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The materials offered in the ITI Treatment Guide are for educational purposes only and intended as a step-by-step guide to treatment of a particular case and patient situation. These recommendations are based on conclusions of the ITI Consensus Conferences and, as such, in line with the ITI treatment philosophy. These recommendations, nevertheless, represent the opinions of the authors. Neither the ITI nor the authors, editors and publishers make any representation or warranty for the completeness or accuracy of the published materials and as a consequence do not accept any liability for damages (including, without limitation, direct, indirect, special, consequential or incidental damages or loss of profits) caused by the use of the information contained in the ITI Treatment Guide. The information contained in the ITI Treatment Guide cannot replace an individual assessment by a clinician, and its use for the treatment of patients is therefore in the sole responsibility of the clinician.

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“… to promote and disseminate knowledge on all aspects of implant dentistry and related tissue regeneration through education and research to the benefit of the patient.”

Acknowledgment

We would like to thank Mr. Thomas Kiss of the ITI Center for his invaluable assistance in the preparation of this volume of the Treatment Guide series. We would also like to express our gratitude to Ms. Juliane Richter (Quintessence Publishing) for typesetting and for coordinating the production workflow, Mr. Per N. Döhler (Triacom Dental) for their editing support, and Ms. Ute Drewes for her excellent illustrations. We also acknowledge continuing support from Straumann AG, ITI’s corporate partner.

Editors and Authors

Contributors

Augmentation procedures to increase the volume of deficient or atrophic alveolar bone have been extensively described in the literature. They are widely performed by numerous surgeons all over the world in an effort to safely place implants where they can support an adequate functional and esthetic prosthesis.

The past few years have seen the development of surgical techniques to deal with bone defects of almost any shape or size, regardless of whether they result from ridge atrophy, trauma, inflammation, tumors, or malformation. Ridge augmentation may, however, run up against limitations and complications for a number of reasons, such as general health issues, dental status, extent and location of the bone defect, patient preference, reluctance to undergo major surgical procedures, or budget considerations.

Generally speaking, the prognoses for implant survival are no less favorable in regenerated bone than in pristine bone.

•Function: to create a volume of vital bone that will accommodate a dental implant sufficiently long and wide for its ideal restorative and functional position.

•Esthetics: to give the associated soft tissues the bony support needed for an esthetic appearance of gingival/mucosal and facial structures.

•Prognosis: to create sufficient bone volume coronally around the neck of the implant to cover the endosseous implant segment, ensuring a tight softtissue seal and a predictable long-term prognosis of the implant.

Secondary goals in selecting a specific approach would be to keep the surgical technique straightforward, to minimize the surgical and postoperative burden for the patient, to ensure low morbidity, and to reduce the number of surgical sessions. Consideration is also given to cost, predictability, and healing time. Clinicians should realize that there may be one or several restorative options to meet the functional and esthetic requirements of a given patient. It is the treatment provider’s responsibility to study these options, propose the best solution and then present the patient with the expected outcome of this favored restorative strategy either in the form of a provisional denture setup and try-in or within an appropriate software environment. In doing so, the patient will have a clear understanding and no misconceptions about the appearance of the final prosthesis. This early preview of the treatment endpoint will clearly disclose any need for bone augmentation procedures to correct deficiencies in the underlying hard and soft tissues.

Anticipating patient requirements in this way has come to be known as “backward planning” and the treatment strategies derived from it as “restoration-driven” (or “prosthetically driven”) approaches. It is part of this rationale that a dentist, rather than accepting a restorative compromise, should consider reconstructing the bone to meet the restorative needs.

Also, there should be no reason for clinicians to withhold from their patients useful procedures of bone augmentation merely because they personally lack the skills to conduct these procedures on their own. It is better to refer a patient to an oral or maxillofacial surgeon than to accept a compromise that may be limiting to the restorative outcome. That said, the referring clinician should still have a good knowledge in the basics of bone augmentation and related options to advise their patients correctly, and it is important to ensure good collaboration between all members of the clinical team.

