Application of a tent-pole screw technology in reconstruction of severe alveolar bone defect: a retrospective study of 30 patients

doi:10.3969/j.issn.1674-8115.2022.06.011

Abstract

Abstract: Objective

·To explore the effect of a tent-pole screw technology on reconstruction of severe alveolar bone defect.

Methods

·Thirty patients underwent tent-pole screw technology to reconstruct severe alveolar bone defects in the Department of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2018 to January 2021 were enrolled. By analyzing and reconstructing the image data of cone-beam computed tomography (CBCT) before and 8 months after operation, the effects of repairing and reconstructing the horizontal, vertical and mixed alveolar bone defects were counted. The alveolar bone volumetric parameters were evaluated by micro-computed tomography (Micro-CT), and trabecular bone number (Tb. N), trabecular bone thickness (Tb. Th), bone volume/total volume (BV/TV) and bone mineral density (BMD) were calculated to assess the maturity of regenerated bone. The regeneration of alveolar bone and remanent scaffold were calculated by analyzing histological sections.

Results

·Eight months after using the tent-pole screw, the vertical bone gain value was 4.81 (1.58, 7.66) mm, and the horizontal post-operative width was 3.96 (2.38, 5.67) mm. Additionally, the bone volume gain was 2 157.22 (776.59, 2 831.63) mm³. Micro-CT analysis of bone core, which was collected 8 months after the surgery, and Tb. N was (3.09±0.68)/mm, Tb. Th was (0.08±0.01) μm, BV/TV was (25.24±5.60)% and BMD was (0.24±0.05) g/cm³. Histological sections showed that the percentages of regenerated bone and remanent scaffold were (16.30±3.57)% and 34% (31.75%, 38.25%), respectively. These data suggested good new bone formation in targeted area. There were no complications or adverse events during surgery or post-operative healing.

Conclusions

·Based on “stability-oriented” alveolar ridge augmentation, using tent-pole screw, membrane pins and packaging structure in a standard operation procedure can achieve beneficial results for bone augmentation, while complications seldom occurre. The tent-pole screw may offer predictable and exceptional outcomes for implantation site preparation, especially for large alveolar defects, which will provide advantages to subsequent implantation and restoration.

Key words: stability-oriented, alveolar bone, bone augmentation, guided bone regeneration, tenting technique, tent screw, package structure, bone defect

CLC Number:

R782.13

WU Jing, ZHAO Zhengyi, ZOU Duohong, YANG Chi, ZHANG Zhiyuan. Application of a tent-pole screw technology in reconstruction of severe alveolar bone defect: a retrospective study of 30 patients[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(6): 768-777.

Figures/Tables 7

Fig 1 Flow chart of the surgical operation

Fig 2 Pre-operative (A) and post-operative (B) CBCT sagittal views of one patient

Fig 3 Bone gain of 30 patients after tent peg surgery for 8 months

Fig 4 Micro-CT reconstruction of alveolar bone for 8 months after operation

Fig 5 Alveolar bone data analysis of Micro-CT reconstruction for 8 months after operation

Fig 6 Histological analysis of the regenerated alveolar bone at 8 months post-operatively

Fig 7 Whole reconstruction flow chart of the patient who underwent a tent-pole screw

