Bone ring technique

Reconstruction and simultaneous implantation using the bone ring technique

The Bone Ring Technique is a surgical method in which a dental implant is inserted into the jawbone and at the same time the jawbone is built up with the help of a ring-shaped bone transplant. The bone ring technique was first published in 2002 by Emeka Nkenke. The combination of jaw augmentation and simultaneous implantation enables the treatment time to be shortened by up to 6 months.

Indications

The indications for the bone ring technique are moderate to severe defects of the alveolar ridge of the upper and lower jaw , which require bone augmentation prior to dental implantation. The technique can be used for single tooth gaps, gaps between teeth, severely atrophied alveolar ridges and sinus floor elevations .

Contraindications

In addition to the usual general contraindications for surgical augmentation of the jaw, special contraindications are a type of defect in which the implant tip can be screwed less than 3 mm into the local bone and thus no primary stability of the implant is achieved.

General procedure

The bone ring technique is generally performed under local anesthesia and under outpatient conditions. At the site to be implanted, the mucous membrane is first unfolded and the defective bone of the alveolar ridge is measured. Then, with a suitable trephine burr, a bone ring is removed from another location (see also removal points for the bone rings) or an allogeneic bone ring is used. The next step is to drill the pilot hole for implant alignment in the area to be implanted. A suitable trephine burr with a central pin is then used to center the bearing for the bone ring to be inserted. In most cases, the bone ring can then be used in the press-fit procedure. The further implant drilling is then carried out through the bone ring according to an individually determined length and diameter. The implant is now slowly screwed into the jawbone through the bone ring and with little pressure to the desired position. If there is no primary stability of the bone ring yet, this can be achieved by using a cover screw or membrane screw through axial compression. As a rule, the surgical area is then covered with a slowly absorbable bone substitute material and a membrane. A saliva-proof wound closure ends the operation. After a healing period of about half a year, the prosthetic restoration of the implant can take place.

Removal sites for the bone rings

When using the body's own bone rings, the extraction regions such as the chin area, the lower branch of the lower jaw and the bony palate are preferred in everyday clinical practice . Removal sites such as the iliac crest or the tibial head are also possible, but are reserved for special indications.

Allogeneic bone rings

Allogeneic ring of bone inserted in the maxillary sinus

Since the availability of prefabricated allogeneic bone rings (bone rings from human donors) on the German market, bone ring technology has experienced a significant boost in its spread and application. There are no possible risks associated with the removal of the body's own bone, such as sensory disturbances, bleeding, injuries to neighboring teeth and infections at the removal site, when using allogeneic bone rings. The operation time is also significantly reduced, which leads to increased patient acceptance. Despite intensive preparation techniques and procedures for sterilizing the allogeneic bone rings, a so-called residual risk for the transmission of infections remains .

Variants of the bone ring technique

A variation of the bone ring technique is to use the ring for a sinus lift on the floor of the maxillary sinus . The bone ring is then fixed in place by the implant. It enables sinus floor elevation and simultaneous implantation to be carried out even with residual bone that is less than a millimeter thick up to the maxillary sinus.

advantages

With the help of the bone ring technique, it is possible to carry out bone grafting and implantation in one operation. This technique can shorten the treatment time by up to 6 months compared to other procedures in which the bone is built up first and implantation takes place in a second procedure. As there is no further operation, this reduces the stress on the patient. Due to the use of standardized trephine burs, there is a good fit between the bone ring and the jawbone. The operating time is significantly reduced. There is no need for complex 3D images and the production of individually milled bone blocks.

disadvantage

The bone ring technique is a technically difficult process that requires precise adherence to the individual surgical steps and should therefore only be used by experienced surgeons. In the event of complications such as wound infections or wound healing disorders, it may be necessary to completely remove the implant together with the bone structure (here bone ring), which is not always necessary with other techniques with a step-by-step approach.

Study situation

A case report published in 2010 by the study group MR Stevens et al. 6 months after surgery showed good osseointegration of the implants and a good soft tissue level in the area of ​​the augmentation. Further studies, mostly based on a few cases, describe the effectiveness of the technology. The use of allogeneic bone rings is currently the subject of clinical research and is showing promising results.

Individual evidence

1. ↑ Emeka Nkenke, Martin Radespiel-Troger, Jorg Wiltfang, Stefan Schultze-Mosgau, Gerhard Winkler: Morbidity of harvesting of retromolar bone grafts: a prospective study . In: Clinical Oral Implants Research . tape 13 , no. 5 , October 2002, ISSN  0905-7161 , p. 514-521 , doi : 10.1034 / j.1600-0501.2002.130511.x ( wiley.com [accessed May 13, 2020]).
2. Jump up ↑ J. Nissan, O. Ghelfan, S. Calderon, O. Mardinger, G. Chaushu: Efficacy of Cancellous Block Allograft Augmentation prior to Implant Placement in the Posterior Atrophic Mandible . In: Clinical Implant Dentistry and Related Research . tape 13 , no. 4 , 2011, p. 279-285 .
3. ^ J. Nissan, V. Marilena, O. Gross, O. Mardinger, G. Chaushu: Histomorphometric analysis following augmentation of the anterior atrophic maxilla with cancellous bone block allograft . In: Int. J. Oral Maxillofac . tape 27 , no. 1 , January 2012, p. 84-89 .
4. ↑ Mark R. Stevens, Hany A. Emam, Mahmoud EL Alaily, Mohamed Sharawy: Implant Bone Rings. One-Stage Three-Dimensional Bone Transplant Technique: A Case Report . In: Journal of Oral Implantology . tape 36 , no. 1 , March 10, 2010, p. 69-74 , doi : 10.1563 / aaid-joi-d-09-00029 .
5. ↑ Girish B Giraddi, Aamir Malick Saifi: Bone ring augmentation around immediate implants: A clinical and radiographic study. In: Annals of maxillofacial surgery. June 21, 2017, accessed August 8, 2017 . 
6. ↑ M. Omara, N. Abdelwahed, M. Ahmed, M. Hindy: Simultaneous implant placement with ridge augmentation using an autogenous bone ring transplant . In: International Journal of Oral and Maxillofacial Surgery . tape 45 , no. 4 , April 1, 2016, p. 535-544 , doi : 10.1016 / j.ijom.2015.11.001 ( sciencedirect.com [accessed August 8, 2017]).
7. ↑ Dennis Flanagan: Cylindrical Ringbone Allograft to Restore Atrophic Implant Sites: A Pilot Study . In: Journal of Oral Implantology . tape 42 , no. 2 , 2016, p. 159-163 , doi : 10.1563 / aaid-joi-D-15-00052 .
8. ↑ Daniel Rothamel, Tim Fienitz, Jan Horn Kiel, Damir Jelusic, Markus Schlee, Ralf Smeets, Bernd Giese Hagen, Arndt Happe, Joachim E. Zöller: New augmentative possibilities by allogeneic bone substitutes - opportunity or risk? In: Quintessence . tape 66 , no. 10 . Quintessenz, Berlin 2015, p. 1167-1177 .

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