The focus of this volume will be on procedures of ridge augmentation performed on healed sites in preparation for delayed implant placement. This approach, here called the “staged” approach (which does not imply that the augmentation procedure itself consists of multiple stages) differs from simultaneous procedures of bone augmentation and implant placement in that they are broken down into an initial surgical session to augment the ridge and a second session for implant placement further down the line. The simultaneous approach is not extensively discussed in this volume. Procedures of sinus floor elevation have been covered extensively in Volume 6 of this ITI Treatment Guide series, and the reader is referred to Volume 3 for details on bone augmentation to support implant procedures in postextraction sites.

It is the authors’ ambition to provide the reader with a systematic way of assessing bone defects that may underlie specific clinical situations and to offer guidelines toward selecting the most appropriate surgical strategies to deal with specific defect types.

Various groups were appointed to deal with different topics at the 4th ITI Consensus Conference in Stuttgart in 2008. Group 4 was assigned to review surgical techniques and biomaterials used in implant dentistry and to evaluate the available evidence supporting their use. Two of four review papers that had been prepared for Group 4 were devoted to materials and methods for ridge augmentation:

•Simon Storgård Jensen and Hendrik Terheyden: Bone augmentation procedures in localized defects in the alveolar ridge: Clinical results with different bone grafts and bone-substitute materials. A review (Jensen and Terheyden 2009)

•Matteo Chiapasco, Paolo Casentini and Marco Zaniboni: Bone augmentation procedures in implant dentistry (Chiapasco and coworkers 2009).

These review papers formed the basis for discussing and subsequently formulating a series of consensus statements and recommendations for clinical procedures (Chen and coworkers 2009). Section 2.1 summarizes the consensus statements and clinical recommendations pertaining to ridge augmentation procedures. Section 2.2 will then update the reader on the more recent literature that has been added since these consensus statements were published in 2009.

2.1	Consensus Statements and Treatment Guidelines Formulated at the 2008 ITI Consensus Conference

2.1.1Consensus Statements

General statements

•Several surgical procedures are available and effective for the augmentation of deficient edentulous ridges to allow implants to be placed. However, most of the studies are retrospective in nature, with small sample sizes and short follow-up periods.

•Therefore, direct comparisons between studies should not be made and definitive conclusions cannot be drawn.

•There are a variety of defect situations with increasing complexity ranging from fenestrations, to dehiscences, to lateral deficiencies, and to vertical deficiencies including combinations of these.

•There are a variety of augmentation materials available with different biologic and mechanical properties ranging from particulate alloplastic materials to intraorally harvested block grafts.

•Survival rates of implants placed in regenerated bone after treatment of localized defects in the alveolar ridge are comparable to survival rates of implants placed in native bone.

•It was not possible to demonstrate the superiority of one augmentation technique over another based on implant survival rates.

Dehiscence- and fenestration-type defects

•Augmentation of dehiscence- and fenestration-type defects is effective in reducing the amount of exposed implant surface. Complete resolution of dehiscence and fenestrationtype defects cannot be predictably accomplished irrespective of the grafting protocol employed.

•Increased defect fill was observed when the augmentation procedure included the use of a barrier membrane.

•Survival rates of implants placed simultaneously with augmentation of dehiscence or fenestration type defects are high.

Horizontal ridge augmentation

•Techniques are available to effectively and predictably increase the width of the alveolar ridge.

•Augmentation utilizing autologous bone blocks with or without membranes results in higher gains in ridge width and lower complication rates than the use of particulate materials with or without a membrane.

•Survival rates of implants placed in horizontally augmented alveolar ridges are high.

Vertical ridge augmentation

•Techniques are available to increase the height of the alveolar ridge. However, their predictability is substantially lower compared to horizontal ridge augmentation procedures.

•Augmentation utilizing autologous bone blocks with or without membranes results in higher gains in ridge height than the use of particulate materials with or without a membrane.

•The complication rate related to vertical augmentation of the alveolar ridge is substantially higher compared to horizontal ridge augmentation procedures.

•Survival rates of implants placed in vertically augmented alveolar ridges are high.

Maxillary sinus floor elevation using the transalveolar approach

•Maxillary sinus floor elevation using the transalveolar approach is predictable for augmenting bone in the posterior maxilla.

•A variety of grafting materials can be safely and predictably used, alone or in combination. These materials include autografts, allografts, xenografts, and alloplastic materials.

•At present, it is not clear whether the introduction of a grafting material improves the prognosis.

