Bone and Soft Tissue Augmentation in Implantology

Thanks also to the further Director of the Department of Cranio-Maxillofacial Surgery, University Hospital Münster, Prof. Dr. mult. Ulrich Joos, as well as to the actual Director, Prof. Dr. Dr. Johannes Kleinheinz, for their scientific support.

My sincere thanks go to the entire team at Quintessence Publishing, especially Dr. Horst W. Haase, Mr. Christian Haase, Mr. Johannes Wolters, and Mrs. Anita Hattenbach, for their support and patience over the years. Many thanks also to Mrs. Avril du Plessis for the excellent correction and editing as well as to Mrs. Ina Steinbrück for the perfect layout.

Finally, the most important thanks are for my wife, Michaela, and my children, Chantal, Elias, and Chérine, for their love, great support, and endless understanding.

Fouad Khoury

Olsberg, Easter 2021

Editor

KHOURY Fouad, DMD, PhD

Director

Privatklinik Schloss Schellenstein

Olsberg, Germany;

Professor

Department of Cranio-Maxillofacial Surgery

University Hospital Münster, Germany

GRUBER Reinhard, DMD, PhD

Professor and Chair

Department of Oral Biology

School of Dentistry

Medical University of Vienna, Austria

HANSER Thomas, DMD, M.Sc.

Deputy Director

Privatklinik Schloss Schellenstein

Olsberg, Germany;

Senior Academic Lecturer

Department of Postgraduate Education

Goethe University Frankfurt, Germany

KEEVE Philip L., DMD, M.Sc.

Private Office for Periodontology and Oral Surgery

Hameln, Germany

KHOURY Charles, DDS, DES, CES, M.Sc.

Professor

Department of Prosthodontics

School of Dentistry

St. Joseph University, Beirut, Lebanon

NEUGEBAUER Joerg, DMD, PhD

Professor

Steinbeis University Berlin, Transfer-Institut, Management of Dental and Oral Medicine;

Senior Academic Lecturer

Interdisciplinary Department for Oral Surgery and Implantology

Department of Craniomaxillofacial and Plastic Surgery

University of Cologne, Germany;

Senior Oral Surgeon

Group Office for Implantology, Dr. Bayer and colleagues, Landsberg am Lech, Germany

ZOELLER Joachim, MD, DMD, PhD

Professor and Chairman

Interdisciplinary Department for Oral Surgery and Implantology

Department of Craniomaxillofacial and Plastic Surgery

University of Cologne, Germany

Foreword

Foreword of the first edition

Preface

Acknowledgments

Editors and Contributors

1 Biology of bone regeneration in augmentative procedures

Reinhard Gruber

1.1 Introduction

1.2 Cells of bone remodeling

1.3 Biology of bone regeneration

1.4 Autograft resorption

1.5 Osteoconductive characteristics of autografts

1.6 Osteogenic properties of autografts

1.7 Osteoinductive properties of autografts

1.8 Summary

1.9 References

2 Diagnosis and planning of the augmentation procedure

2.1 Introduction

2.2 Patient consultation

2.3 Anamnesis

2.4 Specific findings

2.5 Choice of grafting technique

2.6 Conclusion

2.7 References

3 Soft tissue management and bone augmentation in implantology

3.1 Introduction

3.2 The basics of incisions, suturing techniques, and soft tissue healing

3.3 Instruments

3.4 Soft tissue management before augmentation

3.5 Soft tissue management during augmentation and implantation

3.6 Soft tissue management during implant exposure

3.7 Soft tissue management following prosthetic restoration

3.8 References

4 Mandibular bone block grafts: diagnosis, instrumentation, harvesting techniques, and surgical procedures

4.1 Introduction

4.2 Biologic procedure for mandibular bone grafting

4.3 Techniques and methods for intraoral bone harvesting

4.4 Augmentation techniques

4.5 Bone remodeling and volume changes after grafting

4.6 Conclusion

4.7 References

Special Appendix

A. Use of the maxillary tuberosity (MT) in the immediate dentoalveolar restoration (IDR) technique

References

B. The palatal bone block graft (PBBG)

References

C. Alumni case reports

5 Bone grafts from extraoral sites

5.1 Introduction

5.2 Bone harvesting from the calvaria

5.3 Bone harvesting from the tibia

5.4 Bone harvesting from the iliac crest

5.5 References

6 Clinical and scientific background of tissue regeneration via alveolar callus distraction

6.1 Introduction

6.2 History of the callus distraction

6.3 Principles of the callus distraction

6.4 Devices

6.5 Surgical technique

6.6 Distraction in different areas

6.4 Conclusion

6.5 References

7 Complex implant-supported rehabilitation from the temporary to the definitive restoration

7.1 Introduction

7.2 Specific aspects of temporary restorations

7.3 Treatment planning

7.4 Classification of temporary restorations

7.5 Restorative concept

7.6 Fixed complex restoration: step by step

7.7 Long-term provisional

7.8 Surgical procedures

7.9 Final restoration

7.10 Concluding remarks

7.11 References

8 Risk factors and complications in bone grafting procedures

8.1 Introduction

8.2 Risk factors

8.3 Intraoperative complications

8.4 Postoperative complications

8.5 Complications during implant placement after bone grafting

8.6 Complications during implant exposure

8.7 Late complications after prosthetic restoration

8.8 References

Index

Reinhard Gruber

Regenerative dentistry critically depends on the functional understanding of bone biology – to be precise, bone development, bone modeling and remodeling and bone regeneration – in a physiologic but also in a pathologic and pharmacologic context. Bone biology also describes the cellular and molecular regulation behind Wolff’s law (form follows function), which was later refined by Frost’s Mechanostat theory. 44Bone biology is a molecular and cellular system that is essential for mammalian evolution. Besides being a framework connecting to tendons and muscles and for protecting the bone marrow, the skeleton is a storage for calcium and phosphate that is transported via the umbilical vein and later through the mother’s milk into the fetus and newborn. Understanding the delicate interplay of bone-forming cells and bone-resorbing cells – which act in concert with the osteocyte located within the bone matrix, the blood vessels providing support for the respective progenitors, and the cells originally dedicated to the immune system – provides one part of the information necessary for progress in medicine.

The concert has to be orchestrated, which is, in the context of bone biology, the cell-to-cell communication involving the classical path. This path can roughly be divided into local and systemic regulation. Local regulation includes cell communication via cytoplamatic connections or the release of signaling molecules, with particular receptors on the respective target cells. Systemic regulation refers to the endocrine system, whereby hormones or growth factors are released and transported via the bloodstream to target cells elsewhere in the body. It is fascinating to imagine all the different levels – molecular, cellular, tissue, and organ – to be coordinated, with the same aim of homeostasis. In a broader sense, not only does homeostasis maintain the tissue (which would be bone remodeling), it is also the mechanism to regain homeostasis after injury, thus bone regeneration. However, the delicate cellular and molecular mechanisms aiming for homeostasis are sensitive to change; for instance, the drop of steroid hormones during menopause, which causes not only enhanced but also disbalanced bone remodeling and ultimately leads to bone loss and postmenopausal osteoporosis. The mechanical integrity, particularly of the trabecular bone, is rapidly impaired, and fragility fractures of the vertebra and the hip become clinical hallmarks of the disease. 107Postmenopausal osteoporosis is but one example of how bone homeostasis undergoes a catabolic shift that, together with age-related changes, leads to a progression of bone loss over time.