Istvan Urban - Vertical 2 - The Next Level of Hard and Soft Tissue Augmentation

As our study was a retrospective case series introducing a novel space-making mesh, rigorous comparisons with other studies were not viable. We postulate that the mesh macropores would enhance graft vascularization and therefore improve bone regeneration. Future studies should verify whether this assumption is accurate via acquiring bone cores at re-entry to confirm regeneration/bone viability.

Surgeries were performed by a highly experienced clinician, so our outcomes may not be applicable in the case of less seasoned practitioners. A prospective clinical trial is needed to compare VBA results using various space-making frameworks such as PTFE mesh, e-PTFE, and d-PTFE. Future comparisons should be performed particularly for newer space-maintaining devices such as custom titanium mesh and custom-made block grafts. Using a larger patient sample with a more even distribution would verify or refute our findings regarding baseline vertical deficiencies, defect location, patient factors, complications, and bone gain. Such analyses will be helpful for case preparation and materials selection.

As was concluded by Group 4 of the 15th European Workshop on Periodontology on Bone Regeneration, vertical ridge augmentation is an extremely technique-sensitive surgical intervention to be performed only by highly experienced clinicians. 17

The following conclusions can be drawn from our study:

1. Vertical ridge augmentation with RPM and a mixture of autologous bone and xenograft may be a safe and predictable procedure.

2. The extent of the baseline vertical deficiency influences the percentage of bone augmentation achieved, with each additional millimeter increasing the likelihood of incomplete bone regeneration by 2.5 times.

3. The defect location may exert a small influence on the amount of bone gained (< 0.5 mm).

In all the following cases, the d-PTFE membrane was covered with a native collagen membrane. This collagen membrane helps to seal the edges of the membrane, where needed, and potentially aids soft tissue healing ( Figs 2-5to 2-66).

The clinical experience is that the bone quality was better than that at the non-perforated sites. Also, it appears that bone formation is faster than before. It is difficult to say how much faster, but the improved quality means that the bone formation was more rapid. A brave estimation is that an average vertical defect may mature faster by a rate of about 2 months. However, this should be carefully investigated in well-designed randomized clinical trials.

In addition to the preclinical studies, the clinical examples shown in Figures 2-5to 2-66are encouraging in their demonstration of predictability and stable crestal bone after regeneration in different clinical scenarios.

Fig 2-5 Labial view of a severe posterior maxillary vertical defect.

Fig 2-6 Labial view of a perforated polytetrafluoroethylene (PTFE) membrane in place.

Fig 2-7 Labial view of the fixated membrane.

Figs 2-8 and 2-9 Labial and occlusal views of the regenerated bone with three implants.

Figs 2-10 to 2-15 Vertical augmentation of the posterior mandible.

Figs 2-16 to 2-18 Vertical augmentation of the anterior maxilla.

Figs 2-19 to 2-21 Vertical augmentation of the anterior maxilla (cont).

Figs 2-22 to 2-25 Vertical augmentation of the posterior maxilla.

Figs 2-26 to 2-29 Horizontal augmentation of the posterior mandible.