[Alveolar ridge augmentation. Augmentative alveolar ridge surgery using hydroxyapatite].
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Alveolar Ridge Augmentation↗
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Clinical evaluation of freeze-dried block allografts for alveolar ridge augmentation: a case series.
Various grafting materials have been used in guided bone regeneration procedures to augment alveolar ridges deficient in horizontal or vertical dimensions or both. Autogenous block grafts from intraoral and extraoral sites have been used for ridge augmentation with encouraging results. However, the risk of vascular and neurologic injury at the donor site as well as postoperative patient morbidity have been reported following these surgical procedures. The use of a cancellous block allograft could be one alternative to avoid potential donor site complications. Five deficient alveolar ridges in three patients were each grafted with a freeze-dried cancellous block allograft and a resorbable barrier membrane. Ridge measurements taken at baseline, graft placement, and a 6-month reentry surgery demonstrated an increase in alveolar ridge width from 2 to 4 mm. These gains in ridge width compare favorably with other guided bone regeneration studies, suggesting that a freeze-dried cancellous block allograft in conjunction with a resorbable membrane may be an acceptable alternative to the autogenous block graft in the treatment of compromised alveolar ridge deficiencies.
Absorbable Implants↗
Initial experiences using a new implant based distraction system for alveolar ridge augmentation.
With this case report we demonstrate a new technique useful in augmenting alveolar ridges after resection procedures or atrophic loss of volume. The augmentation is done by means of a new osteogenic distractor (manufactured by ACE Surgical Supply Co., Inc., Brockton, MA, USA), the distraction procedure is according to Ilizarov's principles.
Alveolar Ridge Augmentation↗
Vertical alveolar ridge augmentation prior to inferior alveolar nerve repositioning: a patient report.
This report describes treatment of a patient using vertical alveolar ridge augmentation performed prior to transposition of the inferior alveolar nerve (IAN). A preoperative computerized tomographic (CT) scan revealed 2 to 3 mm of bone above the canal in the left mandibular molar region. An autogenous bone graft harvested from the chin area was utilized along with a titanium mesh for vertical alveolar ridge augmentation in this area. CT scan after bone grafting revealed 5 mm of vertical ridge augmentation. Bone height above the IAN was 7 to 8 mm after bone grafting procedure. For IAN transposition, an osteotomy was performed to obtain a lateral access window located 4 mm below the crestal bone along the lateral side of the mandible. Two cylindric hydroxyapatite-coated implants were placed. Autogenous bone from the lateral access window that had been removed en bloc was particulated and placed around the implants. Because vertical alveolar ridge augmentation had been performed, the coronal portion of the implant was not exposed after transposition of the IAN. It is suggested that vertical ridge augmentation may be considered prior to transposition of the IAN in situations where minimal bone height exists above the IAN canal. However, long-term clinical investigations are recommended.
Alveolar Ridge Augmentation↗
[Bone mineral density and biomechanical characters of the augmented alveolar ridge by distraction osteogenesis using Ti-Ni shape memory alloy distractor].
OBJECTIVE: To evaluate the quality of the alveolar ridge augmented by Ti-Ni shape memory alloy (Ti-Ni SMA) distractor. METHODS: All of the mandibular premolars and the first molars were extracted from 12 adult mongrel canines. One month later, box-shaped osteotomy was carried out in the left mandibles and Ti-Ni SMA distractors were imbedded. The right sides served as blank control. The canines were killed 3 or 6 months later and specimens were taken from corresponding area of the experiment sides and the control. Bone mineral density and biomechanical function were measured. RESULTS: Bone mineral density, ultimate compressive strength and Young's Modules of the augmented ridge were lower than the blank control three months after distraction. But the indexes increased and showed no significant difference with the control six months after distraction. CONCLUSIONS: The canines mandibular posterior alveolar ridge could be augmented by distraction osteogenesis using Ti-Ni SMA distractor, and the new bone is strong enough for implant placement.
Alveolar Ridge Augmentation↗
Distraction implants: a new operative technique for alveolar ridge augmentation.
