Assessment of bone gain and neurosensory affection with the sandwich osteotomy technique for vertically deficient posterior mandible using a full digital workflow versus conventional protocol: A randomized split mouth study.

BACKGROUND: Using the sandwich osteotomy technique in the posterior mandible is delicate. This study aimed to assess the safety and the amount of bone gain using a full digital workflow versus the conventional procedure. PATIENTS AND METHODS: This split mouth study included 10 patients with bilateral vertically deficient posterior mandible. One side received conventional sandwich interpositional bone grafting (control group), while the other side received the same protocol using two patient-specific guides. The first guide (cutting guide) was used to place the osteotomies safely and accurately according to the predetermined dimensions and locations, and the second guide was used to fix the mobilized bony segment, leaving the desired gap to be filled with a particulate xenogenic bone graft. RESULTS: Full neurosensory recovery was documented at 2 months postoperative for all patients and bilaterally. After 4 months, there was a statistically significant difference in vertical bone gain between both groups (p = 0.001), measuring an average of 3.76 ± 0.72 mm in the study group and 2.69 ± 0.37 mm in the control group. No statistically significant difference was found between the planned vertical augmentation (3.85 ± 0.58 mm) and the obtained vertical bone gain (3.76 ± 0.72 mm) in the study group (p = 0.765) proving the accuracy of the guided procedure. CONCLUSION: Computer-guided sandwich interpositional grafting is predictable regarding the execution of the osteotomies and the accuracy of fixation of the transport segment.

Utilization of Tenting Pole Abutments for the Reconstruction of Severely Resorbed Alveolar Bone: Technical Considerations and Case Series Reports.

INTRODUCTION: Although various surgical techniques have been utilized in the reconstruction of severely resorbed alveolar bone, its regeneration is still regarded as a major challenge. Most of the surgical techniques used in advanced ridge augmentation have the disadvantages of prolonging the patient's edentulous healing and increasing the need for surgical revisits because simultaneous implant placement is not allowed. This report presents a new and simplified method for advanced ridge augmentation, which utilizes a vertical tenting device. CASE PRESENTATION: The first case presented the reconstruction of the mandibular posterior region with severely resorbed alveolar bone due to peri-implantitis using tenting pole abutment for ridge augmentation. The second and third cases presented three-dimensional ridge augmentations in severely resorbed ridges due to periodontitis. The last case presented horizontal ridge augmentation using a vertical tenting device. All cases were performed under local anesthesia. Implants were simultaneously placed in the bone defect area. A vertical tensioning device was then connected to the implant platform to minimize the collapse of the bone graft during the bone regeneration period due to the contraction of the soft tissue matrix. A sticky bone graft was transplanted onto the exposed surface of the implant and on top of the vertical tensioning device. After covering with an absorbable barrier membrane, the soft tissues were sutured without tension. CONCLUSIONS: In all cases, prosthetic restorations were provided to patients after a bone grafting period of 5-6 months, leading to a rapid restoration of masticatory function. Results tracked for up to 6 years revealed observed stable reconstruction of the alveolar bone. The use of a vertical tenting device can prevent the collapse of biomaterials in the augmented ridge during the healing period, leading to predictable outcomes when achieving three-dimensional ridge augmentation.

Retrospective analysis of augmentation procedures with umbrella screws, a novel tenting technique: a consecutive case series in 279 patients.

