Introduction: In the past, it was thought that presence of sufficient bone was mandatory for dental implants for primary stability. However, in the modern era, several techniques and a variety of materials are available for management of such cases.
Aim: Bone resorption followed by loss of teeth can lead to alveolar ridge defects, which can further impose problems in placement of dental implants. These defects can be in width or height of available bone. Vertical defects in alveolar ridge are quite difficult to manage for dental surgeons. This report describes several techniques for management of deficient bone in esthetic zone for implant placement.
Case report: In this case series, authors have discussed several techniques like ridge splitting and expansion, guided bone regeneration (GBR), block graft, and alveolar distraction osteogenesis (DO) for the management of alveolar defects. Through this case series, authors have tried to describe indications and contraindications of each procedure.
Conclusion: The choice of techniques depends upon the situation and clinician\'s choice. There are no specific guidelines for techniques to be used.
Clinical significance: This case series describes several techniques, which can be employed routinely in cases of deficient bone and will facilitate placement of implants.
Belser UC, Schmid B, Higginbottom F, Buser D. Outcome analysis of implant restorations located in the anterior maxilla: a review of the recent literature. Int J Oral Maxillofac Implants 2004;19(Suppl):30-42.
Buser D, Mericske-Stern R, Bernard JP, Behneke A, Behneke N, Hirt HP, Belser UC, Lang NP. Long-term evaluation of nonsubmerged ITI implants. Part 1: 8-year life table analysis of a prospective multi-center study with 2359 implants. Clin Oral Implants Res 1997 Jun;8(3):161-172.
Higginbottom F, Belser U, Jones JD, Keith SE. Prosthetic management of implants in the esthetic zone. Int J Oral Maxillofac Implants 2004;19(Suppl):62-72.
Goyal S, Iyer S. Bone manipulation techniques. Int J Clin Implant Dent 2009 Jan-Apr;1(1):22-23.
Scipioni A, Bruschi GB, Calesini G. The edentulous ridge expansion technique: a five-year study. Int J Periodontics Restorative Dent 1994 Oct;14(5):451-459.
Chiapasco M, Zaniboni M, Rimondini L. Dental implants placed in grafted maxillary sinuses: a retrospective analysis of clinical outcome according to the initial clinical situation and a proposal of defect classification. Clin Oral Implants Res 2008 Apr;19(4):416-428.
Jensen SS, Terheyden H. Bone augmentation procedures in localized defects in the alveolar ridge: clinical results with different bone grafts and bone-substitute materials. Int J Oral Maxillofac Implants 2009;24 Suppl:218-236.
Simion M, Baldoni M, Zaffe D. Jawbone enlargement using immediate implant placement associated with a split-crest technique and guided tissue regeneration. Int J Periodontics Restorative Dent 1992;12(6):462-473.
Anitua E, Andia I, Ardanza B, Nurden P, Nurden AT. Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost 2004 Jan;91(1):4-15.
Osborn JF. Die alveolar-expansions plastik. Quintessenz 1985;39:9-14.
Scipioni A, Bruschi GB, Calesini G, Bruschi E, De Martino C. Bone regeneration in the edentulous ridge expansion technique: histologic and ultrastructural study of 20 clinical cases. Int J Periodontics Restorative Dent 1999 Jun;19(3):269-277.
Dahlin C, Sennerby L, Lekholm U, Linde A, Nyman S. Generation of new bone around titanium implants using a membrane technique: an experimental study in rabbits. Int J Oral Maxillofac Implants 1989 Spring;4(1):19-25.
Becker W, Becker BE. Guided tissue regeneration for implants placed into extraction sockets and for implant dehiscences: surgical techniques and case report. Int J Periodontics Restorative Dent 1990;10(5):376-391.
Gher ME, Quintero G, Assad D, Monaco E, Richardson AC. Bone grafting and guided bone regeneration for immediate dental implants in humans. J Periodontol 1994 Sep;65(9): 881-891.
Wang HL, Boyapati L. “PASS” principles for predictable bone regeneration. Implant Dent 2006 Mar;15(1):8-17.
Hammerle CH, Jung RE. Bone augmentation by means of barrier membranes. Periodontology 2000 2003;33(1):36-53.
Brånemark PI, Lindström J, Hallen O, Breine U, Jeppson PH, Ohman A. Reconstruction of the defective mandible. Scand J Plast Reconstr Surg 1975;9(2):116-128.
Misch CM. Ridge augmentation using mandibular ramus bone grafts for the placement of dental implants: presentation of a technique. Pract Periodontics Aesthet Dent 1996 Mar;8(2): 127-135.
Nyström E, Ahlqvist J, Gunne J, Kahnberg KE. 10-year follow-up of onlay bone grafts and implants in severely resorbed maxillae. Int J Oral Maxillofac Surg. 2004 Apr;33(3): 258-262.
Dimitriou E, Jones E, McGonagle D, Giannoudis PV. Bone regeneration: current concepts and future directions. BMC Med 2011 May;9:66.
Clementini M, Morlupi A, Agrestini S, Ottria L. Success rate of dental implants inserted in autologus bone graft regenerated area: a systemic review. Oral Implantol (Rome) 2011 Jul;4(3-4): 3-10.
Zouhary KJ. Bone graft harvesting from distant sites: concepts and techniques. Oral Maxillofac Surg Clin North Am 2010 Aug;22(3):301-316.
Misch CM, Misch CE, Resnik RR, Ismail YH. Reconstruction of maxillary alveolar defects with mandibular symphysis grafts for dental implants: a preliminary procedural report. Int J Oral Maxillofac Implants 1992 Fall;7(3):360-366.
Proussaefs P, Lozada J, Kleinman A, Rohrer MD. The use of ramus autogenous block grafts for vertical alveolar ridge augmentation and implant placement: a pilot study. Int J Oral Maxillofac Implants 2002 Mar-Apr;17(2):238-248.
Aalam AA, Nowzari H. Mandibular cortical bone grafts part 1: anatomy, healing process, and influencing factors. Compend Contin Educ Dent 2007 Apr;28(4):206-212.
Saulacic N, Iizuka T, Martin MS, Garcia AG. Alveolar distraction osteogenesis: a systematic review. Int J Oral Maxillofac Surg 2008;37(1):1-7.
Chin M, Toth BA. Distraction osteogenesis in maxillofacial surgery using internal devices: review of five cases. J Oral Maxillofac Surg 1996 Jan;54(1):45-53.
Ilizarov G. The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res 1989 Jan;(238):249-281.
Ilizarov G. The tension-stress effect on the genesis and growth of tissues. Part II. The influence of the rate and frequency of distraction. Clin Orthop Relat Res 1989 Feb;(239):263-285.