Onlay bone grafting of extended resorption of edentulous ridges

•Autologous onlay bone grafting procedures are effective and predictable for the correction of severely resorbed edentulous ridges to allow implant placement. An uneventful healing/consolidation of grafts taken from intra- and/or extraoral donor sites occurs in the majority of cases.

•Acceptable survival rates of implants placed in maxillae and mandibles reconstructed with autologous onlay bone grafts are reported. The survival rates are slightly lower than those of implants placed in native bone.

Maxillary sinus floor elevation using the lateral approach

•Maxillary sinus floor elevation procedures are predictable for augmenting bone in the posterior maxilla.

•A variety of grafting materials can be safely and predictably used, alone or in combination. These materials include autografts, allografts, xenografts, and alloplastic materials.

•The use of autografts does not influence survival rates of rough surface implants, but may reduce healing times.

•The quantity and quality of bone in the residual maxilla influence survival rates of implants independently from the type of grafting procedure.

•Survival rates of rough surface implants placed in augmented maxillary sinuses are similar to those of implants inserted in native bone.

Split-ridge/ridge expansion techniques with simultaneous implant placement

•Split-ridge and expansion techniques are effective for the correction of moderately resorbed edentulous ridges in selected cases.

•Survival rates of implants placed at sites augmented using split-ridge/ridge expansion techniques are similar to those of implants inserted in native bone.

Split-ridge technique with interpositional bone grafts

•There is a lack of evidence concerning the split-ridge technique with interpositional bone graft and delayed implant placement.

Vertical distraction osteogenesis

•Alveolar distraction osteogenesis can be used to augment vertically deficient alveolar ridges in selected cases.

•Alveolar distraction osteogenesis has a high rate of complications. These include change of the distracting vector, incomplete distraction, fracture of the distracting device, and partial relapse of the initial bone gain.

•Survival rates of implants placed at sites augmented using distraction osteogenesis are similar to those of implants inserted in native bone.

Le Fort I osteotomy with interpositional autologous bone grafts

•Le Fort I osteotomy with interpositional autologous bone graft can be used successfully to treat atrophy of the maxilla including cases associated with severe intermaxillary discrepancy.

2.1.2Treatment Guidelines

Bone augmentation procedures should always follow a prosthetically driven plan to allow ideal three-dimensional implant positioning. The concept of “prosthetically driven bone augmentation” should be taken into consideration whenever possible.

Localized defects

•Dehiscence and fenestration-type defects may be successfully managed using a particulate autograft or bone substitute covered with a membrane.

•Horizontal ridge augmentations often require the use of an autologous block graft, which may be combined with a membrane and/or a particulate autograft or bone substitute.

•Vertical ridge augmentations most often require the use of an autologous block graft, which may be combined with a membrane and/or a particulate autograft, allograft, or xenograft. Despite the use of an autologous block graft, elevated rates of complications, including graft resorption, and a need for additional grafting have to be anticipated. Even localized vertical bone deficiencies may require advanced surgical procedures like distraction osteogenesis, interpositional grafts, or onlay grafts from extraoral donor sites.

•The clinician should be aware that the obtainable defect fill decreases and complication rates and need for additional grafting procedures increase with more demanding defect types. The augmentation material should be selected according to the biological and mechanical characteristics needed in the specific clinical situation.

•The use of a membrane is indicated whenever a particulate material is applied.

Autologous onlay bone grafting of severely resorbed edentulous ridges

•Onlay bone grafting is a technique-sensitive procedure and is recommended only for well-trained clinicians.

•Both intraoral donor sites (including the mental symphysis, the mandibular body and ramus, and the maxillary tuberosity) and extraoral donor sites (including the iliac crest and the calvarium) can be used for collecting autologous bone.

•The choice between intraoral and extraoral sites is mainly related to the quantity of bone necessary to reconstruct the deficient alveolar ridge. Preference should be given to donor sites where the cortical component is more prevalent, in order to reduce the risk of early or late resorption of the graft.

•Bone harvesting from the mental symphysis is associated with relevant morbidity, and the quantity of available bone is frequently limited. Neural damage to the incisal nerve occurs frequently. Therefore, the mental symphysis should not be the first choice for harvesting.

•Bone harvesting from the maxillary tuberosity is followed by low morbidity but is not well documented. The quality and quantity of available bone is often poor. Indications are limited to reconstruction of small defects.

