Ridge Augmentation Techniques Research Articles

The Custom Alveolar Ridge-Splitting (CARS) Technique for Predictable Horizontal Ridge Augmentation in the Atrophic Anterior Maxilla: A Retrospective Case Series Study.

Implant-supported restorations have proven to be a predictable option for replacing missing teeth. In cases of inadequate bone quantity, the bone volume can be increased by bone augmentation procedures. Several factors can affect bone regeneration, including the morphology of the defect at the implant site. A defect surrounded by bony walls (an intraosseous defect) is known to yield a highly successful regeneration. The purpose of this retrospective case series study was to present a new step-by-step surgical procedure known as the Custom Alveolar Ridge-Splitting (CARS) technique for maxillary anterior ridge augmentation. This technique creates an intraosseous defect while splitting and augmenting an atrophic ridge. Sixteen consecutive cases were treated with the CARS procedure. All implants were restored and followed for 12 to 24 months after loading, and all cases were effectively treated with successful implant placement. According to this retrospective study, the CARS procedure is simple, successful, and predictable and may be used as a surgical option for horizontal alveolar ridge augmentation in the anterior maxilla.

Autologous chin graft for implant site augmentation revisited

Advanced alveolar bone resorption in the maxillary anterior teeth is a common finding that limits the placement of implants for prosthetic rehabilitation. Autologous bone graft from the mandibular symphysis is one of the oldest techniques in horizontal ridge augmentation techniques for placement of implants in advanced resorption of the alveolar ridge in the maxillary anterior region. This case report revisits the technique carried out using piezoelectric osteotome for harvesting block graft from the mandible to augment the resorbed ridge horizontally to place implant in a young and healthy patient.

The Alveolar Ridge Splitting Technique on Maxillae: A Biomechanical Human Cadaveric Investigation.

The alveolar ridge splitting technique (ARST) offers an alternative to classic ridge augmentation techniques for successful insertion of dental implants. However, the buccal lamella is at risk of fracturing during ARST distraction. To better understand the fracture mechanisms and displacement limits of the split lamella, this study conducted biomechanical tests on human cadaveric maxilla specimens having extremely atrophied alveolar ridges treated with ARST. A total of 12 standardized alveolar splits were prepared on the maxillae of 3 elderly female donors using an oscillating piezoelectric saw. Mimicking the surgical distraction process of the lamella, each split was tested to failure using a dental osteotome attached to the crosshead of an electromechanical testing system. All specimens were scanned by means of high-resolution peripheral quantitative computed tomography prior to and post testing to evaluate split geometries and failure modes. Split stiffness, failure force, and displacement were 27.4 ± 18.7 N/mm, 12.0 ± 8.4 N, and 0.97 ± 0.31 mm, with no significant differences between anatomical sides and split locations (p ≥ 0.17). Stiffness correlated significantly with failure force (R2 = 0.71, p < 0.01). None of the alveolar split widths correlated significantly with the outcomes from biomechanical testing (p ≥ 0.10). The results suggest that simple geometrical measures do not predict the allowed extent of lamella distraction prior to failure. More sophisticated methods are required for surgical planning to optimize the ARST outcomes. Still, the present study may advocate a clinical protocol for the maxilla where the implant site is prepared directly after osteotomy setting and immediately before full lamella dislocation, when the lamella is still stable, resistant to mechanical stress, and bone loss caused by the abrasion of the burr is minimized.

Modified shell technique for vertical ridge augmentation - Case report

Purpose: The placement of an implant is hindered by the absence of an adequate volume of bone. Vertical ridge augmentation is one of the most difficult and unpredictable procedures. The purpose of this report is to present a clinical case of vertical ridge reconstruction around a single tooth with a slight variation in the described ‘modified shell technique’. Case report: the patient had presented with 8.5mm vertical ridge deficiency in the region of central incisor #21. An autogenous graft was harvested from the symphysis. The cortical plate was thinned into the shell and divided into two parts to be placed on both buccal and lingual aspects. They were secured at the desired location using titanium screw as the traction screw since there was a lack of availability of the native bone. Remarkable vertical augmentation of the alveolar bone with minimal bone resorption was noticed on re-entry at 6months. Conclusions: This technique shows an alternate method of vertical augmentation over a small edentulous span presenting minimal amount of bone remaining to secure the grafting material.

