preprosthetic and maxillofacial surgery · 2019. 11. 7. · orthopaedic bone cements (isbn...

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Preprosthetic and maxillofacial surgery

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Preprosthetic and maxillofacial surgery

Biomaterials, bone grafting and tissue engineering

Edited byJoël Ferri and Ernst B. Hunziker

Oxford Cambridge Philadelphia New Delhi

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Published by Woodhead Publishing Limited, 80 High Street, Sawston, Cambridge CB22 3HJ, UKwww.woodheadpublishing.com

Woodhead Publishing, 1518 Walnut Street, Suite 1100, Philadelphia, PA 19102-3406, USA

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First published 2011, Woodhead Publishing Limited© Woodhead Publishing Limited, 2011The authors have asserted their moral rights.

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Contents

Contributor contact details xiIntroduction xvii

1 Bone tissue engineering 1U. Meyer, Düsseldorf University Hospital, Germany, H. P. Wiesmann, J. Neunzehn and U. Joos, Münster University Hospital, Germany

1.1 Introduction 11.2 Bone-repair strategies 21.3 Biophysical effects 41.4 Distraction osteogenesis 51.5 Biomolecules 61.6 Transplantation of cells 71.7 Flap prefabrication 81.8 Extracorporeal strategies 91.9 Cell systems 91.10 Evaluation of engineering success 141.11 References 15

Part I Bone reconstruction in implantology and reconstructive preprosthetic surgery 23

2 Fundamentals of bone grafting in implantology 25P. J. W. Stoelinga, Radboud University Medical Centre, Nijmegen, The Netherlands, J. I. Cawood, Consultant Oral and Maxillofacial Surgeon, Chester, UK

2.1 Introduction 252.2 Scheme for pre-implant surgery 252.3 Fundamentals of bone grafting 282.4 Local bone grafts 312.5 Distant bone grafts 32

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vi Contents


2.6 Conclusions 342.7 References 34

3 Cranial bone grafting in maxillary preprosthetic surgery 36J. F. Tulasne, Zedental.com, France

3.1 Introduction 363.2 Experimental studies 363.3 The surgery 373.4 Discussion 453.5 Conclusions 483.6 References 52

4 Maxillary sinus grafting for implant insertion 54J. Acero, Complutense University of Madrid, Spain

4.1 Introduction 544.2 Anatomic fundamentals: pathophysiology 564.3 Treatment planning: indications and contraindications 584.4 Types of maxillary sinus augmentation for implant insertion:

surgical technique 604.5 Grafting materials 634.6 Results 714.7 Complications of sinus lift 714.8 References 73

5 Symphyseal and alveolar reconstruction in preprosthetic surgery 76D. Goga, F. Sury and T. Tayeb, Trousseau University Hospital, France

5.1 Introduction 765.2 The height improvement 765.3 The increase of thickness 835.4 Particular aspects 965.5 Failure risk factors and complications 975.6 Implant placement at the mandibular symphysis 995.7 Indications and limits of the implant placement

at the symphysis region 1005.8 Conclusions 1025.9 References 102

6 Mandible corpus reconstruction for implant insertion: the available techniques 104J. Ferri and L. Lauwers, Roger Salengro University Hospital, France

6.1 Introduction 1046.2 Anatomical considerations 105

Contents vii


6.3 Different techniques 1056.4 Case studies 1096.5 Conclusion and indications 1096.6 References 113

7 Alveolar bi-directional distraction in preprosthetic surgery 115T. Iizuka, Bern University Hospital, Switzerland

7.1 Introduction 1157.2 Indications for distraction 1157.3 Why is a bi-directional distraction necessary? 1167.4 Bi-directional distraction device 1197.5 Surgical technique for bi-directional distraction 1217.6 Insertion of dental implants and suprastructure 1237.7 Histology and histomorphometry of distracted bone 1247.8 Complications and need for technical improvements 1277.9 Conclusions 1287.10 References 128

8 Alveolar widening using distraction osteogenesis (DO) in maxillofacial surgery 130T. Takahashi and K. Yamauchi, Kyushu Dental College, Japan and T. Iizuka, Bern University Hospital, Switzerland