OBJECTIVES: The consecutive case series accesses the results and experiences of ridge augmentation using an umbrella screw tenting technique. METHOD AND MATERIALS: In total, 279 patients were treated between 26 May 2015 and 16 June 2021, including horizontal and vertical ridge defects. Sex, age, smoking behavior, jaw, graft material, soft tissue thickness, extent of horizontal/vertical augmentation, resorption rate, and occurrence of early/late exposure were evaluated. Bone gain was determined by resorption at the screw head. Only cases without premature screw removal were evaluated metrically (n = 201). All other augmentations were evaluated according to whether implantation was possible with or without further augmentation (n = 27). A target performance index was calculated, which should enable evidence-based comparability of different augmentation methods in future. RESULTS: In total, 54 wound dehiscences (39 early, 15 late exposures) occurred, which corresponds to 24.08% of the augmented sites; 42 umbrella screws were removed prematurely. In all cases an implantation was possible at the desired position afterwards. Cases with a vertical augmentation component showed a higher prevalence of exposure (early, P = .000; late, P = .024). The extent of the vertical augmentation was only relevant for early exposure (P = .048). Mean bone gain of 4.23 ± 1.69 mm horizontally and 4.11 ± 1.99 mm vertically could be achieved. Regression analysis showed that there was no limit in horizontal/vertical direction. Mean percentage target performance index was 75.90 ± 20.54 for vertical and 82.25 ± 16.67 for horizontal portions. CONCLUSION: The umbrella technique is an effective augmentation method, which can be applied to any defect morphology.

The "White Layer Approach": A Graftless Gingival Augmentation Technique following Vertical GBR with Occlusive Titanium Barriers.

Guided bone regeneration surgery always leads to a deformation of the soft tissues consequent to passivation of the flap. In this article, a graftless technique for the restoration of the vestibular depth and for the augmentation of adherent soft tissue, called the "white layer approach", is proposed after a vertical GBR procedure in posterior areas. Six patients (five males and one female) with vertical bone atrophy were enrolled in the study and underwent three-dimensional bone augmentation with titanium barriers. After 6 months, during the second-stage surgery, a 0.5 mm thick layer of white pseudo-periosteum was observed underneath the titanium barrier and over the newly formed bone. The buccal portion of the pseudo-periosteum was left intentionally exposed, in order to promote the spontaneous formation of new adherent gingiva and the restoration of the original depth of the fornix. The implant insertion was then planned 3 months after the WLA in a conventional procedure. The buccal adherent soft tissue height was measured from the crestal point to the most apical point, using a periodontal probe, before the barrier removal at 3 months after the white layer approach (WLA). In all patients, a gain in adherent soft tissue varying from 5 to 8 mm was observed; the average adherent soft tissue gain (ASTG) was 6.75 mm. The vertical bone height was measured by CT scans at baseline and before the implant placement, and showed an average vertical bone gain (AVBG) of 4.08 mm. Within the limitations of this study, vertical GBR with titanium occlusive barriers (OTB) associated with the white layer approach (WLA) may represent a simplified technique for hard and soft tissue augmentation in posterior areas, even without a free gingival graft.

Vertical Ridge Augmentation Using Distraction Osteogenesis Versus Autogenous Bone Grafting: A Systematic Review and Meta-Analysis.

Aim: The aim of this systematic review was to systematically assess the papers comparing the surgical techniques of Alveolar Distraction Osteogenesis(ADO) and Autogenous Bone grafting (ABG) for Vertical Ridge Augmentation in terms of bone gain, bone resorption and incidences of complications. Metholodology: The review was registered on PROSPERO with the ID : CRD42021237671. A broad electronic survey was conducted in the PubMed, Scopus, Web of Science, Cochrane Library, and Virtual Health Library databases of all studies published till 08/03/2022. Four studies fulfilled the criteria to carry out a meta-analysis a in which a total of 58 patients underwent ADO and 43 patients for ABG. A total of 133 implants were placed in the ABG group and 124 in the ADO group. Statistical Analysis: DerSimonian-Laird estimator of variance was used for Random effect meta-analysis. The estimates of an intervention were expressed as the odds ratio (OR) and standard mean difference (SMD) in millimeters. Results: There was statistically significant difference in terms of bone height gain with SMD of - 0.78 (95% 0.04-1.55) in ABG. Bone resorption and complications were statistically insignificant with SMD of 0.52 (95% - 1.59 to 0.56) and OR 0.55 (95% 0.18-1.70), respectively.PROSPERO Registration ID: CRD42021237671.