Modified Two-Stage Split Technique for Controlled Ridge Augmentation in Horizontally Atrophic Posterior Mandible: the First Stage of Research.

Various bone grafting methods are applied to eliminate horizontal atrophy of the jaws. However, problem complexity brings about ongoing research and development of new ways to achieve the predicted stable and long-term results of implantological treatment.The aim of the study was to evaluate the results of the developed method for bone grafting, a modified two-stage split technique for controlled ridge augmentation in horizontally atrophic posterior mandible, using radiological analysis data.Materials and Methods.The study group included 18 patients with horizontally atrophic posterior mandible. According to cone beam computed tomography, 39 jaw segments were assessed before plastic surgery and after applying the two-stage split-crest technique for controlled ridge augmentation. The alveolar ridge width was estimated in the area of its top and at a distance of 1, 3, 5 mm from it using the vector of future implant position and taking into account the angle of inclination of the atrophic region of the mandible.Results.When analyzing edentulous areas in the posterior mandible before treatment, there was rather a large angle of lingual inclination of the alveolar ridge. After 6 months, the average increase in bone tissue width in the region of the alveolar ridge top was 82%, it was 50.6% at a height of 1 mm from the top of the crest, 58.8% at 3 mm height, 46.7% at 5 mm (p≤0.05). Certain patterns of bone tissue growth were revealed depending on the structure of the reconstructed area. The most significant results were obtained in the molar segments of the mandible.Conclusion.The developed modified two-stage split technique for alveolar ridge augmentation allows achieving the required volume of bone tissue in the posterior mandible for successful implant treatment.

Minimally invasive periodontics – A future landscape

Periodontal diseases are a heterogeneous group of diseases characterized by inflammation and the subsequent destruction of the tooth supporting tissue. Conventional periodontal regenerative procedures involving periodontal flaps for access are employed to improve short- and long-term clinical outcomes of periodontally compromised teeth. Minimally invasive therapeutic approaches with minimized incisions and trauma to the soft tissue have proven to be advantageous over the conventional therapy. This review focuses on four such techniques – PerioProtect, Tri-Immuno Phasic Periodontal Therapy, Subperiosteal Minimally Invasive Aesthetic Ridge Augmentation Technique (SMART) and Flapless technique for Bone Graft. PerioProtect is a non-invasive chemical debriding therapy that involves a customized tray for patients to help manage biofilms, growing in the spaces or pockets between teeth and gum tissue. Tri-immuno phasic therapy is minimally invasive technique, by William Hoisington, which allows clinician to go under the gum line and destroy anaerobic bacteria non-surgically. SMART was suggested by Kent et al. in which a small vertical incision is made in the alveolar ridge and bone graft injected under the periodontium. Flapless technique for bone graft is a non-invasive technique which involves scaling and root planing, and insertion of single grains of bone mineral through the crevicular space into the pocket until it is completely filled. These minimally invasive procedures offer an efficient, safe less traumatic alternative in the treatment of periodontitis. Keywords: PerioProtect, Tri-Immuno, Occlusal forces.

Fixation free Inter-positional mandibular grafting a novel technique for alveolar ridge height augmentation versus the conventional fixation technique. (Randomized control clinical trial)

The aim of this study is to determine whether the technique of interpositional grafting of the posterior mandible without the use of fixation device (using bone blocks alone) is superior to the conventional interpositional grafting with fixation (plates and screws). This study was conducted on 15 patients in which 16 mandibular segments were augmented, segments were randomly divided into 2 groups, control receiving interpositional segmental grafting of the posterior mandible with fixation and intervention group receiving same procedure but without grafting and fixed via chin bone blocks. Results revealed better overall clinical and radiographic results toward the intervention group in terms of graft resorption and application but was statistically non-significant, while the histological evaluation yielded to the postulation that no microscopic difference between both techniques in terms of the resultant bone. Thus concluding that interpositional grafting technique without the use of a fixation device was a reliable technique for vertical ridge augmentation of the atrophied posterior mandibular ridges with promising rates of success, reduced complications and reduced bone resorption values compared to conventional interpositional grafting with fixation protocol.

