Ridge Augmentation

The surgical challenge

Ridge augmentation procedures require bone regeneration outside of the existing bony walls or housing and are therefore often considered to be the most challenging surgical procedures in implant dentistry. Horizontal bony deficiencies can be managed with GBR techniques involving Bio-Oss natural bone grafting material and Bio-Gide resorbable bilayer collagen membrane while vertical augmentation may require the use of space-creating support mechanisms and potentially a composite graft with autogenous bone. At the time of implant placement, a contour augmentation procedure is often required to maintain bone and soft tissue at optimal levels and to counteract the effects of biologic width.

Horizontal ridge augmentation

Average crestal bone width
8

Avg. Crestal Bone Width (mm)

P < 0.05 t = 9-10 Months

6.9 mm

4 3.2 mm

When used in combination with Bio-Gide, Bio-Oss provides an effective treatment for horizontal bone augmentation without the need for autogenous bone. Additionally, Bio-Gide serves to contain the graft particles and facilitates soft tissue closure.1
Time of Implant

Baseline

Minimize bone graft resorption with Bio-Oss

% Bone Resorption at Implant Placement
20

t = 5.3 Months
18.3% n=14

15

10 9.3% n=12

Bio-Oss is characterized by a low substitution rate and provides a stable foundation for new bone formation over time. The addition of Bio-Oss granules reduces the resorption of autogenous onlay grafts and prolongs retention of the grafted area, thus improving the final quality of the bone.2
Without Bio-Oss

With Bio-Oss

Bio-Oss creates and maintains optimal esthetic contours

In the esthetic zone it is important that the implant be completely encased in bone. Particularly important is the thickness of the facial bone which must be adequate enough to allow for the biologic width contouring. 2-4 mm in facial bone width is typically preferred.3 Creating appropriate buccal dimension with bone and soft tissue grafting at the time of implant placement is a critical component of a successful esthetic outcome. The use of Bio-Oss granules with or without autogenous bone chips offers good volume stability for contour augmentation procedures because of their low substitution rate. The addition of autogenous bone chips may speed up new bone formation at the boneimplant interface as a result of their osteogenic potential. Contour augmentation with a low-substitution bone filler (i.e. Bio-Oss) offers a clearly reduced risk for mucosal recession compared to immediate implant placement.4

Ridge Augmentation

Often considered the most challenging type of augmentation, building bone and tissue in a vertical direction requires the use of spacemaintaining materials that are form stable and allow for vascularization and cell migration through the often vast area of the graft. Obtaining and maintaining primary soft tissue closure also plays a significant role in the eventual success or failure of a case. Bio-Oss and Bio-Gide are successfully used to manage these considerations for predictable vertical ridge augmentation.

Vertical ridge augmentation

Bio-Oss in combination with a titanium-reinforced membrane - predictable for long-term success

Vertical ridge augmentation using a titanium-reinforced membrane and Bio-Oss alone is a successful and predictable treatment option for rebuilding a resorbed ridge to accomodate implants. This clinical study of vertical ridge augmentation around implants, showed an average vertical bone gain of 5.3 mm 1.7 mm.5

Vertical Bone Height Gain at 6 to 8 months

Bone level after grafting -5.1 mm Bone gain + 5.3 mm Three years after loading, radiologic measurements showed a physiologic bone resorption cone all around the implantabutment connection. However, no decrease of the bone level was detected along the crest. The histologic data presented here confirm the previous literature (i.e., that the association of a Gore-Tex membrane with deproteinized bovine bone allows a vertical ridge augmentation of up to 9 mm without the use of autogenous bone). This presents a significant reduction of the patients morbidity. A mean follow-up of 36 months suggested that this procedure allowed the achievement of a long-term stability of the implant.5

Bone level before grafting

Baseline

6 - 8 months

In a 2-Year prospective study, 16 partially edentulous patients requiring bone augmentation were consecutively treated with reconstructive procedures and delayed implant placement 8 to 9 months later (44 implants). Treatment with a combination graft of Bio-Oss granules and autogenous bone (70:30) in conjunction with titanium mesh yielded 100% implant survival with significant vertical and horizontal bone augmentation.6

Bio-Oss in combination with autogenous bone and titanium mesh

Radiographic evaluation (CT scans) of horizontal and vertical bone augmentation (mm; mean SD)6
Horizontal Bone Dimension Baseline At surgical reentry Bone level change P value* 2.76 0.69 6.92 0.93 4.16 0.59 < 0.01 Vertical Bone Dimension 13.12 4.15 16.83 3.24 3.71 1.24 < 0.01 * Paired t test