•Bone harvesting from the mandibular ramus offers good quality and quantity of available bone, due to the possibility of harvesting from both sides.

•Bone harvesting from the iliac crest offers high quantities of bone. However, the cancellous bone component is dominant and may be associated with a higher risk of unpredictable bone resorption. When bone is harvested from the anterior iliac crest there may be associated transient gait disturbances.

•Bone harvesting from the calvarium offers greater quantities of highly corticalized bone and is associated with low morbidity.

•Accurate modeling and stabilization of the graft with screws, and tension-free primary closure of the overlying flaps, are fundamental to the success of the procedure. Overcorrection of the defect is recommended to compensate for the potential risk of bone resorption. Coverage of the bone grafts with a lowresorption-rate xenograft/alloplastic material, with or without a membrane, may be indicated to reduce bone resorption.

•The economic and biologic costs of bone transplantation must be carefully weighed. In selected clinical situations short and/or reduced-diameter implants may be considered instead.

•The severely atrophic edentulous maxilla frequently needs bone grafts due to poor quality of the residual bone and the presence of pneumatized cavities, including the maxillary sinus and the nose.

•Both implant placement in conjunction with bone grafting and delayed implant placement have been proposed. Delayed implant placement is recommended.

Split-ridge/ridge-expansion techniques

•Split-ridge/ridge-expansion techniques are indicated in selected situations where atrophy of the edentulous ridge has developed horizontally and cancellous bone is present between the oral and facial cortical plates, and adequate residual height exists.

•Excessive facial inclination of the alveolar ridge may contraindicate this procedure, as it may worsen the initial situation from a prosthetic point of view.

•The presence of undercuts may increase the risk of bone fracture.

•This technique is mainly indicated in the maxilla. Ridge expansion in the mandible is frequently difficult due to the brittleness of the bone.

Vertical distraction osteogenesis

•Vertical distraction osteogenesis is a technique-sensitive procedure and is recommended for well-trained clinicians.

•Indications of this technique should be limited to vertically deficient ridges with adequate residual width. As the segment to be distracted has to be at least 3 mm in height, severely deficient mandibles are not good candidates due to the risk of neural damage and/or mandibular fracture.

•The presence of maxillary sinus and/or nasal cavities may be contraindications.

•The rigidity of the palatal mucosa may negatively influence the distraction vector.

Le Fort I osteotomy with interpositional autologous bone grafts

•Le Fort I osteotomy with interpositional autologous bone grafts is indicated in cases of extremely severe resorption, and where there is an unfavorable horizontal and vertical intermaxillary relationship.

•This procedure is technique-sensitive and is recommended for well-trained clinicians.

Sinus floor elevation using the lateral approach

•In sites with limited initial bone height not allowing insertion of the desired implant length, sinus floor elevation via the lateral approach can be used to increase the bone height.

•As atrophy of the maxilla occurs three-dimensionally, the edentulous posterior maxilla should not only be evaluated in terms of initial bone height below the maxillary sinus but also in relation to any vertical and horizontal ridge deficiencies. If relevant vertical/horizontal intermaxillary discrepancy is present, an onlay bone augmentation may be considered to create both sufficient bone volume and proper intermaxillary relationships, to optimize implant placement and related prosthetic restoration.

•Data related to the initial clinical situation should be reported, and defects classified according to well-defined criteria.

•If the initial bone height allows primary implant stability, simultaneous implant placement (one surgical stage) can be recommended. In situations where primary stability cannot be achieved, the elevation of the sinus floor should be performed in a separate surgical procedure followed by delayed implant insertion (two surgical stages).

•Rough-surfaced implants should be utilized. Coverage of the access window with a membrane may be considered when bone substitutes are used as the only grafting material.

Sinus floor elevation using the transalveolar approach

•Sinus floor elevation using the transalveolar approach can be recommended in sites with sufficient alveolar crest width, initial bone height of 5 mm or more, and relatively flat sinus floor anatomy.

•The main disadvantage of this technique is possible perforation of the sinus membrane, which is difficult to detect and to manage. Therefore, the transalveolar technique should only be performed by clinicians with experience in performing sinus floor elevation via the lateral approach.

•A prerequisite for using this technique is that primary implant stability is achieved.

2.1.3Treatment Outcomes

The following treatment outcomes were reported for the 4th ITI Consensus Conference in the review papers of Jensen and Terheyden (2009) and Chiapasco and coworkers (2009).