The importance of soft tissue condition in bone regenerative procedures to ensure long-term peri-implant health.

Bone regenerative procedures have been widely proved to be a reliable treatment option to re-create the ideal pre-implant clinical conditions. Nevertheless, these techniques are not free from post-operative complications which might result in implant failure. Consequently, as demonstrated by the increasing recently published evidence, a careful pre- and intra-operative flap evaluation to ensure an ideal and hermetic tension-free wound closure is of paramount importance to successfully treat bony defects. In this respect, several surgical interventions mainly aimed to increase the amount of keratinized mucosa either to allow an optimal healing after a reconstructive procedure or to establish an optimal peri-implant soft tissue seal have been proposed. The present review summarizes the level of evidence on the surgical clinical aspects which have an impact on the soft tissue handling associated with bone reconstructive procedures and on the importance of soft tissue conditions to enhance and maintain peri-implant health in the long-term.

Dimensional changes after horizontal and vertical guided bone regeneration without membrane fixation using the retentive flap technique: A 1-year retrospective study.

AIM: To evaluate the dimensional changes after horizontal and vertical guided bone regeneration (GBR) without membrane fixation using the retentive flap technique. METHODS: This study retrospectively examined two cohorts that received vertical or horizontal ridge augmentations (VA or HA groups). GBR was performed using particulate bone substitutes and resorbable collagen membranes. The augmented sites were stabilized using the retentive flap technique without any additional membrane fixation. The augmented tissue dimensions were assessed using cone-beam computed tomography at preoperative, immediately postoperative (IP), 4 months (4M), and 1 year (1Y). RESULTS: Postoperative vertical bone gain in 11 participants of VA group amounted to 5.96 ± 1.88 mm at IP, which decreased to 5.53 ± 1.62 at 4M and to 5.26 ± 1.52 mm at 1Y (intragroup p < 0.05). The horizontal bone gain at IP in 12 participants amounted to 3.98 ± 2.06 mm, which decreased to 3.02 ± 2.06 at 4M and to 2.48 ± 2.09 mm at 1Y (intragroup p < 0.05). The mean implant dehiscence defect height after 1Y was 0.19 ± 0.50 mm in the VA group, and 0.57 ± 0.93 mm in the HA group. CONCLUSION: GBR without membrane fixation using the retentive flap technique seems to preserve the radiographic bone dimensions of vertically augmented sites. This technique may be less effective at preserving the width of the augmented tissue.

The Significance of Mylohyoid Muscle Release (MMR) in the Vertical and Horizontal Ridge Augmentation Surgeries; Clinical and Human Cadaver Analyses of the Techniques.

(1) Background: Ridge augmentations either horizontal (HRA) or vertical (VRA) in the posterior mandible are very challenging regenerative procedures. To attain and retain tension-free primary closure, buccal periosteal and mylohyoid muscle releases should be performed. The purpose of the present study was to review, analyze and discuss the three different techniques for the mylohyoid muscle release (MMR) in VRA and HRA surgeries on a clinical and human cadaver level. (2) Presentation of the techniques: Three different techniques are described in the literature regarding the lingual flap management: (i) the finger sweep technique (FST), (ii) the release of the mylohyoid muscle attachment on the lingual flap (MMALF), and (iii) the mylohyoid preservation technique (MPT) in three key anatomical zones. All three techniques, even though they use a different approach, can achieve similar amount of horizontal and vertical mylohyoid muscle release although MPT showed statistically significant higher flap advancement. The human cadaver analyses revealed that all three techniques are considered safe since they do not approximate vital anatomical structures. (3) Conclusions: All three techniques are considered safe, but they are not free of limitations or complications; therefore, they should be performed only by highly experienced and trained clinicians. MPT achieved statistically significant higher flap advancement.

Techniques on vertical ridge augmentation: Indications and effectiveness.

