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Tunnel Technique Vs Open Augmentation With PTFE Membrane for Horizontal Ridge Augmentation
Dental Implant Abstracts DENTAL IMPLANT MODULE: ABSTRACT/HOW I DO IT SESSION October 1, 2015, 1:30 PM-3:00 PM
Tunnel Technique Vs Open Augmentation With PTFE Membrane for Horizontal Ridge Augmentation G. R. Deeb: Virginia Commonwealth University, G. Wilson, U. Zafar, J. Golob Deeb Objective: This retrospective case series evaluated the outcomes of the tunnel technique without membrane placement compared to an open technique with PTFE membrane placement for horizontal ridge augmentation in the mandible and maxilla. Patients and Methods: A retrospective chart review of implant patients treated with the two techniques between 04/2013 and 11/2014 was done. Thirty (n=30)(57%) ridge augmentations were performed via open technique using a PTFE membrane secured with at least 3 titanium screws, while 23 (n=23)(43%) augmentations were completed using the tunnel technique without the use of a membrane as described by Block. Grafting material for both techniques consisted of a 50:50 mix of mineralized freeze-dried bone allograft and bovine-derived hydroxyapatite. All procedures were completed by senior level residents. Patients were followed until implants were placed. The following factors were compared for both techniques: number of visits needed prior to implant placement, dehiscence of the graft or membrane requiring removal of membrane or graft material prior to graft maturation, infection and/or need for antibiotics after the initial perioperative antibiotic course, cost of materials for the initial graft procedure, and percentage of augmented sites that were suitable to receive implants. Results: Within six months of bone grafting, 91% of patients with tunnel technique grafts received dental implants while 86% of patients with the open technique received dental implants (p < 0.05). 39% of membranes got exposed, but only 7% needed removal during the healing phase. Antibiotics were prescribed three times more frequently with the open technique (p<0.05). 65% of patients with open techniques had 5 or more postoperative visits related to complications, while only 11% of patients with tunnel technique had to be seen more than 3 times postoperatively (p<0.05). The average increased cost of materials for the open technique was $336 more than the tunnel technique. Conclusions: The results of this study suggest that for alveolar ridge defects that require horizontal augmentation prior to implant placement, the tunnel technique offers several advantages. The patients
e-6
required fewer postoperative visits, had lower infection rates and less need for systemic antibiotics during the healing phase, fewer required debridement or membrane removal during the healing phase, and overall cost was less.
Use of Transalveolar Sutures to Maintain Vestibular Depth and Keratinized Tissue Following Alveolar Ridge Reduction and Implant Placement for Mandibular Prosthesis G. R. Deeb: Virginia Commonwealth University Reconstruction of the totally edentulous patient with dental implants has become a routine treatment with predictable outcomes. Firm keratinized tissue surrounding the implants and adequate vestibular depth are among the determining factors for long-term implant success. In the staged approach of mandibular implant reconstruction, adequate vestibular depth as well as attached gingiva surrounding the implants can be readily established at the time of implant placement or when the implants are uncovered. However, in cases when extractions and necessary mandibular ridge reduction to create adequate width are done immediately prior to implant placement, maintaining adequate keratinized tissue around the implants, as well as preventing prolapse of the vestibule can present a challenging situation. The aim of this report is to present a technique that allows the surgeon to stabilize vestibular depth and at the same time position the flaps around the implants and preserve the attached gingiva.
Immediate Temporization of Esthetic Zone Implants Placed at the Time of Tooth Removal D. W. Nicholls: Utah Valley Regional Medical Center Immediate temporization of esthetic zone implants placed at the time of tooth removal has four advantages: 1. A single procedure for tooth removal and implant placement; 2. The time required to proceed to final restoration is reduced by 50 %, since osseointegration occurs concurrent with extraction site healing; 3. The peri-coronal tissues are supported by a high quality temporary crown, yielding a superior esthetic result; and
AAOMS 2015
Tunnel Technique Vs Open Augmentation With PTFE Membrane for Horizontal Ridge Augmentation G. R. Deeb: Virginia Commonwealth University, G. Wilson, U. Zafar, J. Golob Deeb Objective: This retrospective case series evaluated the outcomes of the tunnel technique without membrane placement compared to an open technique with PTFE membrane placement for horizontal ridge augmentation in the mandible and maxilla. Patients and Methods: A retrospective chart review of implant patients treated with the two techniques between 04/2013 and 11/2014 was done. Thirty (n=30)(57%) ridge augmentations were performed via open technique using a PTFE membrane secured with at least 3 titanium screws, while 23 (n=23)(43%) augmentations were completed using the tunnel technique without the use of a membrane as described by Block. Grafting material for both techniques consisted of a 50:50 mix of mineralized freeze-dried bone allograft and bovine-derived hydroxyapatite. All procedures were completed by senior level residents. Patients were followed until implants were placed. The following factors were compared for both techniques: number of visits needed prior to implant placement, dehiscence of the graft or membrane requiring removal of membrane or graft material prior to graft maturation, infection and/or need for antibiotics after the initial perioperative antibiotic course, cost of materials for the initial graft procedure, and percentage of augmented sites that were suitable to receive implants. Results: Within six months of bone grafting, 91% of patients with tunnel technique grafts received dental implants while 86% of patients with the open technique received dental implants (p < 0.05). 39% of membranes got exposed, but only 7% needed removal during the healing phase. Antibiotics were prescribed three times more frequently with the open technique (p<0.05). 65% of patients with open techniques had 5 or more postoperative visits related to complications, while only 11% of patients with tunnel technique had to be seen more than 3 times postoperatively (p<0.05). The average increased cost of materials for the open technique was $336 more than the tunnel technique. Conclusions: The results of this study suggest that for alveolar ridge defects that require horizontal augmentation prior to implant placement, the tunnel technique offers several advantages. The patients
e-6
required fewer postoperative visits, had lower infection rates and less need for systemic antibiotics during the healing phase, fewer required debridement or membrane removal during the healing phase, and overall cost was less.
Use of Transalveolar Sutures to Maintain Vestibular Depth and Keratinized Tissue Following Alveolar Ridge Reduction and Implant Placement for Mandibular Prosthesis G. R. Deeb: Virginia Commonwealth University Reconstruction of the totally edentulous patient with dental implants has become a routine treatment with predictable outcomes. Firm keratinized tissue surrounding the implants and adequate vestibular depth are among the determining factors for long-term implant success. In the staged approach of mandibular implant reconstruction, adequate vestibular depth as well as attached gingiva surrounding the implants can be readily established at the time of implant placement or when the implants are uncovered. However, in cases when extractions and necessary mandibular ridge reduction to create adequate width are done immediately prior to implant placement, maintaining adequate keratinized tissue around the implants, as well as preventing prolapse of the vestibule can present a challenging situation. The aim of this report is to present a technique that allows the surgeon to stabilize vestibular depth and at the same time position the flaps around the implants and preserve the attached gingiva.
Immediate Temporization of Esthetic Zone Implants Placed at the Time of Tooth Removal D. W. Nicholls: Utah Valley Regional Medical Center Immediate temporization of esthetic zone implants placed at the time of tooth removal has four advantages: 1. A single procedure for tooth removal and implant placement; 2. The time required to proceed to final restoration is reduced by 50 %, since osseointegration occurs concurrent with extraction site healing; 3. The peri-coronal tissues are supported by a high quality temporary crown, yielding a superior esthetic result; and
AAOMS 2015