Osteogenesis distraction and platelet-rich plasma: combined use in restoration of severe atrophic mandible. Long-term results.
OBJECTIVE
The purpose of this paper is to report long-term results on the use of autologous bone graft and platelet-rich plasma in alveolar distraction osteogenesis (DO) for restoration of severe atrophic mandible. We tested the efficacy as to reabsorption of bone volume, peri-implant reabsorption, implant survival and success rate.


METHODS
Twelve patients were treated. The surgical procedure consisted in mixing autologous bone, harvested from the iliac crest, with autologous platelet concentrate (APC) and in filling the distraction gap with this graft. After a latency of 15 days, a distraction rate of 0.5 mm/day was followed. After a 60-day period of consolidation, the distraction device was removed and implants were placed simultaneously. The abutment connection was accomplished after 6 months. In addition, every patient was evaluated clinically and radiographically annually for 5 years.


RESULTS
Planned alveolar height was reached in 11 out of 12 patients. The total number of implants positioned was 47. At the time of implant positioning, the mean decrease of total bone volume was 2.3%. The mean peri-implant resorption was 0.40 mm at the time of abutment connection, 0.61 mm 1 year after implant loading and 1.51 mm after 5 years. After 5 years of follow-up, the mean rate of vertical bone loss was 18.7%. Instead, the implant survival and success rates were 97.9% and 91.5%, respectively.


CONCLUSIONS
Long-term results allow us to confirm the combination of autologous bone-platelet gel with alveolar DO as an effective and predictable procedure in restoration of severe atrophic mandible.
Robiony
M
M
Department of Maxillo-Facial Surgery, Faculty of Medicine, University of Udine, P.le Santa Maria della Misericordia, 33100 Udine, Italy. massimo.robiony@uniud.it
Zorzan
E
E
Polini
F
F
Sembronio
S
S
Toro
C
C
Politi
M
M
D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000209:etiology / Q000601:surgery; D000540:Alveolar Ridge Augmentation / Q000379:methods*; D001861:Bone Regeneration; D016025:Bone Transplantation; D003758:Dental Implantation, Endosseous / Q000009:adverse effects; D019232:Dental Restoration Failure; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery; D008336:Mandibular Diseases / Q000601:surgery; D008875:Middle Aged; D019857:Osteogenesis, Distraction / Q000379:methods*; D053657:Platelet-Rich Plasma; D055815:Young Adult