Vertical Alveolar Ridge Defects Research Articles

Iliac crest vertical block grafts -placing outside or inside the bone contour: A cohort study.

Challenging defect configurations and dimensions arise from severe, localized vertical alveolar ridge defects caused by trauma or prior surgery. This study aims to analyze three-dimensional bone gain, assess marginal bone stability in such defect configurations, and evaluate the impact of grafting outside the bone contour on the overall outcome, with a focus on iliac crest block grafts as a valid treatment option. The prospective cohort study evaluated patients who required vertical block grafting due to localized bone defects in the maxilla or mandible and who had received iliac grafts. Three-dimensional bone gain was analyzed using cone beam computed tomography (CBCT) after 3 months of bone healing for each treated site and implant position. A comparison between bone grafts inside and outside the bone contour was conducted. Marginal bone stability was measured using intraoral radiographs during routine annual follow-up visits. Seventy patients with 89 treated sites were evaluated. After 3 months of graft healing, the mean vertical bone gain was 11.03 ± 3.54 mm, the mean horizontal bone gain was 7.18 ± 2.00 mm, and the mean graft length was 28.19 ± 11.01 mm. A total of 217 implants were placed in the augmented regions. On implant level, a mean vertical bone gain of 10.44 ± 3.44 mm and a mean horizontal bone gain of 6.54 ± 1.86 mm were measured. Over a 43-month observation period, mesial and distal marginal bone loss averaged 0.44 ± 0.92 mm and 0.49 ± 1.05 mm, respectively. Eight implants were diagnosed with periimplantitis, resulting in the loss of four implants, while no early implant losses were reported. Within the limitations of this study, vertical bone grafts with iliac crest block grafts were found to be a dependable treatment option for dental implant placement, and placing block grafts outside the bone contour did not lead to inferior outcomes.

Comparative evidence of different surgical techniques for the management of vertical alveolar ridge defects in terms of complications and efficacy: A systematic review and network meta-analysis.

To systematically appraise the available evidence on vertical ridge augmentation (VRA) techniques and estimate a treatment-based ranking on the incidence of complications as well as their clinical effectiveness. Searches were conducted in six databases to identify randomized clinical trials comparing VRA techniques up to November 2022. The incidence of complications (primary) and of early, major, surgical and intra-operative complications, vertical bone gain (VBG), marginal bone loss, need for additional grafting, implant success/survival, and patient-reported outcome measures (secondary) were chosen as outcomes. Direct and indirect effects and treatment ranking were estimated using Bayesian pair-wise and network meta-analysis (NMA) models. Thirty-two trials (761 participants and 943 defects) were included. Five NMA models involving nine treatment groups were created: onlay, inlay, dense-polytetrafluoroethylene, expanded-polytetrafluoroethylene, titanium, resorbable membranes, distraction osteogenesis, tissue expansion and short implants. Compared with short implants, statistically significant higher odds ratios of healing complications were confirmed for all groups except those with resorbable membranes (odds ratio 5.4, 95% credible interval 0.92-29.14). The latter group, however, ranked last in clinical VBG. VRA techniques achieving greater VBG are also associated with higher incidence of healing complications. Guided bone regeneration techniques using non-resorbable membranes yield the most favourable results in relation to VBG and complications.

Vertical-guided bone regeneration with a titanium-reinforced d-PTFE membrane utilizing a novel split-thickness flap design: a prospective case series

