Abstract：
Allogeneic cortical bone plates (CP) might be used for alveolar ridge augmentation as an alternative to autogenous grafts (AG) and bone substitutes (BS). We report about a multicenter case series and our experiences of more than 300 cases using CP and the shell technique for reconstruction of the alveolar process to illustrate surgical key steps, variations, and complication management.
Different types of alveolar ridge defects were augmented using the shell technique via CP. The space between the CP and the alveolar bone was filled with either autogenous or allogeneic granules (AUG, ALG) or a mixture of both. Implants were placed after 4-6 months. Microscopic and histological assessments were performed. In addition, space filling using AUG, ALG and bovine BS was discussed.
Scanning electron microscopy demonstrated the compact cortical structure of CP and the porous structure of ALG allowing micro-vessel ingrowth and bone remodeling. Histological assessment demonstrated sufficient bone remodeling and graft resorption after 4-6 months. In total, 372 CP cases and 656 implants were included to data analysis. The mean follow-up period was about 3.5 years. Four implants failed, while all implant failures were caused by peri-implantitis. Next, 30 CP complications were seen, while in 26 CP complications implant placement was possible. CP rehydration, stable positioning by adjusting screws, smoothing of sharp edges, and a tension-free wound closure were identified as relevant success factors. Space filling using ALG and a mixture of AUG/ALG resulted in sufficient bone remodeling, graft resorption and stability of the augmented bone.
CP and the shell technique is appropriate for alveolar ridge augmentation with adequate bone remodeling and low complication rates. Allografts can prevent donor site morbidity and therefore may decrease discomfort for the patient.
Different types of alveolar ridge defects were augmented using the shell technique via CP. The space between the CP and the alveolar bone was filled with either autogenous or allogeneic granules (AUG, ALG) or a mixture of both. Implants were placed after 4-6 months. Microscopic and histological assessments were performed. In addition, space filling using AUG, ALG and bovine BS was discussed.
Scanning electron microscopy demonstrated the compact cortical structure of CP and the porous structure of ALG allowing micro-vessel ingrowth and bone remodeling. Histological assessment demonstrated sufficient bone remodeling and graft resorption after 4-6 months. In total, 372 CP cases and 656 implants were included to data analysis. The mean follow-up period was about 3.5 years. Four implants failed, while all implant failures were caused by peri-implantitis. Next, 30 CP complications were seen, while in 26 CP complications implant placement was possible. CP rehydration, stable positioning by adjusting screws, smoothing of sharp edges, and a tension-free wound closure were identified as relevant success factors. Space filling using ALG and a mixture of AUG/ALG resulted in sufficient bone remodeling, graft resorption and stability of the augmented bone.
CP and the shell technique is appropriate for alveolar ridge augmentation with adequate bone remodeling and low complication rates. Allografts can prevent donor site morbidity and therefore may decrease discomfort for the patient.
摘要：
同种异体皮质骨板（CP）可用于牙槽骨，以替代自体移植物（AG）和骨替代物（BS）。我们报告了一个多中心病例系列，以及我们使用CP和外壳技术重建肺泡过程的300多例病例的经验，以说明手术的关键步骤。变体,和并发症管理。
通过CP使用壳技术增强了不同类型的牙槽骨缺损。CP和牙槽骨之间的空间填充有自体或同种异体颗粒（AUG，ALG）或两者的混合物。在4-6个月后放置植入物。进行显微镜和组织学评估。此外,空间填充使用AUG，讨论了ALG和牛BS。
扫描电子显微镜显示了CP的致密皮质结构和ALG的多孔结构，允许微血管向内生长和骨重建。组织学评估显示4-6个月后有足够的骨重建和移植物吸收。总的来说,包括372例CP病例和656例植入物进行数据分析。平均随访期约为3.5年。四个植入物失败了，而所有的植入物失败都是由种植体周围炎引起的。接下来,30例CP并发症，而在26例CP并发症中，植入是可能的。CP补液,通过调节螺钉稳定定位，平滑锋利的边缘，无张力伤口闭合被确定为相关成功因素。使用ALG和AUG/ALG混合物的空间填充导致足够的骨重建，移植物吸收和增强骨的稳定性。
CP和shell技术适用于牙槽脊增强，具有足够的骨重建和低并发症发生率。同种异体移植物可以防止供体部位的发病率,因此可以减少患者的不适。
通过CP使用壳技术增强了不同类型的牙槽骨缺损。CP和牙槽骨之间的空间填充有自体或同种异体颗粒（AUG，ALG）或两者的混合物。在4-6个月后放置植入物。进行显微镜和组织学评估。此外,空间填充使用AUG，讨论了ALG和牛BS。
扫描电子显微镜显示了CP的致密皮质结构和ALG的多孔结构，允许微血管向内生长和骨重建。组织学评估显示4-6个月后有足够的骨重建和移植物吸收。总的来说,包括372例CP病例和656例植入物进行数据分析。平均随访期约为3.5年。四个植入物失败了，而所有的植入物失败都是由种植体周围炎引起的。接下来,30例CP并发症，而在26例CP并发症中，植入是可能的。CP补液,通过调节螺钉稳定定位，平滑锋利的边缘，无张力伤口闭合被确定为相关成功因素。使用ALG和AUG/ALG混合物的空间填充导致足够的骨重建，移植物吸收和增强骨的稳定性。
CP和shell技术适用于牙槽脊增强，具有足够的骨重建和低并发症发生率。同种异体移植物可以防止供体部位的发病率,因此可以减少患者的不适。
