Neil, a dentist, asks us:
I was wondering what the general surgical opinion was about attempting vertical ridge augmentation, when more than 4mm height is desired.
The literature appears to state that about 5mm is the
average gain using either distraction osteogenesis, sandwich osteotomy
or a titanium reinforced membrane with implants (i.e. Simion).
I would appreciate your thoughts about any of these techniques, or others that have worked well in your hands. Thanks.
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FROM 4 TO 7 MM YOU CAN USE A 8 TO 10 MM IMPLANT WITH A VERTICAL SINUS AUGMENTATION TECHNIQUE. LESS THAN 4 I WOULD USE THE TRADITIONAL WAY (TATUUM, WAIT FOR 9 TO 12 MONTHS AND THEN GO FOR THE IMPLANTS.
IF YOU WANT A VERY SIMPLE AND LESS INVASIVE TECHNIQUE FOR VERTICAL AUGMENTATION, YOU MAY USE DE HYDRAULIC ONE.
I think he meant vertical ridge not sinus augmentation.
I disagree with your numbers. Distraction is a great tool since there is no limitation on the amount of bone you can grow. There are obviously limiting factors such as surrounding anatomy etc to consider. Distraction is sometimes superior than grafting techniques when there is limited soft tissue available, since the soft tissues grow slowly with the distraction, you get not only hard tissue growth but also soft tissue growth.
For 4 mm of bone height, depending on how much bone you have available above the inferior alveolar nerve and how much keratinized tissue to work with, distraction may still be your best option. Second best would be a free graft, ie particulate graft with autogenous and allograft/xenograft mixture and a membrane, or sandwich graft.
One technique I use is placing the implants in their *final* position. Should look like the implant platforms are placed and the implants are sticking out of the bone with 4 mm of threads exposed. Do not over sink the implants or else you will short change your graft. Packing the area with a particulate graft to cover the implant surfaces and placing holes in the membrane so the cover screws can hold the membrane during osseointegration.