8.1 Introduction 1308.2 Alveolar distraction osteogenesis (DO) 1318.3 Horizontal alveolar distraction 1328.4 Horizontal periosteal expansion osteogenesis 1518.5 Histological evaluation 1558.6 Conclusions 1558.7 References 156

9 Bone grafting and Le fort I osteotomy in cases of major atrophy of the maxilla 158J. Ferri and L. Lauwers, Roger Salengro University Hospital, France, P. Elia and H. Dubois, Private practice, France

9.1 Introduction 1589.2 Anatomical consideration of the maxilla 1589.3 The different steps of the technique 1619.4 Discussion 1669.5 Case study 1689.6 Conclusions 1719.7 References 172

viii Contents


Part II Reconstruction in particular situations 173

10 Applications of biomaterials in alveolar and maxillofacial bone reconstruction 175U. Joos, H. P. Wiesmann and J. Neunzehn, Münster University Hospital, Germany, U. Meyer, Düsseldorf University Hospital, Germany

10.1 Introduction 17510.2 Substitute materials 17610.3 Synthetic inorganic materials 17610.4 Synthetic organic materials 17710.5 Natural inorganic materials 17810.6 Natural organic materials 17910.7 References 180

11 Implants in congenital missing teeth 185L. Lauwers, T. Wojcik, G. Raoul and J Ferri, Roger Salengro University Hospital, France

11.1 Introduction 18511.2 Diagnosis 18611.3 Management 18611.4 Rehabilitation cases 19111.5 Conclusions 19711.6 References 198

12 Maxillo-mandibular amputations and implants rehabilitation 199J. Ferri, G. Raoul and L. Lauwers, Roger Salengro University Hospital, France, B. Desmet, Private practice, France, P. Breton, Central Hospital South Lyon, France

12.1 Introduction 19912.2 Strategy for jaw reconstruction 20012.3 Basal bone reconstruction 20312.4 Preparing endosseous implant-step 21412.5 Illustrations of implant-borne prosthesis after

jawbone reconstruction 22212.6 Conclusions 23112.7 References 232

13 Alveolar reconstruction in cleft for implant rehabilitation 236J-B. Seigneuric, Military Instruction Hospital BEGIN, France and M-P. Vazquez, Pierre and Marie Curie University, France

13.1 Introduction 23613.2 Management of orofacial clefts 237

Contents ix


13.3 Implant placement in cleft lip and palate (CLP) 24313.4 Success rates of implant placement 25813.5 Conclusions 25813.6 References 259

14 Bone reconstruction in irradiated situations 264N. Froget, A. Pierrefeu, M. Koppe and P. Breton, Centre Hospital, South Lyon, France

14.1 Introduction 26414.2 Adjuvent treatment 26514.3 Non-vascularised bone graft 26614.4 Coverage flaps 26614.5 Free flap and bone graft association 27114.6 Vascularised bone transfers 27114.7 New techniques 27714.8 Reconstruction principles in irradiated situations 28014.9 References 281

15 Periodontal surgery related to alveolar bone reconstruction for implant insertion 284M. Leconte, T. Wojcik, J. Ferri, Roger Salengro University Hospital, France, M. Mongeot, Private practice, Lille, France

15.1 Introduction 28415.2 Muco gingival environment around natural teeth 28415.3 Role of the keratinized gingiva around the implants 28515.4 Developing a favourable environment around the implants 28515.5 Surgical technique 29015.6 Conclusions 30015.7 References 301

Part III Tissue engineering 303

16 Mucosal and gingival tissue engineering 305R. Neiva and W.V. Giannobile, University of Michigan School of Dentistry, USA

16.1 Overview of oral soft tissue wound healing 30516.2 Traditional approaches 30716.3 Novel approaches for oral soft tissue repair 30916.4 Future trends 31916.5 Acknowledgments 31916.6 References 319

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17 Osteoinductivization of dental implants and bone-defect-filling materials 327E. Hunziker, University of Bern, Switzerland

17.1 Introduction 32717.2 Biomimetic coating technique 32717.3 Conclusions 33317.4 References 333

18 Tissue engineering and endodontics 336S. Simon, Cordeliers Research Centre, France and University of Birmingham, UK, P. Cooper, University of Birmingham, UK, J. Isaac and A. Berdal, Cordeliers Research Centre, France

