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Purpose: Complex bone defects with a horizontal and vertical combined deficiency pose a clinical challenge in implant dentistry. This study reports the case of a young female patient who presented with a perforating bone defect in the aesthetic zone. Materials and methods: Based on prosthetically guided bone regeneration, virtual 3D bone augmentation was planned. A 3D printed customised titanium mesh and the autogenous bone ring technique were then utilised simultaneously to achieve a customised bone contour. After 6 months, the titanium mesh was removed and connective tissue grafting was performed. Finally, implants were placed and the provisional and definitive prostheses were delivered following a digital approach. Vertical and horizontal bone gain, new bone density, pseudo-periosteum type and marginal bone loss were measured. Planned bone volume, regenerated bone volume and regeneration rate were analysed. Results: Staged tooth shortening led to a coronal increase in keratinised mucosa. The customised titanium mesh and bone ring technique yielded 14.27 mm vertical bone gain and 12.9 mm horizontal bone gain in the perforating area. When the titanium mesh was removed, the reopening surgery showed a Type 1 pseudo-periosteum (none or < 1 mm), and CBCT scans revealed a new bone density of ~550 HU. With a planned bone volume of 1063.55 mm3, the regenerated bone volume was 969.29 mm3, indicating a regeneration rate of 91.14%. The 1-year follow-up after definitive restoration revealed no complications except for 0.55 to 0.60 mm marginal bone loss. Conclusion: Combined application of customised titanium mesh and an autogenous bone ring block shows promising potential to achieve prosthetically guided bone regeneration for complex bone defects in the aesthetic zone. [ABSTRACT FROM AUTHOR]

Background: /purpose: Bone ring technique (BRT) is an effective method to reconstruct alveolar bone defects with simultaneous implant placement. This study aimed to evaluate the efficacy of the BRT in single maxillary anterior tooth implantation and its esthetic outcomes over 2–3 years of follow-up. Materials and methods: Fifteen patients with single maxillary incisor loss received autogenous BRT with simultaneous implant placement. The vertical/horizontal bone gain, remaining vertical bone height (RVBH), remaining buccal bone width (RBBW), and vertical/horizontal bone resorption around implant over 2–3 years of follow-up were measured by using cone-beam computed tomography. Esthetic results including white esthetic score (WES), pink esthetic score (PES), and papilla index (PI) were evaluated by clinical recorded photographs. Results: All implants showed evidence of osseointegration, and the mean vertical and horizontal bone gain of 14 sites was 5.55 ± 0.87 mm and 4.73 ± 0.70 mm, respectively. During 2–3 years of follow-up, all mean values of RBBW were more than 2 mm. Main vertical bone loss appeared within 4 months after surgery and the RVBH value decreased as the follow-up duration continued. Maximum buccal bone thickness resorption mostly appeared in the middle level of the implant during the primary two follow-up periods (P

/purpose : Bone ring technique (BRT) is an effective method to reconstruct alveolar bone defects with simultaneous implant placement. This study aimed to evaluate the efficacy of the BRT in single maxillary anterior tooth implantation and its esthetic outcomes over 2–3 years of follow-up. Fifteen patients with single maxillary incisor loss received autogenous BRT with simultaneous implant placement. The vertical/horizontal bone gain, remaining vertical bone height (RVBH), remaining buccal bone width (RBBW), and vertical/horizontal bone resorption around implant over 2–3 years of follow-up were measured by using cone-beam computed tomography. Esthetic results including white esthetic score (WES), pink esthetic score (PES), and papilla index (PI) were evaluated by clinical recorded photographs. All implants showed evidence of osseointegration, and the mean vertical and horizontal bone gain of 14 sites was 5.55 ± 0.87 mm and 4.73 ± 0.70 mm, respectively. During 2–3 years of follow-up, all mean values of RBBW were more than 2 mm. Main vertical bone loss appeared within 4 months after surgery and the RVBH value decreased as the follow-up duration continued. Maximum buccal bone thickness resorption mostly appeared in the middle level of the implant during the primary two follow-up periods (P < 0.05). Esthetic results showed that the mean WES/PES was higher than 17, and more than half cases demonstrated relatively high PI (3 points) throughout the follow-up. BRT could achieve excellent bone augmentation effect and can offer predictable esthetic outcomes for single tooth implant restoration in the esthetic zone. [ABSTRACT FROM AUTHOR]