ObjectivesTo evaluate the feasibility of a newly proposed minimally invasive split-thickness flap design without vertical-releasing incisions for vertical bone regeneration performed in either a simultaneous or staged approach and to analyze the prevalence of adverse events during postoperative healing.Materials and methodsFollowing preparation of a split-thickness flap and bilaminar elevation of the mucosa and underlying periosteum, the alveolar bone was exposed over the defects, vertical GBR was performed by means of a titanium-reinforced high-density polytetrafluoroethylene membrane combined with particulated autogenous bone (AP) and bovine-derived xenograft (BDX) in 1:1 ratio. At 9 months after reconstructive surgery, vertical and horizontal hard tissue gain was evaluated based on clinical and radiographic examination.ResultsTwenty-four vertical alveolar ridge defects in 19 patients were treated with vertical GBR. In case of 6 surgical sites, implant placement was performed at the time of the GBR (simultaneous group); in the remaining 18 surgical, sites implant placement was performed 9 months after the ridge augmentation (staged group). After uneventful healing in 23 cases, hard tissue fill was detected in each site. Direct clinical measurements confirmed vertical and horizontal hard tissue gain averaging 3.2 ± 1.9 mm and 6.5 ± 0.5 mm respectively, in the simultaneous group and 4.5 ± 2.2 mm and 8.7 ± 2.3 mm respectively, in the staged group. Additional radiographic evaluation based on CBCT data sets in the staged group revealed mean vertical and horizontal hard tissue fill of 4.2 ± 2.0 mm and 8.5 ± 2.4 mm. Radiographic volume gain was 1.1 ± 0.4 cm3.ConclusionVertical GBR consisting of a split-thickness flap and using titanium-reinforced non-resorbable membrane in conjunction with a 1:1 mixture of AP+BDX may lead to a predictable vertical and horizontal hard tissue reconstruction.Clinical relevanceThe used split-thickness flap design may represent a valuable approach to increase the success rate of vertical GBR, resulting in predicable hard tissue regeneration, and favorable wound healing with low rate of membrane exposure.

Evaluation of Custom made Xenogenic Bone grafts in Mandibular Alveolar Ridge Augmentation versus Particulate bone graft with titanium mesh

Aim: This study was to evaluate clinically and radiographically the volume changes of alveolar ridge grafting using customized xenogenic bone graft.Materials and Methods: A total of 12 patients with mandibular horizontal and vertical alveolar ridge defects ≥ 3 mm were selected. They were divided into 2 groups: Group I (Test Group) included 6 patients in which mandibular alveolar ridges were reconstructed with customized Xenogenic bone graft Smartbone (IBI S.A., Switzerland). Group II (Control Group) included 6 patients in which mandibular alveolar ridges were reconstructed with particulate Xenogenic bone (Smart bone, IBI S.A., Switzerland) grafting to posterior mandibular ridge with titanium mesh was performed. Volume analysis of the changes in alveolar ridge in both Groups were obtained before and four months after the procedure using CBCT. Densitometric analysis of the Postoperative bone formed and compared with native bone. .Results: Four months postoperatively. Measurements made on cone-beam computerized tomograms, four months postoperative showed significance increase in bone volume by 40 % in the area of newly formed bone in Group I (Customized bone) compared with 23% in Control Group. Statistical significant changes was found in the density of newly formed bone four months post-operatively in both Groups, however there was no significant difference in bone density postoperatively between Group I (customized Bone) and Group II (Control).Conclusion: According to the results, the treatment of defective alveolar ridge augmentation of the mandibular ridge with customized xenogenic bone graft Smartbone (IBI S.A., Switzerland) is successful and produces results consistent with the control Group.

Vertical bone augmentation procedures: Basics and techniques in dental implantology

An appropriate bony situation is essential for dental implant placement and bony support of soft tissues (pink esthetic). Loss of teeth often results in complex horizontal and vertical alveolar ridge defects. They demand advanced bone augmentation techniques for reconstruction. We present the different techniques and materials used in complex bone augmentation. Clinical cases show the application of the methods in the clinical setting. We present current techniques and materials used in complex bone augmentations. Clinical cases show the application of the methods in the clinical setting. Applied techniques include stabilized-guided bone regeneration (GBR), autologous local block augmentation, modified techniques such as Gellrich shell technique including piezosurgery, pelvic bone blocks, complex materials such as graft-derived bone blocks and their unique handling problems. Successful basic principles are reduction of cortical bone healing due to long remodeling time and possible late loss; extended application of materials with interconnecting porous system and particulate material resulting in fast healing analogous to cancellous bone; mechanical stabilization of the augmentation to allow bony healing in vertical defect situations. GBR and autologous bone blocks with minimal cortical thickness and a high volume of particulated material are most favorable techniques.

