Vertical Ridge Augmentation Using Allograft and Synthetic Hydroxyapatites After Strategic Extraction

Abstract

Introduction: Regeneration of sufficient bone mass for implant therapy is difficult in cases presenting with extensive vertical alveolar resorption, particularly when there is a severe loss of attachment at the distal surface adjacent to the area of vertical alveolar ridge resorption. In this case, sufficient bone augmentation for implant placement was achieved by strategic extraction of the canine. This allowed for vertical bone augmentation to be performed up to the alveolar crest of the distal lateral incisor.Case Presentation: Clinical and radiographic assessment indicated inadequate bone for the insertion of dental implants. Severe residual ridge bone resorption was observed from the cervical area of the mandibular left canine to the second molar region. Because of extensive resorption in the distal alveolar bone of the mandibular left canine, adequate vertical bone regeneration could not be obtained without extraction. After the site of the extracted canine had healed, non‐resorbable and resorbable hydroxyapatite as well as demineralized freeze‐dried bone allograft were grafted at a ratio of 1:2:2. This was covered with titanium micromesh. A second bone augmentation on the buccal area was performed to achieve a functionally ideal dental arch. A total of 11.8 mm of vertical bone augmentation was achieved, which is a sufficient amount for implant placement. The regenerated bone remained stable at a loading time of >3 years.Conclusion: This case describes a technique using a strategic extraction to facilitate greater bone height in advanced vertical ridge augmentation without using autogenous bone grafting.