Technique Selection

With this huge array of techniques to select from, one may wonder if there are specific indications for the different alveolar bone augmentation procedures. Systematic review by Milinkovic et al,⁴⁸ aimed to answer this question based on available evidence. They concluded that there is evidence to support use of:

1. GBR at the time of implant placement when dehiscence or fenestration defects are present.

2. Staged GBR for horizontal augmentation in preparation for implant placement when residual crest is 2.9 mm or wider.

3. Block bone grafts as a two-stage approach when the initial width of the ridge is at least 3.2 mm.

4. Ridge splitting and expansion techniques when horizontal deficiency when mean ridge width is at least 3.37 mm with presence of cancellous bone between the cortical plates.

5. Staged approach using either GBR or block grafts or distraction osteogenesis techniques for vertical height gain when 4-7 mm of vertical bone gain is needed.

The authors did note that there was significant heterogeneity and lack of precise description of the edentulous ridge defect in papers selected in this systematic review and hence one cannot extract clear indications for each augmentation technique still leaving the clinician the ultimate responsibility for the final choice. As a general rule, a surgical technique should be chosen in relation to the anatomy at presentation and the expected outcome.⁴⁸ One should be mindful that these procedures are technique – operator – experience sensitive and hence the clinicians expertise plays a significant role in assuring long-term success as much as patient selection and their post-implant therapy maintenance.