Journal of Oral Implantology July 2014 - (Page 365)
CLINICAL
Classification of the Alveolar Ridge Width: Implant-Driven
Treatment Considerations for the Horizontally Deficient
Alveolar Ridges
Len Tolstunov, DDS, DMD1
Among many techniques advocated for the horizontally deficient alveolar ridges, ridge-split has many
advantages. Here, treatment management strategies of the horizontally collapsed ridges, especially the ridgesplit approach, are discussed and a clinically relevant implant-driven classification of the alveolar ridge width is
proposed, with the goal to assist an operator in choosing the proper bone augmentation technique.
Comparison and advantages of two commonly used techniques, ridge-split and block bone graft, are presented.
Key Words: ridge-split, block bone graft, alveolar ridge
INTRODUCTION
I
t has been shown that although bone collapse
after tooth loss is usually three dimensional
(3D), the horizontal deficiency or width loss
develops to a larger extent.1,2 Alveolar width
deficiency can represent loss of buccal (labial)
cortical or medullary bone, or both. Deficiency of
the buccal cortex (cortical plate) after tooth
extraction can present significant difficulty in
implant reconstruction.3,4 The buccal cortical plate
with a thickness ,2 mm next to an implant appears
to have a higher risk of subsequent resorption.5
A variety of implant-driven bone augmentation
techniques for the deficient alveolar bone have
been proposed.6-8 Four of these techniques are
frequently performed: (1) guided bone regeneration
(GBR)/particulate bone grafting;9,10 (2) onlay (veneer) block bone grafting with intraoral sources,
such as chin, ramus, posterior mandible, zygomatic
buttress, and maxillary tuberosity;11-13 (3) ridgesplit/bone graft procedure;14-16 and (4) alveolar
distraction osteogenesis.17-19 Most of these tech1
Private practice, Oral and Maxillofacial Surgery, San Francisco,
Calif, and Departments of Oral and Maxillofacial Surgery,
University of the Pacific, Arthur A. Dugoni School of Dentistry
and University of California San Francisco, San Francisco, Calif.
Corresponding author, e-mail: tolstunov@yahoo.com
DOI: 10.1563/AAID-JOI-D-14-00023
niques are designed to improve horizontal bone
loss before or simultaneously with dental implant
placement.
DIAGNOSIS
AND
TREATMENT PLANNING
It is important to establish a proper diagnosis based
on the alveolar ridge assessment before initiation of
the treatment plan. Initial clinical evaluation supplemented by radiographic images helps in most
cases to distinguish two-dimensional (2D) versus 3D
alveolar bone deficiency. Although minimal bone
loss and patient's lack of desire to go through
grafting surgical procedure(s) can be circumvented
with restorative means, extensive bone atrophy
usually requires surgical correction for a proper
implant placement.
Alveolar bone should be initially assessed
clinically (visually) for a rough width and height
analysis and interarch-occlusal relationships. In
some cases, although 7-8 mm of bone width is
present, it could be lingually (palatally) positioned
and therefore might require an additional buccal
bone grafting for a proper restoratively driven
implant insertion.
Alveolar width can be measured with different
calipers on top of the thin mucosa or by ridge
Journal of Oral Implantology
365
Table of Contents for the Digital Edition of Journal of Oral Implantology July 2014
Upcoming Enhancements to the Publishing Process
Enhanced Osteoblast Proliferation and Corrosion Resistance of Commercially Pure Titanium Through Surface Nanostructuring by Ultrasonic Shot Peening and Stress Relieving
An Interocclusal Recording Method for the Fabrication of Full-Arch Implant-Retained Restorations
Classification of the Alveolar Ridge Width: Implant-Driven Treatment Considerations for the Horizontally Deficient Alveolar Ridges
Repair of a Multiple Implant-Supported Fixed Superstructure With a Metal-Ceramic Resin- Bonded Fixed Partial Denture: A Clinical Report
Postoperative Perforation of the Schneiderian Membrane in Maxillary Sinus Augmentation: A Case Report
The ‘‘Washing Line’’ Suture Technique for Securing the Subepithelial Connective Tissue Graft
Trephine Core: An Alternative Sinus Lift Technique
Second Harvest of Mandibular Ramus Blocks in Bone Augmentation Procedures: A Case Letter
Piezosurgery Applied to Implant Dentistry: Clinical and Biological Aspects
Journal of Oral Implantology July 2014
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