Most ridge augmentations are simple. You may need just a few millimeters of increased width for successful implant placement. These cases are well within the wheelhouse of any dentist who does bone grafts on a regular basis. The following case illustrates a simple and predictable method of gaining ridge width.
Simple Ridge Augmentation
A middle-aged woman presents with a knife edge ridge. The patient would like to add a molar to contact a full maxillary dentition. The plan is to regenerate her ridge and place a large molar to contact her maxillary dentition. See the full case below:
The incision is made in the buccal vestibule just past the attacked gingiva. The incision is carried to the distal of the first bicuspid providing one full tooth distance from the graft site. Care is taken to be aware of the mental nerve. When this incision is closed there is no pressure on the incision line as it lies in the vestibule and not on the ridge.
The flaps are reflected exposing the knife edge ridge. Perforations are made where you want bone to grow. When using resorbable synthetic bone grafts that produce normal bone, the perforations are made to allow access for the regenerative cells to migrate from the cancellous bone into the graft material. Cadaver bone grafts on the other hand, only need bleeding to produce calcification. but the method of acquiring regenerative cells or blood is the same.
The graft site is filled with Ridge Graft Kit. Ridge Graft Kit is a combination of our putty and our OsseoConduct standard granules.
A dense PTFE membrane is laid over the graft material. No tacks or titanium supports are needed. Resorbable synthetic bone grafts heal completely differently from cadaver bone grafts. Synthetic bone grafts require modification in some aspects of grafting. Cadaver bone graft size and shape can become anything the dentist can shape using a titanium framework and get to vascularize. So, placing titanium structures to form the bone graft site works well and is often needed to stabilize the graft material until calcification occurs.
However, the shape of the bone produced by synthetic bone grafts is dictated by the DNA of the mineralizing cells. In normal bone formation, the DNA determines the shape and size of the ultimate bone structure. You can form less bone, but you will never be able to form bone outside the normal contours of the patient’s original bone. As a result, forming titanium structures to dictate the shape of the bone is of no value and can interfere with the regenerative process of synthetic bone grafts.
With resorbable synthetic bone grafts, the graft material needs to adapt to the demands of the regenerative cells and encasing the graft material in a fixed structure will often lead to less than ideal results. Membranes used to cover resorbable synthetic graft materials need to be synthetic. Resorbable collagen membranes are resorbed by the immune system and the inflammation produced by the resorption process will compromise normal bone formation.
The surgical site is closed with no tension because the incision line is not over the ridge.
Oral Bond adhesive is applied to the sutures and the incision line. This secures the sutures and seals the incision line from oral fluids and bacteria.
4 months after grafting. Day of implant placement.
Tissue reflected exposing good ridge formation. In time, a buccal cortical plate of bone will form because a resorbable synthetic grafting material was used. Cadaver bone grafts never form cortical bone.
The osteotomy is moved distal for more occlusal contact.
After 4 months, the bone is well formed with the new bone blending with the original ridge.
The surgical site is closed with Oral Bond only. No sutures required for this technique.
Two weeks post implant placement. The tissues look healthy with no inflammation or patient discomfort caused by sutures.
Gaining width through ridge augmentation can be simple and effective when using a resorbable synthetic graft material. However, we do encounter cases where such simplicity is not effective. These cases can still be simple, but do require new materials, such as our 3D printed ridges.
At this stage, we are reintroducing these grafts with a design modification until further notice.
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American Society for Bone and Mineral Research (ASBMR)
Tissue Engineering and Regenerative Medicine International Society (TERMIS)