TrendMD

References 48

1	SIMION M, SCARANO A, GIONSO L, et al. Guided bone regeneration using resorbable and nonresorbable membranes: a comparative histologic study in humans[J]. Int J Oral Maxillofac Implants, 1996, 11(6): 735-742.
2	BRUNEL G, BROCARD D, DUFFORT J F, et al. Bioabsorbable materials for guided bone regeneration prior to implant placement and 7-year follow-up: report of 14 cases[J]. J Periodontol, 2001, 72(2): 257-264.
3	APRILE P, LETOURNEUR D, SIMON-YARZA T. Membranes for guided bone regeneration: a road from bench to bedside[J]. Adv Healthc Mater, 2020, 9(19): e2000707.
4	DESHPANDE S, DESHMUKH J, DESHPANDE S, et al. Vertical and horizontal ridge augmentation in anterior maxilla using autograft, xenograft and titanium mesh with simultaneous placement of endosseous implants[J]. J Indian Soc Periodontol, 2014, 18(5): 661-665.
5	LE B, ROHRER M D, PRASAD H S. Screw “tent-pole” grafting technique for reconstruction of large vertical alveolar ridge defects using human mineralized allograft for implant site preparation[J]. J Oral Maxillofac Surg, 2010, 68(2): 428-435.
6	XIAO T, ZHAO Y, LUO E, et al. “Tent-pole” for reconstruction of large alveolar defects: a case report[J]. J Oral Maxillofac Surg, 2016, 74(1): 55-67.
7	CHIAPASCO M, CASENTINI P, ZANIBONI M. Bone augmentation procedures in implant dentistry[J]. Int J Oral Maxillofac Implants, 2009, 24(Suppl): 237-259.
8	PEÑARROCHA-DIAGO M, GÓMEZ-ADRIÁN M D, GARCÍA-GARCÍA A, et al. Vertical mandibular alveolar bone distraction and dental implant placement: a case report[J]. J Oral Implantol, 2006, 32(3): 137-141.
9	SOEHARDI A, MEIJER G J, BERGE S J, et al. Lower border bone onlays to augment the severely atrophic (class Ⅵ) mandible in preparation for implants: a preliminary report[J]. Int J Oral Maxillofac Surg, 2014, 43(12): 1493-1499.
10	FELICE P, BARAUSSE C, PISTILLI R, et al. Guided “sandwich” technique: a novel surgical approach for safe osteotomies in the treatment of vertical bone defects in the posterior atrophic mandible: a case report[J]. Implant Dent, 2014, 23(6): 738-744.
11	KIYOKAWA K, RIKIMARU H, KIYOKAWA M, et al. Treatment outcomes of implants performed after regenerative treatment of absorbed alveolar bone due to the severe periodontal disease and endoscopic surgery for maxillary sinus lift without bone grafts[J]. J Craniofacial Surg, 2013, 24(5): 1599-1602.
12	POLI P P, BERETTA M, CICCIU M, et al. Alveolar ridge augmentation with titanium mesh. A retrospective clinical study[J]. Open Dent J, 2014, 8: 148-158.
13	BUSER D, DULA K, BELSER U, et al. Localized ridge augmentation using guided bone regeneration. 1. Surgical procedure in the maxilla[J]. Int J Periodontics Restor Dent, 1993, 13(1): 29-45.
14	URBAN I A, JOVANOVIC S A, LOZADA J L. Vertical ridge augmentation using guided bone regeneration (GBR) in three clinical scenarios prior to implant placement: a retrospective study of 35 patients 12 to 72 months after loading[J]. Int J Oral Maxillofac Implants, 2009, 24(3): 502-510.
15	URBAN I A, MONJE A, LOZADA J L, et al. Long-term evaluation of peri-implant bone level after reconstruction of severely atrophic edentulous maxilla via vertical and horizontal guided bone regeneration in combination with sinus augmentation: a case series with 1 to 15 years of loading[J]. Clin Implant Dent Relat Res, 2017, 19(1): 46-55.
16	SAGHEB K, SCHIEGNITZ E, MOERGEL M, et al. Clinical outcome of alveolar ridge augmentation with individualized CAD-CAM-produced titanium mesh[J]. Int J Implant Dent, 2017, 3(1): 36.
17	CIOCCA L, LIZIO G, BALDISSARA P, et al. Prosthetically CAD-CAM-guided bone augmentation of atrophic jaws using customized titanium mesh: preliminary results of an open prospective study[J]. J Oral Implantol, 2018, 44(2): 131-137.
18	ROCA-MILLAN E, JANÉ-SALAS E, ESTRUGO-DEVESA A, et al. Evaluation of bone gain and complication rates after guided bone regeneration with titanium foils: a systematic review[J]. Materials (Basel), 2020, 13(23): 5346.
19	CORINALDESI G, PIERI F, SAPIGNI L, et al. Evaluation of survival and success rates of dental implants placed at the time of or after alveolar ridge augmentation with an autogenous mandibular bone graft and titanium mesh: a 3- to 8-year retrospective study[J]. Int J Oral Maxillofac Implants, 2009, 24(6): 1119-1128.
20	MCALLISTER B S, HAGHIGHAT K. Bone augmentation techniques[J]. J Periodontol, 2007, 78(3): 377-396.
21	MACHTEI E E. The effect of membrane exposure on the outcome of regenerative procedures in humans: a meta-analysis[J]. J Periodontol, 2001, 72(4): 512-516.
22	MARX R E, SHELLENBERGER T, WIMSATT J, et al. Severely resorbed mandible: predictable reconstruction with soft tissue matrix expansion (tent pole) grafts[J]. J Oral Maxillofac Surg, 2002, 60(8): 878-888.
23	CHASIOTI E, CHIANG T F, DREW H J. Maintaining space in localized ridge augmentation using guided bone regeneration with tenting screw technology[J]. Quintessence Int, 2013, 44(10): 763-771.
24	KHOJASTEH A, BEHNIA H, SHAYESTEH Y S, et al. Localized bone augmentation with cortical bone blocks tented over different particulate bone substitutes: a retrospective study[J]. Int J Oral Maxillofac Implants, 2012, 27(6): 1481-1493.