BACKGROUND: At present, bone defect after tooth loss due to periodontitis and trauma is common and the application of various kinds of bone augmentation techniques has partially solved these problems. However, various commonly used bone augmentation techniques have limitations to varying degrees. To alleviate the above-mentioned problems, an improved technique, bone ring technique, has been proposed to provide clinical workers with more options for bone augmentation. OBJECTIVE: To summarize and review the related research trends of bone ring technique and its clinical application. METHODS: A computer-based search of PubMed, WanFang, VIP, and CBM was performed by the first author. The keywords were “dentition defect, bone augmentation, dental implants, bone defect, bone graft material, bone ring technique” in English and Chinese. The retrieval time was from January 1986 to February 2022. A total of 431 articles were initially retrieved followed by screening, analysis, and summarization, and 60 articles were finally included for literature review. RESULTS AND CONCLUSION: Bone ring technique with concurrent dental implantation can shorten treatment time and avoid secondary operation in patients. Moreover, due to the good mechanical properties, this method is more conducive to the reconstruction and recovery of soft and hard tissue morphology. However, there are also some limitations, such as poor fixation, insufficient bone mass to meet the needs of patients with severe bone defects, and unacceptability of opening a second surgical area. Therefore, more high-quality, long-term and large-sample follow-up studies are still needed to continuously improve the bone ring technique so that it can better cope with dental implantation treatment for various types of dentition defects and bone defects. [ABSTRACT FROM AUTHOR]

The bone ring technique is applied for vertical augmentation, in which the dental implant and autogenous block bone graft are simultaneously inserted. We investigated the healing of bone around implants placed simultaneously using the bone ring technique with and without membrane placement after a 12-month healing period. Vertical bone defects were created on both sides of the mandible of Beagle dogs. Implants were inserted into the defects through bone rings and fixed with membrane screws as healing caps. The augmented sites on one side of the mandible were covered with a collagen membrane. Samples were harvested 12 months after implantation and assessed histologically and by microcomputed tomography analysis. All implants remained throughout the healing period; however, except for 1 implant, they showed lost caps and/or exposure to the oral cavity. The implants had contact with newly formed bone despite frequent bone resorption. The surrounding bone appeared mature. The medians of bone volume and percentages of total bone area and bone-to-implant contact within the bone ring were slightly higher in the group with membrane placement than in that without membrane placement. Nevertheless, none of the evaluated parameters were significantly affected by the membrane placement. In the present model, soft tissue complication was frequent, and the membrane application did not reveal the effect at 12 months after implant placement using the bone ring technique. Sustained osseointegration and maturation of surrounding bone were observed in both groups after a 12-month healing period. [ABSTRACT FROM AUTHOR]

Abstract Background Insufficient bone volume around an implant is a common obstacle when dental implant treatment is considered. Limited vertical or horizontal bone dimensions may lead to exposed implant threads following placement or a gap between the bone and implant. This is often addressed by bone augmentation procedures prior to or at the time of implant placement. This study evaluated bone healing when a synthetic TiO2 block scaffold was placed in circumferential peri-implant defects with buccal fenestrations. Methods The mandibular premolars were extracted and the alveolar bone left to heal for 4 weeks prior to implant placement in six minipigs. Two cylindrical defects were created in each hemi-mandible and were subsequent to implant placement allocated to treatment with either TiO2 scaffold or sham in a split mouth design. After 12 weeks of healing time, the samples were harvested. Microcomputed tomography (MicroCT) was used to investigate defect fill and integrity of the block scaffold. Distances from implant to bone in vertical and horizontal directions, percentage of bone to implant contact and defect fill were analysed by histology. Results MicroCT analysis demonstrated no differences between the groups for defect fill. Three of twelve scaffolds were partly fractured. At the buccal sites, histomorphometric analysis demonstrated higher bone fraction, higher percentage bone to implant contact and shorter distance from implant top to bone 0.5 mm lateral to implant surface in sham group as compared to the TiO2 group. Conclusions This study demonstrated less bone formation with the use of TiO2 scaffold block in combination with implant placement in cylindrical defects with buccal bone fenestrations, as compared to sham sites.

