Techniques on vertical ridge augmentation: Indications and effectiveness

Abstract

Vertical ridge augmentation techniques have been advocated to enable restoring function and esthetics by means of implant‐supported rehabilitation. There are three major modalities. The first is guided bone regeneration, based on the principle of compartmentalization by means of using a barrier membrane, which has been demonstrated to be technically demanding with regard to soft tissue management. This requisite is also applicable in the case of the second modality of bone block grafts. Nonetheless, space creation and maintenance are provided by the solid nature of the graft. The third modality of distraction osteogenesis is also a valid and faster approach. Nonetheless, owing to this technique's inherent shortcomings, this method is currently deprecated. The purpose of this review is to shed light on the state‐of‐the‐art of the different modalities described for vertical ridge augmentation, including the indications, the step‐by‐step approach, and the effectiveness.

Indications and surgical technique for distraction osteogenesis of the alveolar bone for augmentation prior to insertion of dental implants

“…For other procedures such as sandwich osteotomy or onlay block transplantation, a resorption rate of 10-40% is reported, depending on the study and indication. 18,59,68 From a biomechanical point of view, extraosseous versus intraosseous distraction systems are rated more favorably. Although the complication rate is higher with the intraosseous distractor and the implantation success rate is lower, there was no statistical significance between the groups.…”

“…Vertical bone gain for ridge augmentation with bone block averages 4.12 mm (95% CI [3.11 to 5.13 mm]) for autogenous bone blocks. 45,59 Inlay block grafting/sandwich osteotomy seems to compete most closely with ADO in terms of bone gain. Result of a meta-analysis provided a mean gain of 4.92 mm (95% CI [4.26 to 5.58 mm]).…”

“…The frequency of further complications such as sensory disorder or dehiscence can be compared with the values of competing methods. 18,59 Only the procedure of inlay block grafting shows a comparable high rate of complications. With an implant survival rate of 97.3% after 5 years, the ADO procedure can be described as very successful with regard to this aspect.…”

“…Apical soft tissue mobilization with resorbable suture fixation (B), implant insertion (C), and apical positioning of the previously prepared mucosal epithelium over the implant and the vestibular alveolar bone (D). Soft tissue managementpart II: after 3-4 months healing period and exposure of implant using roll flap technique and installation of a gingiva former (E, F).Compared to competing procedures for augmentation of the atrophic jaw, the ADO has the most significant indication restrictions in the posterior region of the maxilla and mandibula, in addition to sandwich osteotomy 18,59,68. The segmental osteotomy for distraction in the area of the lateral mandible only makes sense and is technically feasible if there is sufficient bone available to the nerve canal.…”

3D printing for bone regeneration: challenges and opportunities for achieving predictability

“…Large craniofacial and intra‐oral alveolar bone loss associated with pathology, tumor resection, trauma, developmental defects, and post‐tooth extraction alveolar ridge are prominent clinical problems. Clinically, these large‐volume defects are treated through a mixture of fixation and space creation, combined with autologous, allogeneic, or xenogeneic grafting 2 . However, autogenous grafting is affected by tissue availability, dimensional stability due to rapid resorption, and donor site morbidity, 3 while the use of allogenic and xenogeneic bone substitutes is significantly limited in terms of clinical handling, osteoinduction, possibility of disease transmission and degradation rate.…”