Bio-Oss has been used in implant dentistry for more than 20 years and is characterized by good biocompatibility and osteoconduction, as well as a low substitution rate 7

Ridge Augmentation

Horizontal Ridge Augmentation

Case by Dr. Daniel Buser

Defect with major horizontal bone loss

Corticocancellous bone graft from the chin region

Contouring with Bio-Oss and covering with Bio-Gide (not shown)

Suitable bone site for implant insertion 6 months postoperatively

Case by Dr. Kerry Damascus

At initial examination, tenting screws are placed into the buccal cortex of this narrow anterior ridge. An implant is also inserted into tooth #26 area

A dense Bio-Oss graft designed to widen the ridge covers all but the heads of the tenting screws

Two overlapped Bio-Gide membranes cover the entire grafted site and the flaps sutured primarily

At six months following grafting the ridge is significantly widened with densely formed new bone and ready for implant placement

Vertical Ridge Augmentation

Case by Prof. Massimo Simion

Defect exposed after opening reveals severe vertical bone loss

Augmentation with Bio-Oss granules

A space maintaining membrane fixed buccally with two screws

Suitable bone support for implant insertion 6 months post operatively

Ridge Reconstruction

Case by Dr. J.P. Schmitz

Bio-Oss: Bone (70:30) contained within titanium mesh to augment anterior maxillary ridge deficiency

At time of mesh removal (6 mos.) good ridge bulk is apparent. Thin layer of connective tissue overlying graft is shown

Vestibuloplasty performed to reconstruct original vestibular depth and widen zone of attached gingiva

Implant placement at 8 months.

References
1. 2. 3. 4. Hammerle CH, Jung RE, Yaman D, Lang NP. Ridge augmentation by applying bioresorbable membranes and deproteinized bovine bone mineral: a report of twelve cases. Clin Oral Implants Res. 2008 Jan;19(1):19-25. Epub 2007 Oct 22. Maiorana C, Beretta M, Salina S, Santoro F. Reduction of autogenous bone graft resorption by means of bio-oss coverage: a prospective study. Int J Periodontics Restorative Dent. 2005 Feb;25(1):19-25. Grunder U, Gracis S, Capelli M. Influence of the 3-D bone-to-implant relationship on esthetics. Int J Periodontics Restorative Dent 2005; 25: 113-119. Buser D, Halbritter S, Hart C, Bornstein MM, Grtter L, Chappuis V, Belser UC. Early implant placement with simultaneous guided bone regeneration following single-tooth extraction in the esthetic zone: 12-month results of a prospective study with 20 consecutive patients. J Periodontol. 2009 Jan;80(1):152-62. Cannullo L, Malagnino VA. Vertical ridge augmentation around implants by e-PTFE titanium-reinforced membrane and bovine bone matrix: a 24- to 54-month study of 10 consecutive cases. Int J Oral Maxillofac Implants 2008; 23: 858-866. Pieri F, Corinaldesi G, Fini M, Aldini NN, Giardino R, Marchetti C. Alveolar ridge augmentation with titanium mesh and a combination of autogenous bone and anorganic bovine bone: a 2-year prospective study. J Periodontol 2008; 79: 2093-2103. Buser D, Chen S, Weber HP, Belser U. Early Implant Placement Following Single Tooth Extraction in the Esthetic Zone: Biologic Rationale and Surgical Procedures. Int. Journal of Perio. And Rest. Dent 2008; 28: 441-451.

5. 6. 7.

Osteohealth Companys overriding goal is to develop and distribute with professionalism and integrity products of the highest quality that have been scientifically and clinically proven to enhance patient care. Osteohealth has dedicated its efforts towards the development of products based upon the principles of tissue engineering. In this regard, Osteohealth has made a major commitment to develop and distribute to health care providers superior products engineered to regenerate bone and other tissues in the field of dentistry. Osteohealth Company is a division of Luitpold Pharmaceuticals, Inc., a wholly owned subsidiary of Daiichi Sankyo Co., Ltd, a multinational corporation and one of Japans leading pharmaceutical companies. Incorporate Bio-Oss and Bio-Gide into your practice today by calling our Customer Service Representatives at

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