From practitioner to practitioner - ZZI 03/2011

Comparison of lateral augmentation techniques
Spreading of the alveolar ridge, augmentation with autologous bone blocks and
membrane augmentation in the dental practice

Our own data obtained by the omnibus test of the logistic regression disclose that the model fits the data well, however, the explanatory power of the model is only moderate. This leads to the conclusion that the occurrence of complications is likely to be significantly affected by other factors. One of the factors to be considered is that an inhomogeneous group of patients was examined. The only exclusion criteria were the indication restrictions stipulated in the guidelines of the DGZMK. This means, for example, that the group of patients consisted of both smokers and non-smokers. The standard of domestic oral hygiene varied from patient to patient. Previous periodontal diseases were not taken into consideration. All patients due to receive bone block and membrane augmentations were given antibiotics. The surgeons either administered Clindamycin orally (for three days, starting one day prior to the operation) or Penicillin G intravenously, prior to the operation. The patients were not preselected according to the site and size of the defect. It was left to the dentists to decide which of the three treatment methods they were going to choose. In many cases, mainly where the treatment affected visible areas, spreading of the alveolar crest was not an option due to the uncertain aesthetic results. Despite the increased risk of complications, bone block augmentations are the better option where a perfect cosmetic appearance has to be restored. Likewise, spreading of the alveolar ridge is not a suitable method for augmenting bone segments in the posterior region of the mandible due to the hardness of the bone in that area which equals class I and II (according to Mish) [10]. This type of treatment is therefore limited to the anterior region in the absence of difficult cosmetic conditions and the posterior region of the maxilla. These restrictions are not included in the results of this investigation.

The basics of alveolar ridge spreading were already described by Summers [13, 14] in 1994. The lack of available data in literature described by Aghaloo indicates that this operative technique is not very widespread [5]. One of the likely reasons for this is that spiral osteotomes and oscillating bone saws have only been available for a few years. These have become increasingly popular due to their gentle operation and predictable results. It would therefore seem desirable to use this technique more frequently.

Summary

The present study shows that in the examined group of patients, the complication rate of the spreading of the alveolar ridge is significantly lower than that of bone block and membrane augmentations. The high sensitivity of the techniques complicates the transferability of statements concerning the success rates of the above described surgical methods. Likewise, there are few comparative studies and, due to the differing operative protocols, the results of these studies can only be compared to our own results to a limited extent.

We would like to expressly thank the company Gebr. Brasseler, Lemgo, for their support in the publication of the present manuscript.

 

Conflict of interests: Firma Gebr. Brasseler/Komet: Beratertätigkeit, Schulungen, Vorträge; Firma Dentsply Friadent: Vortragstätigkeit

Correspondence adress

Dr. Martin Dürholt

Marienstr. 1, 32105 Bad Salzuflen

Tel.: 05222 83800

E-Mail: info@dr-duerholt.de

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