Vertical Ridge Augmentation Research Articles

PC373: The cortical lamina technique, a new device for horizontal and vertical ridge augmentation

PC373: The cortical lamina technique, a new device for horizontal and vertical ridge augmentation

PR608A: One stage vertical ridge augmentation and dental implantation with allograft bone rings: results one year after surgery

PR608A: One stage vertical ridge augmentation and dental implantation with allograft bone rings: results one year after surgery

EVALUATION OF ALVEOLAR OSTEOTOMY FOR CORRECTION OF VERTICAL BONE RESORPTION IN ANTERIOR MANDIBULAR RIDGE USING A MIXTURE OF TWO GRAFTED MATERIALS

INTRODUCTION: Extensive loss of alveolar bone and teeth in the anterior mandible presents a complex problem for reconstruction. Alveolar osteotomy technique with the use of mixture of hydroxy apatite and beta-tricalcium phosphate together with injectable PRF is one of the reliable methods to restore vertical ridge deficiencies. OBJECTIVES: : Evaluate vertical ridge augmentation using sandwich osteotomy technique in anterior atrophic mandible and the use of hydroxy apatite, beta-tri-calcium phosphate mixed with injectable PRF as a grafting material. MATERIALS AND METHODS: This study was conducted clinically on 8 patients indicated for vertical ridge augmentation by sandwich technique osteotomy and fixation of the osteomatized segment by micro-plates and screws, and the placement of Ha- BTCP mixed with I-PRF as interpositional graft material. Patients were evaluated clinically and radiographically by using panoramic radiograph and cone beam computed tomography (CBCT). RESULTS: In this study no severe pain was recorded postoperatively. No signs of inflammation or swelling were observed in almost all of the patients along the follow up period. Vertical bone height gain of the residual ridge was satisfactory and prepared the ridge to receive final prosthesis successfully. CONCLUSIONS Sandwich osteotomy technique with Ha- BTCP mixed with I-prf is a reliable method to restore vertical ridge deficiencies in anterior mandible.

Allogeneic bone block for challenging augmentation-a clinical, histological, and histomorphometrical investigation of tissue reaction and new bone formation.

The aim of the present study was the histological investigation of an allogeneic spongious bone block for horizontal and vertical ridge augmentation in humans. The amount of new bone, soft tissue, and residual bone substitute were histomorphometrically assessed after a mean healing period of 6months. Fourteen patients received augmentation with an allogeneic spongious bone block (Tutobone®, Tutogen Medical, Neunkirchen, Germany). After 6months of healing, 28 implants were placed with simultaneous harvesting of bone biopsies for histological and histomorphometrical analysis. Moreover, samples from the bone blocks were collected as blanks and analyzed histologically. The formation of new bone, connective tissue, and remaining bone substitute material as well as vascularization and formation of multinucleated giant cells (MNCGs) within the augmentation bed were analyzed. New bone formation could be observed primarily in close proximity to the bone block. Histomorphometrical analyses showed 18.65 ± 12.20% newly formed bone, 25.93 ± 12.36% allogeneic spongious bone block, and 53.45 ± 10.34% connective tissue. MNCGs were observed on the biomaterial surface. Furthermore, organic residues were evident, as donor-related cellular remnants within the osteocyte lacunae were found in the blank bone blocks and in the analyzed biopsies. Despite the presence of donor-related organic remnants, the bone block shows the ability to serve as a scaffold for new bone formation. Within the limits of the present study, the detect organic remnants seemed not to affect the bone formation or influence the host in the long term. Clinicians have to make a conscious choice of the applied biomaterials with regard to their components and structure to support tissue regeneration and maintain patient safety.

Decision Tree for Vertical Ridge Augmentation.

Vertical ridge augmentation (VRA) procedures before or during dental implant placement are technically challenging and often encounter procedure-related complications. To minimize complications and promote success, a literature search was conducted to validate procedures used for VRA. A decision tree based on the amount of additional ridge height needed (< 4, 4 to 6, or > 6 mm) was then developed to improve the procedure-selection process. At each junction, the clinician is urged to consider anatomical, clinical, and patient-related factors influencing treatment outcomes. This decision tree guides selection of the most appropriate treatment modality and sequence for safe, predictable management of the vertically deficient ridge in implant therapy.

