J Korean Assoc Oral Maxillofac Surg.  2020 Jun;46(3):211-217. 10.5125/jkaoms.2020.46.3.211.

Ridge augmentation in implant dentistry

Affiliations
  • 1Editor-in-Chief of J Korean Assoc Oral Maxillofac Surg, Korea
  • 2Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
  • 3Department of Dentistry & Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
  • 4Editorial Board of J Korean Assoc Oral Maxillofac Surg, Korea
  • 5Department of Oral and Maxillofacial Surgery, Section of Dentistry, Armed Forces Capital Hospital, Armed Forces Medical Command, Seongnam, Korea

Abstract

In patients with insufficient bone height and width, the successful placement of dental implants is difficult with regards to maintaining an ideal pathway and avoiding important anatomical structures. Vertical and/or horizontal ridge augmentation may be necessary using various bone substitute materials and bone graft procedures. However, effective one-wall reconstruction has been challenging due to its poor blood supply and insufficient graft stability. In this paper, the authors summarize current evidence-based literature based on the author’s clinical experience. Regarding bone substitutes, it is advantageous for clinicians to select the types of bone substitutes including autogenous bone. The most important consideration is to minimize complications through principle-based ridge augmentation surgery. Ridge augmentation should be decided with complete consent of the patients due to the possible disadvantages of surgery, complications, and unpredictable prognosis.

Keyword

Ridge augmentation; Autogenous bone; Complications

Figure

  • Fig. 1 Vertical ridge augmentation in a 53-year-old female. A. Allogenic and alloplastic bone substitutes were grafted. B. The titanium mesh was covered and fixed. C. A mucoperiosteal flap was elevated to allow for dental implant placement at 4 months after bone grafting. D. After removal of the titanium mesh, immature woven bone was observed on the coronal side of the grafted bone.

  • Fig. 2 Vertical and horizontal ridge augmentation in a 36-year-old female. A. Ridge augmentation was performed with particulate autogenous bone and allogenic bone and covered with a titanium mesh. B. Intraoral photographs at 4 months after the augmentation. C. The titanium mesh was removed. D. The dental implant was placed at 4 months after the augmentation.

  • Fig. 3 Horizontal ridge augmentation using a block type bone graft. An allogenic bone block was used on the upper site, while an autogenous bone block was used on the lower site. A. The allogenic bone block was fixed with titanium screws in a 68-year-old male. B. Bio-Oss (Geistlich, Switzerland) was packed surrounding the allogenic bone. C. An Ossix membrane (OraPharma, USA) was used to cover the surgical site. D. An autogenous ramus bone block was fixed with titanium screws in a 65-year-old female. E. Bio-Oss was packed surrounding the bone block. F. An Ossix membrane was used to cover the surgical site.

  • Fig. 4 Various techniques for horizontal ridge augmentation. A. Maxillary anterior horizontal ridge augmentation called ‘sandwich bone augmentation.’ Two autogenous bone blocks were grafted on the labial aspect, freeze dried allogenic bone was grafted above the autogenous bone, and a demineralized allogenic bone matrix was implanted over the grafts. Wound closure was performed after covering the resorbable collagen membrane. B. Maxillary anterior ridge splitting and ridge expansion. The thin ridge crest was split with a #15 surgical blade and chisel. Initial implant drilling was performed in the resulting space. Horizontal ridge expansion was performed by sequentially applying the osteotome or screw expander from small to thick in the drilling hole. The amount of expansion could be increased by using additional bone graft materials. C. The autogenous particulate bone graft was fixed by a titanium mesh.

  • Fig. 5 Various techniques for vertical ridge augmentation. A. An autogenous bone block was grafted on the alveolar crest and fixed with titanium screws. B. An autogenous bone block onlay graft was placed simultaneously with sinus bone grafting. C. Distraction osteogenesis was performed vertically on alveolar bone. D. Vertical ridge augmentation was performed with an interpositional bone graft. E, F. Vertical ridge augmentation using particulate bone and a titanium mesh. The autogenous particulate bone graft was fixed by a titanium mesh.

  • Fig. 6 Wound dehiscence and graft material exposure most frequently occurred, often progressing to postoperative infections, graft loss, and total failure.


Cited by  2 articles

Guided bone regeneration
Young-Kyun Kim, Jeong-Kui Ku
J Korean Assoc Oral Maxillofac Surg. 2020;46(5):361-366.    doi: 10.5125/jkaoms.2020.46.5.361.

A ramus cortical bone harvesting technique without bone marrow invasion
Jeong-Kui Ku, Min-Soo Ghim, Jung Ho Park, Dae Ho Leem
J Korean Assoc Oral Maxillofac Surg. 2023;49(2):100-104.    doi: 10.5125/jkaoms.2023.49.2.100.


