Vertical bone augmentation
Successful placement of implants requires sufficient alveolar ridge height. Conventional approaches to increase the ridge height include autogenous bone block grafts, inter-positional bone grafts, and titanium-reinforced membranes.
Augmentation with autogenous bone block grafts
Autogenous bone block grafts are the material of choice to compensate for insufficient bone height. Resorption however, can result in functional and esthetic complications. Contouring the autogenous bone block graft with slow resorbing Geistlich Bio-Oss® bone substitute particles and covering the augmented area with a Geistlich Bio-Gide® collagen barrier reduces graft shrinkage. The use of these biomaterials provides long-term volume preservation of the augmented ridge1.
Vertical resorption of the alveolar ridge is visible.
A mixture of autogenous particulate bone and Geistlich Bio-Oss® is used to cover the bone block grafts and to fill any space between the margins of the grafts and the recipient bed. This procedure will simplify the contouring of the graft.
The grafts (blocks and particulate bone + Geistlich Bio-Oss®) are covered with a resorbable collagen membrane (Geistlich Bio-Gide®) in order to stabilize the particulate graft and to reduce the risk of bone resorption.
Augmentation with titanium-reinforced membranes
Currently, a titanium-reinforced membrane is required for large vertical ridge augmentation when an autogenous bone block graft is not utilized. Although these membranes are often used in these procedures, there is a risk of premature exposure and bacterial infection2,3. The use of Geistlich Bio-Gide® favors soft tissue healing and minimizes wound dehiscences4. A mixture of autogenous bone chips and Geistlich Bio-Oss® granules can be placed underneath the titanium-reinforced membrane. This facilitates both optimal bone formation which is induced by the autogenous bone chips, and volume preservation through the slow resorption rate of the Geistlich Bio-Oss®5 granules.
Vertically atrophied posterior ridge.
The particulate graft consisting of Geistlich Bio-Oss® and autogenous bone is placed around the tenting screws and over the atrophic mandible.
The titanium-reinforced e-PTFE membrane is shaped to adapt to the defect filled with Geistlich Bio-Oss® and autogenous bone chips.
References:
- Chiapasco M, et al.: Clin Oral Implants Res 2013; 23(9): 1012-21.
- Zitzmann N, et al.: Int J Oral Maxillofac Implants 1997; 12(6): 844-52.
- Schneider D, et al.: Clin Oral Implants Res 2013; Feb 25. [Epub ahead of print].
- Tal H, et al.: Clin Oral Implants Res 2008; 19(3): 295-302.
- Simion M, et al.: Clin Oral Implants Res 2007; 18(5): 620-29.
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