Clinical Evaluation of Vertical Ridge Augmentation Using Titanium Reinforced PTFE membrane

Purpose: This study reports four cases of vertical ridge augmentation using titanium reinforced Polytetrafluoroethylene (TR-PTFE) membranes.Material and Methods: Bone augmentation was performed using TR-PTFE membranes in four patients with a vertical bony defect (mean 6.5 ± 0.58 mm) who was scheduled to receive dental implants at the Department of Periodontology, Veterans Health Service Medical Center between January and December 2016. Vertical bony defects were measured intraoperatively using a probe and the exposure of membranes were assessed before and after suture removal and one month after the surgery. The gained area from the reoperation as well as the need for additional bone grafting during implant placement was assessed.Results: The exposure was maintained without inflammation in one site. Placing an implant led to an average of 5.25 ± 0.5 mm vertical augmentation, and none of the cases required additional bone transplantation. A total of ten implants were installed in 4 cases. Over at least 1-year of follow-up, all implants were functioned well.Conclusion: In this case study, bone augmentation using TR-PTFE membranes. led to satisfactory bone regeneration in defective areas with vertical bone resorption. In addition to a greater number of cases, histological assessments should be performed in the future to further substantiate these findings.

Osteointegration of dental implants in augmented bone after bone flap rotation

The article presents clinical case of a patient with partial secondary absence of teeth and maxillary defect because of vertical alveolar bone atrophy. Vertical alveolar ridge augmentation by osseous flap rotation and xenogenous bone block with 10% collagen was performed. Eight months later 4 dental implants with modified surface were placed in the augmentation area. After 3 months 3 implants showed no signs of osteointegration and were removed. Three week later the patient was admitted to ENT department because of maxillary sinusitis symptoms.

Vertical Ridge Augmentation of Atrophic Anterior Mandible with Autogenic Tibia Grafts Compared Allogenic Grafts

Aim: Ridge augmentation for the atrophied mandible or for supporting dental implants is, an effective treatment in patients with alveolar defects that preserve bone height for the placement of implants or desirable appearance. Two common substans for bone augmentation are autografts and allografts. However, it is difficult to demonstrate that one surgical procedure offers better outcomes than another. Our study aimed to address and compare changes in ridge augmentation following autograft and allograft bone grafting within a 6-month follow up period. Materials and Methods: In a randomized blinded clinical trial, 18 patients who were candidates for mandible bone grafts were randomly divided into two autograft (tibia graft) (n = 9) and allograft (n = 9) groups. In the autograft group demineralized frozen dried bone was used. Height of three local points on graft replacement (Right, Middle and Left points) were measured based on the OPG preoperatively and also 3 and 6 months after the grafting. Results: In all patient, the trend of ridge augmentation change was significant within 6 months following grafting; however no difference was observed in height changes between the autograft and allograft procedures. Conclusion: From the clinical point of view, these two procedures appear to have similar efficacies for treating localized mandibular ridge defects. Clinical Significances: Comparison the success rate and increase the anterior of mandibular height between autogenous bone graft and allogeneic bone graft.

The Dilemma of Vertical Ridge Augmentation: The Best and Predictable Technique Available.

The Dilemma of Vertical Ridge Augmentation: The Best and Predictable Technique Available.

