J Clin Exp Dent. 2017;9(12):e1474-81. The effect of social geographic factors on children’s decays Journal section: Oral Surgery doi:10.4317/jced.54372 Publication Types: Review http://dx.doi.org/10.4317/jced.54372 Alternative intraoral donor sites to the chin and mandibular body-ramus David Reininger 1, Carlos Cobo-Vázquez 2, Benjamin Rosenberg 3, Juan López-Quiles 4 1 DDS, Master in Oral Surgery and Implantology. Instructor Professor, Departament of Oral and Maxillofacial Surgery, Universidad de los Andes 2 PhD, DDS, Master in Oral Surgery and Implantology, Universidad Complutense de Madrid 3 DDS 4 DDS, MD, PhD, Maxillofacial Surgeon, Associate Professor, Department of Oral Surgery and Maxillofacial Surgery, Universidad Complutense de Madrid Correspondence: Robles 12729 depto 305c Santiago de Chile [email protected] Reininger D, Cobo-Vázquez C, Rosenberg B, López-Quiles J.���������� Alterna- tive intraoral donor sites to the chin and mandibular body-ramus. J Clin Exp Dent. 2017;9(12):e1474-81. Received: 27/09/2017 Accepted: 23/10/2017 http://www.medicinaoral.com/odo/volumenes/v9i12/jcedv9i12p1474.pdf Article Number: 54372 http://www.medicinaoral.com/odo/indice.htm © Medicina Oral S. L. C.I.F. B 96689336 - eISSN: 1989-5488 eMail: [email protected] Indexed in: Pubmed Pubmed Central® (PMC) Scopus DOI® System Abstract Background: Provide a review of alternative intraoral donor sites to the chin and body-ramus of the mandible that bring fewer complications and that may be used to regenerate small and medium defects. Material and Methods: A review was conducted using the search engine PUBMED and looking manually into scientific journals. Results: From the 35 articles included, 6 corresponded to the coronoids, 3 corresponded to the zygomatic body, 5 corresponded to the anterior maxillary sinus wall, 3 corresponded to the zygomatic alveolar process, 2 correspon- ded to the incisive fossa, 2 corresponded to the anterior nasal spine, 2 corresponded to the palatal region, 5 corres- ponded to the tuberosity, and 7 corresponded to the palatal and mandibular tori. Conclusions: Although there are few complications described when using alternative intraoral donor sites, the main problem with these types of grafts is their scarce bone volume, with only the zygomatic body, anterior sinus wall, and palate sites being able to be used in medium defects. More clinical trials are necessary in order to evaluate the behavior of the alternative donor sites over time. Key words: Grafting, autologous bone, autografts, mandible, maxilla, palate hard, zygoma. Introduction to a systematic review from 2012 (1), a horizontal re- There are several factors that cause the resorption of the sorption of 3.79 +/- 0.23mm and a vertical resorption of alveolar process or in more severe cases the resorption of 0.24 +/- 0.11mm were described, the loss of bundle bone the basal bone. They include bone loss as a consequence being the factor triggering resorption (2). This resorption of trauma, due to tumor surgery, due to periodontal pa- occurs more severely during the first 6 months, there is thology, or as a result of the resorption following dental higher resorption in the vestibular cortical plate, and a extraction itself. In the latter case, specifically, according residual bone resorption range of 0.1mm per year for the e1474 J Clin Exp Dent. 2017;9(12):e1474-81. The effect of social geographic factors on children’s decays maxillary area and of 0.4 mm per year for the mandibu- site from which the graft comes and the technique for lar area (2) is estimated. Furthermore, the degree of bone extracting the graft and commenting on any complica- resorption can be increased due to anatomic, metabolic, tions that may have occurred. All the cadaver studies or functional, and prosthetic factors (3,4). studies on patients with uncontrolled metabolic diseases, Depending on severity, the resorption could cau- having undergone radiotherapy to the head area during se functional and aesthetic alterations, with incorrect the last 24 months or treatment with bisphosphonates gi- crown-to-implant ratios due to excessively long crowns ven intravenously or orally during 3 years or more, with compromising the aesthetic aspect of rehabilitation, or in psychiatric problems, and/or with a heavy smoker (more cases of more severe resorption the implant installation than 10 cigarettes a day), heavy drinker or drug user pro- could be prevented. Most of these complications can be file were automatically excluded. dealt with using regenerative techniques, techniques that The search was conducted using the following MESH are applied when installing the implant or before, with terms: “Bone Transplantation,” “Transplantation, autologous bone, allografts, xenografts, or alloplastic Autologous,” “Autografts,” “Mandible,” “Maxilla,” grafts, in block or particulate form, with or without mem- “Palate, Hard,” “Zygoma,” in the