Treatment of dehiscence defects

Clinical treatments of dehiscence defects were associated with 5-year implant survival rates of 94% to 100% depending on the methods applied. Defect fill varied between 76% and 79% when a barrier membrane was used without filler. In the presence of a filler, defect fill varied between 84% and 87%, the best results being obtained with deproteinized bovine bone mineral (DBBM) in the form of Bio-Oss® (Geistlich, Waldenburg, Switzerland) in conjunction with a resorbable non-crosslinked collagen membrane (Bio-Gide®; Geistlich).

Staged horizontal ridge augmentation

Staged procedures of horizontal ridge augmentation were associated with 5-year implant survival rates of 97% to 100% depending on the methods applied. Gains in ridge width varied between 3.2 and 4.7 mm depending on the materials used. The best results were obtained with mixtures of DBBM and particulated autologous bone, including the use of a resorbable membrane. The smallest gains in width were reported with allografts.

Staged vertical ridge augmentation

Staged procedures of vertical ridge augmentation were associated with 5-year implant survival rates of 97% to 100% depending on the methods applied. Gains in ridge height varied between 3.6 and 9.2 mm depending on the materials used. The greatest gains were obtained with iliac onlay grafts and the smallest ones with mixtures of DBBM and particulated autologous bone.

Complication rates

Complication rates of 12% to 26% were reported for single-stage augmentation of dehiscence defects, mainly including soft-tissue dehiscences and wound infections. The highest rates of membrane exposure were generally observed with membranes consisting of expanded polytetrafluoroethylene (ePTFE).

Staged procedures of horizontal augmentation were found to involve a wide variety of complication rates, averaging between 5% and 43% across the reviewed studies. The 43% rate was again reported for ePTFE membranes and was mainly a function of membrane exposure. For the other materials, the mean complication rates were generally 5%.

Vertical procedures involved higher complication rates than horizontal ones, ranging from 14 to 26% of cases. The lowest rate was identified for intraoral block grafts, the highest rate for iliac bone harvesting – the latter predominantly involving complications of postoperative pain at the donor site and gait disturbances.

2.2	Literature Review
	L. Cordaro

Several reviews have been devoted to alveolar bone augmentation techniques. Most of the studies were intended to demonstrate the usefulness of specific techniques of alveolar bone reconstruction by reporting treatment outcomes, complications, and success rates for the reconstructed bone areas, the inserted implants, and perhaps the prostheses (Jensen and Terheyden 2009; Chiapasco and coworkers 2009; Aghaloo and Moy 2007).

The results of these systematic reviews indicate that numerous reconstructive techniques have been demonstrated to be relatively safe and effective, including:

•Grafting with autologous bone blocks

•Lateral sinus floor elevation with bone grafting materials

•Transcrestal sinus floor elevation with osteotomes or other purpose-designed instruments

•Simultaneous or staged GBR with barrier membranes and bone grafts and/or substitutes

•Horizontal ridge splitting/expansion with osteotomes or devices

•Vertical or horizontal distraction osteogenesis

•Osteotomies with jaw repositioning and grafting

Staged or simultaneous procedures to augment the jawbone are widely performed with different techniques and varying outcomes by clinicians around the world.

However, since the majority of these clinical studies were not governed by well-defined inclusion criteria, most of the available data have to do with the augmentation procedures themselves without focusing on the clinical baseline situations. Some studies on GBR, for instance, reported treatment outcomes in patients with partially and completely edentulous jaws who had presented with dissimilar defect types at baseline. This lack of information on initial defect situations makes it difficult for clinicians to arrive at evidence-based decisions about what method of augmentation they should preferably use on a given clinical defect.

This volume of the Treatment Guide series is intended to guide clinicians faced with different types of edentulism and defect types in selecting the most appropriate clinical procedure in each clinical situation. In Chapter 3, a classification of the defect-types will be presented, and in Chapter 4 a schematic description of the preferred surgical approach for the given baseline clinical situation will be provided. These clinical recommendations are based on the outcomes of a recent systematic review which was undertaken to identify the clinical indications for various bone augmentation procedures in relation to defect type and dimensions (Milincovic and Cordaro 2013).

