Vertical Alveolar Ridge Augmentation in Implant Dentistry E-Book
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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Vertical Augmentation of the Alveolar Ridge in Implant Dentistry: A Surgical Manual presents the main methods of vertical ridge augmentation in a clinically focused surgical manual. After an introductory section to the alveolar ridge and requirements for dental implants, sections are devoted to each procedure: guided bone regeneration, sinus lift, distraction osteogenesis, block grafting, and free bone flaps. * Chapters written by international experts in each augmentation procedure * Step-by-step instruction for each technique * More than 1,100 clinical photographs and illustrations
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Seitenzahl: 918
Veröffentlichungsjahr: 2016
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CONTENTS
Cover
Title Page
Copyright
Dedication
Contributors
Preface
Acknowledgments
Introduction
Section I: Introduction
Chapter 1: Introduction and Bone Augmentation Classification
I. Particulate Bone Grafting
II. Block Bone Grafting
III. Alveolar Distraction Osteogenesis
IV. Free Distant Bone Flap Transfer with Microvascular Anastomosis
References
Chapter 2: Applied Surgical Anatomy of the Jaws
Anatomy of the mandible
Anatomy of the Maxilla
Growth of the Alveolar Process
Conclusion
References
Chapter 3: Prosthetic Comprehensive Oral Evaluation in Implant Dentistry: Team Approach
History and the Team Approach
Vertical Space Requirements
The Edentulous Patient
Treatment Options For the Edentulous Mandible
Treatment Options For the Edentulous Maxilla
The Partially Edentulous Patient
Biologic Width and Soft Tissue Esthetics
The Single Implant Supported Crown
Multiple Implant Supported Crowns
Conclusion
Acknowledgments
References
Chapter 4: Orthodontic Therapy in Implant Dentistry: Orthodontic Implant Site Development
Introduction
Orthodontic Implant Site Development
Orthodontic Extrusion
Tooth Preservation and Delayed Orthodontic Space Opening
The Orthodontic Implant Site Switching
Orthodontic Retention
Summary
Acknowledgments
References
Chapter 5: Radiographic Evaluation of the Alveolar Ridge in Implant Dentistry. Cone Beam Computed Tomography
Introduction
Conventional Radiography
Principles of Cone Beam Computed Tomography
CBCT Technical Parameters
Diagnostic Imaging Objectives for Implant Treatment Planning
Radiation Risks From CBCT Examinations
Guidelines and Position Statements on CBCT Use in Diagnosis and Treatment Planning of the Dental Implant Patient
References
Chapter 6: Classification of Alveolar Ridge Defects in Implant Dentistry
Introduction
Palacci–Ericsson Classification of the Alveolar Ridge
Discussion
Conclusion
References
Chapter 7: Alveolar Ridge Augmentation: An Algorithmic Approach
Introduction
Patient Selection and Preparation
Types of Defects
Types of Procedures
Future Possibilities
Summary
References
Chapter 8: The Fourth Dimension of 3D Surgical Alveolar Ridge Reconstruction: Bone and Soft Tissue Grafting to Compensate for Dynamic Craniofacial Changes Associated with Aging in Partially Edentulous Patients Influencing Placement Consideration for Osseointegrated Implants
Introduction
Changes Associated with Aging
Implant Treatment Planning to Reduce Adverse Effects of the Aging Face
Summary
References
Section II: Guided Bone Regeneration (GBR) with Particulate Graft for Vertical Alveolar Ridge Defects
Chapter 9: Dental Implant Site Development with Particulate Bone Grafts and Guided Bone Regeneration
Introduction
Regenerative Material Selection
Membranes
Bone Graft Materials
Indications for Particulate Bone Grafts
Particulate Grafts Combined with GBR in Ridge Preservation Prior to Implant Placement
Alveolar Ridge Augmentation
Indications for Particulate Grafts in Conjunction With Implant Placement
Indications for Particulate Grafts After Implant Placement
Management of Complications Associated with Particulate Grafts
References
Chapter 10: Vertical Augmentation of the Alveolar Ridge with Titanium-Reinforced Devices (Protected Bone Regeneration)
Introduction
Titanium Mesh Device
Surgical Procedure
Bone Quality and Quantity of the Augmented Area by Titanium Mesh and Autogenous Particulate Bone Graft
Complications
Indications and Timing of Implant Placement
References
Chapter 11: Pedicled Sandwich Plasty (Osteotomy) with Particulate Inlay Graft for Vertical Alveolar Ridge Defects
Bone Classification and Bone Regeneration Techniques
Distraction Osteogenesis
Vertical Pedicled Sandwich Plasty (PSP)
Horizontal Widening of the Alveolar Crest (Horizontal PSP) (See Also Tolstunov, Book I)
Discussion
References
Chapter 12: Piezoelectric Surgery for Atrophic Mandible: Vertical Ridge Augmentation with Sandwich Osteotomy Technique and Interpositional Allograft
Introduction
Discussion
Conclusion
References
Section III: Subantral Grafting (Sinus Lift) for Vertical Ridge Augmentation in the Posterior Maxilla
Chapter 13: Implant Diagnosis and Treatment Planning for the Posterior Edentulous Maxilla
Introduction
History of the Sinus Lift
Anatomy, Development, Histology, and Physiology of the Maxillary Sinus
Biological Basis of the Sinus Lift
Indications
Contraindications
Diagnosis and Treatment Planning
Lateral Window Technique (Lateral or Direct Sinus Lift)
Crestal Approach (Crestal or Indirect Sinus Lift)
Simultaneous Versus Delayed Implant Placement
Sinus Lift at the Time of Tooth Removal
Post-Operative Care
References
Chapter 14: Crestal Sinus Floor Elevation: Osteotome Technique
Introduction