following form: brane, which can be resorbable or non-resorbable (5,6). (“Bone Transplantation”[Mesh] OR “Transplantation, Among all bone alternatives, autologous bone continues Autologous”[Mesh] OR “Autografts”[Mesh] AND to be the gold standard in bone regeneration (7,8), due to (“Mandible”[Mesh] OR “Maxilla”[Mesh] OR “Palate, its osteogenic, osteoinductive, and osteoconductive pro- Hard”[Mesh] OR “Zygoma”[Mesh]), then adding the perties, in addition to its growth factors and the fact that filters between 1990 and September 2015, human be- it does not cause immunogenic reactions (7). ings, English or Spanish language. Autologous grafts are classified according to their origin Two reviewers (D.R. and C.C.) examined independently being intraoral or extraoral, and according to their embr- the titles and abstracts of all the references selected in yologic origin being endochondral or membranous (7). the initial search. All studies to be selected had to meet In general, extraoral grafts are used in large defects, whi- the inclusion criteria; in those cases in which reading the le intraoral grafts are used in medium or small defects. title and the abstract was not enough to know if said cri- The main advantages of intraoral grafts are the following: teria were met the whole texts were read. Thus, a com- they are located near the recipient site, they reduce ope- plete list of the articles to be fully read by each reviewer rative time, they allow using a lower amount of anes- separately was made. Then, the reviewers read the full thetic, they involve less morbidity and discomfort in the articles and selected the studies that were going to be in- patient, and they allow the use of local anesthesia and do cluded in the final review. In cases of disagreement on a not require hospitalization (7,9,10). The most frequently specific article, a third person (J.L.Q.) joined the original used intraoral donor sites are the chin and body or ramus two reviewers in a discussion to decide. In order to avoid of the mandible, the main disadvantages of which are selection bias the authors hid the name of the journal, the their high number of postoperative complications (11- institutions and names of the authors for the review. 13), including sensitivity alterations in the teeth, mucosa or skin, alterations that can be temporary or permanent; Results opening limitations; and facial outline alterations. The initial search resulted in a total number of 4,660 ar- Therefore, the objective of this study is to review, analy- ticles, which then were reduced to 2,691 after the appli- ze, and compare the different intraoral donor sites that cation of the filters. These 2,691 articles were reduced to are used in the maxillofacial region, specifically at al- 120 with only the abstracts, with a coincidence percenta- veolar level, and that may provide alternative donor sites ge of 94.6% between the reviewers. A total of 60 articles with a lower rate of postoperative complications. were fully read, of which 34 were finally selected, with a coincidence of 100% between the reviewers. The search Material and Methods was complemented with the manual review, which re- A review of literature from 1990 to march 2017 was con- sulted in the addition of one article from the Journal of ducted using the PUBMED database and looking ma- Oral and Maxillofacial Surgery (Fig. 1). nually into the following journals: Journal of Oral and When analyzing the results of each donor site indepen- Maxillofacial Surgery, International Journal of Oral and dently (Table 1, 1 continue): Maxillofacial Surgery, Clinical Oral Implants Research, I.- Coronoid process: Clinical Implant Dentistry and Related Research, Jour- Of the total amount of articles, 6 correspond to the use of nal of Oral Implantology, and International Journal of the coronoids process as donor site (14-19), with which a Oral and Maxillofacial Implants. The inclusion criteria total of 131 patients were treated. The graft was applied for the studies were: studies conducted between 1990 in block form in 99.3% of the cases and in particula- and 2016, both prospective and retrospective, in English te form in the remaining 0.7%. The goal of the surgery or Spanish, conducted on humans, indicating clearly the was auricular reconstruction in 49.6% of the patients, e1475 J Clin Exp Dent. 2017;9(12):e1474-81. The effect of social geographic factors on children’s decays nitrate oxide sedation in 61.1% of the cases, under lo- cal anesthesia only in 25%, and under general anesthesia in the remaining 2.7%. The osteotomy was performed with rotatory instruments in 66.6%. of the cases, with implant burrs in 22.2%, and with trephine in the remai- ning 11.1%. III.- Anterior maxillary sinus wall 5 articles (23–27) were selected, in which a total of 138 patients were treated. The graft was applied in particu- late form in 73.2% of the cases and in block form in the remaining 26.8%.