How does bone regenerate without grafts?
The question we are asked most often is how part of the maxillary bone can reform without using graft material. The answer lies in a histological and ultrastructural study, published in 1999, conducted on twenty clinical cases treated with the edentulous ridge expansion technique (ERE): biopsies taken in the months following surgery showed that osteoblasts differentiate from pre-existing mesenchymal cells located on the walls of the surgical breach, depositing new bone within the space created between the two cortical plates, through the process of second-intention healing.
In other words, bone tissue is not replaced by a foreign material: it is the site itself, correctly prepared, that produces the newly formed bone needed for implant placement.
Based on this mechanism, the ERE technique has been applied clinically on a large scale: a study of 329 implants in 170 patients documented a 98.8 per cent success rate. Its localized application to the management of the maxillary sinus floor reached a 97.5 per cent success rate on 499 implants in 303 patients, treated between 1988 and 1993. Both studies, published in 1994 and 1998 respectively, are the original publications on which the ERE technique is based.
The implant, without a graft, in a single session
When the bone ridge does not have sufficient horizontal volume to accommodate the implant, the most common approach is a bone or synthetic graft associated with membranes, before proceeding, generally in a later session, to place the implant. In Rome, the Studio Calesini team applies the procedures described above that activate second-intention healing, moving the entire osteo-muco-gingival complex while preserving its biological vitality and inducing tissue neoformation, instead of replacing it with foreign material.
Naturally, patient selection and the assessment of surgical risk remain a non-negotiable clinical step. The advantage of the MTM approach, when applicable, is placing the implant in the correct three-dimensional position planned case by case, and tissue regeneration in a single surgical session, without the waiting time a conventional bone graft would require before proceeding, and without the need for multiple interventions.
Managing peri-implant soft tissue
The same biomimetic principle applies to peri-implant soft tissue. Morphogenic Tissue Management shapes the morphology of the gum, papillae and mucogingival margin around an implant, guiding it prosthetically during second-intention healing, instead of surgically reconstructing it with flaps or connective tissue grafts. The goal is a stable biomimetic result, especially in the most aesthetically visible areas.
The common thread of this approach is respecting and harnessing second-intention repair processes and their synergy with the implant-prosthetic components, to regenerate the osteo-muco-gingival tissue mutilated by the loss of natural teeth, considerably improving the mimetic integration of the prosthetic devices.
A second opinion based on the MTM approach
If you have been offered a large bone graft, or told that implants are not possible, it is worth requesting an evaluation with the MTM approach. You can request a second opinion at Studio Calesini, in Rome.
Frequently asked questions
It is a biomimetic implant-prosthetic protocol developed in Rome, building on the work of the Bruschi-Scipioni-Calesini study group. It synthesises a set of operative techniques published between 1994 and 2009 that harness the natural healing processes of the tissues (bone and mucogingiva) to regenerate them, instead of replacing them with foreign materials.
Yes, under appropriate clinical conditions. A histological study of 20 cases (1999) documented that, in the space created by the edentulous ridge expansion technique (ERE), pre-existing mesenchymal cells on the walls of the surgical breach differentiate into osteoblasts and deposit new bone: the site itself, correctly prepared, produces the bone needed for implant placement.
The founding techniques (edentulous ridge expansion and localized sinus floor management) were published by the Bruschi-Scipioni-Calesini group between 1994 and 1999. Their synthesis into a single protocol, Morphogenic Tissue Management, was later developed by doctors Gaetano Calesini and Agostino Scipioni.
Both. The same biomimetic principle applies to peri-implant soft tissue: MTM shapes the gum, papillae and mucogingival margin by guiding it prosthetically during healing, instead of surgically reconstructing it with flaps or connective tissue grafts.
Cited sources
- Scipioni A, Bruschi GB, Calesini G. The edentulous ridge expansion technique: a five-year study. Int J Periodontics Restorative Dent. 1994;14(5):451-9. PMID 7751111
- Scipioni A, Bruschi GB, Calesini G, Bruschi E, De Martino C. Bone regeneration in the edentulous ridge expansion technique: histologic and ultrastructural study of 20 clinical cases. Int J Periodontics Restorative Dent. 1999;19(3):269-77. PMID 10635173
- Bruschi GB, Scipioni A, Calesini G, Bruschi E. Localized management of sinus floor with simultaneous implant placement: a clinical report. Int J Oral Maxillofac Implants. 1998;13(2):219-26. PMID 9581408
- Scipioni A, Calesini G, Micarelli C, Coppè S, Scipioni L. Morphogenic bone splitting: description of an original technique and its application in esthetically significant areas. Int J Prosthodont. 2008;21(5):389-97. PMID 18950058
- Calesini G, Micarelli C, Coppè S, Scipioni A. Edentulous site enhancement: a regenerative approach for the management of edentulous areas. Part 1. Pontic areas. Int J Periodontics Restorative Dent. 2008;28(5):517-23. PMID 18991003
- Calesini G, Micarelli C, Coppè S, Scipioni A. Edentulous site enhancement: a regenerative approach to the management of edentulous areas. Part 2. Peri-implant tissues. Int J Periodontics Restorative Dent. 2009;29(1):49-57. PMID 19244882