Cortical lamina technique: A therapeutic approach for lateral ridge augmentation using guided bone regeneration

Abstract

Background: The present study aimed at evaluating the efficacy of a novel technique, the bone lamina technique, in horizontal ridge augmentation clinically & radiographically using a combination of allogenic cortical shell, particulate xenograft and resorbable collagen membrane.

Material and methods: Localized horizontal ridge defects, in ten patients (6 male, 4 female), with bucco-palatal ridge width less than 5 mm were included in this study. Localised ridge augmentation was performed using bone lamina technique with mineralised allogenic shell of 1 mm thickness trimmed to the appropriate size using stereo-lithographic models and fixed to the recipient site with stainless steel micro-screws of 1 mm diameter. The space between the shell & host bone was filled with particulate xenograft followed by placement of collagen membrane and primary closure of the site. Clinical parameters including ridge width before & after flap reflection & radiographic (CBCT) ridge width measurements were recorded pre-operatively,and six months after the augmentation procedure. Results obtained were analysed statistically.

Results: The mean clinical ridge width before flap reflection (BFR), after flap reflection (AFR) & radiographically was 3.7 ± 0.74 mm, 2 ± 0.70 mm & 1.77 ± 0.71 mm respectively at baseline which increased to 6.8 ± 0.95 mm, 5.15 ± 0.98 mm & 4.90 ± 0.90 mm with a mean gain in ridge width of 3.1 ± 0.63 mm (p< 0.005), 3.15 ± 0.63 mm (p<0.005) & 3.13 ± 0.70 mm (p< 0.005) respectively.

Conclusions: The present study demonstrates that bone lamina technique can be effective means of horizontal ridge augmentation and the use of mineralized allograft in combination with xenograft and collagen membrane leads to good amount of bone regeneration for subsequent implant placement. Key words:Dental implant, guided bone regeneration, horizontal ridge defect, ridge augmentation.

Figure 1

a) Pre-operative radiographic (saggital) view of ridge width. b) Pre-operative radiographic (panoramic) view of ridge width. c) 3-D stereolithographic model of the recipient site. d) Cortical lamina trimmed to appropriate dimensions.

Figure 2

a) Clinical view of surgical site after flap reflection. b) Fixation of cortical shell to the recipient site with miniscrew. c) Particulate xenograft filled into the space between the cortical lamina & host bone. d) Primary closure of the site.

Figure 3

a) Six months post-operative radiographic (sagittal) view of augmented site. b) Clinical view of surgical site at re-entry after 6 months. c) Clinical view after implant placement.