Bone Resorption During Submerged Healing After Guided Bone Regeneration

The aim of this study was to evaluate bone resorption quantitatively during the healing period subsequent to ridge augmentation. Sixteen patients requiring vertical ridge augmentation before implant placement were recruited in the study. The study used an allograft and nonresorbable membrane. A custom acrylic stent was used to measure changes in bone volume. Augmented bone was compared with remaining bone 6 months after guided bone regeneration (α = 0.05 by means of the paired t test). All sites following the six months post-surgery were analyzed. Overall changes in alveolar bone were observed with a mean resorption rate of 19.8% (p<0.001). The vertical bone measurement indicated a mean resorption rate of 22.8% (range = 18.5% - 26.5%). The horizontal measurement indicated a mean resorption rate of 18.7% (range = 12.6% - 26.0%). Among the sixteen sites, four sites with post-operative complications including membrane exposure showed an average of 42.1% resorption rates. Loss in graft quantity was observed after ridge augmentation using an allograft and nonresorbable membrane during submerged healing before implant placement. Further studies with larger sample sizes are recommended to confirm its findings.

Is Bone Morphogenetic Protein-2 as Effective as Alveolar Distraction Osteogenesis for Vertical Bone Regeneration?

The aim of this study was to assess the clinical effectiveness of alveolar distraction osteogenesis (ADO) versus recombinant human bone morphogenetic protein-2 (rh-BMP-2) for vertical ridge augmentation. Few data have been published on vertical bone regeneration using rh-BMP-2. The authors implemented a retrospective cohort study and enrolled a sample composed of patients with deficient alveolar vertical bone height. The primary predictor variable was vertical augmentation with BMP-2 and a titanium mesh or ADO. The primary outcome variable was gain in vertical bone height (millimeters) measured using computed tomography. The secondary outcome variable was postoperative complications, namely need for further grafting before or simultaneous with implant placement, soft tissue dehiscence, paresthesia, infection, implant failure, and pain. Other outcomes included implant stability at time of placement and follow-up (implant stability quotient by resonance frequency analysis), surgical time (minutes), and total treatment time until implant placement (weeks). Other study variables included location of reconstruction (maxilla or mandible). Appropriate bivariate statistics were computed and statistical significance was set a P value less than .05. The retrospective review yielded 21 patients in the BMP group and 19 in the ADO group. For the BMP-2 group, the average vertical bone gain was 2.96±1.8mm overall (maxilla, mean 3.6±3.1mm; mandible, mean 2.32±1.8mm). For the ADO group, this gain was 4±1.69mm overall (maxilla, mean 2.8±1.94mm; mandible, mean 5.2±4.67mm). For complications, group BMP showed a statistically minor tendency for more postoperative problems, such as wound dehiscence. For implant survival, group BMP showed a 92.2% survival rate versus 96.3% in group ADO at 3 to 45months after delivery of the prosthesis (average, 22months). The 2 techniques showed similar values in absolute vertical bone gain. Group ADO showed a slightly better outcome in outright vertical regenerative potential, albeit with a more frequent need for regrafting before and simultaneous with implant placement. Group BMP showed a lesser need for regrafting, despite having a higher postoperative complication rate.

Human Studies of Vertical and Horizontal Alveolar Ridge Augmentation Comparing Different Types of Bone Graft Materials: A Systematic Review.

Alveolar ridge augmentation can be completed with various types of bone augmentation materials (autogenous, allograft, xenograft, and alloplast). Currently, autogenous bone is labeled as the "gold standard" because of faster healing times and integration between native and foreign bone. No systematic review has currently determined whether there is a difference in implant success between various bone augmentation materials. The purpose of this article was to systematically review comparative human studies of vertical and horizontal alveolar ridge augmentation comparing different types of bone graft materials (autogenous, allograft, xenograft, and alloplast). A MEDLINE search was conducted under the 3 search concepts of bone augmentation, dental implants, and alveolar ridge augmentation. Studies pertaining to socket grafts or sinus lifts were excluded. Case reports, small case series, and review papers were excluded. A bias assessment tool was applied to the final articles. Overall, 219 articles resulted from the initial search, and 9 articles were included for final analysis. There were no discernible differences in implant success between bone augmentation materials. Generally, patients preferred nonautogenous bone sources as there were fewer hospital days, less pain, and better recovery time. Two articles had industrial support; however, conclusions of whether that support influenced the outcomes could not be determined. Future comparative studies should compare nonautogenous bone sources and have longer follow-up times.