In the past alveolar ridge augmentation was mainly based on autologous or allogenic bone transplants. Since 1996 alveolar ridge distraction has enabled local osseous build-up without bone transplantation. The 'distraction implant', uniting qualities of a distraction apparatus with those of a dental implant, has been in use for three years at the Department of Oral and Maxillofacial Surgery of Graz University. Its application in patients with alveolar ridge atrophy and other defects is demonstrated and the first results are presented in this study. Three patients with severe alveolar ridge atrophy of the edentulous mandible, three with extensive alveolar ridge defects and three with local alveolar defects following traumatic loss of a single tooth were treated with distraction implants. Segmental osteotomy was carried out in all patients and one or two distraction implants were positioned. Following this alveolar ridge distraction was carried out. In seven cases there were no complications, whereas in one patient distraction was discontinued, and altogether two distraction implants had to be removed. All complications were treated by conventional operative techniques. Fifteen of 17 distraction implants were loaded successfully. Alveolar ridge distraction by means of distraction implants is an adequate method of alveolar ridge augmentation resulting in improved implant sites and gingival conditions. The segment for distraction should not be smaller than an upper central incisor. The implants can be used for prosthetic treatment, but long-term results are still not finalised.
Adult↗
[Vertical alveolar ridge augmentation using distraction osteogenesis].
Alveolar ridge atrophy can be acquired or congenital. Alveolar ridge augmentation can be performed using bone grafting but a donor site morbidity is unavoidable and some resorption of the grafted bone occurs. Distraction osteogenesis offers an alternative method for bone reconstruction without donor site morbidity and sufficient stability of the final results. In order to place implants, vertical alveolar augmentation using Distraction Osteogenesis has been applied to 14 patients aged 17 to 55 years old with edentulous alveolar ridge, 8 in the mandible and 6 in the maxilla. Vertical alveolar bone distraction was started by performing a segmental alveolar osteotomy followed by insertion of a central distraction device--Lead System (Endosseous alveolar distraction system, Leibinger). After three days of latency period, the distraction was started in a rate of 0.8 mm per day for 9 to 16 days as needed. The retention period for the new bone maturation was twice as long as the active distraction period. After removal of the device, 23 cylindrical threaded implants were inserted. The results revealed increase of the alveolar bone height with new bone formation that was observed radiographically and clinically at the removal of the distraction device. The amount of elevation was 7-13 mm. In follow-up of 6-14 months, failure of only one implant was noted, due to inadequate transported bone stability. The advantages of alveolar bone distraction are: Increase of the alveolar bone height with new bone formation, minimal resorption of bone without the bone graft disadvantages. A long term follow up after the bone height achieved and implant anchorage should be performed in the future.
Adolescent↗
Alveolar ridge augmentation with rhBMP-2 and bone-to-implant contact in induced bone.
The objective of this study was to examine alveolar ridge augmentation following implantation of recombinant human bone morphogenetic protein (rhBMP-2) with an allogeneic freeze-dried demineralized bone matrix (DBM) mixed with autologous blood. A second objective was to evaluate bone-to-implant contact in induced bone. Bilateral surgically created supraalveolar ridge defects in five young adult beagle dogs were implanted with the rhBMP-2-DBM-blood device. Transmucosal dental implants were placed at weeks 8 and 16 postsurgery The animals were euthanized 24 weeks following ridge augmentation. Healing was uneventful in all animals. Radiographic observations indicated substantial bone formation, including regions of radiolucency, at week 8. At week 16, the radiolucencies were generally resolved, and the trabecular structure of the induced bone resembled that of the adjacent residual bone. There were no remarkable differences in radiographic observations between weeks 16 and 24 after ridge augmentation. Histologic analysis revealed dense woven and lamellar induced bone. Any residual DBM appeared remineralized, at least in part. A large portion of the dental implants (approximately 70%) were housed in induced bone with evidence of limited crestal resorption. There was no significant difference in bone density between induced and residual bone, and the levels of bone-to-implant contact were similar (approximately 55%). The rhBMP-2 construct used in this study has a potential to augment alveolar ridge defects. Also, no difference in levels of osseointegration may be expected in induced and residual bone following a two-stage procedure of rhBMP-2-induced ridge augmentation and dental implant placement.