A New Surgical Protocol For Horizontal Ridge Augmentation: Simplified Apposition Technique. Human Histologic and Radiographic Analysis After 2.5 Years of Follow-Up, A Case Report

Following tooth extraction, alveolar ridge undergoes a physiological and inevitable remodeling process that could influence the prosthodontic rehabilitation. Therefore, augmentation of an insufficient bone volume is often indicated, although it remains a significant challenge in clinical practice. The aim of this case report was to scientifically validate a new minimally invasive surgery technique called “Simplified Apposition Technique” (S.A.T), which consists in the use of deproteinized bovine bone, human fibrin glue and collagen membrane in association with a post-extraction socket, in order to obtain an increase of the horizontal ridge dimension in the nearby atrophic bone crest. A 69-years-old man patient was enrolled in this study. The hopeless tooth 4.7 was extracted and the ridge reconstruction and the socket preservation were carried out following S.A.T. After 11 months, the formation of newly bone was evaluated through radiographic analysis (Cone Beam Computed Tomography, CBCT) comparing the status before and after surgery and at 2.5 years of follow-up. Simultaneously, an implant was placed in the regenerated site and the bone chips remaining in the drills were used for the histological evaluation. The CBCT revealed an increase of the bone crest width from 3.7 to 6.5 mm and, after 2.5 years of follow-up, the bone width has remained stable. The histological evaluation showed various stages of bone formation and maturation with a good integration of the regenerated area. According to these results, S.A.T can be considered a good surgical technique for horizontal ridge augmentation in the atrophic bone, near the extraction site.

Interantral alveolar ridge splitting for maxillary horizontal expansion and simultaneous dental implant insertion: A case report.

IntroductionDental implants present an advanced technique for the rehabilitation of partial or edentulous patients. Tooth loss caused by caries, periodontal disease or systemic factors often results in a decline of the bucco-lingual alveolar ridge dimension. Within one year the initial bone width can be resorbed up to 50%. As a consequence dental implants may be limited for rehabilitation and cannot be performed in a conventional manner because of the risk of dehiscence and fenestrations. Bone blocks, guided bone regeneration (GBR), horizontal osteogenic distraction and bone grafts may be used for augmentation procedures. In case of sufficient vertical bone dimension, an alveolar ridge splitting and augmentation technique (ARST) can be conducted. This case has been reported in line with PROCESS criteria [1].Case presentationWe present a 51-year old female patient, who has had a full denture for about 30 years. The reason for consultation was the demand for a fixed prosthesis. Dental implants in combination of the ARST with GBR allowed us to correct horizontal deformities of the alveolar ridge.DiscussionWe discuss the possibility of using the ARST in the interantral region for a full arch rehabilitation of the maxilla with simultaneous dental implant placement in a narrow alveolar ridge.ConclusionThe ARST in addition to simultaneous implant placement with a GBR can be successfully used for a full arch rehabilitation of the maxilla in a narrow alveolar ridge.

Statements and Recommendations for Guided Bone Regeneration: Consensus Report of the Guided Bone Regeneration Symposium Held in Bologna, October 15 to 16, 2016.

In the past 10 years, long-term studies have demonstrated that guided bone regeneration (GBR) is a successful and reliable technique for vertical and horizontal ridge augmentation, but strict and rigorous protocols must be adopted. Because no reports have yet been published with statements and clinical recommendations for GBR, a closed meeting of all authors was organized to discuss this matter during a GBR symposium held in Bologna (Italy) in October 2016. The authors focused on the findings of systematic and narrative reviews, prepared before the meeting, covering aspects of the clinical management of GBR techniques. Successively, a discussion based on the scientific evidence and on the experts' opinions led to the formulation of statements, clinical recommendations, and implications for future research. To avoid complications and to optimize outcomes, the following factors should be considered by clinicians: patient selection; analysis of defect type; blood supply; antibiotic treatment; flap passivation; delayed implant placement; combination of autogenous bone and xenograft or allograft; rigorous fixation of membranes; removal after 6 to 9 months; analysis of complications; soft-tissue management; and high care in scarred sites and in esthetic areas. The present consensus report reviewed the scientific evidence and provided specific guidelines and recommendations for clinical practice and the different approaches to GBR techniques to ensure surgical success and predictable outcomes.