Abstract Background Dimensional changes after dental extraction frequently lead to situations in which bone augmentation procedures are required prior to dental implant placement. Bone ring technique (BRT) has been described as a one-stage approach to restore vertical alveolar ridge defects, in which an autogenous or allogeneic cortico-cancellous bone block graft is stabilized with a dental implant inserted simultaneously. The objective of this systematic review was to evaluate the clinical performance of BRT. Materials and methods This review was conducted according to PRISMA guidelines. An electronic search was conducted in four databases: (1) The National Library of Medicine (MEDLINE/PubMed) via Ovid; (2) Web of Science (WOS); (3) SCOPUS; and (4) Cochrane Central Register of Controlled Trials (CENTRAL). The Newcastle-Ottawa Quality Assessment Scale and The Joanna Briggs Institute Critical Appraisal tool were used to assess the quality of evidence in the studies reviewed. Results Sixteen studies with a total of 186 patients treated with 219 bone rings bocks were included in the review. The studies showed a mean bone gain of 4.94 mm, mean bone resorption of 0.83 mm, and mean marginal bone loss of 0.57 mm after a mean follow-up period of 13.35 months. A mean bone ring survival rate of 97.26% and implant survival rate of 94.97% were recorded. Conclusions BRT would appear to be an adequate alternative technique for restoring single vertical alveolar ridge defects with simultaneous dental implant placement. However, further studies comparing this technique with other vertical ridge augmentation procedures in different clinical scenarios are needed to confirm the present results.

Purpose: Complex bone defects with a horizontal and vertical combined deficiency pose a clinical challenge in implant dentistry. This study reports the case of a young female patient who presented with a perforating bone defect in the aesthetic zone., Materials and Methods: Based on prosthetically guided bone regeneration, virtual 3D bone augmentation was planned. A 3D printed customised titanium mesh and the autogenous bone ring technique were then utilised simultaneously to achieve a customised bone contour. After 6 months, the titanium mesh was removed and connective tissue grafting was performed. Finally, implants were placed and the provisional and definitive prostheses were delivered following a digital approach. Vertical and horizontal bone gain, new bone density, pseudo-periosteum type and marginal bone loss were measured. Planned bone volume, regenerated bone volume and regeneration rate were analysed., Results: Staged tooth shortening led to a coronal increase in keratinised mucosa. The customised titanium mesh and bone ring technique yielded 14.27 mm vertical bone gain and 12.9 mm horizontal bone gain in the perforating area. When the titanium mesh was removed, the reopening surgery showed a Type 1 pseudo-periosteum (none or < 1 mm), and CBCT scans revealed a new bone density of ~550 HU. With a planned bone volume of 1063.55 mm3, the regenerated bone volume was 969.29 mm3, indicating a regeneration rate of 91.14%. The 1-year follow-up after definitive restoration revealed no complications except for 0.55 to 0.60 mm marginal bone loss., Conclusion: Combined application of customised titanium mesh and an autogenous bone ring block shows promising potential to achieve prosthetically guided bone regeneration for complex bone defects in the aesthetic zone.