18.1 Introduction 33618.2 The dentine-pulp complex 33818.3 Pulpal responses to injury 34518.4 Pulp capping and dentine-pulp complex regeneration 35118.5 Root canal tissue regeneration 35318.6 Conclusions 35718.7 References 357

19 Tooth regeneration: current status 363J. J. Mao, Columbia University Medical Center, USA

19.1 Introduction 36319.2 Translational barriers of tooth regeneration and

dental pulp regeneration 36419.3 Cell homing approach for tooth regeneration 36619.4 Discussion and future trends 36919.5 Acknowledgments 37019.6 References 370

Index 375


Contributor contact details

EditorsProfessor Joël FerriOral and Maxillofacial DepartmentRoger Salengro University HospitalCHRULilleF-59000FranceE-mail: [email protected]

Professor Ernst B. HunzikerCenter of Regenerative Medicine for

Skeletal Tissues Department of Clinical ResearchUniversity of BernHochschulstrasse 4 CH-3012 BernSwitzerlandE-mail: [email protected]

Chapter 1Professor Ulrich MeyerClinic for Maxillofacial and Plastic

Facial SurgeryDüsseldorf University HospitalHeinrich-Heine UniversityMoorenstr. 540225 DüsseldorfGermanyE-mail: [email protected]

Dr Hans Peter Wiesmann and Dr Jörg Neunzehn

Biomineralisation and Tissue Engineering Group

Department of Experimental Maxillofacial Surgery

Münster University HospitalWestphalian Wilhelms UniversityWaldeyerstrasse 3048149 MünsterGermanyE-mail: [email protected]

[email protected]

Professor Ulrich Joos*Clinic for Cranio-Maxillofacial

SurgeryUniversity of MünsterWaldeyerstrasse 3048149 MünsterGermanyE-mail: [email protected]

(* = main contact)

xi

xii Contributor contact details


Chapter 2Professor Paul J. W. Stoelinga*Radboud University Medical CentrePostbus 91016500 HBNijmegenThe NetherlandsE-mail: [email protected]

Professor John I. Cawood Consultant Oral and Maxillofacial

SurgeonChesterUKE-mail: [email protected]

Chapter 3Dr J. F. TulasneDirector of Space Maxillofacial

SurgeryZedental.com83 Rue de Silly92100 Boulogne BillancourtFranceE-mail: [email protected]

Chapter 4Professor Julio AceroDepartment of Maxillofacial SurgeryGregorio Marañón University

HospitalComplutense University of MadridC. Doctor Esquerdo 4628007 MadridSpainE-mail: [email protected]

Chapter 5Professor Dominique Goga*,

Dr Florent Sury and Dr Talel Tayeb

Department of Maxillofacial and Oral Surgery

Trousseau University HospitalAvenue de la République37044, Chambray-les-toursToursFranceE-mail: [email protected]

[email protected]

Chapter 6Professor Joël Ferri* and

Dr Ludovic LauwersOral and Maxillofacial DepartmentRoger Salengro University HospitalCHRULilleF-59000FranceE-mail: [email protected]

Chapter 7Dr Tateyuki IizukaProfessor and ChairmanDepartment of Cranio-Maxillofacial

SurgeryInselspitalBern University HospitalCH-3010 Bern, SwitzerlandE-mail: [email protected]

Chapter 8Professor Tetsu Takahashi*Professor and ChairmanDivision of Oral and Maxillofacial

Reconstructive SurgeryKyushu Dental College2-6-1 ManazuruKokurakita-KuKitakyushu-City803-8580FukuokaJapanE-mail: [email protected]

Contributor contact details xiii


Dr Kensuke YamauchiAssistant ProfessorDivision of Oral and Maxillofacial

Reconstructive SurgeryKyushu Dental College2-6-1 ManazuruKokurakita-KuKitakyushu-City803-8580FukuokaJapan

Dr Tateyuki IizukaProfessor and ChairmanDepartment of Cranio-Maxillofacial

SurgeryInselspitalBern University HospitalCH-3010 BernSwitzerlandE-mail: [email protected]