The literature search for this review was performed in the Medline (PubMed) and Cochrane Library databases, using search criteria that returned any pertinent clinical trials published between 1990 and 2012, and supplemented by a hand search of the most relevant journals.

All types of clinical investigations were considered, including controlled clinical trials with or without randomization, prospective and retrospective studies and including papers that presented data on augmentation volumes while not reporting all outcome measures.

Inclusion criteria

•Information on defect type (fenestration defects, dehiscence defects, vertical or horizontal or combined defects in partially or completely edentulous jaws)

•Information on pre- and postoperative ridge dimensions and on bone gains

Applicable criteria for completely edentulous jaws were confined to information on ridge and defect characteristics and on bone gains.

Exclusion criteria

•Surgery performed simultaneously with immediate implant placement into fresh extraction sockets (type 1, ITI classification)

•Sinus floor augmentation without additional ridge augmentation

•Case reports

•Reports on techniques not disclosing clinical outcomes

•Studies providing histological data only

•Surgery preceded by peri-implantitis, trauma, tumor ablation, or treatment of various medical syndromes

Treatment outcomes extracted for review

•Pre- and postoperative defect sizes and/or postoperative bone gains (reported as defect fill or linear bone gain)

•Implant survival and success rates at augmented sites

•Implant failure rates

•Complication rates

All studies meeting the inclusion criteria were grouped by types of edentulism (partial or complete), defect types (fenestration, dehiscence, horizontal, vertical), and techniques of augmentation. In this way, the authors were able to relate the outcomes of augmentation procedures to defect types and dimensions. Studies not disclosing the initial situations were excluded because they offered no insights into indications for specific procedures.

2.2.1Included Studies

The review included 35 studies on horizontal defects in partially edentulous cases—16 of them with GBR performed at the time of implant placement, 5 with staged GBR, 8 with block grafts, and 6 with ridge splitting/expansion. A total of 19 studies covered vertical defects in partially edentulous cases—4 with simultaneous GBR, 2 with staged GBR, 6 with block grafts, and 7 with distraction osteogenesis. Edentulous jaws were covered by 15 studies—9 with block grafting for vertical or horizontal augmentation or both, and 6 with Le Fort I osteotomies.

2.2.2Patients with Partially Edentulous Jaws

Illustrations:	Ute Drewes, CH-Basel, www.drewes.ch
Copyediting:	Triacom Dental, D-Barendorf, www.dental.triacom.com
Graphic Concept:	Wirz Corporate AG, CH-Zürich
Production:	Juliane Richter, D-Berlin

