Simultaneous Impacted Third Molar Extraction and Lateral Ramus Block Graft Harvest for Horizontal Ridge Augmentation: A Case Series

Simultaneous or staged lateral ridge augmentation: A clinical guideline on the decision-making process

Lateral ridge augmentation is a standard surgical procedure that can be performed prior to (staged) or simultaneously with implant placement. The decision between a simultaneous or staged approach involves considering multiple variables. This paper proposed a decision-making process that serves as a guideline for choosing the best treatment choice based on the available evidence and the author's clinical experience.

Maxillary Alveolar Ridge Expansion with Split-Crest Technique Compared with Lateral Ridge Augmentation with Autogenous Bone Block Graft: a Systematic Review

Objectives

The objective of the present systematic review was to test the hypothesis of no difference in implant treatment outcome after maxillary alveolar ridge expansion with split-crest technique compared with lateral ridge augmentation with autogenous bone block graft.

Material and Methods

A MEDLINE (PubMed), Embase and Cochrane Library search in combination with a hand-search of relevant journals was conducted. Human studies published in English until 8th of February, 2018 were included.

Results

One comparative and four noncomparative studies fulfilled the inclusion criteria. Both treatment modalities disclosed high survival rate of implants with few complications. High survival rate of prosthesis, implant stability values, limited peri-implant marginal bone loss and gain in maxillary alveolar ridge width were reported with the split-crest technique. Patient-reported outcome measure and length of patient treatment time was not assessed in any of the included studies.

Conclusions

The split-crest technique seems to be useful for horizontal augmentation of maxillary alveolar deficiencies with high survival rate of prosthesis and implants. However, further long-term randomized controlled trials with larger patient sample as well as assessment of patient-reported outcome measures and patient treatment time are needed before well-defined conclusions can be provided about the two treatment modalities.

Success rates and complications of autologous onlay bone grafts and sinus lifts in patients with congenital hypodontia and after trauma

Autogenous bone remains the gold standard for augmentation of the alveolar ridge in congenital hypodontia and appreciable post-traumatic deformity. This generally reflects the volume of material required for such defects and the osteogenic potential of the grafts. Morbidity at the donor site and success rates may lead to autogenous grafts being superseded by xenografts or alloplastic materials in the future, but we know of little evidence to confirm this. All patients having augmentation of the alveolar ridge or sinus lift to enable subsequent placement of implants between 01 January 2009 and 31 December 2016 were identified from a prospectively-gathered database held at the Queen Elizabeth Hospital, Birmingham. Morbidity was recorded, with overall success defined as a graft that enabled subsequent placement of an implant. During this period the following grafts: calvarial (n=4), iliac crest (n=4), and ramus (n=149) were recorded, as well as 53 sinus lifts. Sinus lift augmentation with BioOss^® had the highest success rate (51/53). Calvarial and iliac crest grafts had higher failure rates (2/4 and 3/4, respectively) than those from the mandibular ramus (6/149, 4%). Fifteen of 149 (10%) ramus grafts resulted in transient anaesthesia of the inferior alveolar nerve but no patients developed any permanent morbidity at the donor or recipient sites. Ramus grafts are a predictable method of bone augmentation with only transient morbidity at the donor site. Higher failure rates for extraoral grafts probably reflect their use in more challenging cases when more bone is required. Bilateral ramus grafts are an alternative to extraoral grafts and may be supplemented by bovine-derived particulate grafts with no appreciable increase in complications.