For horizontal bone augmentation, using block grafts in order to measure it by CBCT and avoid taking an extra one right after grafting.
Yes, because the screw is fixed in the palatal plate and will not move during healing.
I have written a review on crestal bone loss to be published soon in periodontology 2000, if interested mail me at [email protected]
Our group has one paper Published in Clinical Oral Implants Research and another one in General Dentistry regarding this
If you intend to find out if there are volumetric changes in the graft after a certain period of time, I suggest you take CBCT immediately after installing the graft and at the time point you intend to study. The amount of radiation is limited. The measurements errors with any clinical device are different (and probably higher) than the errors on CBCT, thus comparisons of clinical with radiographic measurements will give rise to questions about the measurement errors. Moreover it is possible to "subtract" the 3D images obtained from the 2 CBCT's to calculate volumetric block graft changes. The fixation screw can be used as landmarks.
This is another paper from patients treated by me where we studied particulated graft vs block bone in the edentulous maxilla (nice to see so many great people taking part in this discussion). Otherwise I agree it to be a good idea to use the screw as it is stable in the bone.
J Craniomaxillofac Surg. 2012 Dec;40(8):654-9. doi: 10.1016/j.jcms.2011.10.032. Epub 2011 Dec 3.
Particulate vs. block bone grafts: three-dimensional changes in graft volume after reconstruction of the atrophic maxilla, a 2-year radiographic follow-up.
Dasmah A, Thor A, Ekestubbe A, Sennerby L, Rasmusson L.
1)
Pelegrine AA, da Costa CE, Correa ME, Marques JF Jr.
Clin Oral Implants Res. 2010 May;21(5):535-42. doi: 10.1111/j.1600-0501.2009.01891.x. Epub 2010 Mar 11.
2)
da Costa CE, Pelegrine AA, Fagundes DJ, Simoes Mde J, Taha MO.
Gen Dent. 2011 Sep-Oct;59(5):e200-5.
It is not clear what you mean buccal flange. Do you mean buccal flange is the crestal level of buccal bone? In our research, we measure the bone resorption from implant platform to first bone to implant contact in histologic section. Thanks.
Greetings and thanks for all your comments. Dr. Lee, for buccal flange I meant the most buccal/external bone of the block graft once placed. Certainly, I do believe that this might be a good alternative to avoid rejections of any ethical committee. Assuming that it is considered an option, which CBCT software would you consider more precise for measuring this distance?
Dear all, it is clear that what Dr. Lee proposes in its research should be the gold standard for measuring resorption of bone grafts after implant placement. However, the histologic study of bone grafts sections together with the inserted implant is not reliable in clinical practice. Alberto, I agree with you in that measuring distance from the top of the screw should be appropriate enough to control bone resorption, at least in the bucco-lingual direction. Although an immediate post-op CBCT should be more accurate for comparison with delay CBCT, it is not always routinely performed. Go ahead with your clinical research. I would focus on onlay grafting for the anterior upper maxilla.
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