Vertical ridge augmentation techniques have been advocated to enable restoring function and esthetics by means of implant-supported rehabilitation. There are three major modalities. The first is guided bone regeneration, based on the principle of compartmentalization by means of using a barrier membrane, which has been demonstrated to be technically demanding with regard to soft tissue management. This requisite is also applicable in the case of the second modality of bone block grafts. Nonetheless, space creation and maintenance are provided by the solid nature of the graft. The third modality of distraction osteogenesis is also a valid and faster approach. Nonetheless, owing to this technique's inherent shortcomings, this method is currently deprecated. The purpose of this review is to shed light on the state-of-the-art of the different modalities described for vertical ridge augmentation, including the indications, the step-by-step approach, and the effectiveness.

Reconstruction of vertical alveolar ridge deficiencies utilizing a high-density polytetrafluoroethylene membrane /clinical impact of flap dehiscence on treatment outcomes: case series/.

OBJECTIVES: The aim of this study was to evaluate the effects of membrane exposure during vertical ridge augmentation (VRA) utilizing guided bone regeneration with a dense polytetrafluoroethylene (d-PTFE) membrane and a tent-pole space maintaining approach by registering radiographic volumetric, linear and morphological changes. METHODS: In 8 cases alveolar ridge defects were accessed utilizing a split-thickness flap design. Following flap elevation VRA was performed with tent-pole space maintaining approach utilizing the combination of a non-reinforced d-PTFE membrane and a composite graft (1:1 ratio of autogenous bone chips and bovine derived xenografts). Three-dimensional radiographic evaluation of hard tissue changes was carried out with the sequence of cone-beam computed tomography (CBCT) image segmentation, spatial registration and 3D subtraction analysis. RESULTS: Class I or class II membrane exposure was observed in four cases. Average hard tissue gain was found to be 0.70 cm3 ± 0.31 cm3 and 0.82 cm3 ± 0.40 cm3 with and without membrane exposure resulting in a 17% difference. Vertical hard tissue gain averaged 4.06 mm ± 0.56 mm and 3.55 mm ± 0.43 mm in case of submerged and open healing, respectively. Difference in this regard was 14% between the two groups. Horizontal ridge width at 9-month follow-up was 5.89 mm ± 0.51 mm and 5.61 mm ± 1.21 mm with and without a membrane exposure respectively, resulting in a 5% difference. CONCLUSIONS: With the help of the currently reported 3D radiographic evaluation method, it can be concluded that exposure of the new-generation d-PTFE membrane had less negative impact on clinical results compared to literature data reporting on expanded polytetrafluoroethylene membranes.

Vertical ridge augmentation (VRA) with the use of a cross-linked resorbable membrane, tenting screws, and a combination grafting technique: a report of three cases.

OBJECTIVE: The purpose of the present study was to present vertical ridge augmentation (VRA) with the use of cross-linked resorbable membrane, tenting screws, and a combination grafting technique. REPORT: Three cases are presented. Case 1: A 67-year-old ASA II patient required VRA at the areas of the mandibular left second premolar and first molar. Flap management was performed with the use of periosteal release on the buccal aspect and 23 mm of mylohyoid muscle release on the lingual aspect. VRA was completed with the use of four self-tapping tenting screws, and 1:1 mix of anorganic bovine bone matrix (ABBM) and particulate mineralized bone allograft. A cross-linked resorbable membrane was placed over the buccal and lingual aspect, and a double line of suturing was performed to secure the tension-free closure. Twelve months postoperatively, 4 mm of VRA was confirmed with CBCT. Two implants were placed with >35 Ncm primary stability. Case 2: A 64-year-old ASA I patient required VRA at the area of the maxillary first premolar. Flap management was performed with the use of periosteal release on the buccal aspect and VRA was performed with a 9-mm self-tapping screw, 1:1 mix of ABBM and particulate mineralized bone allograft, a cross-linked resorbable membrane, and a double line of suturing. Twelve months postoperatively, VRA of 6.2 mm on the buccal aspect and 7.9 mm on the lingual aspect were confirmed with CBCT. An implant was placed with > 35 Ncm primary stability in combination with horizontal ridge augmentation. Case 3: A 70-year-old ASA II patient required horizontal and VRA at the area of the mandibular left canine. Following extraction, a lateral pedicle sliding flap was completed to enhance the soft tissue volume of the site. After 6 weeks, flap management was performed with the use of buccal periosteal release, VRA was completed with two self-tapping screws, 1:1 mix of ABBM and particulate mineralized bone allograft, a cross-linked resorbable membrane, and a double line of suturing. Eight months postoperatively there was 5.3 mm of bone regeneration on the vertical dimension and 3.9 mm on the horizontal dimension. An implant was placed with primary stability of 45 Ncm. CONCLUSION: Successful VRA can be achieved with proper flap management to achieve tension-free closure, a cross-linked collagen membrane, tenting screws, and a combination grafting technique. The VRA ranged from 4.0 to 7.9 mm.