Reference

References

1. Chiapasco M, Casentini P, Zaniboni M. 2009; Bone augmentation procedures in implant dentistry. Int J Oral Maxillofac Implants. 24(Suppl):237–59. PMID: 19885448.
2. Aghaloo TL, Moy PK. 2007; Which hard tissue augmentation techniques are the most successful in furnishing bony support for implant placement? Int J Oral Maxillofac Implants. 22(Suppl):49–70.
3. Chiapasco M, Tommasato G, Palombo D, Scarnò D, Zaniboni M, Del Fabbro M. 2018; Dental implants placed in severely atrophic jaws reconstructed with autogenous calvarium, bovine bone mineral, and collagen membranes: a 3- to 19-year retrospective follow-up study. Clin Oral Implants Res. 29:725–40. DOI: 10.1111/clr.13281. PMID: 29876968.
Article
4. Simion M, Fontana F, Rasperini G, Maiorana C. 2007; Vertical ridge augmentation by expanded-polytetrafluoroethylene membrane and a combination of intraoral autogenous bone graft and deproteinized anorganic bovine bone (Bio Oss). Clin Oral Implants Res. 18:620–9. DOI: 10.1111/j.1600-0501.2007.01389.x. PMID: 17877463.
Article
5. Chiapasco M, Zaniboni M, Rimondini L. 2007; Autogenous onlay bone grafts vs. alveolar distraction osteogenesis for the correction of vertically deficient edentulous ridges: a 2-4-year prospective study on humans. Clin Oral Implants Res. 18:432–40. DOI: 10.1111/j.1600-0501.2007.01351.x. PMID: 17501979.
Article
6. Restoy-Lozano A, Dominguez-Mompell JL, Infante-Cossio P, Lara-Chao J, Espin-Galvez F, Lopez-Pizarro V. 2015; Reconstruction of mandibular vertical defects for dental implants with autogenous bone block grafts using a tunnel approach: clinical study of 50 cases. Int J Oral Maxillofac Surg. 44:1416–22. DOI: 10.1016/j.ijom.2015.05.019. PMID: 26116063.
Article
7. Park YJ, Choi GH, Jang JR, Jung SG, Han MS, Yu MG, et al. 2009; The effect of new bone formation of onlay bone graft using various graft materials with a titanium cap on the rabbit calvarium. J Korean Assoc Maxillofac Plast Reconstr Surg. 31:469–77.
8. Roccuzzo M, Ramieri G, Bunino M, Berrone S. 2007; Autogenous bone graft alone or associated with titanium mesh for vertical alveolar ridge augmentation: a controlled clinical trial. Clin Oral Implants Res. 18:286–94. DOI: 10.1111/j.1600-0501.2006.01301.x. PMID: 17298495.
Article
9. Draenert FG, Huetzen D, Neff A, Mueller WE. 2014; Vertical bone augmentation procedures: basics and techniques in dental implantology. J Biomed Mater Res A. 102:1605–13. DOI: 10.1002/jbm.a.34812. PMID: 23733418.
Article
10. Schliephake H, van den Berghe P, Neukam FW. 1991; Osseointegration of titanium fixtures in onlay grafting procedures with autogenous bone and hydroxylapatite. An experimental histometric study. Clin Oral Implants Res. 2:56–61. DOI: 10.1034/j.1600-0501.1991.020202.x. PMID: 1667093.
Article
11. Waasdorp J, Reynolds MA. 2010; Allogeneic bone onlay grafts for alveolar ridge augmentation: a systematic review. Int J Oral Maxillofac Implants. 25:525–31. PMID: 20556251.
12. Draenert FG, Kämmerer PW, Berthold M, Neff A. 2016; Complications with allogeneic, cancellous bone blocks in vertical alveolar ridge augmentation: prospective clinical case study and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol. 122:e31–43. DOI: 10.1016/j.oooo.2016.02.018. PMID: 27236830.
Article
13. Hahn J. 2004; 8-year onlay bone graft and ridge augmentation with PepGen P-15: a clinical and radiographic case study. Implant Dent. 13:228–31. DOI: 10.1097/01.id.0000136916.28634.d3. PMID: 15359158.
Article
14. Byun HY, Wang HL. 2008; Sandwich bone augmentation using recombinant human platelet-derived growth factor and beta-tricalcium phosphate alloplast: case report. Int J Periodontics Restorative Dent. 28:83–7. PMID: 18351206.
15. Hartlev J, Spin-Neto R, Schou S, Isidor F, Nørholt SE. 2019; Cone beam computed tomography evaluation of staged lateral ridge augmentation using platelet-rich fibrin or resorbable collagen membranes in a randomized controlled clinical trial. Clin Oral Implants Res. 30:277–84. DOI: 10.1111/clr.13413. PMID: 30715758.
Article
16. Jeon IS, Heo MS, Han KH, Kim JH. 2013; Vertical ridge augmentation with simultaneous implant placement using β-TCP and PRP: a report of two cases. J Oral Maxillofac Surg Med Pathol. 25:226–31. DOI: 10.1016/j.ajoms.2012.05.016.
Article
