Hadi Antoun A prospective randomized study

Jean Max Sitbon

Henri Martinez
comparing two techniques of bone
Patrick Missika augmentation: onlay graft alone or
associated with a membrane

Authors’ affiliation: Key words: endosseous implant, bone reconstruction, autogenous graft, non-resorbable
Hadi Antoun, Jean Max Sitbon, Henri Martinez,
membrane
Patrick Missika, Department of Oral Surgery
and Oral Implantology, School of Dentistry,
University Paris 7, Denis Diderot, Paris, France Abstract: Two techniques of ridge augmentation using onlay bone graft alone or
Correspondence to: associated with a non-resorbable membrane have been previously described. This
Hadi Antoun prospective, randomized study compared these two techniques at 6 months, in terms of
9, rue Galilée bone gain, resorption and quality obtained at edentulous sites. Osseous measurements
75 116 Paris
France were taken using stents, callipers and CT-scans. Membrane exposure occurred at one
Tel: π33 1 4723 8325 site, 4 weeks after placement. Endosseous implants were successfully placed at all grafted
Fax: π33 1 4720 3158
sites. The mean graft thickness for all subjects was 4.7 mm (range: 2.3–6.2 mm). Overall
e-mail: hantoun/noos.fr
mean resorption was 1.5 mm (range: 0–4.6 mm) whereas overall mean width gain was
3.2 mm (range: 0.8–6.2 mm). Six months following surgery, the membrane group
experienced significantly less bone resorption than the graft alone group (P⬍0.01).
Width augmentation did not differ significantly between the two groups. In conclusion,
combining a membrane with an onlay graft demonstrates less bone resorption with a
minimal risk of complications. Longer follow-up is needed to confirm the benefits of
using a non-resorbable membrane.

Date:
Accepted 13 November 2000
To cite this article:
Antoun H, Sitbon JM, Martinez H, Missika P. A
prospective randomized study comparing two
techniques of bone augmentation: onlay graft alone
or associated with a membrane
Clin. Oral Impl. Res. 12, 2001; 632–639
Copyright C Munksgaard 2001
ISSN 0905-7161
The use of osseointegrated implants has
become an important treatment option
for the replacement of missing teeth in
fully and partially edentulous patients
(Brånemark et al. 1985; van Steenberghe
et al. 1990). However, insufficient height
or width of the alveolar bone at the im-
plantation site as a result of trauma, ex-
traction of teeth with advanced peri-
odontal disease or apical lesions, hinders
the feasibility of such procedures.
The morphology of the bone defect is
an important consideration when se-
lecting an appropriate method for bone
reconstruction. Several techniques of
autogenous bone grafts, such as onlay
grafts (Breine & Brånemark 1980; Lin et
al. 1990; Antoun et al. 1995), guided
bone regeneration (Nyman et al. 1989;
Buser et al. 1990, 1995), or a combi-
nation of these procedures (Jovanovic et
al. 1992; Buser et al. 1993; Jovanovic &
Buser 1994; Giovannolli & Renouard
1995; Antoun et al. 1996; Buser et al.
1996) have been used for bone recon-
struction with varying degrees of suc-
cess. In that respect, if primary stability
of endosseous implants is achieved, ex-
posed threads can be covered with
autogenous bone associated with a
membrane (Jovanovic et al. 1992; Jov-
anovic & Buser 1994; Giovannolli & Re-
nouard 1995; Antoun et al. 1996). If pri-
mary stability or appropriate positioning
cannot be achieved, ridge augmentation
should be performed before implan-
tation.
The use of an autogenous bone graft
for bone reconstruction is highly rec-
ommended due to its osteogenic prop-
erties. This approach was introduced by
Brånemark et al. (1975) and is now a