Crestal Sinus Floor Elevation, Grafting, and Implant Placement Using the Osteotome Technique
History
Indications and Contraindications
Applied Surgical Anatomy
Graft Sources
Crestal (Indirect or Transalveolar) Sinus Floor Elevation with Implant Placement
Trans-Socket Sinus Floor Elevation with Bone Grafting After Extraction
Complications
Conclusion
References
Chapter 15: Flapless Crestal Sinus Augmentation: Hydraulic Technique
Introduction
Surgical Instruments
Technique
Advantages
Grafting Material
Conclusion
References
Chapter 16: Piezoelectric Surgery for Atrophic Maxilla: Minimally Invasive Sinus Lift and Ridge Augmentation, Role of Growth Factors
Introduction
Piezoelectric Inserts for Sinus Augmentation
A. Lateral Sinus Augmentation Using Autologous Concentrated Growth Factors Alone
B. Crestal Sinus Augmentation Using Hydrodynamic Piezoelectric Sinus Augmentation (HPISE) and Autologous Concentrated Growth Factors
References
Chapter 17: Sinus Floor Elevation and Grafting: The Lateral Approach
Indications and Contraindications
Applied Surgical Anatomy
Surgical Technique: Lateral Sinus Floor Elevation and Grafting
Complications
Conclusion
References
Chapter 18: Posterior Maxillary Sandwich Osteotomy Combined with Sinus Floor Grafting for Severe Alveolar Atrophy
Introduction
Technique
Clinical Application
Discussion
References
Chapter 19: Management of Complications of Sinus Lift Procedures
Introduction
Perforation
Sinusitis and Infection
Bleeding
Hematoma
Neurosensory Changes
Oroantral Fistula
Flap Dehiscence and Graft Exposure
Injury to Adjacent Teeth
Implant Loss
Mucocele Formation
Conclusion
References
Section IV: Alveolar Distraction Osteogenesis for Vertical Alveolar Ridge Augmentation
Chapter 20: Distraction Osteogenesis for Implant Site Development: Diagnosis and Treatment Planning
Introduction
Basic Principles of Distraction Osteogenesis
Indications for Alveolar Distraction Surgery for Implant Site Development
Contraindications for Alveolar Distraction Surgery
Diagnosis and Treatment Planning for Alveolar Distraction
Clinical Examination
Regional Anatomic Considerations Specific to Alveolar Distraction
Stereolithic Models
Planning Surgery
Osteotomy Design
Steps of Distraction Osteogenesis Surgery (Also see Figure 20.2)
Planning Implant Placement Into Distracted Alveolar Bone
Conclusions on Planning DO for Dental Implants
References
Chapter 21: Alveolar Distraction Osteogenesis for Vertical Ridge Augmentation: Surgical Principles and Technique
Introduction
Surgical Rationale of Alveolar DO
Biological Rationale of Alveolar DO
Indications and Contraindications
Surgical Principles and Treatment Planning for Lveolar DO
Phases of Alveolar DO
Advantages and Disadvantages of ADO
Alveolar DO Devices
Complications
Conclusions
References
Chapter 22: Management of Maxillary and Mandibular Post-Traumatic Alveolar Bone Defects with Distraction Osteogenesis Technique
Introduction
Different Distraction Devices
Description of the Method of Alveolar Distraction Osteogenesis (ADO)
Latency Period, Rate of Bone Elongation, and Consolidation Period
Controlling the Vector of Distraction
Bone Resorption and Survival of Implants Inserted after Distraction Osteogenesis
The Use of Osteogenic Molecules and Stem Cells
Advantages of distraction osteogenesis [16, 57–59]
Complications and Disadvantages of Alveolar Distraction [25, 27, 41, 60–70]
Conclusion
References
Chapter 23: Management of Complications of Alveolar Distraction Osteogenesis Procedure
Introduction
Pre-Operative Complications
Intraoperative Complications
Post-Operative Complications
Post-Consolidation Complications
Conclusion
References
Section V: Autogenous Block Bone Grafting for Vertical Alveolar Ridge Augmentation
Chapter 24: Vertical Alveolar Ridge Augmentation with Autogenous Block Grafts in Implant Dentistry
Introduction
Recipient Site Classification and Defect Analysis
Description of the Technique: Donor Sites for Block Bone
Discussion
Conclusion
Disclaimer
References
Section VI: Free Bone Flaps and Osseointegrated Implants for Mandibular and Maxillary Alveolar Bone Reconstruction
Chapter 25: Mandibular and Maxillary Alveolar Bone Reconstruction with Free Bone Flaps and Osseointegrated Implants
Introduction
Fibula Free Flap
Free Fibula Osteocutaneous Flap Harvest Technique
Osteotomy and Plating
Osseointegrated Dental Implants
Discussion
Conclusions
References
Section VII: Soft Tissue Grafting for Implant Site Development
Chapter 26: Soft Tissue Grafting for Implant Site Development: Diagnosis and Treatment Planning
Introduction
Indications
Contraindications
Diagnosis and Treatment Planning
Conclusion
References
Chapter 27: Soft Tissue Grafting Techniques in Implant Dentistry
Introduction
Types of Soft Tissue Grafts
Conclusion
References
Chapter 28: Management of Complications Associated with Soft Tissue Grafting in Implant Dentistry
Introduction
Complications
Conclusion
References
Section VIII: Tissue Engineering of the Alveolar Complex
Chapter 29: Alveolar Bone Augmentation via In Situ Tissue Engineering
Introduction
Surgical Approach to Alveolar Ridge Augmentation (Vertical and Horizontal) In Implant Dentistry
A Technique Modification for Defects Requiring Only Horizontal Ridge Augmentation
Conclusion
References
Chapter 30: Bone Marrow Aspirate: Rationale and Aspiration Technique
Introduction
Aspiration Sites
Anterior Iliac Crest Bone Marrow Aspiration
Complications
Application of the Bone Marrow Aspirate
Rationale for the Application of Bone Marrow Aspirate to Graft Sites
Conclusion
References
Chapter 31: Alveolar Complex Regeneration
Tooth Development
