Techniques on vertical ridge augmentation: Indications and effectiveness.

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

Is alveolar ridge preservation an overtreatment?

The morphology and dimensions of the postextraction alveolar ridge are important for the surgical and restorative phases of implant treatment. Adequate new bone formation and preservation of alveolar ridge dimensions following extraction will facilitate installation of the implant in a restorative position, while preservation of soft tissue contour and volume is essential for an aesthetic and implant-supported restoration with healthy peri-implant tissues. Alveolar ridge preservation (ARP) refers to any procedure that aims to: (i) limit dimensional changes in the alveolar ridge after extraction facilitating implant placement without additional extensive bone and soft tissue augmentation procedures (ii) promote new bone formation in the healing alveolus, and (iii) promote soft tissue healing at the entrance of the alveolus and preserve the alveolar ridge contour. Although ARP is a clinically validated and safe approach, in certain clinical scenarios, the additional clinical benefit of ARP over unassisted socket healing has been debated and it appears that for some clinicians may represent an overtreatment. The aim of this critical review was to discuss the evidence pertaining to the four key objectives of ARP and to determine where ARP can lead to favorable outcomes when compared to unassisted socket healing

A Textbook of Advanced Oral and Maxillofacial Surgery

The scope of OMF surgery has expanded; encompassing treatment of diseases, disorders, defects and injuries of the head, face, jaws and oral cavity. This internationally-recognized specialty is evolving with advancements in technology and instrumentation. Specialists of this discipline treat patients with impacted teeth, facial pain, misaligned jaws, facial trauma, oral cancer, cysts and tumors; they also perform facial cosmetic surgery and place dental implants. The contents of this volume essentially complements the volume 1; with chapters that cover both basic and advanced concepts on complex topics in oral and maxillofacial surgery

Clinical and Computerized Tomographic Evaluation of Lateral Ridge Augmentation using Corticocancellous Block Autograft Harvested from the Symphysis Region: A 6 Month Study

BACKGROUND: The present study was to evaluate the clinical and spiral computer tomographic outcome of Misch & Judy Division B Ridge defects following reconstructive surgery with the use of corticocancellous block autograft harvested from the symphysis region and were followed for 6 months interval. MATERIALS & METHOD: Nine patients selected from the Outpatient Department of Periodontics, Ragas Dental College & Hospital, Chennai, were included in this clinical trial for horizontal ridge augmentation using corticocancellous block autograft obtained from the symphysis region. These patients exhibited with Misch & Judy Division B ridge defect, with missing single tooth in the maxillary and mandibular region. All these patients were assessed clinically and with spiral Computer Tomography at baseline and 6 months. The clinical parameters assessed were mean width of keratinized gingiva, mean changes in the horizontal ridge dimension using spiral computer tomography and mean changes in the vertical bone height at the edentulous site using radiographs were done at baseline and 6 months. Statistical analysis was done using paired T test. RESULTS: At the end of 6 month period there was no significant difference in the mean width of keratinized gingiva at the augmented sites. Spiral Computer Tomographic analysis at the augmented sites exhibited an average increase of 1.6 mm at the crest level, 2.9mm at 2mm level from the crest and 2.8mm at 4mm from the crest level 6 months post operatively. In terms of radiographs at the vertical bone changes at the augmented sites most of the sites exhibited loss of crestal bone at 6 months with a change of 2.5mm. CONCLUSION: The present clinical study clearly demonstrates the use of corticocancellous autogenous block graft in horizontal ridge augmentation of Misch & Judy Division B ridge defects as a predictable treatment modality

RIDGE PRESERVATION FOLLOWING TOOTH EXTRACTION

Tooth extraction initiates a complex bone modelling and remodelling process, leading to undesirable vertical and horizontal topographic changes. Alveolar Ridge Preservation (ARP) techniques have been developed, to promote physiological healing at the alveolus, reducing the bone and soft-tissue dimensional change, enabling future implant placement. Unfortunately, the outcomes associated with ARP procedures are inconclusive. The PhD was designed to compare linear and cross-sectional alveolar ridge dimensions, mucosal characteristic, composition of new bone and implant outcomes measures, following ARP. Unassisted socket healing acted as the Control. The study used two systematic reviews, to answer the questions: Does ARP following tooth extraction improve implant treatment, and what are the hard and soft tissue changes following ARP at 4-months healing. The reviews indicated ARP did not affect implant success or survival in an augmented socket. Limited evidence was present, to support the benefits of ARP in reducing the requirement for bone augmentation at implant placement. ARP was associated with preservation of the alveolar ridge height and a variable reduction in alveolar ridge width. Evidence did not identify the superiority of a particular ARP technique, when evaluating bone and soft tissue dimensional changes, gingival tissue characteristics, bone healing and patient outcome measures. These observations led to the development of a single blinded, randomised controlled trial, that compared Guided Bone Regeneration (GBR) and Socket Seal (SS) ARP technique, with the Control. The results indicated that GBR ARP, was effective at preserving the coronal buccal socket contour, reducing the vertical, horizontal and socket-area bone dimensions, whilst stabilising soft-tissue contours and mucosal topography. SS offered an advantage in vertical contour preservation. ARP techniques resulted in less new bone formation than the Control, with GBR requiring a reduced need for further augmentation at implant placement (ANOVA-Tukey/p<0.05). The use of an ARP technique did not affect implant success and survival

Prospective Clinical Study with New Materials for Tissue Regeneration: A Study in Humans

Objective: This study was performed to evaluate the clinical, radiographic, and histomorphometric outcomes of novel bone grafting materials and dental membranes and to compare the results with current data from literature. Materials and Methods: New synthetic bone substitutes, consisting of biphasic calcium phosphate, in the ratio of 60% hydroxyapatite and 40% β-tricalcium phosphate, were applied in bony defects and covered by either a novel synthetic poly(lactic-co-glycolic) acid (PLGA) or porcine collagen membrane. A sample of 51 biomaterials was placed in a total of 20 patients during different surgical protocols. Implants were simultaneously inserted, and in case of sinus floor elevations 6 months later. Pre- and postoperative cone-beam computed tomographies were taken. Bone biopsies were harvested from augmented sides and processed for histomorphometric evaluation. Statistical Analysis: Averages and ranges were calculated for the percentage of newly formed bone, residual biomaterial, and connective tissue. Data were submitted to analyze the radiological mean differences in length, width, and density. Paired t-tests were deployed for the analysis of differences within each group between the baseline (preoperative) and the final (postoperative) measurements. Results: The mean bone gain in length and width were 0.96 ± 3.33 mm (+27.59%) and 1.22 ± 1.87 mm (+30.48%), respectively. The bone density was increased by a factor of 4, reaching an average of 387.47 ± 328.86 HU. Histomorphometric evaluations revealed new bone formation of 41.44 ± 5.37%, residual biomaterial of 24.91 ± 7.32%, and connective tissue of 33.64 ± 4.81%. The mean healing period was 8.32 ± 3.00 months. Conclusions: Data from this study confirmed the suitability of the tested materials in dental surgery. The biomaterials may be recommended for various clinical procedures. A satisfactory level of increase of new bone was reported in augmented sides. No significant differences were observed between the tested membranes. PLGA might be superior to other membranes for their easier handling.Odontologí