Oral and maxillofacial surgery
Alveolar ridge augmentation for implant fixation: status review

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This literature review was performed to illustrate and compare different alveolar ridge augmentation procedures before dental implant placement. The review was based on clinical and research studies listed in Pubmed. There is not enough evidence to support any single method as gold standard for any given condition, and choice seemed to be based on personal preferences. There is a lack of long-term survival data or success rates of grafting materials regarding donor and recipient sites. Although ridge splitting and distraction osteogenesis techniques eliminate donor site morbidity, circumvent the use of grafting materials, and reduce the operation time, some disadvantages and limitations should be considered. More studies are needed to compare the fate and characteristics of new bone obtained by these different procedures, as well as subsequent implant survival rates.

Section snippets

Preoperative Evaluation of Alveolar Ridge

Presurgical radiographic evaluation aims at obtaining measurements of bone dimensions to determine the appropriate implant size, and locating important anatomical landmarks, such as the maxillary sinus and the inferior alveolar nerve.16 Various radiographic approaches, such as panoramic, periapical, occlusal, cephalometric, and tomographic radiographs have been used for assessment of bone dimensions.17 However, two-dimensional assessment provides little information of bone thickness at

Classifications of Alveolar Ridge

  • A

    In 1963, Atwood described 6 classes of alveolar ridge atrophy23:

    • I

      Preextraction normal bone.

    • II

      Postextraction normal bone: after extraction and before resorption started.

    • III

      High, well rounded, adequate in height and width.

    • IV

      Knife-edge, adequate height, inadequate width.

    • V

      Low, well rounded, inadequate height and width.

    • VI

      Depressed ridge.

  • B

    In 2004, Juodzbalys and Raustia, using panoramic x-ray, computerized tomography, and ridge-mapping calipers with 347 patients, classified alveolar ridge atrophy into 3 types11

Nonsurgical Prosthetic Management of Partial or Complete Edentulism

Rehabilitation of mandibular25 or maxillary edentulism26 with complete or removable partial denture depends on the underlying bone, gingiva, and/or surrounding teeth for support. In the maxilla, immediate denture placement reduces bone resorption compared with healing without denture, but the same role is of less evident in mandible.27 However, long-term use of removable dentures can cause alveolar ridge bone resorption owing to continuous pressure imposed by the prosthesis. This is often an

Sinus floor elevation (sinus lift with bone grafting)

This procedure is used to increase the height of atrophied maxillary ridge, typically limited to the molar and premolar regions. The sinus should show no sign of pathology preoperatively.88 Sinus lift grafting and implant placement can be done in either 1 or 2 steps, depending on the amount of available bone. Simultaneous grafting and implant placement can be done if there is a height of ≥5 mm intact alveolar bone to provide adequate mechanical support during implant healing.89 If the available

Conclusion

A variety of surgical techniques and devices have been developed to rehabilitate horizontally and vertically atrophied alveolar ridge, with no evidence-based criterion standard procedure for each indication. Bone grafts harvested from intraoral sites showed better outcomes overall compared with those obtained from calvaria and iliac crest. However, there are not enough data regarding the fate of different bone grafts, how much they retain their original size and shape in relation to donor and

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