Horizontal bone augmentation
Successful placement of implants in complete or partly edentulous patients requires sufficient alveolar ridge width. Horizontal bone augmentation increases ridge width.
Conventional approaches include screwing an autogenous bone block into remaining lingual/palatinal walls or stimulating new bone formation under form-stable membranes.
Autogenous bone blocks
Autogenous bone blocks are the material of choice to compensate insufficient bone width. Extensive resorption, however, can result in functional and aesthetic failures1.
Contouring the bone block with Geistlich Bio-Oss® and covering the augmented area with Geistlich Bio-Gide® considerably reduces graft shrinkage2.
Screwing of autogenous bone block to horizontal defect.
Contouring of the autogenous bone block with Geistlich Bio-Oss® granules as protective measure against resorption.
Covering of the autogenous bone block and the Geistlich Bio-Oss® with the resorbable membrane Geistlich Bio-Gide®.
Form-stable membranes
An alternative GBR approach to obtain more bone width uses form-stable titanium-reinforced membranes, which generate space for bone formation3. However, due to their material properties they are associated with impaired healing of the overlaying soft tissue and are non-resorbable, so require a second surgery for their removal4.
In order to overcome this complication, Geistlich Bio-Gide® can be used to completely immobilise and protect a particulated bone graft, thus leading to horizontal augmentations5:
- Geistlich Bio-Gide® is fixed securely with pins on the lingual/palatinal and buccal side
- Packed compactly with autogenous bone chips and Geistlich Bio-Oss® granules, creating a sausage skin effect
- Graft material is completely immobilised and stable
Occlusal view of severely atrophied posterior mandibular ridge.
Buccal view after application of a 1:1 mixture of autogenous particulated bone and Geistlich Bio-Oss® granules.
Buccal view of a single Geistlich Bio-Gide® membrane, which is fixed with titanium pins stably in the cortical bone of the jaw. Using the “sausage technique” the fixated membrane completely immobilises the bone graft creating the sausage skin effect.
Geistlich Bio-Gide® collagen membrane provides a viable replacement for non-resorbable barriers and does not require secondary surgery.
References:
- Maiorana C, et al.: Int J Periodontics Restorative Dent 2005; 25(1): 19-25.
- Maiorana C, et al.: Open Dent J 2011; 5: 71-78.
- Schlegel KA, et al.: Int J Oral Maxillofac Implants 2003; 18(1): 53-58.
- Jensen T, et al.: Clin Oral Implants Res 2012; 23(8): 902-10.
- Proussaefs P, et al.: Int J Oral Maxillofac Implants 2002; 17(2): 238-48.
- Proussaefs P, et al.: Int J Periodontics Restorative Dent 2006; 26(1): 43-51.
- von Arx T & Buser D: Clin Oral Implants Res 2006; 17(4): 359-66.
