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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