Background: Dimensional changes after dental extraction frequently lead to situations in which bone augmentation procedures are required prior to dental implant placement. Bone ring technique (BRT) has been described as a one-stage approach to restore vertical alveolar ridge defects, in which an autogenous or allogeneic cortico-cancellous bone block graft is stabilized with a dental implant inserted simultaneously. The objective of this systematic review was to evaluate the clinical performance of BRT. Materials and methods: This review was conducted according to PRISMA guidelines. An electronic search was conducted in four databases: (1) The National Library of Medicine (MEDLINE/PubMed) via Ovid; (2) Web of Science (WOS); (3) SCOPUS; and (4) Cochrane Central Register of Controlled Trials (CENTRAL). The Newcastle-Ottawa Quality Assessment Scale and The Joanna Briggs Institute Critical Appraisal tool were used to assess the quality of evidence in the studies reviewed. Results: Sixteen studies with a total of 186 patients treated with 219 bone rings bocks were included in the review. The studies showed a mean bone gain of 4.94 mm, mean bone resorption of 0.83 mm, and mean marginal bone loss of 0.57 mm after a mean follow-up period of 13.35 months. A mean bone ring survival rate of 97.26% and implant survival rate of 94.97% were recorded. Conclusions: BRT would appear to be an adequate alternative technique for restoring single vertical alveolar ridge defects with simultaneous dental implant placement. However, further studies comparing this technique with other vertical ridge augmentation procedures in different clinical scenarios are needed to confirm the present results. [ABSTRACT FROM AUTHOR]

Objective: The main objective of this case report is to introduce a one‐stage bone block augmentation with a cylindrical freeze‐dried bone allograft (FDBA) and simultaneous implantation for the reconstruction of a single‐tooth bone defect. Clinical Considerations: The report describes this method on the basis of radiographical and clinical images derived from a single patient. Conclusions: The report demonstrates the time‐saving and successful application of this treatment concept, which has the potential to increase patient satisfaction and comfort. Clinical Significance: The application of the presented technique enabled a prosthetic rehabilitation of the extracted tooth about 3 months earlier as compared to the conventional procedure, while demonstrating no compromises regarding clinical outcome, functionality and esthetics. [ABSTRACT FROM AUTHOR]

The main objective of this manuscript was to demonstrate the use of freeze-dried bone allografts (FDBA) by means of a technique of simultaneous bone augmentation and implant placement (“Bone Ring Technique„) in different indications, i.e., ridge reconstruction and sinus floor elevation procedure with a maxillary bone height of less than 4 mm. Moreover, cases with an up to 3-year follow-up were chosen to analyze the techniques of mid-term clinical success. Finally, the purification success of the FDBA was analyzed by means of established scanning electron microscopic (SEM) and histological methods. The FBDA bone ring was applied in three different patients and indications and presented; the healing success was analyzed on the basis of radiographical and clinical images. For analysis of the purification of the allogeneic bone, previously established histological methods and scanning electron microscopy (SEM) were applied. All analyzed patient cases showed that the FDBA-based bone ring was fully integrated into newly built alveolar bone. Furthermore, the observations revealed that the three-dimensional bone reconstructions in maxilla and mandible were stable within the observational period of up to 3 years. Altogether, the present data show that the application of the Bone Ring Technique using the FDBA rings allows for successful regeneration of alveolar bone with a predictable clinical outcome, functionality and esthetics. Moreover, the material analyses showed that the allogeneic bone tissue was free of cells or cell remnants, while the (ultra-) structure of the bone matrix has been retained. Thus, the biological safety of the FDBA has been confirmed.