Alveolar Process↗
Use of titanium mesh for staged localized alveolar ridge augmentation: clinical and histologic-histomorphometric evaluation.
The use of titanium mesh for localized alveolar ridge augmentation was evaluated by clinical, radiographic, laboratory, and histologic-histomorphometric evaluation. Seventeen patients participated in this study. All patients required localized alveolar ridge augmentation before placement of dental implants. An equal mixture of autogenous bone graft and inorganic bovine mineral (Bio-Oss) was used as a bone graft material. Autogenous bone graft was harvested intraorally. Titanium mesh was submerged for 8.47 months (SD 2.83). Impressions were taken intraorally before bone grafting, 6 months after bone grafting, and 6 months after implant placement. Impressions were used to measure the volume of alveolar ridge augmentation and provide linear laboratory measurements regarding the results of bone augmentation. Bone quality (type II-IV) was recorded during implant surgery. Standardized linear tomographs were taken before bone grafting and before implant placement. A biopsy was harvested with a trephine bur from the grafted area during implant surgery for histologic-histomorphometric evaluation. In all cases the grafted area had adequate bone volume and consistency for placement of dental implants. Early mesh exposure (2 weeks) was observed in 2 patients, and late exposure (>3 months) was observed in 4 patients. Volumetric laboratory measurements indicated 0.86 cc (SD 0.69) alveolar augmentation 1 month after bone grafting, 0.73 cc (SD 0.60) 6 months after bone grafting, and 0.71 cc (SD 0.57) 6 months after implant placement. This indicated 15.11% resorption 6 months after bone grafting, and no further resorption occurred after implant placement. Linear laboratory measurements indicated vertical augmentation of 2.94 mm (SD 0.86) 1 month after bone grafting, 2.59 mm (SD 0.91) 6 months after bone grafting, and 2.65 mm (SD 1.14) 6 months after implant placement. The corresponding measurements for labial-buccal augmentation were 4.47 mm (SD 1.55), 3.88 mm (SD 1.43), and 3.82 mm (SD 1.47). Radiographic evaluation indicated 2.56 mm (SD 1.32) vertical augmentation and 3.75 mm (SD 1.33) labial-buccal augmentation. Histomorphometric evaluation indicated 36.47% (SD 10.05) new bone formation, 49.18% (SD 6.92) connective tissue, and 14.35% (SD 5.85) residual Bio-Oss particles; 44.65% (SD 22.58) of the Bio-Oss surface was in tight contact with newly formed bone. The use of titanium mesh for localized alveolar ridge augmentation with a mixture of autogenous intraorally harvested bone graft and Bio-Oss offered adequate bone volume for placement of dental implants. Intraorally harvested autogenous bone graft mixed with Bio-Oss under a titanium mesh offered 36.47% new bone formation, and 15.11% resorption occurred 6 months after bone grafting.
Adolescent↗
[Indication, methods and results in absolute mandibular alveolar ridge augmentation].
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Alveolar Ridge Augmentation↗
[Alveolar ridge augmentation with nonresorbable hydroxylapatite].
A two year prospective evaluation of the use of nonresorbable, hydroxylapatite to augment deficient alveolar ridges was performed. Implants were delivered subperosteally, usually using local or general anesthesia. The resultant stable, soft tissue base and improved ridge height and contour have contributed to a comfortable, retentive, stable denture for these patients.
Alveolar Bone Loss↗
Alveolar ridge augmentation using nonresorbable hydroxylapatite with or without autogenous cancellous bone.