632

well-accepted procedure in oral and
maxillofacial rehabilitation (Tolman
1995). It represents the gold standard in
the repair of alveolar atrophy and bone
defects.
The iliac crest is the most common
site used to harvest large amounts of
autogenous bone (Listrom & Symington
1988; Misch & Dietsch 1994). Various
other extra-oral donor sites have also
been investigated, such as calvarium
(Tessier 1982; Tulasne et al. 1990), tibia
and rib (Kamiji et al. 1992; Schliephake
et al. 1994). The use of local bone grafts
from the maxilla and mandible, such as
the palate, maxillary tuberosity, zygo-
matic arch and coronoid process, has
also been described (Wolford & Cooper
1985; Moenning & Graham 1986;
Wood & Moore 1988). Block-type grafts
may be harvested from the mandibular
symphysis, body, or ramus area (Bosk-
er & Van Dijk 1988; Sindet-Pedersen &
Enemark 1988, 1990; Koole et al. 1989;
Misch et al. 1992; Misch 1997).
Several clinical studies have shown
evidence of bone gain, using bone grafts
from intraoral sites for ridge augmenta-
tion (Breine & Brånemark 1980; Antoun
et al. 1995; Buser et al. 1996). However,
the rate of resorption remains substan-
tial and has rarely been documented.
Combining a membrane with an
autogenous bone graft may limit graft re-
sorption. A barrier membrane could be
used to contain and stabilize the particu-
late graft, allowing bone regeneration in
any remaining space and minimizing
overall loss of bone volume (Fonseca et
al. 1980; Dado & Izquierdo 1989).
We conducted a prospective, ran-
domized study comparing two tech-
niques of bone augmentation, the first
evaluating onlay bone graft alone and
the second bone graft associated with a
non-resorbable membrane. The primary
objective of this study was to compare
the two techniques following 6 months
of healing, in terms of bone resorption
and augmentation. The bone quality ob-
tained at the grafted sites was also evalu-
ated clinically and histologically.
Material and methods
Twelve subjects (6 males, 6 females),
with a mean age of 34 years (range: 18–
Antoun et al . RCT of bone augmentation using bone graft alone or with a membrane
52 years), were recruited between Jan-
uary 1997 and February 1998. Seven sub-
jects (8 surgical sites) were randomized
to the bone graft alone group and five
subjects to the group treated with bone
graft associated with a non-resorbable
membrane.
Patient selection
As part of the study entry criteria, all
subjects had to have a maxillary or man-
dibular edentulous ridge, which required
width augmentation prior to implant
placement. The edentulous area should
allow placement of at least one standard
implant and should not have exceeded a
four-tooth span. In addition, an intraoral
bone donor site should be available. All
patients had no known contraindi-
cations to intraoral surgery. Finally, a
signed, written, informed consent form
was obtained from all subjects prior to Fig. 1. Calliper with individual stent used to
measure crestal width.
any study-related procedures.
Evaluations performed at baseline in-
cluded a study cast, wax-up, panoramic
radiograph, periapical radiographs, CT- liper (Mauser DigitalA, Oraltronics, Bre-
scan, surgical stent and blood tests. men, Germany). The measurements
were made on a line drawn 3 mm from
Measurements the edge, perpendicular to the longitudi-
nal axis of the crest.
Two different techniques were used to
measure crestal width. The first used a Surgical technique
calliper with an individual stent (Fig. 1).
The stent was prepared on the study cast The patients were premedicated one
using hard acrylic resin where the calli- hour preoperatively with 60 mg pred-
per should fit. At the time of surgery, the nisone, 1 g amoxicillin plus clavulanic
stent was rigidly fixed to neighboring acid and 20 mg diazepam. They were
teeth. The calliper was then blocked and asked to rinse with 0.2% chlorhexidine
two width measurements (mesial and for 2 minutes. Patients with known al-
distal) were recorded at each site before lergy to penicillin received 1 g erythro-
and after graft placement. Six months mycin. Following surgery, antibiotics
later, the same measurements were as- were prescribed for 6 days and pred-
sessed during re-entry surgery. nisone was tapered over 2 days. The pa-
The second technique used for tients were also instructed to start chlor-
measuring crestal width utilized a CT- hexidine mouth rinses (3 times a day for
scan performed at baseline and 5 months 2 weeks) on the second day following
after graft surgery (Fig. 2). The same op- surgery, to reduce the risk of infection.
erator performed both CT-scans. A stan- The surgical technique was performed
dardized protocol was followed for all as described by Misch et al. (1992). Fol-
patients, where axial views parallel to lowing local anesthesia (Articaı̈ne 4%;
the hard palate or the mandibular base Adrenaline 1/100 000) of the recipient
were obtained. Coronal sections, perpen- site, a crestal incision displaced towards
dicular to the axial sections, were as- the palatal side was performed. Diver-
sessed every 2 mm from the proximal as- gent releasing incisions were made buc-
pect of the adjacent teeth. cally adjacent to neighboring teeth, and
The crestal width was measured on full thickness flaps were elevated at the
each coronal view with an electronic cal- buccal and palatal aspects of the jaw (Fig.
633 | Clin. Oral Impl. Res. 12, 2001 / 632–639
Antoun et al . RCT of bone augmentation using bone graft alone or with a membrane