Ridge augmentation and implant placement on maxillary anterior area with deficient alveolar ridge : case report

Atrophic alveolar ridge of maxillary anterior area is commonly observed after the extraction of teeth in patients with severely compromised periodontal disease, causing difficulties with implant placement. Successful esthetics and functional implant rehabilitation rely on sufficient bone volume, adequate bone contours, and ideal implant positioning and angulation. The present case report categorized the ridge augmentation techniques using guided bone regeneration (GBR) on the maxillary anterior site by Seibert classification. Case I patient presented for implant placement in the position of tooth #11. The alveolar ridge was considered a Seibert classification I ridge defect. Simultaneous implant placement and GBR were performed. Eight months after implantation, clinical and radiological examinations were performed. Case III patient presented with discomfort due to mobility of the upper maxillary anterior site. Due to severe destruction of alveolar bone, teeth #11 and #12 were extracted. After three months, the alveolar ridge was considered a Seibert classification III ridge defect. A GBR procedure was performed; implantation was performed 6 months later. Approximately 1-year after implantation, clinical and radiological examinations were performed. During the whole treatment period, healing was uneventful without membrane exposure, severe swelling, or infection in all cases. Radiographic and clinical examinations revealed that atrophic hard tissues and buccal bone contour were restored to the acceptable levels for implant placement and esthetic restoration. In conclusion, severely resorbed alveolar ridge of the maxillary anterior area can be reconstructed with ridge augmentation using the GBR procedure so that dental implants could be successfully placed.

A Three-Stage Split-Crest Technique: Case Series of Horizontal Ridge Augmentation in the Atrophic Posterior Mandible

This paper introduces a three-stage split-crest (TSSC) technique for horizontal ridge augmentation in the atrophic posterior mandible. The first stage consists of splitting the ridge. Following a 3- to 4-week healing interval, the second stage consists of expansion of the cortical plate (without elevating the periosteum) and placement of a bone replacement graft material. After 3 to 4 months of healing, the implants are placed. The advantages of this three-stage technique are increased vascularization to the surgical area, a decrease in procedure complications, and improved implant survival rates. An extended treatment time is the main disadvantage. The purpose of this retrospective case series is to review and discuss a new step-by-step surgical procedure of a TSSC technique using a delayed implant placement protocol. The results, advantages, and limitations were also presented.

USE OF PLATELET-RICH FIBRIN IN MAXILLOFACIAL SURGERY

Platelet Rich Fibrin (PRF) is autologous biomaterial which is the second-generation platelet concentrate. It has a favorable biological properties that accelerate healing of soft tissue, and bone, giveing a wide range of applications found in oral and maxillofacial surgery and other surgical fields. PRF technique was developed by Choukroun et al in 2001 and it represents a second generation of autologous platelet concentrate, which is used to accelerate the healing of soft and hard tissue. In contrast to the PRP, the PRF is composed of autologous fibrin matrix in which a large amount of platelets and their growth factors are embedded. PRF-graft is used in augmentative techniques residual bone defects, alone or in combination with biomaterials. When the alveolar ridge augmentation technique GBR, the PRF membranes can be used for protection and stabilization of bone compensation. PRF accelerates the healing of soft tissue and reduces the possibility of dehiscence and exposure of the membrane.

Guided Bone Regeneration with Collagen Membranes and Particulate Graft Materials: A Systematic Review and Meta-Analysis.

