Holmquist@lg.se
authors.forename: Per
authors.initials: P
authors.lastname: Holmquist
authors.forename: Amir
authors.initials: A
authors.lastname: Dasmah
authors.forename: Lars
authors.initials: L
authors.lastname: Sennerby
authors.forename: Mats
authors.initials: M
authors.lastname: Hallman
mesh_terms: D000368:Aged; D016301:Alveolar Bone Loss / Q000473:pathology / Q000601:surgery; D000540:Alveolar Ridge Augmentation / Q000379:methods*; D001284:Atrophy; D001843:Bone Cements; D018786:Bone Substitutes; D016025:Bone Transplantation / Q000379:methods*; D003758:Dental Implantation, Endosseous / Q000379:methods*; D015921:Dental Implants; D017268:Dental Prosthesis Retention / Q000379:methods; D019094:Dental Prosthesis, Implant-Supported; D005260:Female; D006801:Humans; D007575:Jaw, Edentulous / Q000473:pathology / Q000534:rehabilitation / Q000601:surgery; D007576:Jaw, Edentulous, Partially / Q000473:pathology / Q000534:rehabilitation / Q000601:surgery; D008297:Male; D008437:Maxilla / Q000473:pathology* / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements; D018786:Bone Substitutes; D015921:Dental Implants