Fig. 2. CT-scan is performed before bone augmentation (a) and 5 months after graft surgery (b).

3). All fibrous tissue was removed and
the lateral aspect of the ridge was perfor-
ated with a surgical bur to facilitate vas-
cularization of the graft.
An onlay bone graft was harvested
from the mandible symphysis area (Fig.
4). It was obtained under the apices of
the mandibular incisors and canines and
above the lower border of the chin using
an intraoral approach. The block graft
was re-contoured to fit the defect and se-
cured with titanium screws (Fig. 5). Can-
cellous bone was harvested from the do-
nor site to fill discrepancies.
Depending on the result of the treat-

Fig. 3. At day 0, preparation of the recipient site and the first measurements Fig. 5. The block of bone is adapted and secured to the recipient site. New
are taken. measurements are recorded.

Fig. 4. An onlay bone graft is harvested from the symphysis area. Fig. 6. Depending on randomization, an e-PTFE membrane covers the graft.

634 | Clin. Oral Impl. Res. 12, 2001 / 632–639

 Antoun et al . RCT of bone augmentation using bone graft alone or with a membrane

ment randomization (carried out on the
day of surgery), the graft was protected,
or not protected, with a membrane,
which was fixed with mini-titanium
screws (Fig. 6). The membrane used was
an expanded-polytetrafluoroethylene (e-
PTFE) non-resorbable membrane (W.L.
Gore & Associates, Flagstaff, AZ, USA).
Prior to suturing, horizontal releasing
incisions were made with a scalpel
through the periosteum of the mucosal
flap covering the graft to achieve ten-
sion-free wound closure. The incisions
were closed with interrupted and mat-
tress sutures using 3–0 Gore-Tex or vic-
ryl sutures depending on whether a
membrane was used.
Follow-up
The patients returned for follow-up
every two weeks for the first month,
then once a month until re-entry surgery
at 6 months. At the follow-up visits,
both recipient and donor sites were clin-
ically evaluated for soft tissue healing,
graft and/or membrane exposure.
Re-entry
At 6 months, a second surgery was per-
formed at the recipient site (Fig. 7). New
measurements were taken on the grafted
site using the same calliper and stent. Im-
plants of the Brånemark systemA (13 or
15 mm long, 3.75 mm diameter, Nobel
Biocare AB, Gothenburg, Sweden) were
then placed in an optimal position (Fig. 8).
Bone quality
A histological and clinical evaluation of
the grafted bone was performed at re-
entry.
Clinical evaluation
Using a Næ 23 probe, the bone quality at
the grafted site was ranked on a scale of
1 to 5: 1Ωvery soft, 2Ωsoft, 3Ωdense
(allows slight penetration of the probe),
4Ωvery dense (resistant to probing) and
5Ωnormal bone (Mattout et al. 1996).
Histological evaluation
A trephine bur with an external diam-
eter of 3 mm was used to obtain bone
biopsies at the implant site before prep-
aration of the recipient bed. The biopsies
were washed three times with phosphate
buffer solution and fixed at 4 æC in 2.5%
glutaraldehyde buffered with 0.1 m so-
dium cacodylate buffer. After 2 h in the
fixative solution, they were soaked over-
night in 0.2 m sodium cacodylate buffer,
pH 7.2. Then they were postfixed in
0.2% OsO4 in 0.1 m sodium cacodylate
buffer pH 7.2 for 30 minutes. After dehy-
dration in graded ethanol, they were em-
bedded in situ in Epon 812. Semi-thin
sections were then obtained with a dia-
mond knife and stained with toluidine
blue or with neutral red stains. All sec-
tions were examined under a light mi-
croscope.
Statistical tests
Statistical analysis was performed on all
observed data at the different evaluation
points. The data were not treated as
paired data. Due to the small number of
cases (12 patients and 13 intervention
sites), non-parametric tests were used for
rank analysis. The Mann-Whitney test
was used with both 5% and 1% signifi-
cance levels, respectively.
Minimum, maximum, mean and me-
dian values are shown in the tables to
illustrate the different variables but were
not considered for the statistical test.
Only the rank values for each patient
were used.

