1 lecture | Hours TBD | EN

Course Description

Patients with atrophic alveolar bone have a variety of different presentations, including vertical versus horizontal atrophy, anatomic features such as flat vs sloped defect walls or con-cavities, various bone density (e.g. cortical vs cancellous bone).

Each of these features can affect the efficacy of bone augmentation, either in a favorable or unfavorable manner. The oral location (posterior vs anterior maxilla, post vs anterior mandible) requires special considerations. Therefore, the approach utilized needs to thoroughly analyze and classify the site and patient characteristics in order to select an appropriate technique, material and protocol. Another consideration is the potential of complications for the selected protocol and a risk assessment to determine the likelihood of encountering negative outcomes, based on patient features. Three dimensional reconstruction of the alveolar bone requires several components for successful bone regeneration. The components for 3D reconstruction include 1) Bone substitute (allograft or xenograft), 2) osteogenic cells, 3) osteogenic signals (growth factors), 4) blood supply and 5) wound stabilization. Many controversies remain, including whether, a) membrane are really necessary, b) primary closure or open healing concept, The protocol presented for 3D reconstruction of alveolar bone and mucosa will increase the likelihood of successful outcome and reduces the potential for complications.

Educational Objectives

• Diagnosis
  Classification of alveolar ridge deficiencies
• Risk Assessment:
  Patient and site characteristics
  Management of patient/site risks

Material Selection

Autogenous: methods and location of harvesting

• Xenograft: effects of sintering temperature
• Allograft: DFDBA, FDBA, cortical, cancellous
• Alloplastic: HA, TCP, biphasic HA/TCP
• Platelet Rich Fibrin (PRF):
  • Biology
  • Protocol
  • Applications
• Membrane Selection

Evidence-based Therapy

• Evidence on efficacy of GBR and other techniques

Biology

• Biology of wound healing
• Biology of osteogenesis
• Biology of growth factors
• Integration of various bone graft material

Flap Design:

• Flap design in posterior maxilla
• Flap design in posterior mandible
• Flap design in anterior maxilla
• Flap design in anterior mandible
• Achieving tension-free flap
• Management of failed sites with scarred periosteum
• Pedicle flap
• VISTA: vestibular access for bone augmentation

Regenerative techniques:

• Block grafting
• Cortical Shell technique
• Guided bone regeneration (GBR)
• Tent-pole technique

Suture material and techniques:

• Suture techniques for effective flap adaptation
• Resorbable vs non-resorbable suture
• Prevention of graft exposure