1	Introduction H. Terheyden, L. Cordaro
2	Consensus Statements on Ridge Augmentation and Review of the Literature
2.1	Consensus Statements and Treatment Guidelines Formulated at the 2008 ITI Consensus Conference
2.1.1	Consensus Statements
2.1.2	Treatment Guidelines
2.1.3	Treatment Outcomes
2.2	Literature Review L. Cordaro
2.2.1	Included Studies
2.2.2	Patient with Partially Edentulous Jaws
2.2.3	Patients with Completely Edentulous Jaws
2.3	References of the Systematic Review
3	Preoperative Assessment and Planning L. Cordaro
3.1	Anatomy
3.1.1	Bone Quality and Quantity for Implant Placement
3.1.2	Resorption Patterns in the Edentulous Maxilla and Mandible
3.1.3	Bone Situation at Adjacent Teeth
3.1.4	Periodontal Evaluation of Adjacent Teeth
3.1.5	Anatomical Limitations and Risks
3.2	Medical History
3.2.1	Risk Factors Jeopardizing the Success of Surgical and Restorative Treatment
3.2.2	Systemic Conditions Involving an Increased Risk of Medical Complications
3.3	Clinical Examination and Planning Aids
3.3.1	Study Casts and Diagnostic Wax-Up
3.3.2	Radiographic Examination and Planning
3.4	Alternatives to Staged Augmentation
3.4.1	Type of Edentulism and Defect Type
4	Methods for Ridge Augmentation H. Terheyden, L. Cordaro
4.1	The GBR Principle
4.2	Flap Design and Surgical Access for Ridge Augmentation
4.3	Healing of Autologous Bone Block Grafts
4.4	Harvesting Autologous Bone from Intraoral Sites
4.4.1	Harvesting Bone from the Mandibular Ramus
4.4.2	Bone Harvesting from the Anterior Mandible (Chin)
4.5	Harvesting of Autologous Bone from Extraoral Sites
4.5.1	Iliac Bone Grafts
4.5.2	Calvarial Bone
4.5.3	Other Extraoral Sites
4.6	Bone Quality and Quantity
4.7	Biomaterials: Selection of Bone Substitutes and Membranes
4.8	Mixed Bone Grafts
4.9	Fixation of Block Grafts Using Plates and Screws
4.10	Prevention of Premature Graft Resorption
4.11	Simultaneous Versus Staged Augmentation
4.12	Surgical Planning for Ridge Augmentation in the Esthetic Zone
4.13	Augmentation Protocols
4.13.1	Dehiscence Defects and Fenestrations
4.13.2	Onlay Graft for Lateral Ridge Augmentation (Staged Procedure)
4.13.3	Ridge Splitting for Lateral Ridge Augmentation
4.13.4	Vertical Ridge Augmentation
4.13.5	Shell Technique for Vertical Augmentation
4.13.6	Interpositional Graft for Vertical Augmentation
4.13.7	Swinging Interpositional Graft for Vertical and Horizontal Augmentation
4.13.8	Interpositional Graft for Vertical Augmentation in the Maxilla (Le Fort I Level)
4.14	Guidelines for Selecting the Appropriate Augmentation Protocol
4.15	Wound Infection Prophylaxis and Antibiotics
4.16	Medications and Postoperative Care
4.17	Provisional Prostheses
5	Implant Placement in Augmented Sites and Treatment Outcomes H. Terheyden, L. Cordaro
5.1	Implant Placement in Augmented Sites
5.1.1	Healing Time of Bone-Block and GBR Reconstructions
5.1.2	Re-entry Stage and Removal of Osteosynthesis Materials
5.2	Treatment Outcomes after Implant Placement
5.2.1	Implant Survival
5.2.2	Augmentative Effects of Different Materials and Techniques
5.2.3	Complication Rates of Different Materials and Techniques
6	Clinical Case Presentations
6.1	Autologous Block Graft and Guided Bone Regeneration (GBR) for Horizontal Ridge Augmentation in the Anterior Maxilla D. Buser, U. Belser
6.2	Staged GBR with Allogeneic Particulate Grafting Material for Single-Tooth Replacement E. Lewis, F. Lozano
6.3	Guided Bone Regeneration (GBR) with a Particulated Autologous Graft and an ePTFE-Reinforced Membrane for Vertical Augmentation of a Single-Tooth Edentulous Space in the Esthetic Zone P. Casentini
6.4	Autologous Block Graft and Guided Bone Regeneration (GBR) for Horizontal Ridge Augmentation in the Posterior Mandible D. Buser, B. Schmid
6.5	Autologous Iliac-Crest Graft for Anterior Blocks and Bilateral Sinus Floor Elevation in a Completely Edentulous Maxilla W. D. Polido, P. E. Pittas do Canto
6.6	Ridge Preservation and Implant Placement for a Fixed Dental Prosthesis After a Car Accident M. Roccuzzo
6.7	Shell Technique for Horizontal and Vertical Maxillary Bone Augmentation in a Partially Edentulous Patient with Aggressive Periodontal Disease Luca Cordaro
6.8	Horizontal Augmentation with Iliac Bone Grafts in the Treatment of Non-Syndromic Oligodontia D. Weingart
6.9	Bilateral Horizontal Ridge Augmentation with Block Bone Grafts Using a Piezoelectric Device for Fixed Implant Restoration Y.-D. Kwon
6.10	Iliac and Calvarial Bone Blocks for Onlay Grafting of a Severely Resorbed Edentulous Maxilla M. Chiapasco, P. Casentini
6.11	Iliac-Crest Block for Vertical and Horizontal Space Filling in the Anterior Maxilla W. D. Polido, J. E. Roehe Neto
6.12	Le Fort I Interpositional Graft and Mandibular Sandwich Osteotomy for Maxillofacial Rehabilitation after Severe Periodontitis H. Terheyden
7	Management of Complications H. Terheyden
8	Conclusions L. Cordaro, H. Terheyden
9	References

Preface

Acknowledgment

Editors and Authors

Contributors

Table of Contents

S. Chen	D. Buser	D. Wismeijer