Table 1. Width resorption: graft plus Table 2. Width gain: graft plus membrane Table 3. Graft width: graft plus membrane
membrane versus graft alone (P∞0.01) (values versus graft alone (non-significant) (values versus graft alone (non-significant) (values
are listed in increasing order) are listed in increasing order) are listed in increasing order)

Graft plus Graft Graft plus Graft Graft plus Graft

membrane alone membrane alone membrane alone
Site number (mm) (mm) Site number (mm) (mm) Site number (mm) (mm)

6 0.0 5 0.8 13 2.3

11 0.0 3 1.0 12 3.0

9 0.1 12 1.5 5 3.3

4 0.5 8 2.7 10 3.4

12 0.8 11 3.0 8 4.5

7 1.7 10 3.0 7 4.9

2 1.8 7 3.2 11 5.0

8 1.8 9 3.3 4 5.1

1 1.8 13 4.0 3 5.6

10 2.0 2 4.2 2 6.0

13 2.0 1 4.3 14 6.0

5 2.5 4 4.5 1 6.1

3 4.6 6 6.2 6 6.2

Maximum 0.8 4.6 Maximum 6.2 4.3 Maximum 6.2 6.1

Minimum 0.0 1.7 Minimum 1.5 0.8 Minimum 2.3 3.3

Mean values 0.3 2.3 Mean values 3.7 2.9 Mean values 4.0 5.1

Median values 0.1 1.9 Median values 3.3 3.1 Median values 3.4 5.3

635 | Clin. Oral Impl. Res. 12, 2001 / 632–639

Antoun et al . RCT of bone augmentation using bone graft alone or with a membrane

Fig. 7. At re-entry, the grafted site is re-evaluated and measurements are Fig. 9. At the re-entry, a histologic study showed a mixture of cellular and
taken with the same stent and calliper. acellular cortical bone.