The aim of this meta-analysis was to evaluate different methods for guided bone regeneration using collagen membranes and particulate grafting materials in implant dentistry. An electronic database search and hand search were performed for all relevant articles dealing with guided bone regeneration in implant dentistry published between 1980 and 2014. Only randomized clinical trials and prospective controlled studies were included. The primary outcomes of interest were survival rates, membrane exposure rates, bone gain/defect reduction, and vertical bone loss at follow-up. A meta-analysis was performed to determine the effects of presence of membrane cross-linking, timing of implant placement, membrane fixation, and decortication. Twenty studies met the inclusion criteria. Implant survival rates were similar between simultaneous and subsequent implant placement. The membrane exposure rate of cross-linked membranes was approximately 30% higher than that of non-cross-linked membranes. The use of anorganic bovine bone mineral led to sufficient newly regenerated bone and high implant survival rates. Membrane fixation was weakly associated with increased vertical bone gain, and decortication led to higher horizontal bone gain (defect depth). Guided bone regeneration with particulate graft materials and resorbable collagen membranes is an effective technique for lateral alveolar ridge augmentation. Because implant survival rates for simultaneous and subsequent implant placement were similar, simultaneous implant placement is recommended when possible. Additional techniques like membrane fixation and decortication may represent beneficial implications for the practice.

Insufficient evidence about the comparative effectiveness of 3 horizontal ridge augmentation techniques

Deeb GR, Tran D, Carrico CK, Block E, Laskin DM, Deeb JG. How effective is the tent screw pole technique compared to other forms of horizontal ridge augmentation [published online ahead of print June 13, 2017]? J Oral Maxillofac Surg. http://dx.doi.org/10.1016/j.joms.2017.05.037.

Retrospective Case Series Analysis to Evaluate Ridge Augmentation Procedure Applied to Immediate Implant Placement in the Esthetic Zone: Five-Year Longitudinal Evaluation Using Cone Beam Computed Tomography.

Using simultaneous transplantation of bone graft materials, this study examined the long-term outcomes of a ridge augmentation technique applied to deficient labial alveolar bone plate in the esthetic zone. Results were based on a case series in which study cases (n = 10) were divided into two groups. Group 1 exhibited intact labial alveolar bone, while group 2 alveolar bone was dehiscent at the labial aspect. The clinical outcome was longitudinally monitored using cone beam computed tomography 4 to 7 years after the procedure. The final postoperative examination noted bone augmentation in labial bone width for groups 1 and 2 of 2.48 ± 0.60 and 2.62 ± 0.68 mm, respectively (Mann-Whitney U test, P = .40), indicating the effectiveness of this technique when applied to dehiscent labial bone. More importantly, these measurements did not significantly change during the last 2 to 4 years of follow-up monitoring, suggesting the success of this technique when applied to immediate implant placement.

The application of a delayed expansion technique for horizontal alveolar ridge augmentation in dental implantation

The aim of this study was to evaluate the application of delayed expansion of the alveolar ridge in dental implantation. This method avoids the need to harvest autogenous bone and the requirement to fix a block with screws, and could help prevent the uncontrolled fracture and avascular necrosis that may result from the traditional alveolar split. Eighteen patients and 43 implants were included in this retrospective study. The width of the alveolar ridge was measured before implantation, immediately after implantation, and after the final restoration. The width increased significantly after the insertion of implants and decreased slightly after bone remodelling. Overall, the width of the alveolar ridge increased by 2.37±1.44mm on average, ranging from −0.20mm to 5.75mm. The results suggest the use of delayed expansion for horizontal alveolar bone augmentation; however, the maxillary premolar area may not be a suitable site.

How Effective Is the Tent Screw Pole Technique Compared to Other Forms of Horizontal Ridge Augmentation?

The tent screw pole technique is one of the methods available for practitioners to perform horizontal ridge augmentation to facilitate dental implant placement. The purpose of this study was to evaluate the efficacy of the tent screw pole technique for horizontal ridge augmentation and to compare the results with those of the tunnel technique and open ridge augmentation. In this retrospective cohort study, 35 patients underwent horizontal ridge augmentation with the tent screw pole technique, a 1:1 ratio of mineralized freeze-dried bone allograft and particulate bovine hydroxyapatite, and a resorbable collagen membrane. The incidence of early wound dehiscence and membrane exposure, the number of courses of antibiotics and postoperative visits required for their management, and the number of sites that subsequently had successful implant placement were recorded. These parameters were compared with those in 21 patients who had undergone horizontal ridge augmentation by the tunnel technique and 31 patients who had been treated using an open procedure and a resorbable polytetrafluoroethylene (PTFE) membrane in the authors' previous study (J Oral Maxillofac Surg 74:1752, 2016). Implant placement rate was similar for all 3 methods (71 to 97%). However, there were significant differences among the 3 surgical techniques for membrane exposure and wound dehiscence (P=.0033), graft loss (P=.0256), courses of antibiotics (P=.0017), and postoperative visits (P=.0043). The PTFE method consistently had the highest rate of complications, whereas the tent screw and tunnel techniques were comparable. All 3 techniques allowed a high rate of implant placement; however, the PTFE technique was consistently associated with increased postoperative complications compared with the other 2 methods. The tent screw technique might be more favorable than the tunnel technique in cases in which the bony deficiency is flat.

