A guided bone regeneration technique for vertical bony augmentation in the maxilla

Abstract

Vertical defects of the anterior alveolar crest limit esthetic and functional success of the implant supported prosthesis. Hard tissue grafting is often required before implant grafting. Although many techniques exist for hard tissue augmentation the outcome of vertical alveolar ridge augmentation is often unpredictable. Vertical bone augmentation historically has been a very difficult objective to complete. Due to soft tissue tension it often results in the displacement or complete resorbtion of the graft, dehiscence of the overlying soft tissue and subsequent loss of the graft. This case report describes a new approach to vertical alveolar ridge augmentation using a titanium mesh scaffold, Bio-GIde collagen membrane, and an admixture of cortico-cancellous anterior iliac crest bone and Bio-Oss xenograft material. The titanium mesh scaffold was used to establish and contain the desired height and bulk of the graft. The collagen membrane which was laid over the titanium mesh was used to isolate and seal the graft from the oral cavity as well and to prevent infiltration of granulation tissue into the hard tissue matrix. There was a small area of membrane perforation over the titanium mesh during the healing period. This area was noted to have some soft tissue infiltration and a small loss of graft material. The overall bulk and height of the graft under the mesh was maintained, and significant alveolar ridge height and bulk was achieved. The titanium scaffold technique showed promising initial results for vertical ridge height and bulk augmentation. It is a tool that can be used to augment large defects where other techniques may be less predictable. Our hypothesis is that if there were not a membrane perforation complete retention of the graft would have been achievable. This may be rectified in using a dual membrane or a thicker material. More cases and further study are needed to establish predictability and long-term retention of the graft.