Results
In this study comparing bone augmenta-
tion using bone graft alone or bone graft
associated with a membrane, healing
was uneventful with only one graft site
showing membrane exposure after 4
weeks. The patient was administered 1.5
g amoxicillin plus clavulanic acid daily,
was instructed to apply a 0.2% chlorhex-
idine gel on the exposed site and to rinse
Table 4. Width gain with CT-scan
measurements: graft plus membrane versus
graft alone (non-significant) (values are
listed in increasing order)
3 times daily with 0.2% chlorhexidine.
The membrane was removed 2 weeks
later and at that time there was no clin-
ical sign of infection. The etiology of
this exposure remained unclear.
Initial graft width, bone gain and
width resorption measurements were
obtained at all intervention sites (nΩ13,
patients nΩ12). There was a significant
difference in the width resorption with a
mean of 0.3 mm in the membrane group
versus 2.3 mm in the graft alone group
(P⬍0.01, Table 1). However, the differ-
ence in the width gain was not signifi-
cant, with a mean of 3.7 mm in the
membrane group versus 2.9 mm in the
graft alone group (Table 2). The graft
width obtained was comparable in both
groups, with a mean of 4.0 mm in the
membrane group versus 5.1 mm for the
graft alone group (Table 3).
The CT-scan measurements were
available for all subjects, except patient
9 at baseline (Table 4). There was no sig-
nificant difference between the groups in
terms of width gain, with a mean of 4.2
mm in the membrane group versus 2.5
mm in the graft alone group.

Graft plus Graft

membrane alone Implant placement. Implants were
Site number (mm) (mm) successfully placed in an optimal
8 0.9 position at all grafted sites.
3 1.4

7 2.2 Bone quality

12 2.3 Clinical evaluation
2 2.4 All grafted sites were classified as 5 (nor-
13 2.6
mal density bone) except 2 sites in the
membrane group which were classified
1 3.0
as 3. These 2 sites were characterized by
10 3.0
thin soft tissue on the buccal aspect of
11 3.7 the graft.
5 4.2

6 4.9
Histological results
4 5.9
A histologic analysis could be performed
Maximum 5.9 4.2 on bone biopsies obtained from 6 pa-
Minimum 2.3 0.9 tients. Most of the sections showed a
Mean values 4.2 2.5 dense bone tissue with a mixture of
Fig. 8. A Brånemark implant is placed in an opti- empty and osteocyte-containing lacunae
Median values 4.3 2.5
mal position in the grafted area. (Fig. 9).