Chapter 9Professor Joël Ferri* and

Dr Ludovic LauwersOral and Maxillofacial DepartmentRoger Salengro University HospitalCHRULilleF-59000FranceE-mail: [email protected]

[email protected]

Dr P. Elia and Dr H. DuboisPrivate practiceLilleFrance

Chapter 10Professor Ulrich MeyerClinic for Maxillofacial and Plastic

Facial Surgery

University Hospital of DüsseldorfHeinrich-Heine UniversityMoorenstr. 540225 DüsseldorfGermanyE-mail: [email protected]

Dr Hans Peter Wiesmann and Dr Jörg Neunzehn

Biomineralisation and Tissue Engineering Group

Department of Experimental Maxillofacial Surgery

University Hospital of MünsterWestphalian Wilhelms UniversityWaldeyerstrasse 3048149 MünsterGermanyE-mail: [email protected]

[email protected]

Professor Ulrich Joos*Clinic for Cranio-Maxillofacial

SurgeryUniversity of MünsterWaldeyerstrasse 3048149 MünsterGermanyE-mail: [email protected]

Chapter 11Professor J. Ferri*, Dr Ludovic

Lauwers, Dr Thomas Wojcik and Dr Gwenael Raoul

Oral and Maxillofacial DepartmentRoger Salengro University HospitalCHRULilleF-59000FranceE-mail: [email protected]

[email protected] [email protected] [email protected]

xiv Contributor contact details


Chapter 12Professor Joël Ferri*, Dr Gwenael

Raoul and Dr Ludovic LauwersOral and Maxillofacial DepartmentRoger Salengro University HospitalCHRULilleF-59000FranceE-mail: [email protected]

[email protected] [email protected]

Dr B. DesmetPrivate practiceF-59000LilleFrance

Professor P. BretonDepartment of Maxillo-facial

surgeryCentral Hospital South LyonCHU Lyon Sud69310 Pierre BeniteFrance

Chapter 13Dr J-B. Seigneuric*Military Instruction Hospital BEGINDepartment of Maxillofacial Surgery

and Stomatology 69 Avenue de Paris94163 Saint-Mandé CedexFranceE-mail: [email protected]

Professor M-P. VazquezPierre and Marie Curie UniversityUFR of Medicine Pierre and

Marie CurieParisFrance

Chapter 14Dr Nicolas Froget, Dr Antoine

Pierrefeu, Dr Matthieu Koppe and Professor Pierre Breton*

Department of Stomatology, Maxillo-Facial Surgery and Plastic Surgery of the Face

Claude Bernard University Lyon 1Centre Hospital South Lyon69310Pierre BéniteFranceE-mail: [email protected]

Chapter 15Professor Joël Ferri*,

Dr M. Leconte and T. WojcikOral and Maxillofacial DepartmentRoger Salengro University HospitalCHRULilleF-59000FranceE-mail: [email protected]

Dr M. MongeotPrivate practiceLilleFrance

Chapter 16Dr Rodrigo NeivaDepartment of PeriodontologyUniversity of Florida – College of

Dentistry, 1395 Center Drive, Rm D10-19C Gainesville

FL 32610-0434USAE-mail: [email protected]

Dr William V. Giannobile*Michigan Centre for Oral Health

Research

Contributor contact details xv


University of Michigan School of Dentistry

1011 N. University Ave.Ann ArborMI 48109-1078USAE-mail: [email protected]

Chapter 17Professor E. B. HunzikerCenter of Regenerative Medicine

for Skeletal Tissues Department of Clinical ResearchUniversity of BernSwitzerlandE-mail: [email protected]

Chapter 18Dr Stéphane Simon*Cordeliers Research Centre – UMRS

872Team 5 – Physiopathologie Orale

Moléculaire15 rue de l’Ecole de Médecine75 270 PARIS cedex 06FranceE-mail: [email protected]

And

Laboratory of Oral BiologySchool of DentistryUniversity of BirminghamSaint Chad’s QueenswayBirminghamB4 6NNUK

Dr Paul CooperLaboratory of Oral BiologySchool of DentistryUniversity of BirminghamSaint Chad’s QueenswayBirminghamB4 6NNUK