Our study aimed to evaluate the effectiveness of the bone ring technique for ridge augmentation using Demineralized Freeze - Dried Bone Allograft block in Siebert's class II/class III defects along with simultaneous implant placement. A total of 15 partially edentulous patients (16 surgical sites) with Siebert's class II and/or class III defects in the anterior region of both jaws requiring ridge augmentation along with implant placement were selected. Starting from the first stage, surgery (Ridge augmentation+ implant placement) was done in the first month. Then, with continuous follow-ups and radiographic assessment, after 6 months of 2nd stage surgery was done, the implant was loaded with the final restoration. Significant results were revealed with all the parameters other than keratinized gingival and peri-implant mucosa thickness. With the mean bone resorption of 1.22 mm and 1.17 mm at the mesial and distal site at a 6-month interval, the success rate of the bone ring technique was 93.75%. The allograft bone ring technique showed a favorable outcome for the reconstruction of large vertical defects., Competing Interests: None, (© 2022 Biomedical Informatics.)

Vertical bone augmentation is an important challenge in dental implantology. Existing vertical bone augmentation techniques, along with bone grafting materials, have achieved certain clinical progress but continue to have numerous limitations. In order to evaluate the possibility of using biomaterials to develop bone substitutes, medical devices and/or new bone grafting techniques for vertical bone augmentation, it is essential to establish clinically relevant animal models to investigate their biocompatibility, mechanical properties, applicability and safety. The present review discusses recent animal experiments related to vertical bone augmentation. In addition, surgical protocols for establishing relevant preclinical models with various animal species were reviewed. The present study aims to provide guidance for selecting experimental animal models of vertical bone augmentation. [ABSTRACT FROM AUTHOR]

The main objective of this manuscript was to demonstrate the use of freeze-dried bone allografts (FDBA) by means of a technique of simultaneous bone augmentation and implant placement ("Bone Ring Technique") in different indications, i.e., ridge reconstruction and sinus floor elevation procedure with a maxillary bone height of less than 4 mm. Moreover, cases with an up to 3-year follow-up were chosen to analyze the techniques of mid-term clinical success. Finally, the purification success of the FDBA was analyzed by means of established scanning electron microscopic (SEM) and histological methods. The FBDA bone ring was applied in three different patients and indications and presented; the healing success was analyzed on the basis of radiographical and clinical images. For analysis of the purification of the allogeneic bone, previously established histological methods and scanning electron microscopy (SEM) were applied. All analyzed patient cases showed that the FDBA-based bone ring was fully integrated into newly built alveolar bone. Furthermore, the observations revealed that the three-dimensional bone reconstructions in maxilla and mandible were stable within the observational period of up to 3 years. Altogether, the present data show that the application of the Bone Ring Technique using the FDBA rings allows for successful regeneration of alveolar bone with a predictable clinical outcome, functionality and esthetics. Moreover, the material analyses showed that the allogeneic bone tissue was free of cells or cell remnants, while the (ultra-) structure of the bone matrix has been retained. Thus, the biological safety of the FDBA has been confirmed. [ABSTRACT FROM AUTHOR]

Background: An insufficient bone volume at the maxillary anterior region often restricts dental implant treatment and commonly leads to poor aesthetic outcomes. The defective site requires bone grafting as an initial surgical intervention before dental implant placement. In dental implantology, reconstructing osseous defects using autologous block bone grafts, biomaterials, or a combination of both is a routine surgical procedure. This study aims to evaluate the efficacy of autogenous, symphyseal, bone ring block grafts after the augmentation of defective sockets and clinical application of grafts in the maxillary anterior region with immediate insertion of a dental implant in a single surgical procedure., Materials and Methods: The study included eight patients (five females and three males) with 12 defective sockets. The technique included removing the bone from the chin region for transplant, fitting the three-dimensional bone rings in the prepared sockets of the maxillary anterior region, and screwing the dental implants through the rings. Patients underwent postoperative clinical examinations every day during the first week and then every month for 6 months., Results: In two cases, the wound dehisced but healed by secondary intervention during the follow-up period. In one case, the ring graft sequestrated because of infection in postoperative month 2, the osseous defect was reconstructed with biomaterials. The remaining cases healed with no infection, and no other case failed during the first year., Conclusion: This technique showed promising and advantageous results, and thus, could be an alternative treatment to other autogenous graft techniques, particularly for defective sockets., Competing Interests: None