636 | Clin. Oral Impl. Res. 12, 2001 / 632–639


Discussion
This study with a small number of sub-
jects, using an e-PTFE membrane com-
bined with a bone graft for ridge aug-
mentation prior to implant placement,
showed significantly less width resorp-
tion than with a bone graft alone 6
months following surgery. Moreover, the
membrane group experienced higher
width gain than the graft alone group
even though initial graft width was
smaller in the membrane group. The
most likely hypothesis that can explain
the apparent benefits of the membrane
lies in its probable protective effect dur-
ing the healing time following bone
grafting.
Results of width gain demonstrated
with CT-scans were in accordance with
those obtained with the callipers, show-
ing a trend towards an increased width
in the membrane group as compared to
the graft alone group. This radiograph-
ical method is reliable and may be used
to assess techniques of bone augmenta-
tion.
The quality of the grafted bone was
evaluated clinically and histologically at
the implant site. Clinical assessment
was more subjective and enabled evalu-
ation of the external aspect of the graft
only. However, it did provide a good clin-
ical impression of the density of the
bone especially during drilling and im-
plant placement. The histological evalu-
ation was of questionable value since
only six implant sites could be analyzed,
yielding a mixture of cellular and acellu-
lar cortical bone. Our main concern was
whether the analyzed bone was har-
vested from the grafted area, from the re-
cipient site area or from both sites. This
point could not be elucidated further, so
harvesting bone for histological analysis
was stopped after Patient 6. In addition,
histochemical markers that would have
allowed some differentiation between
old and new bone, were not used in this
study.
In this study, the use of a non-re-
sorbable membrane was well tolerated
and was associated with a low compli-
cation frequency. Only one patient ex-
perienced membrane exposure, not pre-
cluding successful implant placement
after membrane removal and proper
Antoun et al . RCT of bone augmentation using bone graft alone or with a membrane
wound management. This case was
probably related to the team’s relative
experience with the technique, as there
were no additional exposures. Moreover,
a prompt diagnosis should prevent infec-
tion and limit graft resorption.
One of the major drawbacks of using a
membrane is that it is a time-consuming
procedure due to the necessity of
adapting and fixing the membrane with
mini-titanium screws. In addition, a sub-
stantial increase in the total inter-
vention cost is incurred.
Clinical studies of bone augmentation
with pre- and post-augmentation meas-
urements are rare. Other studies re-
ported that mandibular bone grafts,
which are primarily cortical bone, ex-
hibit little bone volume loss and demon-
strate good incorporation after a short
healing time (Misch et al. 1992; Jensen
et al. 1994; Antoun et al. 1995; William-
son 1996). However, these publications
are retrospective and their measure-
ments of the resorption could be ques-
tionable.
A preliminary study on crestal en-
largement in 22 consecutive patients
(ten Bruggenkate et al. 1992) has shown
50% resorption of the onlay grafts after 6
months, with a final mean crestal width
gain of 1.6 mm. These results were con-
firmed in another study published by the
same authors (Krekeler et al. 1993). In
comparison, subjects undergoing crestal
augmentation with graft alone in our
study experienced higher width gain at 6
months (mean of 2.9 mm).
Buser et al. (1996) evaluated the com-
bined use of autografts and e-PTFE mem-
branes in a series of 40 patients treated
for lateral ridge augmentation. Their pre-
and post-augmentation measurements
showed crest enlargement from a mean
of 3.5 to 7.1 mm, thus a mean augmenta-
tion of 3.6 mm. This result is compar-
able to that obtained in the present
study where the group treated with bone
graft plus membrane experienced a mean
width gain of 3.7 mm.
Other factors than the membrane may
influence the healing process, such as
the healing time period (Misch et al.
1992; Antoun et al. 1995), the size of the
bone graft (Fonseca et al. 1980; Dado &
Izquierdo 1989) and the embryologic ori-
gin of the graft (Smith & Abramson
1974; Zins & Whitaker 1983).
Experimental evidence suggests that
grafts from membranous bone show less
resorption than endochondral bone
(Smith & Abramson 1974; Zins & Whi-
taker 1983). Although cancellous grafts
revascularize more rapidly than cortical
grafts, cortical membranous grafts revas-
cularize more rapidly than endochondral
bone grafts with a thicker cancellous
part (Kusiak et al. 1985). Another hy-
pothesis is that the improved survival of
membranous bone grafts is the result of
their thicker cortical layer (Marx 1992).
Despite the fact that the mandibular
symphysis donor site is a membranous
