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Revista Española de Cirugía Oral y Maxilofacial

On-line version ISSN 2173-9161Print version ISSN 1130-0558


OCHANDIANO CAICOYA, S.. Bone cavity filling with alloplastic material in maxillofacial surgery. Rev Esp Cirug Oral y Maxilofac [online]. 2007, vol.29, n.1, pp.21-32. ISSN 2173-9161.

Two types of defects are differentiated in bone regeneration studies. Those that lack a capacity for spontaneous regeneration during the entire life of the individual (critical size defect) and those that do have this capacity (non-critical size defect), providing the adequate conditions are found such as blood clot stability, space-maintaining and mechanical rest (the guided bone regeneration concept). In this controversy, bony defects of the maxillary sinus and the residual cavities after cyst removal are revised. Both are non-critical size defects that conserve several walls. Many authors used to conclude that for sinus elevation, using autologous bone in the graft material was always necessary, either on its own or mixed differently with biomaterials in proportions that were not defined, 50:50, 20:80 etc. Clinical evidence, which has also been reflected in the literature over recent years, contradicts this conclusion and it has been stated that biomaterials on their own in the maxillary sinuses achieve results that are comparable to those achieved with autologous bone, providing the ossification period is increased. We review new studies that even dispute the need for using any type of graft at all in order to achieve new bone formation within the maxillary sinus. The results in the residual cavities of bony defects after cyst removal, if various walls can be conserved, are even more conclusive. The best treatment for these defects is direct closure of the mucosa and waiting for the spontaneous regeneration of the defect. The use of autologous bone is unnecessary and, if we introduce biomaterials, we still do not achieve better biomechanical behavior of the residual bone. Ossification is delayed and the number of complications increases. Only in total thickness defects will the use of membranes be of any benefit. The defects that have lost various walls can loose their capacity for spontaneous regeneration and, in these cases, autologous bone as well as biomaterials and regeneration membranes can be useful.

Keywords : Bone regenerative; Alloplastic materials; Bone graft.

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