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However, donor site morbidity, limited bone availability, unpredictable resorption rates, and residual deformities remain important challenges [4].
Zygomatic implantology (ZI) has been first mentioned by Aparicio et al. in 1993 [1], then proposed by Brånemark [2] in order to overcome bone availability after maxillectomy.
Various surgical techniques including ridge splitting, ridge expansion, lateral augmentation, and horizontal distraction osteogenesis are necessary to increase bone availability in the narrow alveolar ridge.
Autografts are the only grafts that provide osteoinductivity; unfortunately, autografts often have unpredictable resorption, morbidity at the donor site, and limited bone availability, which has stimulated research to find new alternatives for bone tissue engineering.
Then, the surgeon evaluated the bone availability and if implant placement was considered possible, a core bone biopsy was harvested with the use of a trephine, replacing the first drill of the implant bed preparation (2 mm diameter and 10 mm length, Hager and Meisinger® Neuss, Germany).
However, apart from limited bone availability and many times second surgery site complications such as donor side morbidity, possible fracturing of the donor bone may occur [ 5].
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They suggested that acidosis from grain feeding may also cause hypocalcaemia, although this conflicts with the findings of [ 3] who found that acidosis increased bone calcium availability by releasing calcium from amorphous CaPO4 and CaCO3 in the bone matrix.
The most significant nutritional influence on bone is the availability of calcium.
The significance with respect to bone of adequate availability of calcium to animals or humans is that the mechanical strength of bone is proportional to its mineral content.
Given the multilineage differentiation capacity and autologous availability, bone marrow (BM) derived mesenchymal stem cells (MSC), with or without genetic modification, have been extensively studied for myocardial reparability [ 7, 26, 29].
However, its use is limited by susceptibility artifact at the prosthesis-bone interface, local availability, patient compliance, and cost (Hayter et al. 2011a).
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