Tooth-Bone (Alveolar Complex) Regeneration Approaches
Summary
Acknowledgments
References
Index
End User License Agreement
List of Tables
Table 1.1
Table 4.1
Table 5.1
Table 6.1
Table 8.1
Table 8.2
Table 8.3
Table 10.1
Table 10.2
Table 13.1
Table 22.1
Table 24.1
Table 24.2
Table 24.3
Table 24.4
Table 24.5
Table 26.1
Table 26.2
Table 26.3
Table 26.4
Table 26.5
Table 29.1
Table 30.1
List of Illustrations
Figure 2.1
Figure 2.2
Figure 2.3
Figure 2.4
Figure 2.5
Figure 2.6
Figure 3.1
Figure 3.2
Figure 3.3
Figure 3.4
Figure 3.5
Figure 3.6
Figure 3.7
Figure 3.8
Figure 3.9
Figure 3.10
Figure 3.11
Figure 3.12
Figure 3.13
Figure 3.14
Figure 3.15
Figure 3.16
Figure 4.1
Figure 4.2
Figure 4.3
Figure 4.4
Figure 4.5
Figure 4.6
Figure 5.1
Figure 5.2
Figure 5.3
Figure 5.4
Figure 5.5
Figure 5.6
Figure 5.7
Figure 5.8
Figure 5.9
Figure 5.10
Figure 5.11
Figure 5.12
Figure 5.13
Figure 5.14
Figure 5.15
Figure 5.16
Figure 5.17
Figure 5.18
Figure 5.19
Figure 5.20
Figure 5.21
Figure 5.22
Figure 5.23
Figure 6.1
Figure 6.2
Figure 6.3
Figure 6.4
Figure 6.5
Figure 6.6
Figure 6.7
Figure 6.8
Figure 6.9
Figure 6.10
Figure 6.11
Figure 6.12
Figure 6.13
Figure 6.14
Figure 6.15
Figure 6.16
Figure 6.17
Figure 6.18
Figure 6.19
Figure 6.20
Figure 6.21
Figure 6.22
Figure 6.23
Figure 6.24
Figure 6.25
Figure 6.26
Figure 6.27
Figure 6.28
Figure 6.29
Figure 6.30
Figure 6.31
Figure 6.32
Figure 6.33
Figure 6.34
Figure 6.35
Figure 6.36
Figure 6.37
Figure 6.38
Figure 6.39
Figure 7.1
Figure 7.2
Figure 7.3
Figure 7.4
Figure 7.5
Figure 7.6
Figure 7.7
Figure 7.8
Figure 7.9
Figure 7.10
Figure 7.11
Figure 7.12
Figure 7.13
Figure 7.14
Figure 7.15
Figure 7.16
Figure 8.1
Figure 8.2
Figure 8.3
Figure 8.4
Figure 8.5
Figure 8.6
Figure 8.7
Figure 8.8
Figure 8.9
Figure 8.10
Figure 8.11
Figure 8.12
Figure 8.13
Figure 8.14
Figure 9.1
Figure 9.2
Figure 9.3
Figure 9.4
Figure 9.5
Figure 9.6
Figure 9.7
Figure 9.8
Figure 9.9
Figure 9.10
Figure 9.11
Figure 9.12
Figure 9.13
Figure 9.14
Figure 9.15
Figure 9.16
Figure 9.17
Figure 9.18
Figure 9.19
Figure 9.20
Figure 9.21
Figure 9.22
Figure 9.23
Figure 9.24
Figure 9.25
Figure 9.26
Figure 9.27
Figure 9.28
Figure 10.1
Figure 10.2
Figure 10.3
Figure 10.4
Figure 10.5
Figure 10.6
Figure 10.7
Figure 10.8
Figure 10.9
Figure 10.10
Figure 10.11
Figure 10.12
Figure 10.13
Figure 10.14
Figure 10.15
Figure 10.16
Figure 10.17
Figure 10.18
Figure 10.19
Figure 10.20
Figure 10.21
Figure 10.22
Figure 10.23
Figure 10.24
Figure 10.25
Figure 10.26
Figure 10.27
Figure 10.28
Figure 10.29
Figure 10.30
Figure 10.31
Figure 10.32
Figure 10.33
Figure 10.34
Figure 10.35
Figure 10.36
Figure 10.37
Figure 10.38
Figure 10.39
Figure 10.40
Figure 10.41
Figure 10.42
Figure 10.43
Figure 10.44
Figure 10.45
Figure 10.46
Figure 10.47
Figure 10.48
Figure 10.49
Figure 10.50
Figure 10.51
Figure 10.52
Figure 10.53
Figure 10.54
Figure 10.55
Figure 10.56
Figure 10.57
Figure 10.58
Figure 10.59
Figure 10.60
Figure 10.61
Figure 11.1
Figure 11.2
Figure 11.3
Figure 11.4
Figure 11.5
Figure 11.6
Figure 11.7
Figure 11.8
Figure 11.9
Figure 11.10
Figure 11.11
Figure 11.12
Figure 11.13
Figure 11.14
Figure 11.15
Figure 11.16
Figure 11.17
Figure 11.18
Figure 11.19
Figure 11.20
Figure 11.21
Figure 11.22
Figure 11.23
Figure 11.24
Figure 11.25
Figure 11.26
Figure 11.27
Figure 11.28
Figure 11.29
Figure 11.30
Figure 11.31
Figure 11.32
Figure 12.1
Figure 12.2
Figure 12.3
Figure 12.4
Figure 12.5
Figure 12.6
Figure 12.7
Figure 12.8
Figure 12.9
Figure 12.10
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Figure 12.13
Figure 12.14
Figure 12.15
Figure 12.16
Figure 12.17
Figure 12.18
Figure 12.19
Figure 12.20
Figure 12.21
Figure 12.22
Figure 12.23
Figure 12.24
Figure 12.25
Figure 12.26
Figure 12.27
Figure 12.28
Figure 12.29
Figure 12.30
Figure 12.31
Figure 12.32
Figure 12.33
Figure 12.34
Figure 12.35
Figure 13.1
Figure 13.2
Figure 13.3
Figure 13.4
Figure 13.5
Figure 13.6
Figure 13.7
Figure 13.8
Figure 13.9
Figure 13.10
Figure 13.11
Figure 13.12
Figure 13.13
Figure 13.14
Figure 13.15
Figure 13.16
Figure 13.17
Figure 13.18
Figure 13.19
Figure 13.20
Figure 13.21
Figure 14.1
Figure 14.2
Figure 14.3
Figure 14.4
Figure 14.5
Figure 14.6
Figure 14.7
Figure 14.8
Figure 14.9
Figure 14.10
Figure 14.11
Figure 14.12
Figure 14.13
Figure 14.14
Figure 14.15
Figure 14.16
Figure 14.17
Figure 14.18
Figure 14.19
Figure 15.1
Figure 15.2
Figure 15.3
Figure 15.4
Figure 15.5
Figure 15.6
Figure 15.7
Figure 15.8
Figure 15.9
Figure 15.10
Figure 15.11
Figure 15.12
Figure 15.13
Figure 15.14
Figure 15.15
Figure 15.16
Figure 15.17
Figure 15.18
Figure 15.19
Figure 15.20
Figure 15.21
Figure 16.1
Figure 16.2
Figure 16.3
Figure 16.4
Figure 16.5
Figure 16.6
Figure 16.7
Figure 16.8
Figure 16.9
Figure 16.10
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Figure 16.15
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Figure 16.21
Figure 16.22
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Figure 16.28
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Figure 16.35
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Figure 16.39
Figure 16.40
Figure 16.41
Figure 16.42
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Figure 16.44
Figure 16.45
Figure 16.46
Figure 16.47
Figure 16.57
Figure 16.58
Figure 16.59
Figure 16.60
Figure 16.61
Figure 16.62
Figure 16.63
Figure 16.64
Figure 16.65
Figure 16.66
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Figure 16.68
Figure 16.69
Figure 16.48
Figure 16.49
Figure 16.50
Figure 16.51
Figure 16.52
Figure 16.53
Figure 16.54
Figure 16.55
Figure 16.56
Figure 17.1
Figure 17.2
Figure 17.3
Figure 17.4
Figure 17.5
Figure 17.6
Figure 17.7
Figure 17.8
Figure 17.9
Figure 17.10
