Introduction:
Bone augmentation, also known as bone grafting, is a procedure generally used when the current bone mass of the jaw is not apt for incorporating dental implants successfully. If there is minimal bone loss, minor bone augmentation, also referred to as simultaneous augmentation, can be utilized. It can be done during implant placement and increases the amount of bone around an implant to make sure the gums remain healthy.
When Is an Augmentation Procedure Necessary in Implant Dentistry?
Missing teeth can always be replaced by the best prosthetic option recommended by your dentist: implants. Dental implantation is not only a painless surgical procedure done under local anesthesia, just like any other surgical procedure, but it can restore long-term function and esthetic efficiency for the patient.
However, the main clinical challenge for the implant dentist remains how to compensate long term bone loss in edentulous patients. Suppose the tooth or teeth missing in question is immediately replaced after extraction or loss. In that case, the alveolar bone volume is not only regrown back to an extent around the dental implant, just as in the case of a natural tooth, but it would also create no further clinical additional procedures to be performed by the dentist like accessory strategies for augmenting bone with bone grafts or guided tissue regeneration procedures.
In clinical cases where there is chronic bone loss or even insufficient bone volume, then augmentation procedures are only the primary advanced modality to be adopted by the implantologist in current day implant dentistry for modifying the altered bone volume or resorptive processes that occur, which in fact, is an immediate process that follows an extraction of tooth loss.
What Is the Purpose of Bone Augmentation and Buccal Bone Preservation?
The purpose of bone augmentation is to achieve or help in the slow but sure eventual reconstruction of the bone volume to facilitate the procedure of dental implantation. Osseointegration, which is the phenomenon or science crucial to the dental implant fusion with the surrounding bone it is embedded in, is considered a complete process that depends only on one essential underlying factor for the long term success of the dental implant, which is the quality of the grafted bone and its stability.
Research shows that the lamella region of the buccal bone is considered the key factor for dental implant success. When this buccal bone undergoes resorption or is weakened by stress, trauma or local irritation, periodontal or gingival disease, or numerous other accessory factors that impact oral health like poor oral hygiene, chronic tooth loss that has led to tooth resorption or cases of systemic diseases, immune disorders, immunocompromised patients, etc., then there may be a risk of definitive implant failure more so in the long run because of the buccal bone loss. Hence the preservation of buccal bone is crucial to the success of the dental implant to be stable on the buccal implant surface.
What Is the Lateral Alveolar Ridge Augmentation Technique?
The lateral bone augmentation technique is used for bone graft success and, consequentially, dental implant success by achieving the correct bone volume needed for osseointegration or dental implant fusion to the alveolar bone.
Though this technique of lateral augmentation is majorly adopted for bone filling, preservation, remodeling, etc., it can be done through different techniques that vary from operator to operator. It will be done under computer controller operator-induced local anesthesia. However, the familiar principle the lateral augmentation technique utilizes is a barrier form used at a certain specific distance from the alveolar bone.
The barrier membrane materials would be either bone block grafts that are fixed with the help of osteosynthesis screws or they would be fixed by resorbable bone pins using a resorbable barrier material. In whichever case of the two clinical scenarios by the implant dentist, the fixation of this barrier is done at the alveolar crest. In this space or distance created between the alveolar bone and the barrier membrane or material used, the space is filled by usually using a particulate bone material or a suitable bone replacement or bone graft material.
Techniques: There are primarily two ways or techniques that have gained popularity in dental literature:
1. BBG-D or Bone Block Graft Technique: This technique is in which autologous bone block particles fill the space between the barrier and the alveolar ridge. The retromolar region of the mandibular ramus is used for obtaining bone slices.
2. Sonic Weld Rx Shell Technique (SWST): In this technique, the space between the barrier and alveolar ridge is filled by a mixture of both autologous bone block particles and a bone substitute material. In clinical conditions or scenarios where the donor region cannot be used extensively for grafting purposes, the second technique proves more beneficial or advantageous in conserving the donor region for isolating and obtaining the bone block material. In this technique, the buccal surface of the graft is constructed as an amorphous and resorbable layer that remains dimensionally stable for long-term graft and implant success.
Inclusion Criterion: For the lateral augmentation technique procedure to be successful certain inclusion criteria are necessary, such as:
Ideally, the patients should be above the age of 18 years, and the body growth should be complete for dentofacial stability of the bone graft and long-term implant success. There should be adequate bone width of the alveolar region of at least 2 mm to 3 mm, more so in thin buccal bone regions like in the case of the anterior maxilla. Preoperative assessment and implant planning should be done before the lateral augmentation bone procedure to confirm and crosscheck the underlying bone density and bone width available in the patient.
The Exclusion Criterion: Patients below 18 years of age because skeletal and dentofacial growth cannot be termed fully complete even after 16 years. Patients should not be on any medications like Bisphosphonate therapies or anticoagulants as they can interfere with bone remodeling and graft success. Other exclusion criteria include people with diabetes, coronary heart diseases, immunocompromised conditions, underlying systemic diseases, cancers, and oral tumors (benign or malignant).
Conclusion:
Hence as per this commonly advanced technique used by dental implantologists, the lateral augmentation technique's scope and purpose lie in the high survival rate for both bone grafts to compensate and maintain bone volumes for which the dental implant osseointegration or fusion is a pivotal factor indeed for long term success rates in dental implant cases.
