Bone Marrow Aspirate Concentrate and Xenograft Versus Autograft and Xenograft in the 3D Reconstruction of Atrophic Maxillary Ridges: A Split-Mouth Randomized Controlled Trial

Clinical Snapshot

Key Findings

• P Value: Not reported for primary outcomes

• Effect Size: No statistically significant differences in bone gain measurements

• Primary Outcome: Vertical bone gain: BMAC 3.47±0.87mm vs Autograft 4.10±0.67mm; Horizontal bone gain: BMAC 3.476±0.59mm vs Autograft 2.918±0.80mm

• Nnt Or Sensitivity: Bone area percentage significantly higher with BMAC (47.9% vs 28.5%); Mature bone percentage higher with BMAC (67.7% vs 26.5%)

• Confidence Interval: Not reported

Clinical Application

Requires specialised surgical expertise, CBCT imaging, virtual planning software, and access to bone marrow aspiration facilities Technique applicable in Australian oral and maxillofacial surgery practices; BMAC may reduce patient morbidity compared to autograft harvesting; cost-effectiveness unclear without PBS coverage data Edentulous patients with severe maxillary ridge atrophy requiring extensive bone augmentation prior to implant placement

Abstract

PURPOSE: To evaluate bone quality and quantity after 3D augmentation of vertically and horizontally atrophied maxillary ridges and compare the use of bone marrow aspirate concentrate (BMAC) and xenograft versus autograft and xenograft, both using prebent titanium (Ti) mesh over a virtually augmented model. MATERIALS AND METHODS: Ten fully edentulous patients with severe maxillary vertical and horizontal bone loss were recruited. Virtual horizontal and vertical bone augmentation was performed for the deficient ridge to produce virtually augmented models for prebent Ti meshes preoperatively. Each patient was rehabilitated with BMAC and xenograft on one side of their mouth (test side) and with autograft and xenograft on the other (control side). For the test side, the mesh was loaded with a mix of xenograft and BMAC from the anterior iliac crest. For the control side, the mesh was loaded with a 1:1 ratio of xenograft to autograft mix. The meshes on both sides were fixed in place using miniscrews. RESULTS: CBCT scans were performed 6 months postoperatively for all patients. The test side showed a mean vertical bone gain of 3.47 ± 0.87 mm, which was comparable to that of the control side (4.10 ± 0.67 mm). The test side also showed a mean horizontal bone gain of 3.476 ± 0.59 mm, which was higher than that of the control side (2.918 ± 0.80 mm). While the mean resorption rate in the test side (106.2 ± 108.6 mm) was lower than the mean value in the control side (193.3 ± 107.9 mm), the differences in bone gain were not statistically significant. However, a statistically significant higher bone area percentage (47.9%) as well as a higher percentage of mature bone (67.7%) were detected in the test side compared to the control side (28.5% and 26.5%, respectively). CONCLUSIONS: 3D alveolar reconstruction using prebent Ti meshes loaded with xenograft mixed with BMAC could be a reliable and less complicated technique for vertically and horizontally atrophied maxillary ridges.

References

1. 1.Moustafa, A., Shawky, M., El Moshy, S., Mounir, M., Nassar, Y., & Bahaa, M. (2026). Bone marrow aspirate concentrate and xenograft versus autograft and xenograft in the 3D reconstruction of atrophic maxillary ridges: A split-mouth randomized controlled trial. The International Journal of Oral & Maxillofacial Implants. https://doi.org/10.11607/jomi.11310