Ridge Augmentation Comparing an Allograft Containing Harvested Autogenous Bone to an Allograft with Lot Verified Osteoinductive Activity.
Patel A, Greenwell H, Hill M, Shumway B, Radmall A.
Introduction. The availability of osseous grafts with verified osteoinductive activity due to the presence of bone morphogenetic proteins (BMP) has improved the possibility of ridge augmentation without the need to harvest autogenous bone. The primary aim of this study is to determine if the addition of autogenous bone to an allograft provides a superior result to the use of a graft with verified osetoinductive activity.
Methods. Fourteen patients with a horizontal ridge defect and at least one adjacent tooth were entered into this randomized, controlled, blinded clinical trial. Seven patients in the Autogenous group (AG) received a ridge augmentation graft consisting of mineralized, particulate cortico-cancellous allograft plus autogenous bone particles obtained with a scraper in a 70:30 ratio. Seven patients in the BMP group received a demineralized bone matrix allograft containing cortico-cancellous chips and exhibiting lot verified osteoinductive activity. All grafts were covered with bovine xenograft, an acellular dermal matrix GBR membrane and primary closure was obtained using a superficial split thickness flap for maximum flap release. At 4-months the site was re-entered, a trephine core was harvested for histologic analysis, and a dental implant was placed.
Results. For the AG mean initial crestal ridge width of 3.2 ± 0.7 mm was increased to 6.7 ± 1.7 mm for a mean gain of 3.5 ± 1.4 mm, or 112%. In the BMP group mean initial crestal ridge width was 3.0 ± 0.6 mm which was increased to 6.8 ± 1.9 mm for a mean gain of 3.8 ± 1.6 mm, or 128%. The mean gain for both groups was statistically significant (p < 0.05) but the were no significant differences between groups (p > 0.05). Mean vertical ridge height change relative to a stent was 0.0 ± 0.8 mm for the AG group and -0.3 ± 0.6 mm for the BMP group. This change was not statistically significant for either group (p > 0.05). Histologic analysis showed a mean of 35 ± 17% vital bone for the AG group vs. 39 ± 6% for the BMP group. The difference between groups was not statistically significant (p > 0.05).
Conclusions. Both treatments provided similar gain of ridge width, minimal loss of ridge height, and a similar percentage of vital bone. This means that in this study harvesting autogenous bone did not provide any additional benefit when compared to an allograft alone that had lot verified osteoinductive activity.