Dr Julianne Isaac and Ariane BerdalCordeliers Research Centre –

UMRS 872Team 5 – Physiopathologie Orale

Moléculaire15 rue de l’Ecole de Médecine75 270 PARIS cedex 06FranceE-mail: [email protected]

Chapter 19Professor Jeremy J. MaoColumbia University Medical Center630 W. 168 St. – PH7ENew YorkNY 10032USAE-mail: [email protected]


Introduction

Ever since osteointegration principles were established by Bränemark, the use of implants in oral and maxillo-facial surgery are being more widely developed throughout the world. Use of these techniques has never been abandoned. The innumerable publications on the theme of oral implantology show the interest of the medical community for these rehabilitations.

However, even though implantations are exceptionally successful a minimum of bone is mandatory to guarantee a primary stability and so assure the bone integration. Whenever this bone is not present the implant insertion is more complicated requiring complex or more uncertain techniques. For these cases pre-prosthetic implantation surgery has been developed in order to repair the missing or insufficient bone in order to admit a simple implant insertion.

Classically, the reconstruction is done using the autogenous cancellous bone. Progressively, after development by many surgeons, the use of membranous bone has been suggested in order to assure both a less painful harvesting and a lower resorption rate. However, in complex cases such as amputations or after irradiation, the use of vascularized bone flaps or distraction procedures are the only solutions possible. Today these techniques are used widely throughout the world and permit the reconstruction of just about any deficit in nearly any situation.

Despite all this, and even for very simple surgery, any bone harvesting has a certain morbidity forever present in the surgical procedure. To lessen this morbidity the surgeons have ‘dreamed’ of being able to repair bone by ‘creating’ it from structures which would not be harvested from the patient. In this optic the use of biomaterials has been developed. These techniques have vastly progressed using scaffold, stem cells (to induce bone and blood vessels) and proteins which stimulate the bone growth. However despite the quality of the re-construction techniques using these biomaterials none have replaced the autogenous bone graft, which remains the ‘gold standard’ of bone reconstruction.

Far beyond bone reconstruction today's biotechnologies are studying how to make absent or lost teeth grow again. This is a major challenge for which we can imagine the consequences in maxillary reconstruction. In the light of their progress this dream could soon become reality. . .

xviii Introduction


The objective of this work is to take stock of all these techniques permitting the reconstruction of the bone which supports the implants and also to consider the future and bring to light all the possibilities that biomaterials and tissue engineering can offer. To this aim this work has been divided in three parts.

The first part (bone reconstruction in implantology and reconstructive pre-prosthetic surgery) talks of the techniques, which although recent, have been validated by the international medical community. It enlightens the reader on today’s possibilities of reconstruction with recognized procedures even though the choice of techniques is often a subject of discussion.

The second part (reconstruction in particular situations) studies the reconstruction in certain circumstances. It guides the reader on particular cases. The techniques used are often complex for situations which are often complex themselves. For instance implants rehabilitation in irradiated fields or in cleft lip and palate are studied in this section.

The third part covers tissue engineering. It carries out a study on the state of what is known today about bone, gums and dental organs creation. It is an open window on the techniques which could rapidly become revolutionary in dento-maxillo-facial reconstruction.

Professor Joël FerriProfessor Ernst B. Hunziker


1

1Bone tissue engineering

U. MEYER, Düsseldorf University Hospital, Germany, H. P. WIESMANN, J . NEUNZEHN and

U. JOOS, Münster University Hospital, Germany

Abstract: In modern regenerative medicine and tissue engineering, the reconstruction and repair of bony defects is one of the most intensively investigated subjects. Standard surgical approaches that are currently implemented to facilitate the repair of osseous tissue include guided bone regeneration, distraction osteogenesis and the autotransplantation of bone. In the field of tissue engineering, extracorporeal strategies, such as flap prefabrication and the seeding of biocompatible scaffolds with either stem cells, committed osteoprogenitor cells or osteoblast-like cells, are favoured options. In this chapter, the limitations and potentials of the various techniques and strategies are addressed.

Key words: bone-tissue engineering, bone repair, autologous bone, guided bone regeneration, distraction osteogenesis.