A four-year prospective evaluation of the use of nonresorbable, particulate hydroxylapatite (HA) to augment deficient alveolar ridges was performed. The material was used alone and in combination with finely crushed autogenous cancellous bone. Implants were delivered subperiosteally by syringe injection, usually using local anesthesia for Class I to Class III ridges and general anesthesia for Class III and Class IV ridges. The improved ridge height and width were stable. Postoperative resorption with significant loss of ridge height, frequently seen with rib and iliac crest onlayed grafts, was not observed with HA augmentation. Permanent denture construction began as early as three weeks postoperatively and by four to six weeks if HA was combined with autogenous cancellous bone. It was possible to place mandibular staple implants simultaneously or following HA augmentation. Visor osteotomy techniques were improved by use of HA to produce a wider, more convex stable ridge. Although skin, mucosa, or dermal vestibuloplasties were performed as early as three months postoperatively in a small number of patients, there appeared to be a lesser need for vestibuloplasty after HA augmentation than after onlay bone grafting. In addition, prosthodontists performed fewer denture relines after HA augmentation than after onlay bone grafts. The authors believe the most significant factor accounting for these observations is the firm, nonmobile mucosal base resulting from augmentation with HA. The resultant stable, soft tissue base and improved ridge height and contour have contributed to a comfortable, retentive, stable denture for these patients. The prosthetic and surgical procedures are easier to perform and have produced superior, more permanent results than onlay bone grafts and alloplasts. Preliminary studies also point to exciting possibilities for use of HA as a bone substitute/marrow extender in maxillary and mandibular defects, cysts, and clefts and in osteotomies for orthognathic surgery.
Adult↗
Localized alveolar ridge augmentation before orthodontic treatment. A case report.
Extraction spaces are usually characterized by narrow, atrophic alveolar ridges, which make it difficult to move teeth orthodontically within these areas. Guided tissue regeneration is often used for alveolar ridge augmentation in implantology. In the case presented, localized alveolar ridge augmentation was performed as a preliminary procedure before orthodontic closure of an edentulous space. Guided tissue regeneration enhances the possibilities of orthodontic treatment in adult patients.
Adult↗
The use of resorbable collagen membrane in conjunction with autogenous bone graft and inorganic bovine mineral for buccal/labial alveolar ridge augmentation: a pilot study.
STATEMENT OF PROBLEM: No study provides human histologic evidence regarding the use of resorbable collagen membrane for a 2-stage localized alveolar augmentation procedure. PURPOSE: The purpose of this pilot study was to evaluate the potential of use of a resorbable collagen membrane in conjunction with an autogenous bone graft and inorganic bovine mineral (IBM) for labial/buccal alveolar ridge augmentation prior to placing dental implants. Material and methods Seven consecutively treated human patients participated in the study. All patients received labial/buccal alveolar ridge augmentation. An autogenous block graft was secured at the recipient site with fixation screws and a mixture of autogenous particulate with IBM was placed at the periphery. Resorbable collagen membrane was used as a barrier. Radiographic and laboratory measurements were made to quantify ridge augmentation and resorption rate. Preoperative and postoperative stone casts were used to quantify alveolar ridge augmentation. Volumetric evaluation was measured in mL whereas linear laboratory evaluation was measured in millimeters. Measurements were made 1 and 6 months after bone grafting. Histologic and histomorphometric analysis from the grafted area evaluated new bone formation, and osteoconductivity of IBM. RESULTS: For all patients Type II to III bone quality was achieved at the augmented sites. The implant survival rate was 100% at second-stage surgery. No complication was observed at the recipient sites. Radiographic evaluation revealed 4.65 mm labial/lingual augmentation, whereas laboratory analysis revealed 4.57 mm. Volumetric laboratory analysis demonstrated 1.00 (+/- 0.29) mL alveolar ridge augmentation 6 months after bone grafting and 13.79% resorption between months 1 and 6. Histomorphometric analysis revealed that on average, the area occupied by bone was 34.28% (range 24 to 50; +/-9.05),] soft tissue 46.00% (+/-9.20%; range 30% to 55%), and IBM particles 19.71% (+/-11.74%, range 3% to 42%). The proportion of the surface of the IBM particles in contact with bone was 47.14% (range 15% to 64%; SD 17.21%). CONCLUSIONS: Resorbable collagen membranes may be used as barriers for labial/buccal alveolar ridge augmentation procedures.
Absorbable Implants↗
Hydroxyapatite for alveolar ridge augmentation: indications and problems.