Figure 17.11
Figure 17.12
Figure 17.13
Figure 17.14
Figure 17.15
Figure 17.16
Figure 17.17
Figure 18.1
Figure 18.2
Figure 18.3
Figure 18.4
Figure 18.5
Figure 18.6
Figure 18.7
Figure 18.8
Figure 18.9
Figure 18.10
Figure 18.11
Figure 18.12
Figure 19.1
Figure 19.2
Figure 19.3
Figure 19.4
Figure 19.5
Figure 19.6
Figure 19.7
Figure 19.8
Figure 19.9
Figure 19.10
Figure 20.1
Figure 20.2
Figure 20.3
Figure 20.4
Figure 20.5
Figure 20.6
Figure 20.7
Figure 20.8
Figure 20.9
Figure 20.10
Figure 20.11
Figure 20.12
Figure 20.13
Figure 20.14
Figure 20.15
Figure 20.16
Figure 20.17
Figure 20.18
Figure 20.19
Figure 20.20
Figure 20.21
Figure 20.22
Figure 20.23
Figure 20.24
Figure 20.25
Figure 20.26
Figure 20.27
Figure 20.28
Figure 20.29
Figure 20.30
Figure 20.31
Figure 20.32
Figure 20.33
Figure 20.34
Figure 20.35
Figure 20.36
Figure 20.37
Figure 20.38
Figure 20.39
Figure 20.40
Figure 20.41
Figure 20.42
Figure 20.43
Figure 20.44
Figure 20.45
Figure 20.46
Figure 21.1
Figure 21.2
Figure 21.3
Figure 21.4
Figure 22.1
Figure 22.2
Figure 22.3
Figure 22.4
Figure 22.5
Figure 22.6
Figure 22.7
Figure 22.8
Figure 22.9
Figure 23.1
Figure 23.2
Figure 23.3
Figure 23.4
Figure 23.5
Figure 23.6
Figure 23.7
Figure 23.8
Figure 23.9
Figure 23.10
Figure 23.11
Figure 23.12
Figure 23.13
Figure 23.14
Figure 24.1
Figure 24.2
Figure 24.3
Figure 24.4
Figure 24.5
Figure 24.6
Figure 24.7
Figure 24.8
Figure 24.9
Figure 24.10
Figure 24.11
Figure 24.12
Figure 24.13
Figure 24.14
Figure 24.15
Figure 24.16
Figure 24.17
Figure 24.18
Figure 24.19
Figure 24.20
Figure 24.21
Figure 24.22
Figure 24.23
Figure 25.1
Figure 25.2
Figure 25.3
Figure 25.4
Figure 25.5
Figure 25.6
Figure 25.7
Figure 25.8
Figure 25.9
Figure 25.10
Figure 25.11
Figure 25.12
Figure 25.13
Figure 25.14
Figure 25.15
Figure 25.16
Figure 25.17
Figure 26.1
Figure 26.2
Figure 26.3
Figure 26.4
Figure 26.5
Figure 26.6
Figure 26.7
Figure 26.8
Figure 27.1
Figure 27.2
Figure 27.3
Figure 27.4
Figure 27.5
Figure 27.6
Figure 27.7
Figure 27.8
Figure 27.9
Figure 27.10
Figure 27.11
Figure 27.12
Figure 27.13
Figure 27.14
Figure 27.15
Figure 27.16
Figure 27.17
Figure 27.18
Figure 27.19
Figure 27.20
Figure 27.21
Figure 27.22
Figure 27.23
Figure 27.24
Figure 27.25
Figure 27.26
Figure 27.27
Figure 27.28
Figure 27.29
Figure 27.30
Figure 27.31
Figure 27.32
Figure 27.33
Figure 27.34
Figure 27.35
Figure 27.36
Figure 27.37
Figure 27.38
Figure 27.39
Figure 27.40
Figure 27.41
Figure 27.42
Figure 27.43
Figure 27.44
Figure 27.45
Figure 27.46
Figure 27.47
Figure 27.48
Figure 27.49
Figure 27.50
Figure 27.51
Figure 27.52
Figure 27.53
Figure 27.54
Figure 27.55
Figure 27.56
Figure 27.57
Figure 27.58
Figure 27.59
Figure 27.60
Figure 27.61
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Figure 27.63
Figure 27.64
Figure 27.65
Figure 27.66
Figure 27.67
Figure 27.68
Figure 27.69
Figure 27.70
Figure 27.71
Figure 27.72
Figure 27.73
Figure 27.74
Figure 27.75
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Figure 27.77
Figure 27.78
Figure 27.79
Figure 27.80
Figure 27.81
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Figure 27.83
Figure 27.84
Figure 27.85
Figure 27.86
Figure 27.87
Figure 28.1
Figure 28.2
Figure 28.3
Figure 28.4
Figure 28.5
Figure 28.6
Figure 28.7
Figure 28.8
Figure 28.9
Figure 28.10
Figure 28.11
Figure 29.1
Figure 29.2
Figure 29.3
Figure 29.4
Figure 29.5
Figure 29.6
Figure 29.7
Figure 29.8
Figure 29.9
Figure 29.10
Figure 29.11
Figure 29.12
Figure 29.13
Figure 29.14
Figure 29.15
Figure 29.16
Figure 29.17
Figure 29.18
Figure 29.19
Figure 29.20
Figure 29.21
Figure 29.22
Figure 29.23
Figure 29.24
Figure 30.1
Figure 30.2
Figure 30.3
Figure 30.4
Figure 30.5
Figure 30.6
Figure 30.7
Figure 30.8
Figure 30.9
Figure 30.10
Figure 30.11
Figure 30.12
Figure 30.13
Figure 30.14
Figure 30.15
Figure 30.16
Figure 30.17
Figure 30.18
Figure 30.19
Figure 30.20
Figure 30.21
Figure 30.22
Figure 30.23
Figure 30.24
Figure 30.25
Figure 30.26
Figure 30.27
Figure 30.28
Figure 30.29
Figure 30.30
Figure 30.31
Figure 30.32
Figure 30.33
Figure 30.34
Figure 30.35
Figure 30.36
Figure 30.37
Figure 30.38
Figure 30.39
Figure 31.1
Figure 31.2
Figure 31.3
Figure 31.4
Guide
Cover
Table of Contents
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Part 1
Chapter 1
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Vertical Alveolar Ridge Augmentation in Implant Dentistry
A Surgical Manual
Edited by
Len Tolstunov, DDS, DMD
Private Practice, Oral and Maxillofacial Surgery, San Francisco, California, USA
Assistant Clinical Professor, Department of Oral and Maxillofacial Surgery, UCSF and UOP Schools of Dentistry, San Francisco, California, USA
Copyright © 2016 by John Wiley & Sons, Inc. All rights reserved
Published by John Wiley & Sons, Inc., Hoboken, New Jersey
Published simultaneously in Canada
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Library of Congress Cataloging-in-Publication Data
Names: Tolstunov, Len, editor.
Title: Vertical alveolar ridge augmentation in implant dentistry : a surgical
manual / edited by Len Tolstunov.
Description: Ames, Iowa : John Wiley & Sons Inc., 2016. | Includes index.
Identifiers: LCCN 2015036875 | ISBN 9781119082590 (cloth)
Subjects: | MESH: Alveolar Ridge Augmentation—methods. | Bone
Transplantation. | Dental Implantation—methods.
Classification: LCC RK667.I45 | NLM WU 600 | DDC 617.6/93—dc23 LC record available at http://lccn.loc.gov/2015036875
Background cover image: GettyImages-92816396/AbleStock.com
Dedication
This book is dedicated to my wife, Marina, for her sacrifices and unlimited love, and our children, Deana and Antony, who provided the light and drive to make this book possible.
