DILEMMA

 

Reconstruct to "ideal" ridge & gingival form

Prosthesis replaces missing hard & soft tissues

 

Build the ridge or build the bridge? Enrole the patient in the decision

 

Minimize Morbidity - Maximize Results

 

 

DEFECT MORPHOLOGY

Vertical Augmentation in intra-bony defects, such as sockets or sinus is much easier than vertical extra-bony augmentation

VERTICAL BONE AUGMENTION characterization is essential to establish difficulty

 

 

 

COLOGNE CLASSIFICATION

(6'40'')

Orientation of the defect

Augmentation needs

Augmentation to defect relationship

(inside the contour vs outside the contour)

 

COLOGNE + SAC Classification 

SAC

(Straightforward Advanced Complex)

Vertical & Combined defects are always advanced or complex

 

DENTIST'S SKILLS & PATIENT'S HEALTH AND COMPLIANCE

 

 

 

SYSTEMATIC REVIEWS ON BONE AUGMENTATION

We don't have the data to establish which technique or material works better.

 

 

HORIZONTAL BONE AUGMENTATION

GBR tends to grow less bone than a block graft.

 

How much horizontal gain do I need?

(14')

Algorithm for horizontal augmentation

 

 

TISSUE ENGINEERING TRIAD

Signaling molecules

Cells

Scaffold

With time & adequate environment leads to Bone Regeneration

 

 

TITANIUM MESH

Main reason to get exposure is inadequate free tension closure of the flap.

 

Exposure leads to less bone volume augmentation.

 

Early exposure (within 2 or 3 weeks after surgery).

Late exposure (after 2 or 3 weeks).

 

The search today is finding a resorbable scaffold.

 

ALLOGENEIC BONE BLOCKS

Slower turnover

Growth factors, as BMP, can enhance its turnover

 

 

 

VERTICAL BONE AUGMENTATION

(28'39'')

 

3 groups of vertical bone augmentation:

(29'30'')

5mm or less

5-10mm

more than 10mm

 

POSTERIOR MANDIBLE

Short implants vs Vertical augmentation

Short implants: 8.5mm or less

 

 

 

 

CROWN TO ROOT RATIO

VS

CROWN TO IMPLANT RATIO

(33'57'')

 

These ratio must be seen in different ways.

 

Stress is highest on the crest of the ridge, at the neck of the implant.

Increasing the implant length does not improve the crown to implant ratio.

As long as the prosthetic crown stays within the confines of the implants there is no increase in the stress if the crown is higher. However if the crown is larger and falls out of the confines of the implant there will be an increase of stress.

 

SYSTEMATIC REVIEWS

High crowns

 

 

 

DOES BONE AUGMENTATION IMPROVE RESULTS?

 

No consensus of what is the better technique in vertical bone augmentation in the posterior mandible.

 

Short implants

vs

Vertical augmentation

Short implants less complications