The increased use of hydroxyapatite for augmentation of residual alveolar ridges has created some problems in the subsequent fabrication of complete denture prostheses. Although hydroxyapatite appears to be an effective substitute for resorbed alveolar ridges, its use is not indicated for all patients. In addition, the premise that "if a little is good, a lot is better" does not apply. The following conclusions can be drawn. Augmentation should not be considered if vestibular extension will provide acceptable results. Placement of hydroxyapatite should improve the contour and amount of the residual alveolar ridge. Use as little as possible to accomplish the goal. Preprosthetic surgery should permit vertical as well as horizontal extension of the denture. Augmentation should not result in the need to use lining mucosa to support a complete denture. Vestibular extensions are indicated for most augmented alveolar ridges. The relative strength of the strong arch should not be increased in prognathic or retrognathic ridge relationships. Preprosthetic surgery should be a combined surgical-prosthodontic treatment endeavor. If a foundation is created that cannot be used effectively for the support, retention, and stability of an intended prosthesis, little benefit is provided for the patient. Small variations in intended treatment can significantly increase success of the prosthesis (Fig. 13). Unfortunately, the relative ease of hydroxyapatite placement has led to its use in patients who do not require augmentation and augmentation in amounts and regions that are not conducive to improving denture success. A coordinated effort between the surgeon and the prosthodontist will usually result in treatment that provides the best potential foundation for a specific patient.
Alveolar Ridge Augmentation↗
Experimental alveolar ridge augmentation by distraction osteogenesis using a simple device that permits secondary implant placement.
The purpose of this study was to develop an improved technique of alveolar ridge augmentation by distraction osteogenesis using distraction screws, and to investigate tissue reactions to titanium implants at the distraction site. The left mandibular premolars were extracted from 6 adult dogs. After 12 weeks, a box-shaped osteotomy of the alveolar bone was carried out, and distraction devices were placed on the transport and base segments. After a 7-day latency period, the alveolar bone was augmented by 7 mm vertically at a rate of 1.0 mm/day. Just after distraction, these devices were replaced with dental implants for fixation of the transport segment and bone formation of the distraction site. Histologic and radiographic evaluations were made at 8 and 12 weeks after distraction. Vertical augmentation averaged 6.1 mm after 12 weeks of consolidation. It was possible to lengthen the alveolar bone without great difficulty, and good bone formation was recognized in the distraction site. Greater integration between the implant and the distracted bone was observed at 12 weeks after distraction than at 8 weeks. Distraction osteogenesis was successfully applied to alveolar ridge augmentation by this improved technique, and the implants osseointegrated in the augmented ridge.
Alveolar Ridge Augmentation↗
The science of alveolar ridge augmentation.
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Alveolar Process↗
Evaluation of a hydroxylapatite (HA)/resorbable suture implant for alveolar ridge augmentation.
A new type of hydroxylapatite (HA) particle configuration and implant system for alveolar ridge augmentation was investigated. The PermaRidge implant system was designed to provide better HA particle handling and retention characteristics. Torous-shaped particles were bound together with resorbable sutures into rope-like bundles. The implants were placed as a single unit rather than as individual particles delivered via syringe. Six adult beagle dogs underwent bilateral mandibular tooth extraction. After an eight-week healing period, the animals had PermaRidge implants placed on the right side and HA particles alone placed on the left side. Two animals were killed at each of four, eight, and 16 weeks post-operatively. Radiographically, the PermaRidge implants maintained initial augmentation height throughout the course of the study. There was no compaction of the implant or problems with containment and migration of the HA particles. The HA particles alone demonstrated an approximate 25% decrease in augmentation height with time in situ. The majority of augmentation height was lost within the first four weeks post-operatively. There was also significant particle compaction and migration present in the implant sites. Histologically, the PermaRidge implants demonstrated bone growth into the augmentation, often extending 2-3 particle diameters (2-3 mm). The remainder of the implant was filled with dense connective tissue. There was intimate contact of the ingrown bone with the HA surface. The HA particles alone demonstrated minimal bone ingrowth, with extensive fibrous tissue infiltration. The results indicate that the PermaRidge implant system may provide a viable alternative to HA particles alone for the augmentation of the deficient alveolar ridge.
Alveolar Ridge Augmentation↗