bone, some sites in the graft alone group
have shown significant resorption.
Conclusions
This prospective study compared two
techniques of osseous augmentation at
edentulous sites. Although subject num-
bers were too small to draw robust con-
clusions, associating a membrane to an
onlay osseous graft demonstrated sig-
nificantly less bone resorption when
compared to onlay bone graft alone. This
benefit must be weighed against poten-
tial drawbacks, such as increased time
and cost of the procedure, and the risk of
short-term membrane exposure, al-
though minimal in this study. Future
studies must be conducted in order to
evaluate the long-term implant prog-
nosis associated with both techniques.
Acknowledgements: The authors would
like to gratefully acknowledge the ‘‘As-
sociation Française d’Implantologie’’ and
Nobel Biocare France for grant support, J.
R. Nefussi (Laboratoire d’Odontologie Na-
dine Forest) for the histology and J. F. Bar-
ret for the dental laboratory assistance.
Résumé
Deux techniques d’épaississement osseux utilisant
soit un greffon osseux onlay soit le même mais associé
a une membrane non-résorbable ont été décrites pré-
cédemment. Cette étude randomisée et prospective a
comparé ces deux techniques sur une période de six
mois, en terme de gain osseux, de résorption et de qua-
lité obtenus au niveau des sites édentés. Les mesures
osseuses ont été relevées à l’aide de stents, de pieds à
coulisse et des scanners CT. L’exposition de la mem-
brane s’est produite dans un site quatre semaines ap-
637 | Clin. Oral Impl. Res. 12, 2001 / 632–639
Antoun et al . RCT of bone augmentation using bone graft alone or with a membrane
rès son placement. Les implants endo-osseux ont été
placés avec succès dans tous les sites greffés. L’épais-
seur moyenne du greffon pour tous les sujets était de
4.7 mm, de 2.3 à 6.2 mm. La résorption moyenne gé-
nérale était de 1.5 mm, de 0 à 4.6 mm, tandis que les
gains de largeur moyenne étaient de 3.2 mm, de 0.8 à
6.2 mm. Six mois après la chirurgie, le groupe avec
membrane avait significativement moins de ré-
sorption osseuse que le groupe avec greffon seulement
(P∞0.01). L’augmentation de la largeur ne différait pas
de manière significative entre les deux groupes. En
conclusion, l’association d’une membrane avec un
greffon onlay s’est accompagnée de moins de ré-
sorption osseuse avec un risque minimal de complica-
tion. Un suivi plus long s’avère nécessaire pour
confirmer les avantages de l’utilisation d’une mem-
brane non-résorbable.
Zusammenfassung
Die zwei Techniken der Alveolarknochenaugmenta-
tion, einerseits mit einem membrangedeckten (nicht-
resorbierbare Membran) und andererseits mit einem
ungedeckten Onlay-Transplantat, wurden schon frü-
her beschrieben. Diese Studie verglich beide Techni-
ken nach sechs Monaten hinsichtlich Knochenge-
winn, Resorptionen und Qualität der augmentierten
Stellen. Die Knochenvermessungen erfolgten mittels
Schablonen, Absteckzirkeln und CT-Schnitten. Nach
vier Wochen kam es bei einer Membran zur Exposi-
tion. Die enossalen Implantate konnten bei allen auf-
gebauten Stellen erfolgreich eingesetzt werden. Die
durchschnittliche Transplantatdicke betrug bei allen
Probanden 4.7 mm (Bandbreite: 2.3–6.2 mm). Die
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638 | Clin. Oral Impl. Res. 12, 2001 / 632–639
durchschnittliche Gesamtresorption betrug 1.5 mm
(Bandbreite: 0–4.6 mm), währenddem der durch-
schnittliche Gewinn an Gesamtbreite 3.2 mm betrug
(Bandbreite: 0.8–6.2 mm). Sechs Monate nach der
Chirurgie zeigte die Gruppe mit Membranen signifi-
kant weniger Knochenresorptionen als die Gruppe
ohne Membranen (P∞0.01). In der Breite des Augmen-
tates unterschieden sich die zwei Gruppen nicht signi-
fikant. Zusammenfassend kann man sagen, dass die
Kombination der Membrantechnik mit einem Onlay-
Transplantat bei minimalsten Komplikationen zu ge-
ringeren Knochenresorptionen führt. Es braucht nun
aber eine verlängerte Beobachtungszeit um die Vortei-
le des Einsatzes einer nicht resobierbaren Membran zu
bestätigen.
Resumen
Se han descrito previamente dos técnicas de aumento
de la cresta usando injerto óseo superpuesto única-
mente o asociado con una membrana no reabsorvible.
Este estudio prospectivo, aleatorio comparó las dos
técnicas a los 6 meses, en términos de ganancia ósea,
reabsorción y calidad obtenida en las zonas edéntulas.
Se tomaron mediciones óseas usando calibres, y escá-
ner CT. En un lugar ocurrió exposición de la membra-
na, 4 semanas tras la colocación. Los implantes endoó-
seos se colocaron con éxito en todos los lugares injer-
tados. El grosor medio para todos los sujetos fue de 4.7
mm (rango: 2.3–6.2 mm). En total la reabsorción me-
dia fue 1.5 mm (rango: 0–4.6 mm) mientras que en
total la media de ganancia de grosor fue 3.2 mm (ran-
go: 0.8–6.2 mm). Seis meses tras la cirugı́a, el grupo de
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