25	赵永强, 蒋练. 帐篷式骨增量技术在口腔种植中的应用研究进展[J]. 口腔疾病防治, 2020, 28(12): 811-816.
	ZHAO Y Q, JIANG L. Application of the tent bone augmentation technique in dental implants[J]. J Prev & Treat Stomatol Dis, 2020, 28(12): 811-816.
26	POURDANESH F, ESMAEELINEJAD M, AGHDASHI F. Clinical outcomes of dental implants after use of tenting for bony augmentation: a systematic review[J]. Br J Oral Maxillofac Surg, 2017, 55(10): 999-1007.
27	FARIAS D, CACERES F, SANZ A, et al. Horizontal bone augmentation in the posterior atrophic mandible and dental implant stability using the tenting screw technique[J]. Int J Periodontics Restorative Dent, 2021, 41(4): e147-e155.
28	CÉSAR NETO J B, CAVALCANTI M C, SAPATA V M, et al. The positive effect of tenting screws for primary horizontal guided bone regeneration: a retrospective study based on cone-beam computed tomography data[J]. Clin Oral Implants Res, 2020, 31(9): 846-855.
29	王潇轶, 王国庆, 李芳, 等. “帐篷螺丝”技术在后牙种植区水平骨增量中的临床疗效观察[J]. 现代口腔医学杂志, 2022, 36(01): 27-29.
	WANG X Y, WANG G Q, LI F, et al. Clinical observation of horizontal bone augmentation during posterior tooth implantation with tent-screw technique[J]. J Modern Stomatol, 2022, 36(01): 27-29.
30	邹多宏, 刘昌奎, 薛洋, 等. 帐篷钉技术在牙槽骨修复与再生中的临床应用及操作规范[J]. 中国口腔颌面外科杂志, 2021, 19(1): 1-5.
	ZOU D H, LIU C K, XUE Y, et al. Clinical application of Tent-Peg technique in the reparation and regeneration of alveolar bone-standard operational practice[J]. China J Oral Maxillofac Surg, 2021, 19(1): 1-5.
31	HURLEY L A, STINCHFIELD F E, BASSETT A L, et al. The role of soft tissues in osteogenesis. An experimental study of canine spine fusions[J]. J Bone Joint Surg Am, 1959, 41-A: 1243-1254.
32	LIU J, KERNS D G. Mechanisms of guided bone regeneration: a review[J]. Open Dent J, 2014, 8: 56-65.
33	RASIA-DAL POLO M, POLI P P, RANCITELLI D, et al. Alveolar ridge reconstruction with titanium meshes: a systematic review of the literature[J]. Med Oral Patol Oral Cir Bucal, 2014, 19(6): e639-e646.
34	MISCH C M, JENSEN O T, PIKOS M A, et al. Vertical bone augmentation using recombinant bone morphogenetic protein, mineralized bone allograft, and titanium mesh: a retrospective cone beam computed tomography study[J]. Int J Oral Maxillofac Implants, 2015, 30(1): 202-207.
35	RIBEIRO FILHO S A, FRANCISCHONE C E, DE OLIVEIRA J C, et al. Bone augmentation of the atrophic anterior maxilla for dental implants using rhBMP-2 and titanium mesh: histological and tomographic analysis[J]. Int J Oral Maxillofac Surg, 2015, 44(12): 1492-1498.
36	DAGA D, MEHROTRA D, MOHAMMAD S, et al. Tentpole technique for bone regeneration in vertically deficient alveolar ridges: a prospective study[J]. Oral Biol Craniofac Res, 2018, 8(1): 20-24.
37	DEEB G R, TRAN D, CARRICO C K, et al. How effective is the tent screw pole technique compared to other forms of horizontal ridge augmentation?[J]. J Oral Maxillofac Surg, 2017, 75(10): 2093-2098.
38	WANG H L, BOYAPATI L. "PASS" principles for predictable bone regeneration[J]. Implant Dent, 2006, 15(1): 8-17.
39	SCHWARZ F, ROTHAMEL D, HERTEN M, et al. Immunohis-tochemical characterization of guided bone regeneration at a dehiscence-type defect using different barrier membranes: an experimental study in dogs[J]. Clin Oral Implants Res, 2008, 19(4): 402-415.
40	OH T J, MERAW S J, LEE E J, et al. Comparative analysis of collagen membranes for the treatment of implant dehiscence defects[J]. Clin Oral Implants Res, 2003, 14(1): 80-90.
41	LI X, WANG X, ZHAO T, et al. Guided bone regeneration using chitosan-collagen membranes in dog dehiscence-type defect model[J]. J Oral Maxillofac Surg, 2014, 72(2): 304. e1-e14.
42	CLAVERO J, LUNDGREN S. Ramus or chin grafts for maxillary sinus inlay and local onlay augmentation: comparison of donor site morbidity and complications[J]. Clin Implant Dent Relat Res, 2003, 5(3): 154-160.
43	YAMAUCHI K, TAKAHASHI T, FUNAKI K, et al. Histological and histomorphometrical comparative study of β-tricalcium phosphate block grafts and periosteal expansion osteogenesis for alveolar bone augmentation[J]. Int J Oral Maxillofac Surg, 2010, 39(10): 1000-1006.
44	KLINGE B, ALBERIUS P, ISAKSSON S, et al. Osseous response to implanted natural bone mineral and synthetic hydroxylapatite ceramic in the repair of experimental skull bone defects[J]. J Oral Maxillofac Surg, 1992, 50(3): 241-249.
45	QUIÑONES C R, HÜRZELER M B, SCHÜPBACH P, et al. Maxillary sinus augmentation using different grafting materials and dental implants in monkeys. Part Ⅳ. Evaluation of hydroxyapatite-coated implants[J]. Clin Oral Implants Res, 1997, 8(6): 497-505.
46	PIATTELLI M, FAVERO G A, SCARANO A, et al. Bone reactions to anorganic bovine bone (Bio-Oss) used in sinus augmentation procedures: a histologic long-term report of 20 cases in humans[J]. Int J Oral Maxillofac Implants, 1999, 14(6): 835-840.
47	HALLMAN M, SENNERBY L, LUNDGREN S. A clinical and histologic evaluation of implant integration in the posterior maxilla after sinus floor augmentation with autogenous bone, bovine hydroxyapatite, or a 20:80 mixture[J]. Int J Oral Maxillofac Implants, 2002, 17(5): 635-643.
48	BLOCK M S, DEGEN M. Horizontal ridge augmentation using human mineralized particulate bone: preliminary results[J]. J Oral Maxillofac Surg, 2004, 62(9 Suppl 2): 67-72.

