#TubulesLive Event: Principles of Bone Augmentation for Implant Dentistry

So here's a bit of catching up, one of the recent #TubulesLive events was with Koray Feran who spoke about the principles of bone augmentation in implant dentistry; is less really more?

Sinus lift augmentation and bone graft

So why do we need bone for implants?

  1. For the stability of the implant for primary placement but also during functional activity
  2. To create bone contour for the planning of an ideal prosthetic restoration
  3. Stability of peri-implant issues in the long term i.e. the volume and vascularity of bone which does not resorbs
Koray talked us through his presentation with a variety of cases he's treated. Each case demonstrated the advanced techniques that are now used to aid in the predictable placement of dental implants. Here are some of his main points from his talk:
  • Literature suggests that 8mm is desirable amount of vertical bone to place an implant, but anything above 6mm is acceptable
  • What is more important than height is the WIDTH of bone, therefore augmentation of bone width is more important than bone height
  • Recession around implants is caused by a lack of width of bone, the incorrect positioning of the implant or the bone around the implant resorbing over time
  • It has been shown that labial soft tissue thickness is related to bone width
  • Bone augmentation can either be particular or block grafting
  • You should generally approach treatment to minimise loss of tissue and maximise the natural healing process e.g. immediate implant placement, ridge preservation techniques, atraumatic extractions
  • You should also plan prosthetic restorations well with CT scans and 3D imaging
  • Implants in the aesthetic zone should be placed into the palatal bone to prevent recession
  • You should always try to augment thin labial plates to increase the quality of the soft tissue 
  • Graft material can be synthetic or autogenous - a novel way to contain a synthetic graft is with a titanium cage
  • Autogenous grafts can be harvested from the oblique ridge of the mandible but you will need to CT scan before you do this to check the position of the ID nerve
  • The problem with block autogenous bone grafts is that the bone isn't very vascular so it is not ideal to withstand occlusal forces
  • Augmenting a lower resorbed mandible can be difficult because of the ID nerve but also because it tends to resorb to a knife-edge. 
  • Bone-rings can also be used for bone augmentation which the implant will hold in the correct position - these can be set sizes or custom made
  • Bone-rings will revascularise better than autogenous block grafts

Have you used bone-rings or titanium cages when augmenting bone? Or do you have any other tips? Please leave your comments in the section below!

To see my posts about previous #TubulesLive events see here

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