Contributors
Oded Bahat, BDS, MSD
Diplomate
American Board of Periodontology
Beverly Hills, CA, USA
Michael L. Beckley, DDS
Assistant Clinical Professor Department of Oral and Maxillofacial Surgery University of the Pacific, Arthur A. Dugoni School of Dentistry Private Practice, Oral and Maxillofacial Surgery, Livermore, CA, USA
Ali Borzabadi-Farahani, DDS, MScD MOrth RCS(Ed)
Fellowship Craniofacial Orthodontics (CHLA/USC)
Associate Clinical Teacher, Orthodontics
Warwick Dentistry
Warwick Medical School
University of Warwick
Coventry, UK
Locum Consultant Orthodontist NHS England, UK
Visiting Professor
Department of Orthodontics School of Dentistry Shahid Beheshti University of Medical Sciences
Tehran, Iran
Suheil Boutros, DDS, MS
Private Practice
Limited to Periodontics and Implants Surgery
Grand Blanc, MI, USA
Vishtasb Broumand, DMD, MD
Private Practice, Oral and Maxillofacial Surgery
Phoenix, AZ, USA
Adjunct Assistant Clinical Professor
Department of Oral and Maxillofacial Surgery
University of Florida College of Dentistry
Gainesville, FL, USA
Clinical Assistant Professor of Oral Maxillofacial Surgery
A.T. Still University
MD Anderson Cancer Center
Arizona School of Dentistry and Oral Health
Mesa, AZ, USA
Paulo M. Camargo, DDS, MS, MBA
Professor
Tarrson Family Endowed Chair in Periodontics
Associate Dean of Clinical Dental Sciences
UCLA School of Dentistry
Los Angeles, CA, USA
Edward I. Chang, MD
Assistant Professor
Department of Plastic Surgery
The University of Texas MD Anderson Cancer Center
Houston, TX, USA
Byung-Ho Choi, DDS, PhD
Professor
Department of Oral and Maxillofacial Surgery
Yonsei University Wonju College of Medicine Wonju, South Korea
Fereidoun Daftary, DDS, MSD
Clinical Practice, Center for Implant and Esthetic Dentistry Beverly Hills, California, USA
Stephanie J. Drew, DMD
Private Practice The New York Center for Orthognathic and Maxillofacial Surgery West Islip New York, USA
Assistant Clinical Professor Stony Brook University Hospital and Hofstra Medical School New York, USA
Rolf Ewers, MD, DMD, PhD
Chairman
University Hospital for Cranio Maxillofacial and Oral Surgery
Medical University of Vienna
Vienna, Austria
J Marshall Green III, DDS
Lieutenant US Navy
Fellow
Maxillofacial Oncology and Reconstructive Surgery
Division of Oral and Maxillofacial Surgery
University of Miami, Miller School of Medicine
Miami, FL, USA
Matthew M. Hanasono, MD
Professor
Department of Plastic Surgery
The University of Texas MD Anderson Cancer Center
Houston, TX, USA
Alan S Herford, DDS, MD, OMFS
Chair and Professor
Oral and Maxillofacial Surgery Department
Loma Linda University
Loma Linda, CA, USA
Andreas L. Ioannou, DDS
Dental Fellow
Department of Developmental and Surgical Sciences
Division of Periodontology
University of Minnesota
Minneapolis, MN, USA
Fawad Javed, BDS, PhD
Division of General Dentistry
Eastman Institute for Oral Health
University of Rochester
New York, NY, USA
Ole T. Jensen, DDS, MS
Adjunct Professor
School of Dentistry
University of Utah
Salt Lake City, UT, USA
Douglas E. Kendrick, DDS
Department of Oral and Maxillofacial Surgery
The University of Iowa Hospitals and Clinics
Iowa City, IA, USA
Arash Khojasteh, DMD, MS
Associate Professor
Department of Oral and Maxillofacial Surgery
Director
Dental Research Center, Dental School
Shahid Beheshti University of Medical Sciences
Tehran, Iran
George A. Kotsakis, DDS, MS
Assistant Professor
Department of Periodontics
University of Washington
Seattle, WA, USA
Steven J. LoCascio, DDS
Clinical Associate Professor
Department of Oral and Maxillofacial Surgery
University of Tennessee Graduate School of Medicine
Knoxville, TN, USA
Clinical Assistant Professor
Department of Prosthodontics
Louisiana State University Health Sciences Center
School of Dentistry
New Orleans, LA, USA
Full Time Private Practice, Limited to Prosthodontics and Maxillofacial Prosthetics
Knoxville, TN, USA
Ramin Mahallati, DDS
Clinical Practice, Center for Implant and Esthetic Dentistry
Beverly Hills, CA, USA
Sanjay M. Mallya, BDS, MDS, PhD
Associate Professor and Program Director
Section of Oral and Maxillofacial Radiology
UCLA School of Dentistry
Los Angeles, CA, USA
Robert E. Marx, DDS
Professor of Surgery and Chief
Division or Oral and Maxillofacial Surgery
University of Miami Miller School of Medicine
Miami, FL, USA
Nelson Monteiro, PhD
Postdoctoral Fellow
Department of Orthodontics
Division of Craniofacial and Molecular Genetics
Tufts University School of Dental Medicine
Boston, MA, USA
Katina Nguyen, DDS, OMFS
Research Fellow
Oral and Maxillofacial Surgery Department
Loma Linda University
Loma Linda, CA, USA
Patrick Palacci, DDS
Brånemark Osseointegration Center Marseille, France
Visiting Professor
Boston University
Boston, MA, USA
Visiting Professor
Andrés Bello University Santiago de Chile
Chile
Visiting Professor
Maimónides University
Buenos Aires, Argentina
Flavia Q. Pirih, DDS, PhD, MS
Assistant Professor
Section of Periodontics
UCLA School of Dentistry
Los Angeles, CA, USA
Adi Rachmiel, DMD, PhD
Professor
Department of Oral and Maxillofacial Surgery
Rambam Health Care Campus
Haifa, Israel
Bruce Rappaport Faculty of Medicine Technion–Israel
Institute of Technology
Haifa, Israel
Shravan Renapurkar, BDS, DMD
Assistant Professor Department of Oral and Maxillofacial Surgery Virginia Commonwealth University Richmond, VA, USA
Ayleen Rojhani, DDS: OMFS
Senior Resident
Oral and Maxillofacial Surgery Department
Loma Linda University
Loma Linda, CA, USA
Rabie M. Shanti, DMD, MD
Fellow in Head and Neck Oncologic Surgery/Microvascular Reconstructive Surgery
Department of Oral and Maxillofacial/Head and Neck Surgery
Louisiana State University Health Sciences Center
Shreveport, LA, USA
Dekel Shilo, DMD, PhD
Department of Oral and Maxillofacial Surgery
Rambam Health Care Campus
Haifa, Israel
Dennis Smiler, DDS, MScD
Oral and Maxillofacial SurgeonEncino, CA, USA
Dong-Seok Sohn, DDS, PhD
Professor and Chair
Department of Oral and Maxillofacial Surgery
Daegu Catholic University
School of Medicine
Daegu, Korea
Richard Sullivan, DDS
Vice-President
Clinical Technologies
Nobel Biocare North America
Yorba Linda, CA, USA
Tetsu Takahashi, DDS, PhD
Professor and Chairman
Department of Oral and Maxillofacial Surgery
Tohoku University Graduate School of Dentistry
Sendai, Miyagi, Japan
Len Tolstunov, DDS, DMD
Private Practice, Oral and Maxillofacial Surgery
San Francisco, CA, USA
Assistant Clinical Professor
Department of Oral and Maxillofacial Surgery
UCSF and UOP Schools of Dentistry
San Francisco, CA, USA
Maria J. Troulis, DDS, MS
Chief of Service Department of Oral and Maxillofacial Surgery Massachusetts General Hospital, Walter C. Guralnick Professor and Chair of Oral and Maxillofacial Surgery Harvard School of Dental Medicine Boston, MA, USA
Peter S. Wöhrle, DMD, MMedSC
Clinical Practice, Newport Beach, CA, USA
Kensuke Yamauchi, DDS, PhD
Lecturer
Department of Oral and Maxillofacial Surgery
Tohoku University Graduate School of Dentistry
Sendai, Miyagi, Japan
Vice Director
Dental Implant Center, Tohoku University Hospital
Sendai, Japan
Pamela C. Yelick, PhD
Professor
Department of Orthodontics
Director
Division of Craniofacial and Molecular Genetics
Tufts University School of Dental Medicine
Boston, MA, USA
Homayoun H. Zadeh, DDS, PhD
Associate Professor and Director
Division of Periodontology
Laboratory for Immunoregulation and Tissue Engineering
Diagnostic Sciences Dental Hygiene
University of Southern California
Los Angeles, CA, USA
Vincent B. Ziccardi, DDS, MD, FACS
Professor and Chair/Program Director, Assistant Dean of Hospital Affairs
Department of Oral and Maxillofacial Surgery
Rutgers School of Dental Medicine
Newark, NJ, USA
Preface
“Education is not a learning of facts, but training of the mind to think,”
Albert Einstein.
