Is the Tunnel Technique More Effective Than Open Augmentation With a Titanium-Reinforced Polytetrafluoroethylene Membrane for Horizontal Ridge Augmentation?

Abstract

Studies have shown that horizontal ridge augmentation with a nonresorbable membrane is subject to a relatively frequent occurrence of dehiscence and loss of the graft. This study was designed to compare the outcomes of a tunnel technique versus an open technique using a titanium-reinforced polytetrafluoroethylene (PTFE) membrane. A retrospective cohort study, in which the data were collected by chart review, was designed to compare patients who had undergone horizontal ridge augmentation with a 1:1 ratio of mineralized freeze-dried allograft and particulate bovine hydroxyapatite by the tunnel technique with patients who had undergone an open technique with a titanium-reinforced PTFE membrane. The incidence of wound dehiscence or membrane exposure, the number of postoperative visits required, and the number of systemic antibiotic courses needed, as well as the number of grafted sites that subsequently were amenable to routine implant placement after graft maturation, were compared between the 2 techniques. The differences in implants placed between the 2 methods were analyzed with the Fisher exact test. The secondary hypothesis (regarding wound dehiscence, number of postoperative visits, and number of systemic antibiotic courses) was analyzed by Poisson regression. The chart review found 52 patients, with 21 treated by the tunnel technique and 31 treated with the open technique. Within 6months after bone grafting, 18 patients (86%) treated with tunnel technique grafts received dental implants whereas 22 patients (71%) treated with the open technique received dental implants. Dehiscence developed in a greater proportion of ridge augmentations with the PTFE method (52% vs 19%). There was a trend toward an increased number of courses of antibiotics prescribed for this group (P= .11), as well as a significant increase in the number of postoperative visits required (P=.003). For horizontal defects amenable to either technique, the findings of this study show the tunnel technique is a more cost-effective option with similar success to the open technique.