Vertical Ridge Augmentation With a Honeycomb Structure Titanium Membrane: A Technical Note for a 3-Dimensional Curvature Bending Method.

Guided bone regeneration is the most commonly used technique for vertical ridge augmentation (VRA), and it is popular because it is less invasive and highly formative. Since the augmented site is exposed to external pressure, it is preferable to support the membrane using a framework to maintain the shape of the VRA. Recently, a titanium framework-reinforced ultrafine titanium membrane was developed by laser processing technology. The technique allows microperforations to be made (φ20 µm) into a titanium membrane, which is expected to prevent fibrous tissue ingrowth from outside the membrane. In addition, significant bone regeneration was confirmed on ridge defects in previous animal studies. However, the membrane tends to crumple during the bending process, because it is very thin (20 nµm); thus, the bending procedures are technically sensitive. Since this titanium honeycomb membrane was first approved for clinical use in Japan, no international clinical reports have been published. The purpose of this case report is to describe a technical note for a 3-dimensional curvature bending method in VRA using the newly developed honeycomb structure titanium membrane.

Effectiveness of the bone ring technique and simultaneous implant placement for vertical ridge augmentation: a systematic review.

BACKGROUND: Dimensional changes after dental extraction frequently lead to situations in which bone augmentation procedures are required prior to dental implant placement. Bone ring technique (BRT) has been described as a one-stage approach to restore vertical alveolar ridge defects, in which an autogenous or allogeneic cortico-cancellous bone block graft is stabilized with a dental implant inserted simultaneously. The objective of this systematic review was to evaluate the clinical performance of BRT. MATERIALS AND METHODS: This review was conducted according to PRISMA guidelines. An electronic search was conducted in four databases: (1) The National Library of Medicine (MEDLINE/PubMed) via Ovid; (2) Web of Science (WOS); (3) SCOPUS; and (4) Cochrane Central Register of Controlled Trials (CENTRAL). The Newcastle-Ottawa Quality Assessment Scale and The Joanna Briggs Institute Critical Appraisal tool were used to assess the quality of evidence in the studies reviewed. RESULTS: Sixteen studies with a total of 186 patients treated with 219 bone rings bocks were included in the review. The studies showed a mean bone gain of 4.94 mm, mean bone resorption of 0.83 mm, and mean marginal bone loss of 0.57 mm after a mean follow-up period of 13.35 months. A mean bone ring survival rate of 97.26% and implant survival rate of 94.97% were recorded. CONCLUSIONS: BRT would appear to be an adequate alternative technique for restoring single vertical alveolar ridge defects with simultaneous dental implant placement. However, further studies comparing this technique with other vertical ridge augmentation procedures in different clinical scenarios are needed to confirm the present results.

Sinus bone graft and simultaneous vertical ridge augmentation: case series study.

