Dental implants: Poor bone quantity/quality

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Nobel Biocare’s Jonathan Fleet discusses dental implants for patients with poor bone quantity/quality

Over the past few decades, the use of dental implants has become increasingly common and implantology is now a well-established method for restoring missing teeth [1]. Research indicates that dental implants are an effective treatment with long-term success and survival rates [2&3]. ,

However, implant success and survival can be adversely affected by several factors, including periodontal disease, age, and a history of smoking [4]. One particular issue affecting long-term success is an insufficient bone volume in the jaw [5]. Poor bone quality and quantity are key factors for implant failure [6&7]. ,

The volume and quality of bone may be reduced in some patients for a number of reasons, such as the use of oral bisphosphonates, trauma and age. Bisphosphonates can lead to osteonecrosis of the jaw; while patients who lose teeth due to trauma may subsequently lose bone [8] and increasing age can lead to greater bone porosity and decrease in density [9&10]. ,

Guided bone regeneration
While it may appear that dental implants should not be considered for patients with poor bone quantity or quality, it is still possible to use them, even when bone morphology is not ideal. Bone augmentation procedures can be performed either before or during implant placement [11]. More specifically, guided bone regeneration (GBR) can be done, which is a surgical technique in which the affected area can be regenerated by filling the bone defect with some form of bone graft or substitute and using a barrier membrane to protect the graft. The membrane maintains the space for bone regeneration and prevents the ingrowth of connective tissue [12].

Evidence shows that GBR is a predictable technique that allows for successful implant placement in patients with poor bone volume. One systematic review of studies that involved patients who required GBR prior to implant placement found implant success rates higher than 90% [13].

What options are available?
Various regenerative products are available that are both safe and reliable. For example, Nobel Biocare has developed a range of regenerative products, which includes creos xenogain and creos xenoprotect. Creos xenogain is a biocompatible deproteinised bovine bone mineral matrix, which is easy to handle and has a slow resorption rate.
A study of several patients for whom bovine bone material was used has shown that it leads to good healing responses and reliable results [14].

Creos xenoprotect is a resorbable collagen membrane. Composed of a network of highly purified porcine collagen and elastin fibres it demonstrates high mechanical strength, has outstanding handling properties, does not become sticky when hydrated, and is easy to reposition and unfold. A study examining the performance of creos xenoprotect in 24 patients found that it facilitates bone gain to support implant placement [15].

In conclusion we can say that the development of high-quality regenerative products to be used when performing GBR means dental implants can be confidently provided for patients with poor bone quality or quantity.

Author


Jonathan Fleet is the Nobel Biocare Product Manager UK & Ireland. For more information, call Nobel Biocare on 0208 756 3300, or visit www.nobelbiocare.com 

References:

1] Lekholm U, Gunne J, Henry P, Higuchi K, Linden U, Bergsrom C, van Steenberghe D. Survival of the Bränemark implant in partially edentulous jaws: a 10-year prospective multicenter study. Int J Oral Maxillofaci Implants 1999;14:639-45.
2] Al-Sabbagh M, Thomas MV, Bhavsar I, De Leeuw R. Effect of bisphosphonate and age on implant failure as determined by patient-reported outcomes. J Oral Implant 2015;XLI:e287-e91.
3] Lekholm U, Gunne J, Henry P, Higuchi K, Linden U, Bergsrom C, van Steenberghe D. Survival of the Bränemark implant in partially edentulous jaws: a 10-year prospective multicenter study. Int J Oral Maxillofaci Implants 1999;14:639-45.
4] Al-Sabbagh M, Thomas MV, Bhavsar I, De Leeuw R. Effect of bisphosphonate and age on implant failure as determined by patient-reported outcomes. J Oral Implant 2015;XLI:e287-e91.
5] Baj A, Trapella G, Lauritano D, Candotto V, Mancini GE, Gianni AB. An overview on bone reconstruction of atrophic maxilla: success parameters and critical issues. J Biol Regul Homeost Agents 2016;30:209-15.
6] Johns RB, Jemt T, Heath MR, Hutton JE, McKenna S, McNamara DC, van Steenberghe D, Taylor R, Watson RM, Hermann I. A multicenter study of overdentures supported by Bränemark implants. Int J Oral Maxillofac Implants 1992;7:513-22.
7] Chrcanovic B, Albrektsson T, Wennerberg A. Bone quality and quantity and dental implant failure: a systematic review and meta-analysis. Int J Prosthodont 2017;30:219-37.
8] Alani A, Djemal S, Bishop K, Renton T. Guidelines for selecting appropriate patients to receive treatment with dental implants: priorities for the NHS. London: Royal College of Surgeons; 2012.
9] Bryant SR, Zarb GA. Outcomes of implant prosthodontic treatment in older adults. J Can Dent Assoc 2002;68:97-102.
10] Al-Sabbagh M, Thomas MV, Bhavsar I, De Leeuw R. Effect of bisphosphonate and age on implant failure as determined by patient-reported outcomes. J Oral Implant 2015;XLI:e287-e91.
11] Wessing B, Montero E, Urban I, Zechner W, Schuh C, Alandez J, Gonzalez-marting O, Polizzi G, Meloni S, Emmerich M, Sanz I. Randomized, prospective, multi-center study evaluating creos xenoprotect versus Bio-Gide in dehiscence defects: bone augmentation results. European Association for Osseointegration Congress; 2016.
12] Wessing B, Montero E, Urban I, Zechner W, Schuh C, Alandez J, Gonzalez-marting O, Polizzi G, Meloni S, Emmerich M, Sanz I. Randomized, prospective, multi-center study evaluating creos xenoprotect versus Bio-Gide in dehiscence defects: bone augmentation results. European Association for Osseointegration Congress; 2016.
13] Clementini M, Morlupi A, canullo L, Agrestini C, Barlattani A. Success rate of dental implants inserted in horizontal and vertical guided bone regenerated areas: a systematic review. Int J Oral Maxillofac surg 2012;41:847-52.
14] Shin S-Y, Hwang Y-J, Kim J-h, Seol Y-J. Long-term results of new deproteinized bovine bone material in a maxillary sinus graft procedure. J Periodontal Implant Sci 2014;44:259-64.
15] Wessing B, Montero E, Urban I, Zechner W, Schuh C, Alandez J, Gonzalez-marting O, Polizzi G, Meloni S, Emmerich M, Sanz I. Randomized, prospective, multi-center study evaluating creos xenoprotect versus Bio-Gide in dehiscence defects: bone augmentation results. European Association for Osseointegration Congress; 2016.