Screw “Tent-Pole” Grafting Technique for Reconstruction of Large Vertical Alveolar Ridge Defects Using Human Mineralized Allograft for Implant Site Preparation

The purpose of this study was to evaluate the effectiveness of using titanium screws in combination with particulate human mineralized allograft, in a "tenting" fashion, to augment large vertical alveolar ridge defects for implant placement. This prospective case study evaluated augmentation in consecutive patients with large (>7 mm) vertical alveolar ridge defects. Vertical ridge augmentation was performed using mineralized allograft placed around titanium screws to tent out the soft tissue matrix. The ridges were clinically evaluated 4 to 5 months after augmentation, and implants were placed at that time. Bone cores were harvested from all patients for histologic evaluations. Fifteen patients were treated in this prospective case study, and the mean vertical augmentation was 9.7 mm. Two patients had wound dehiscence resulting in loss of graft and requiring secondary grafting before implant placement. Five patients required 2-stage grafting procedures to achieve ideal ridge height before implant placement. Clinical evaluation of the grafted sites upon re-entry revealed uniform ridge anatomy. Histomorphometric analysis of 7 specimens revealed a mean bone content of 43%. A total of 32 implants were placed into grafted sites in 15 patients. All implants were integrated and successfully restored. Mean follow-up was 16.8 months after implant placement. Tenting of the periosteum and soft tissue matrix with titanium screws maintains space and minimizes resorption of mineralized particulate allograft. This technique offers predictable functional and esthetic reconstruction of large vertical defects without the use of autogenous bone and is capable of osseointegration. More studies are needed to evaluate the stability of vertically grafted bone after long-term loading.

Poster 033: Screw “Tent-Pole” Grafting Technique for Vertical Augmentation of the Severely Atrophic Alveolar Ridge for Implant Site Preparation

Objectives: Horizontal alveolar ridge augmentation using intra-oral autogenous block grafts to augment localize alveolar ridge defects prior to implant placement is a predictable method. However, reconstruction of large vertical alveolar defects has traditionally been difficult. The purpose of this study is to evaluate the effectiveness of using titanium screws in combination with particulate human mineralized allograft, in a “tenting” fashion, to augment large vertical alveolar ridge defects for implant placement.

Vertical alveolar ridge augmentation using autogenous bone grafts and platelet-enriched fibrin glue with simultaneous implant placement

The aim of this study was to evaluate the combined use of autogenous bone and platelet-enriched fibrin glue as grafting material for vertical alveolar ridge augmentation with simultaneous implant placement in a canine alveolar ridge defect model. In 6 mongrel dogs, bilateral vertical alveolar ridge defects were created in the mandible. After 3 months of healing, 2 dental implants were placed in each defect of the mandible, creating 6-mm supra-alveolar peri-implant defects. The 2 implants per defect were subjected to surgical treatments involving either a combination of autogenous bone grafts and platelet-enriched fibrin glue, or a conventional flap procedure only (control). After a healing period of 6 months, the dogs were humanely killed for histological and histometric analyses. Implant placement alone produced limited vertical alveolar height (0.6 +/- 0.4 mm). However, alveolar augmentation including a combination of autogenous bone grafts and platelet-enriched fibrin glue with simultaneous implant placement resulted in alveolar ridge augmentation amounting to 4.2 +/- 1.0 mm, comprising 63% of the defect height. New bone-implant contact was 40.5% in the defects treated with combined autogenous bone grafts and platelet-enriched fibrin glue, and was 48.4% in the resident bone; this difference was not statistically significant. The present study demonstrates that vertical alveolar ridge augmentation using autogenous bone grafts and platelet-enriched fibrin glue with simultaneous implant placement might effectively increase vertical alveolar ridge height and allow for an acceptable level of osseointegration.