BACKGROUND: This study aims to examine the outcome of simultaneous maxillary sinus lifting, bone grafting, and vertical ridge augmentation through retrospective studies. METHODS: From 2005 to 2010, patients with exhibited severe alveolar bone loss received simultaneous sinus lifting, bone grafting, and vertical ridge augmentations were selected. Fifteen patients who visited in Seoul National University Bundang Hospital were analyzed according to clinical records and radiography. Postoperative complications; success and survival rate of implants; complications of prosthesis; implant stability quotient (ISQ); vertical resorption of grafted bone after 1, 2, and 3 years after surgery; and final observation and marginal bone loss were evaluated. RESULTS: The average age of the patients was 54.2 years. Among the 33 implants, six failed to survive and succeed, resulting in an 81.8% survival rate and an 81.8% success rate. Postoperative complications were characterized by eight cases of ecchymosis, four cases of exposure of the titanium mesh or membrane, three cases of peri-implantitis, three cases of hematoma, two cases of sinusitis, two cases of fixture fracture, one case of bleeding, one case of numbness, one case of trismus, and one case of fixture loss. Prosthetic complications involved two instances of screw loosening, one case of abutment fracture, and one case of food impaction. Resorption of grafted bone material was 0.23 mm after 1 year, 0.47 mm after 2 years, 0.41 mm after 3 years, and 0.37 mm at the final observation. Loss of marginal bone was 0.12 mm after 1 year, and 0.20 mm at final observation. CONCLUSIONS: When sinus lifting, bone grafting, and vertical ridge augmentation were performed simultaneously, postoperative complications increased, and survival rates were lower. For positive long-term prognosis, it is recommended that a sufficient recovery period be needed before implant placement to ensure good bone formation, and implant placement be delayed.

Vertical Alveolar Augmentation Using BMP-2/ACS/Allograft with Printed Titanium Shells to Establish an Early Vascular Scaffold.

Traditional reconstruction of major alveolar ridge deficiency has required autogenous cortical cancellous particulate bone grafts, often augmented with particulate allogeneic components. Now there is a new concept to consider, that of orthoalveolar form. This paradigm shift involves components of the tissue engineering triad of inductive growth factors combined with a matrix and stem cells, together with osteotomies or devices designed for space maintenance. Reported here is early experience with computer technology used to redesign deficient alveolar ridges deriving ideal alveolar-shaped bone-forms made from powdered titanium, sintered by laser at high temperature using rapid prototype technology.

Vertical ridge augmentation using a porous composite of uncalcined hydroxyapatite and poly-DL-lactide enriched with types 1 and 3 collagen.

BACKGROUND: Previous studies have shown that porous composite blocks containing uncalcined hydroxyapatite (u-HA; 70 wt%) with a scaffold of poly-DL-lactide (PDLLA, 30 wt%) are biodegradable, encourage appropriate bone formation, and are suitable for use as a bone substitute in vertical ridge augmentation. The present study aimed to accelerate osteogenesis in vertical ridge formation by adding types 1 and 3 collagen to the u-HA/PDLLA blocks and assessing the effect. MATERIAL AND METHODS: The bone substitute in the present study comprised porous composite blocks of u-HA (70 wt%) with a PDLLA (27-29 wt%) scaffold and enriched with types 1 and 3 collagen (1.7 ~ 3.4 wt%). The control blocks were composed of u-HA (70 wt%) and PDLLA (30 wt%). The materials were formed into 8-mm diameter, 2-mm high discs and implanted onto the cranial bones of six rabbits. The animals were sacrificed 4 weeks after implantation, and histological and histomorphometrical analyses were performed to quantitatively evaluate newly formed bone. RESULTS: New bone formation occurred with both block types, showing direct contact with the original bone. Mean ± standard deviation bone formation was significantly greater in the experimental blocks (25.6% ± 4.8%) than in the control blocks (17.0% ± 4.7%). CONCLUSIONS: Histological and histomorphometrical observations indicated that new bone was formed with both block types. The u-HA/PDLLA block with types 1 and 3 collagen is a more promising candidate for vertical ridge augmentation than the u-HA/PDLLA alone block.