“Anatomy is destiny,”
Sigmund Freud.
Implant Dentistry (Oral Implantology) is a constantly evolving dental and surgical clinical practice and science. There are a variety of books that come out every year on different aspects of this surgical–restorative discipline. Large hardcover textbooks with a name containing at least two words implant and dentistry heavily dominate shelves of medical/dental bookstores of many publishing companies and subsequently homes of many dentists who are happy to dedicate themselves to a lifelong learning. For different reasons, these expensive and authoritative books are often not top sellers. These books often become “shelve-bound”, collecting dust but more importantly providing little practical use in spite of their original intent.
During my professional dental graduate and oral and maxillofacial surgery postgraduate studies in three universities, I have always enjoyed more practical books – clinical manuals. These usually smaller medical, surgical, and dental books in a hard or soft cover were my mobile knowledge friends that I could take with me anywhere and study “on the go” in any setting. Arguably, these friendly manuals are preferred by most medical and dental students, residents, and doctors alike.
A good example of this type of clinically relevant practical book for me has always been Rapid Interpretation of EKG's by Dale Dubin, MD. This is by far one of the most widely read and studied medical books by any medical or dental practitioner who had to learn about electrocardiography (EKG). This outstanding book is now in its successful 6th Edition and has always been a No.1 Best Seller. Why? I believe this is not only because it is a brilliantly written book accompanied by easy to follow photos, graphs, and tables, as well as quizzes and interactive courses, but also because of the book's immense practicality and relevance for any health science student or practitioner or often a lay reader/learner.
The book that you are holding in your hands is an attempt to write this sort of book, a very clinically relevant surgical manual, a practical guide on the WHY and HOW of the alveolar bone augmentation in implant dentistry, a “take to the operative room” book full of clinically oriented chapters that can be easily understood and followed.
In the middle of writing this book, due to an enormous amount of accumulated techniques for the alveolar ridge augmentation, Dr. Ole Jensen (whom I consider my mentor and who wrote an Introduction for this book) suggested that it would be an impossible and confusing task to demonstrate to doctors, residents, and students all these amazing surgical techniques in a single book volume. The size of this book would be enormous and practicality of having something very relevant with you and being able to “carry it around” would be a daunting task. That is how slowly the concept of two volumes (two books, really) evolved where horizontal and vertical ridge augmentation techniques in a style of a surgical manual-atlas full of case reports and illustrative photos are described in separate books.
The first book (Book I) contains multiple surgical techniques intended for mainly width-deficient alveolar ridges and thus the book is, in general, about the horizontal ridge augmentation; the second book, Vertical Alveolar Ridge Augmentation in Implant Dentistry: A Surgical Manual (Book II) contains a variety of surgical procedures designed for height (and volume) deficient alveolar ridges and therefore is about vertical and three-dimensional ridge augmentation. Both books do not claim to be a complete all-inclusive dissertation of all alveolar bone augmentation techniques. That would be impossible and impractical. Many surgical techniques are being proposed almost daily on the pages of peer-review oral surgical, periodontal, implant, and general dental journals and other publications. They are also often modified from the original versions with the discovery of new instrumentation and advances in computer technology. Two books approach was a logical (we thought) attempt to “split” the presented material into horizontal and vertical surgical techniques for the sake of learning.
Our goal with these two intrinsically linked books was to present a variety of commonly used and sometimes less known surgical techniques from a different point of view in a clear and concise manner with photographs and illustrations, and supplemented by case reports. Each book starts with the applied surgical anatomy and embryology of the jaws, move through diagnosis and treatment planning, which includes a team approach with restorative practitioner (prosthetic chapter) and often an orthodontic colleague (orthodontic implant side development chapter), and then move to a variety of hard (and even soft) tissue augmentation techniques. Each book ends with a glance into the future (quickly becoming a present-day reality), like tissue engineering, stem-cell technology, and organ regeneration. All these chapters were written by top-notch surgical specialists (surgeons–researchers–lecturers) from around the globe in the area of their particular expertise.
A reader of any skill or knowledge- a surgical resident or a new dental practitioner, an experienced periodontist or an oral and maxillofacial surgeon- pay a special attention to the following three surgical concepts presented in these books:
Soft tissue versus hard tissue augmentation, or a combined hard–soft tissue augmentation approach that is often needed in the esthetic zone.
Static versus dynamic bone augmentation of the alveolar ridge (block graft versus distraction osteogenesis, or ridge-split versus orthodontic forced eruption, or guided bone regeneration (GBR) versus periosteal expansion osteogenesis).
Two-dimensional versus three-dimensional versus four-dimensional (predicting future bone changes associated with aging) bone augmentation.
As the editor and one of many contributors of these two surgical manuals, I hoped to accomplish the intended goal of these two books - to present a clinically relevant surgical material that would be read and re-read many times during your career and, therefore, would undoubtedly benefit your patients. If this will happen, I will consider myself a happy man.
Len Tolstunov
Acknowledgments
I would like to express my sincere gratitude to all 70 individuals from around the globe (from 10 countries) who became contributors to these two books (65 chapters in total) for their unselfish sharing of their knowledge, expertise, talent, and time. This was a volunteer army of top-notch professionals who sacrificed their own personal time to contribute to these books and thus to dental and medical education. In the process of book writing and production, many of them have become my friends and genuine collaborators whom I admire and look up to.
I especially would like to acknowledge my wife, Marina, who had to occupy her life with new hobbies and interests to fill the gap that her husband created for two full years by not being around all the time and spending numerous hours in the office occupied with this project. Marina is the love of my life and I would be remiss forgetting her sacrifices, which are numerous. My kids, Deana and Antony, were a daily part of my comfort zone that I needed so much in order to express myself clearly, genuinely, and completely on the pages of this book.