17. Molly L, Quirynen M, Michiels K, van Steenberghe D. 2006; Comparison between jaw bone augmentation by means of a stiff occlusive titanium membrane or an autologous hip graft: a retrospective clinical assessment. Clin Oral Implants Res. 17:481–7. DOI: 10.1111/j.1600-0501.2006.01286.x. PMID: 16958685.
Article
18. Oh SH. 2008; Vertical alveolar bone augmentation using thin block and chip bone graft technique: case report. J Korean Assoc Maxillofac Plast Reconstr Surg. 30:108–13.
19. Merli M, Migani M, Esposito M. 2007; Vertical ridge augmentation with autogenous bone grafts: resorbable barriers supported by ostheosynthesis plates versus titanium-reinforced barriers. A preliminary report of a blinded, randomized controlled clinical trial. Int J Oral Maxillofac Implants. 22:373–82. PMID: 17622003.
20. Wang HL, Misch C, Neiva RF. 2004; "Sandwich" bone augmentation technique: rationale and report of pilot cases. Int J Periodontics Restorative Dent. 24:232–45. PMID: 15227771.
21. Longoni S, Sartori M, Apruzzese D, Baldoni M. 2007; Preliminary clinical and histologic evaluation of a bilateral 3-dimensional reconstruction in an atrophic mandible: a case report. Int J Oral Maxillofac Implants. 22:478–83.
22. Proussaefs P, Lozada J. 2005; The use of intraorally harvested autogenous block grafts for vertical alveolar ridge augmentation: a human study. Int J Periodontics Restorative Dent. 25:351–63. PMID: 16089043.
23. Carini F, Longoni S, Amosso E, Paleari J, Carini S, Porcaro G. 2014; Bone augmentation with TiMesh. autologous bone versus autologous bone and bone substitutes. A systematic review. Ann Stomatol (Roma). 5(Suppl 2 to No 2):27–36. PMID: 25678948. PMCID: PMC4308965.
24. von Arx T, Buser D. 2006; Horizontal ridge augmentation using autogenous block grafts and the guided bone regeneration technique with collagen membranes: a clinical study with 42 patients. Clin Oral Implants Res. 17:359–66. DOI: 10.1111/j.1600-0501.2005.01234.x. PMID: 16907765.
Article
25. Hellem S, Astrand P, Stenström B, Engquist B, Bengtsson M, Dahlgren S. 2003; Implant treatment in combination with lateral augmentation of the alveolar process: a 3-year prospective study. Clin Implant Dent Relat Res. 5:233–40. DOI: 10.1111/j.1708-8208.2003.tb00206.x. PMID: 15127994.
Article
26. Schmid J, Hämmerle CH, Stich H, Lang NP. 1991; Supraplant, a novel implant system based on the principle of guided bone generation. A preliminary study in the rabbit. Clin Oral Implants Res. 2:199–202. DOI: 10.1034/j.1600-0501.1991.020407.x. PMID: 8597623.
27. Roos-Jansåker AM, Franke-Stenport V, Renvert S, Albrektsson T, Claffey N. 2002; Dog model for study of supracrestal bone apposition around partially inserted implants. Clin Oral Implants Res. 13:455–9. DOI: 10.1034/j.1600-0501.2002.130502.x. PMID: 12453120.
Article
28. Stenport VF, Roos-Jansåker AM, Renvert S, Kuboki Y, Irwin C, Albrektsson T, et al. 2003; Failure to induce supracrestal bone growth between and around partially inserted titanium implants using bone morphogenetic protein (BMP): an experimental study in dogs. Clin Oral Implants Res. 14:219–25. DOI: 10.1034/j.1600-0501.2003.00861.x. PMID: 12656883.
Article
29. Simion M, Dahlin C, Rocchietta I, Stavropoulos A, Sanchez R, Karring T. 2007; Vertical ridge augmentation with guided bone regeneration in association with dental implants: an experimental study in dogs. Clin Oral Implants Res. 18:86–94. DOI: 10.1111/j.1600-0501.2006.01291.x. PMID: 17224028.
Article
30. Kloss FR, Offermanns V, Kloss-Brandstätter A. 2018; CEComparison of allogeneic and autogenous bone grafts for augmentation of alveolar ridge defects-A 12-month retrospective radiographic evaluation. Clin Oral Implants Res. 29:1163–75. DOI: 10.1111/clr.13380. PMID: 30303581. PMCID: PMC6282851.
31. Urban I, Traxler H, Romero-Bustillos M, Farkasdi S, Bartee B, Baksa G, et al. 2018; Effectiveness of two different lingual flap advancing techniques for vertical bone augmentation in the posterior mandible: a comparative, split-mouth cadaver study. Int J Periodontics Restorative Dent. 38:35–40. DOI: 10.11607/prd.3227. PMID: 29240202.
Article
32. Shet UK, Cho MS, Hur JW, Oh CJ, Chung K, Park HJ, et al. 2012; Evaluation of augmented alveolar bone and dental implant after autogenous onlay block bone graft. J Korean Dent Assoc. 50:329–38.
33. Oh JK, Choi BJ, Lee BS. 2009; The histologic study of bone healing after horizontal ridge augmentation using auto block bone graft. J Korean Assoc Maxillofac Plast Reconstr Surg. 31:207–15.
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