Assessment of vertical ridge augmentation and labial prominence using buccal versus palatal approaches for maxillary segmental sandwich osteotomy (inlay technique): A randomized clinical trial.

BACKGROUND: The aim of this study was to evaluate the final vertical gain at the deficient anterior maxillary alveolar ridges using buccal versus palatal approaches for maxillary segmental sandwich osteotomy (inlay technique). This is a single-institutional randomized comparative clinical trial. MATERIAL AND METHODS: The study population was 16 patients with edentulous anterior maxillary alveolar ridges (40 implant sites). Patients were randomly divided into two equal groups. Both groups received sandwich osteotomy with down fracture of the deficient anterior maxillary alveolar ridge, using buccal approach (control group) and palatal approach (study group) with interpositional alloplastic bone blocks fixed with miniplates. Assessment included the mean percentage of vertical gain at the proposed implant sites after 4 months, taken from cross-sectional cuts of a cone beam computed tomography. RESULTS: All cases showed uneventful wound healing and a total of 40 delayed implant placement were done. Results showed that there was no statistical significance between the 2 groups in terms of bone height (P = .43) and labial prominence (P = .5) CONCLUSION: Both techniques were successful where the mean percentage of 4 months postoperative vertical bone gain of the control group was 79.9% and that of the study group was 76.5%.

Tissue Engineering for Vertical Ridge Reconstruction.

This article provides an overview of basic tissue engineering principles as they are applied to vertical ridge defects and reconstructive techniques for these types of deficiencies. Presented are multiple clinical cases ranging from office-based dentoalveolar procedures to the more complex reconstruction of postresection mandibular defects. Several different types of regenerative tissue constructs are presented; either used alone or in combination with traditional reconstructive techniques and procedures, such as maxillary sinus augmentation, Le Fort I osteotomy, and microvascular free tissue transfer. The goal is to also familiarize the reconstructive surgeon to potential future strategies in vertical alveolar ridge augmentation.

Long-term Evaluation of Peri-implant Bone Level after Reconstruction of Severely Atrophic Edentulous Maxilla via Vertical and Horizontal Guided Bone Regeneration in Combination with Sinus Augmentation: A Case Series with 1 to 15 Years of Loading.

BACKGROUND: To the best of the authors' knowledge, there is very limited clinical data on the outcomes of simultaneous guided bone regeneration (GBR) for horizontal and/or vertical bone gain for the reconstruction of severely atrophic edentulous maxilla. Therefore, the purpose of the clinical series presented herein was to clinically evaluate long-term horizontal and vertical bone gain, as well as implant survival rate after reconstruction of severely atrophic edentulous maxillary ridges. MATERIAL AND METHODS: Sixteen patients (mean age: 64.6 ± 14.6 years of age) were consecutively treated for vertical and/or horizontal bone augmentation via GBR in combination with bilateral sinus augmentation utilizing a mixture of autologous and anorganic bovine bone. Implant survival, bone gain, intraoperative/postoperative complications and peri-implant bone loss were calculated up to the last follow-up exam. RESULTS: Overall, 122 dental implants were placed into augmented sites and have been followed from 12 to 180 months (mean: 76.5 months). Implant survival was 100% (satisfactory survival rate of 97.5%). Mean bone gain was 5.6 mm (max: 9 mm; min: 3 mm) While vertical bone gain was 5.1 ± 1.8 mm; horizontal bone gain was 7.0 ± 1.5 mm. No intraoperative/postoperative complications were noted. Mean peri-implant bone loss values were consistent within the standards for implant success (1.4 ± 1.0 mm). At patient-level, only one patient who had three implants presented with severe peri-implant bone loss. CONCLUSION: Complete reconstruction of an atrophied maxilla can be successfully achieved by means of guided bone regeneration for horizontal and/or vertical bone gain including bilateral sinus augmentation using a mixture of anorganic bovine bone and autologous bone.