I also would like to thank the representatives of John Wiley & Sons for their skillful and patient daily guidance through the uncharted (for me) territory of writing my first professional book. They are Rick Blanchette, Commissioning Editor, Teri Jensen, Editorial Assistant, and Jenny Seward and Catriona Cooper, Senior Project Editors. Patricia Bateson, an academic copyeditor, was instrumental in carrying out a thorough screening of each chapter to make sure it was written in correct English and the content made understandable sense. Shikha Pahuja at the final stage of book production was essential in working with each contributor and the editor to make sure that each and every chapter is ready for the publication. I am very grateful to these Wiley professionals for their exemplary work and meticulous attention to details. Brittany King, our book artist-illustrator, deserves special accolades for her artistry in medical illustrations and patience in dealing with those who need them.
I am also very grateful to my dear staff at our Van Ness Oral and Maxillofacial Surgery Center in San Francisco, who helped me to run my full-time surgical practice simultaneously with full-time book writing without major distress. They are Vilma Mejia, Liliya Kaganovsky, Marina Tolstunov, and Ann Siebert.
Many professional teachers and colleagues have unknowingly contributed to this book through the education they have provided to me. They include teachers and oral surgeons at the Moscow Medical Stomatological Institute in Moscow, Russia, the University of the Pacific in San Francisco, and the University of California San Francisco.
Introduction
In modern implant-driven oral rehabilitation, alveolar bone deficiency is defined by what is necessary for successful dental implant osseointegration. This need for adequate quantity and quality of bone has led to the development of several innovative methods for alveolar ridge augmentation. At the same time, improved implant technology, like computer-guided implant placement methods, have lessened the need for complex augmentation procedures. The practitioner may ask what is needed for a specified treatment without regard to full regeneration of hard tissue. Where once large-scale reconstruction was considered, now minimally invasive surgical procedures are employed. The clinician then may ask what kind of minimally invasive procedures can and should be performed to support a restoratively driven implant treatment plan. This book will attempt to answer this question.
In addition to osseointegration, there are other factors to consider, including regaining alveolar form and associated esthetic gingival contour – effects termed orthoalveolar form. Orthoalveolar form, however, implies that the alveolar process and associated soft tissues are restored to ideal form and function with alveolar arches in functional occlusal relationship, including alveolar width and height and gingival drape essential for osseointegration and subsequent long-term function of dental implants. This means that the alveolus is not only restored to its original form but also often increased in bone mass and quality of soft tissue to accommodate dental implants. It is important to be familiar with a variety of surgical procedures in order to achieve an orthoalveolar form. This book will attempt to demonstrate these techniques.
Practitioners sometimes lose sight of what they need to accomplish. Completion of a surgical grafting procedure may not be needed for the prescribed implant procedure. Final restoratively driven surgical outcome according to a precise implant treatment plan helps to keep the whole dental team on track of what is needed to accomplish in each particular case. The surgeon must visualize where implant elements need to be placed, decide if the bone mass is needed there to support implants, and graft accordingly. This requires preprosthetic planning, which may include the use of surgical guide or navigation. The plan may prescribe staged or simultaneous grafting, even secondary grafting after implant placement. Whatever the plan, surgical efforts should attempt to gain added bone stock within the envelope of function, choosing a surgical method that has a biological basis for success. This book will attempt to illustrate these methods.
The surgical method of grafting is judged by early and late healing events but include the concepts of consolidation, functional remodeling, resistance to resorption, and bioactive capability for osseointegration. An ideal bone graft should therefore be well consolidated, undergo remodeling without significant resorption, and be well vascularized. Bone graft substitutes, like alloplasts, xenografts, and possibly allografts, may not fully integrate with native bone. Various forms of autografts, recombinant biomimetics, and autologous cell-based therapies may have an improved biological basis but require advanced surgical skills and technical support. This book will attempt to describe these therapies.
The quest for ideal bone graft is continuing. New techniques are constantly being introduced to simplify, improve, or expand indications for alveolar reconstruction. Currently, surgical techniques for implant-driven alveolar ridge augmentation can be classified into four broad categories. These would include: (1) guided tissue and bone regeneration (with or without titanium-reinforced devices), (2) block grafting (extraoral and intraoral), (3) ridge-split with formation of osteoperiosteal (pedicled) flaps, and (4) distraction osteogenesis. Alveolar ridge deficiency can also be classified according to defect morphology such as vertical defects, horizontal defects, combination defects, and complete absence of bone. Science and practice of alveolar ridge reconstruction is still a descriptive surgical discipline with numerous variables to consider, not the least of which is the “patient factor” that includes the patient's general medical condition, patient's wishes and desires (wants and needs), and patient's cooperation. This book will attempt to address these factors of importance.
Another factor to consider in any surgery is the healing capacity of the host's recipient site being grafted. In many cases, it can be more important than the type of material used for grafting. If the site is well vascularized and the grafting procedure is done well, complete incorporation of the bone graft may occur. Interestingly, in 1668, the very first bone graft (harvested from a dog) worked so well that it could not be removed when the patient asked for it to be removed for religious reasons at a later date. Failure of a bone graft, often attributed to the material used, probably happens more often due to host site healing deficiency or flawed surgical technique rather than the intrinsic property of the graft material per se.
One factor that has become extremely important is simplification of treatment, that is, economy of surgery, management, and expenditure. This means that the social contract between patient and physician has narrowed to favor minimally invasive procedures, shortened treatment times, simplified surgical management, and affordability. This is why an immediate function implant treatment has become so prevalent, even in the face of simultaneous bone grafting. The difficulty with simplification is proper diagnosis, comprehensive treatment planning, and adequate training. In addition, consensus on bone grafting and decision-making process are often limited to experience-based case report knowledge and lacking level I and II evidence-based controlled studies that are frequently difficult to find.
The purpose of this clinically oriented book in two volumes is to demonstrate the various techniques of implant-driven horizontal (Book I) and three-dimensional/vertical (Book II) alveolar bone augmentation treatment in use today in an easy to follow, step-by-step format. An international and multidisciplinary group of surgical specialists, well known in their own fields, will present various surgical methods that will be illustrated graphically and supplemented by multiple intraoperative photographs. Benefits, risks, alternatives and complications of each technique will be demonstrated and scientific references will be provided, giving a reader a true insight into each surgical technique. This, hopefully, will help a reader to improve the knowledge of a selected technique as well as broaden the scope of surgical modalities that can be successfully employed in his or her practice. If you are a true learner, this book is for you.
Ole T. Jensen
Section IIntroduction
Chapter 1Introduction and Bone Augmentation Classification
Len Tolstunov
Private Practice, Oral and Maxillofacial Surgery, San Francisco, California, USA
Department of Oral and Maxillofacial Surgery, UCSF and UOP Schools of Dentistry, San Francisco, California, USA
Brånemark's discovery of osseointegration arguably became one of the most significant events in dentistry in the twentieth century [1, 2]. It could be stated that this discovery divided dentistry into two periods: pre-implant era or era of symptomatic (symptom-driven) dentistry and an implant era or era of physiologic dentistry. In the first period, restorative dentistry had only two meaningful treatment options for failed teeth or edentulous jaws: removable dentures and fixed bridges. Both removable dentures and fixed bridges relied on support of adjacent teeth and underlying alveolar mucosa with little consideration for bone preservation.