New predictable vertical ridge augmentation with a collagen membrane, bovine bone mineral, and fibrin fibronectic sealer system

New predictable vertical ridge augmentation with a collagen membrane, bovine bone mineral, and fibrin fibronectic sealer system

Vertical ridge augmentation in the atrophic mandible may result in bone augmentation and implant survival and success

Vertical ridge augmentation in the atrophic mandible may result in bone augmentation and implant survival and success

Principles for Vertical Ridge Augmentation in the Atrophic Posterior Mandible: A Technical Review.

Guided bone regeneration has become more predictable due to advances in material sciences. Nevertheless, vertical ridge augmentation (VRA) remains a potential challenge due to the complexity of soft tissue management. This becomes more complicated in the posterior atrophic mandible due to limited access and poorer blood supply. As such, a number of critical elements must be taken into consideration in treatment planning. Anatomical structures potentially jeopardize intraoperative adverse events such as bleeding or neurosensory disturbances. The attachment of the mylohyoid often compromises lingual flap advancement. This technical review summarizes the critical factors to be assessed prior to VRA for the posterior mandible and provides a sequenced approach to bone grafting and to attaining a tension-free flap for successful bone regeneration and long-term peri-implant tissue stability.

Vertical Ridge Augmentation and Soft Tissue Reconstruction of the Anterior Atrophic Maxillae: A Case Series.

Severe vertical ridge deficiency in the anterior maxilla represents one of the most challenging clinical scenarios in the bone regeneration arena. As such, a combination of vertical bone augmentation using various biomaterials and soft tissue manipulation is needed to obtain successful outcomes. The present case series describes a novel approach to overcome vertical deficiencies in the anterior atrophied maxillae by using a mixture of autologous and anorganic bovine bone. Soft tissue manipulation including, but not limited to, free soft tissue graft was used to overcome the drawbacks of vertical bone augmentation (eg, loss of vestibular depth and keratinized mucosa). By combining soft and hard tissue grafts, optimum esthetic and long-term implant prosthesis stability can be achieved and sustained.

A stepwise under-prepared osteotomy technique improves primary stability in shallow-placed implants: a preliminary study for simultaneous vertical ridge augmentation.

Simultaneous vertical ridge augmentation (VRA) can reduce treatment procedures and surgery time, but the concomitant reduction in primary stability (PS) of a shallow-placed implant imparts risk to its prognosis. Although several studies have reported improvements in PS, there is little information from any simultaneous VRA model. This study aimed to evaluate whether tapered implants with stepwise under-prepared osteotomy could improve the PS of shallow-placed implants in an in vitro model of simultaneous VRA. Tapered implants (Straumann® Bone Level Tapered implant; BLT) and hybrid implants (Straumann® Bone Level implant; BL) were investigated in this study. A total of 80 osteotomies of different depths (4, 6, 8, 10mm) were created in rigid polyurethane foam blocks, and each BLT and BL was inserted by either standard (BLT-S, BL-S) or a stepwise under-prepared (BLT-U, BL-U) osteotomy protocol. The PS was evaluated by measuring maximum insertion torque (IT), implant stability quotient (ISQ), and removal torque (RT). The significance level was set at P<0.05. There were no significant differences in IT, ISQ or RT when comparing BLT-S and BL-S or BLT-U and BL-U at placement depths of 6 and 8mm. When comparison was made between osteotomy protocols, IT was significantly greater in BLT-U than in BLT-S at all placement depths. A stepwise under-prepared osteotomy protocol improves initial stability of a tapered implant even in a shallow-placed implant model. BLT-U could be a useful protocol for simultaneous VRA.

Dimensional alterations following vertical ridge augmentation using collagen membrane and three types of bone grafting materials: A retrospective observational study.