Subperiosteal Minimally Invasive Aesthetic Ridge Augmentation Technique (SMART): A New Standard for Bone Reconstruction of the Jaws.

Traditional guided bone regeneration techniques include flap mobilization and placement of a bone graft, often with the use of space-maintaining devices and cell-occlusive membranes. This approach is associated with frequent complications that negatively affect the outcome of the augmentation and the peri-implant soft tissue esthetics. Although current tunneling techniques have focused on periodontal soft tissue applications, earlier publications described their use for horizontal augmentation of mandibular posterior edentulous ridges in full-denture patients. More recently, the use of recombinant human platelet-derived growth factor (rhPDGF-BB) was tested with different bone matrices to treat maxillary anterior edentulous spans. The present case series reports the use of a subperiosteal minimally invasive aesthetic ridge augmentation technique (SMART) to treat 60 single and multiple edentulous, dentate, and implant sites on 21 patients and five treatment categories with a follow-up period ranging from 4 to 30 months. The technique includes the use of a laparoscopic approach to deliver a growth factor/xenograft combination into a subperiosteal pouch. No flap elevation, cell-occlusive membranes, space-maintaining devices, or decortication procedures were used. The results from this case series demonstrated predictable and consistent bone regeneration. The average gain in ridge width for all treatment categories was 5.11 mm (SD 0.76 mm), which compares favorably with previously published reports. Morbidity and complication rates were consistently reduced as well. Human histology results show xenograft particles surrounded by newly formed bone. The role of the periosteum as a source of pluripotent cells in growth factor–mediated bone regeneration is discussed.

Minimal invasive horizontal ridge augmentation using subperiosteal tunneling technique.

BackgroundThe goal of this study was to retrospectively evaluate the prognosis of minimal invasive horizontal ridge augmentation (MIHRA) technique using small incision and subperiosteal tunneling technique.MethodsThis study targeted 25 partially edentulous patients (10 males and 15 females, mean age 48.8 ± 19.7 years) who needed bone graft for installation of the implants due to alveolar bone deficiency. The patients took the radiographic exam, panoramic and periapical view at first visit, and had implant fixture installation surgery. All patients received immediate or delayed implant surgery with bone graft using U-shaped incision and tunneling technique. After an average of 2.8 months, the prosthesis was connected and functioned. The clinical prognosis was recorded by observation of the peri-implant tissue at every visit. A year after restoration, the crestal bone loss around the implant was measured by taking the follow-up radiographs.One patient took 3D-CT before bone graft, after bone graft, and 2 years after restoration to compare and analyze change of alveolar bone width.ResultsThis study included 25 patients and 39 implants. Thirty eight implants (97.4 %) survived. As for postoperative complications, five patients showed minor infection symptoms, like swelling and tenderness after bone graft. The other one had buccal fenestration, and secondary bone graft was done by the same technique. No complications related with bone graft were found except in these patients. The mean crestal bone loss around the implants was 0.03 mm 1 year after restoration, and this was an adequate clinical prognosis.A patient took 3D-CT after bone graft, and the width of alveolar bone increased 4.32 mm added to 4.6 mm of former alveolar bone width. Two years after bone graft, the width of alveolar bone was 8.13 mm, and this suggested that the resorption rate of bone graft material was 18.29 % during 2 years.ConclusionsThe bone graft material retained within a pouch formed using U-shaped incision and tunneling technique resulted with a few complications, and the prognosis of the implants placed above the alveolar bone was adequate.