For the last 50 years of the second and modern period of dentistry, restorative (reconstructive) dentistry has been utilizing physiologic treatment by replacing missing or failing teeth with bone-anchored (osseointegrated) endosseous implants that have an ability to maintain the alveolar bone in a similar manner to a natural dentition. A new principle of bone preservation was based on the concept of endosseous bone loading (EBL). Dental implants also removed an unnecessary load from adjacent teeth, thus decreasing and eliminating deteriorating effects of removable and fixed tooth-borne prostheses on natural dentition, strengthening masticatory function, and improving esthetics and patient's comfort.
Initially surgically driven, implant dentistry was concerned mainly with an implant integration of dental implants. It was soon to become clear that in order to properly restore endosseously placed implants, they have to be inserted into the bone in a restoratively driven position, identical or close to where the natural teeth used to be, even if bone was no longer available in the area. Implant dentistry has emerged as a prosthetically driven surgical–restorative discipline.
In the last few decades, it became clear that success of implant dentistry and longevity of dental implants depend on three factors (“implant triangle”). These factors are: (1) a proper restoratively driven placement of implants, (2) the presence of a sufficient amount of bone stock, a foundation for the osseointegration, and (3) the presence of healthy peri-implant soft tissue for proper implant hygiene and maintenance. Missing any one component of the implant triangle tends to eventually result in compromise of implant health or longevity, and can often lead to implant failure.
The presence of bone atrophy or resorption due to tooth loss and trauma (among many other factors) has led to the development of a variety of implant-driven bone augmentation procedures in a single or staged fashion. This two-volume book is about bone augmentation techniques applicable to implant dentistry. A variety of bone augmentation procedures for the deficient (atrophied) alveolar bone has been proposed in the literature [3–5] and are described in these two books. Each method has its indications and contraindications, its proponents and opponents. The following four alveolar ridge reconstruction techniques are frequently used in oral implantology and are described in this book:
Guided bone regeneration (GBR) with particulate bone graft [6, 7].
Onlay (veneer) extraoral (hip, rib, calvarium) [8] and intraoral (chin, ramus, posterior mandible, zygomatic buttress, maxillary tuberosity) [9–11] block bone graft.
Ridge-split/bone graft and sandwich osteotomy [12–14].
Alveolar distraction osteogenesis [15, 16].
To simplify learning of the surgical techniques, the editor (Tolstunov) of this book divided them roughly into two categories: horizontal augmentation and vertical (volumetric) augmentation. Book I inspects horizontal bone augmentation of alveolar ridges with bone width deficiency and Book II scrutinizes vertical bone augmentation of alveolar ridges with bone height loss. Both books do not claim to be a complete all-inclusive dissertation of all alveolar bone augmentation techniques. That would be impossible and impractical. Many surgical techniques are being proposed almost daily on the pages of peer-review oral surgical, periodontal, implant, and general dental journals and other publications. They are also often modified from the original versions with the discovery of new instrumentation and computer technology.
Classifications tend to simplify learning of a certain subject. They often give a reader a “bird's-eye view” of the complex topic. There is a variety of different classifications of alveolar bone augmentation in implant dentistry. Table 1.1 demonstrates the editor's classification. Based on years of teaching, practicing and in the process of writing this book, we offer the classification that can, hopefully, be well understood by students, surgical residents, and doctors, and be conceptually robust from the biologic point of view. Examine Table 1.1 after finishing this chapter.
Table 1.1 Classification of alveolar ridge augmentation procedures through bone grafting in implant dentistry (both vertical and horizontal).
Types
Graft donor site
Type of augmentation
Graft type, flap type, and graft revascularization
Graft consolidation
Augmenting tissues
I. Inlay (interpositional) bone graft:
A. Particulate
1. GBR (three–four-wall tooth socket or bone defect)
None or autogenous (if used)
Static
Free graft
Limited mucoperiosteal flap; endosteal (mainly) revascularization
Woven-to-lamellar; starts with bone formation
Hard tissue
2. Ridge-split or pedicled sandwich osteotomy (two-wall horizontal or vertical bone defect)
Osteomucoperiosteal vascular flap [17–19]; two-to-three surfaces of vascularization: endosteal – from both split bone surfaces plus periosteal (lingual- for vertical, buccal- for horizontal) [20]
3. Sinus lift (subantral augmentation)
No flap (crestal approach) or mucoperiosteal flap (lateral approach); endosteal and periosteal neovascularization (sinus membrane plays a role of periosteum)
4. Tent-pole technique with autogenous cortical block bone
Mucoperiosteal flap; tenting block graft does not get vascularity and tends to resorb
B. Block
Local (intraoral) or distant (extraoral)
No flap; endosteal (mainly) revascularization
Woven-to-lamellar; starts with bone resorption
II. Onlay (juxtaposed) bone graft:
A. Particulate
1. GBR (one–two-wall socket or bone defect) or subperiosteal tunnel
None or autogenous (local or distant)
Static
Free graft
; mucoperiosteal flap; endosteal (mainly) revascularization initially, additional vitality from reattached periosteum comes in 3-4 weeks.
Woven-to-lamellar; starts with bone formation
Hard tissue
2. Tent-pole technique with Ti-mesh, screws or implants [21–23]
Endosteal (mainly) revascularization of the particulate graft
B. Block
Local (intraoral) or distant (extraoral)
Endosteal (mainly) revascularization of the block graft
Woven-to-lamellar; starts with bone resorption
III. Alveolar distraction osteogenesis
None
Dynamic
No graft, mucoperiosteal flap
Endosteal (mainly) and periosteal revascularization (lingual or palatal)
Callus formation, similar to fracture healing,
intramembranous
(mostly) ossification followed by bone remodeling
Hard and soft tissue (simultaneously distracted/expanded)
IV. Free bone flap transfer (with microvascular anastomosis)
Distant
Static
Free bone–soft tissue flap
Microanastomosis between local (recipient) and distant (donor) vascular networks plus endosteal (recipient) revascularization
Callus formation, similar to fracture healing,
endochondral
ossification followed by bone remodeling
Hard and soft tissue (simultaneously transferred)
The editor's recommendation for readers of this two-volume book is to open the book on any chapter that seems clinically relevant at that particular moment and read/learn/study the technique thoroughly. Targeted (selective) reading is common and productive in medical literature. After finishing one chapter, you might want to come back later to the same chapter to re-think its content. Then, move on to another chapter on a different type of (horizontal or vertical) augmentation for comparison, as well as read current literature on this subject. This might help you to eventually select the technique that suits you (feels best in your hands). Always remember the biologic rationale of each procedure when selecting the one to help your particular patient.
For a novice dental surgeon or an experienced dental practitioner while studying surgical methods and techniques, I would suggest paying special attention to the following:
Soft tissue versus hard tissue augmentation: what is needed and what is the priority, especially in the esthetic zone.
Static versus dynamic bone augmentation techniques: block graft versus distraction osteogenesis, ridge-split versus orthodontic forced eruption, etc.