Various biomaterials have been introduced for vertical ridge augmentation to replace autogenous block bone grafting. This retrospective study radiographically evaluated dimensional alterations of the vertically augmented alveolar ridge using collagen membrane and 3 types of materials: autogenous bone block, allogenous bone block, and particulated bone substitute. The electronic medical records of 32 patients who received vertical ridge augmentation using 3 types of materials were searched: 9 for autogenous bone block, 12 for allogenous bone block, and 11 for particulated bone substitutes. The vertical bone gain, progression of bone resorption, and peri-implant marginal bone loss after prosthetic loading were measured on follow-up radiographs. The alveolar ridge was vertically augmented by 5.13 ± 1.61, 4.54 ± 2.48, and 3.90 ± 0.85 mm (mean ± standard deviation) after grafting with autogenous bone block, allogenous bone block, and particulated bone substitute, respectively. The radiographic vertical height of the augmented ridge that received autogenous bone block reduced continuously during the first year but was stable thereafter. Sites that received allogenous bone block or particulated bone substitute exhibited dimensional shrinkage for up to 1.5 years postsurgery. However, the peri-implant marginal bone loss did not exceed 1 mm throughout the observational periods in all groups. The clinical findings of this study suggest that the alveolar ridge can be vertically augmented using either allogenous bone block or particulated bone substitute. However, they require a longer healing period to ensure dimensional stability compared to the autogenous bone block.

Mandibular Regional Anatomical Landmarks and Clinical Implications for Ridge Augmentation.

Mandibular ridge augmentation via guided bone regeneration in the atrophic mandible is considered one of the most challenging scenarios for implant-supported oral rehabilitation. Uneventful wound healing has clearly demonstrated its impact on the final regenerative outcome. Soft tissue management must be precise and adequate to attain flap-free wound closure. Accordingly, it demands exhaustive insight and expertise to avoid damaging the neighboring structures. The cadaver study described herein discusses the mandibular morphologic landmarks (ie, musculature, vascularization, innervation, and salivary glands) necessary to safely perform regenerative procedures in the atrophic mandibular ridge, such as vertical ridge augmentation and dental implant surgery. The potential intraoperative complications are presented, as well as clinical implications of which the clinician must be aware to prevent adverse surgical events during regenerative surgery and implant placement in this anatomical region.

Vertical Ridge Augmentation in the Atrophic Mandible: A Systematic Review and Meta-Analysis.

To systematically appraise the effectiveness/reliability of vertical ridge augmentation (VRA) in the atrophic mandible. Articles that addressed any one of the following four areas were included in this study: amount of VRA, implant survival (ISR) and success rates (SSR) in the area of newly regenerated bone, complication rate during the bone augmentation procedure, and bone resorption. An electronic literature search was conducted by two independent reviewers in several databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register databases for articles reporting VRA in the atrophic mandible via distraction osteogenesis (DO), inlay block grafting (IBG), onlay block grafting (OBG), and guided bone regeneration (GBR). For meta-analysis, two primary (VRA and ISR [%]) and two secondary outcomes were studied (SSR [%] and vertical bone resorption [VBR] [%}). Additionally, for qualitative assessment, complications (ie, causes of failure) were further extracted and comprehensively described. Overall, 73 full-text papers were evaluated. Of these, 52 articles fulfilled the inclusion criteria. The weight mean (WM) of VRA (± SD) was 4.49 ± 0.33 mm (95% CI: 3.85 to 5.14 mm). It was most notable that DO involved greater VRA than IBG, and thus, significantly higher than GBR and OBG. The technique significantly influenced the mean VRA obtained (P < .001). Nonetheless, no technique showed superiority in terms of ISR or SSR. VBR and complications were shown to be minimized for GBR. If ~ 4 mm of VRA is needed, any technique in optimum local and systemic conditions should be equally reliable in the atrophic mandible. However, when greater VRA is needed, DO and IBG have demonstrated accuracy. By means of complication and VBR rates, GBR was shown to have the lowest. For ISR and SSR, no statistical differences existed among all techniques. Controlled studies are needed to examine the long-term peri-implant bone fate and the frequency of biologic complications in each technique applied for the vertical augmentation of the atrophied mandible.