1.1 Introduction

Bone repair is one of the most intensively investigated subjects in reconstructive surgery (for a review of this topic, see Schultz et al., 2000). Current approaches to skeletal reconstructive surgery make use of biomaterials, autografts or allografts, but each technique has its drawbacks. These include donor-site morbidity and shortage of material for autografts (Damien and Parsons, 1991), immunological problems and the risk of transmitting infectious diseases for allografts. Many artificial materials, such as metals, ceramics and polymers, have been used as substitutes for bone in maintaining skeletal function (Binderman and Fin, 1990), none of which is an ideal replacement for autologous osseous tissue in current clinical practice. The use of biomaterials is a common treatment option. One of the main advantages of tissue grafts over non-living biomaterials is that they contain living cells and tissue-inducing substances which confer biological plasticity. Research is currently in progress to develop cell-containing hybrid materials and to create replacement tissues that remain interactive after implantation, imparting physiological functions as well as structure to the tissue or organ damaged by disease or trauma (Alsberg et al., 2001).

In the field of tissue engineering generally, and not least in that relating to bone, living cells are exploited in various ways to restore, maintain or enhance tissue functions (Langer and Vacanti, 1993; Lysaght and Reyes, 2001). There exist three principal therapeutic strategies for treating diseased or lost tissue in patients: (i) in-situ tissue regeneration, (ii) implantation of freshly isolated or cultured cells,

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2 Preprosthetic and maxillofacial surgery


and (iii) implantation of a bone-like tissue construct that has been assembled in vitro from cells and scaffolds. In the case of in-situ regeneration, the formation of new tissue is induced by the implantation of a specific scaffold or by the application of extrinsic growth factors, which stimulate the body’s own cells and promote local tissue repair. Cellular implantation involves the direct injection of suspensions or small aggregates of autologous or allogenic cells into the damaged or lost region in the absence or presence of a degradable scaffold. In the case of tissue implantation, a complete three-dimensional construct is grown in vitro from a cell-seeded scaffold, which is introduced into the defect once it has reached ‘maturity’ (Loty et al., 2000; Meyer et al., 2004a; Schliephake et al., 2001). In this chapter, each of these strategies will be described. Alternatives to extracorporeal approaches that are important in clinical decision making will also be discussed; so, too, will the possibility of combining clinical techniques with extracorporeal tissue-engineering methodologies.

1.2 Bone-repair strategies

1.2.1 Autologous bone

The ‘gold’ standard for the reconstruction of osseous defects is autologous bone. There exist two classical ways of repairing bony defects using autologous cells: one involves augmenting local host-cell population, and the other the transplantation of grafted bone (Fig. 1.1).

The healing of bony lesions can be promoted by augmenting the host-cell population only if the status of the repair site is conducive to this process. If the soft and hard tissues are still healthy, then the host cells can usually be induced to proliferate. But if the tissue is irritated or necrotic, or if the wound is infected, attempts in this direction will probably fail.

1.1 Bone repair by autologous cells

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Bone tissue engineering 3


1.2.2 Guided bone regeneration

To improve defect healing by the ingrowth of local host cells, membrane techniques can be applied (Fig. 1.2). This approach, known as ‘guided bone regeneration’, is mainly used to repair bony defects in the maxilla and mandible. The principle of this method of bone regeneration is to effectively protect osseous tissue from the ingrowth of soft tissue by introducing a physical barrier (Lang et al., 1994). The success of this technique has been demonstrated in a number of controlled animal studies and clinical trials (Buser et al., 1996; Berglundh and Lindhe, 1997; Fiorellini et al., 1998). The pattern of healing has been shown to involve all steps of de novo bone formation, including blood-clot formation, invasion by osteoprogenitor cells and their terminal differentiation into osteoblasts. The extracellular matrix that is produced by the osteoblasts undergoes mineralization, and the woven bone that is thereby formed is later remodelled into lamellar bone (Hämmerle et al., 1998). The success of guided bone regeneration critically depends upon the size and the geometry of the defect. Osseous defects will be more effectively repaired if they are surrounded by more than two bony

1.2 Principle and histology of membrane-based guided bone regeneration.

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preprosthetic and maxillofacial surgery · 2019. 11. 7. · orthopaedic bone cements (isbn...

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