[1]	Jian-ming YUAN, Bin WEI, Wei-xing XU, Lei ZHANG. CBCT effects of different abutment angles on alveolar bone changes in maxillary anterior teeth [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(3): 339-343.
[2]	LI Yuan, SHI Jun-yu, ZHANG Xiao, LAI Hong-chang. Correlation between the morphology of alveolar bone defect in the maxillary anterior region and the outcome of guided bone regeneration [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2020, 40(10): 1414-1419.
[3]	ZHOU Jie, SHU Rong, GONG Yin, XIE Yu-feng. Therapeutic effect of orthodontic intrusion combined with periodontal regenerative surgery in the treatment of pathologic migration of upper incisors [J]. , 2018, 38(5): 536-.
[4]	YU Jin-feng, HU Yun, HUANG Ming-na, CHEN Jun, MING Ye, ZHENG Lei-lei. Three-dimensional study on symmetry of the first molar and its peripheric alveolar bone in skeletal class Ⅲ patients with mandibular deviation [J]. , 2018, 38(3): 288-.
[5]	ZHOU Di, WU Yan, WANG Yun-ji, FAN Xiao-ping. Comparison of alveolar bone changes in maxillary anterior area secondary to different kinds of retraction method of anterior teeth: a cone-beam computed tomography study [J]. , 2018, 38(11): 1375-.
[6]	JIA Lang, HUANG Rong-zhong, WANG Yu-le, JIA Gong-wei . Effects of different intensity of extracorporeal shock wave combined with bone marrow mesenchymal stem cells transplantation on the repair of bone defect in rats [J]. , 2016, 36(12): 1706-.
[7]	YI Cheng-qing, MA Chun-hui, ZHANG Guo-qiao, et al. Expression characteristics of CXCL13 and CXCR5 in osteogenic microenvironmentof bone defect model [J]. , 2012, 32(12): 1536-.