Variety of Surgical Guides and Protocols for Bone Reduction Prior to Implant Placement: A Narrative Review

Abstract

Edentulism and terminal dentition are still considered significant problems in the dental field, posing a great challenge for surgical and restorative solutions especially with immediate loading protocols. When the implant placement is planned immediately after extraction with irregular bone topography or there is an un-leveled alveolar ridge topography for any other reason, bone reduction may be required to level the alveolar crest in order to create the desired bone architecture allowing for sufficient bone width for implant placement and to insure adequate inter-arch restorative space. Bone reduction protocols exist in analog and digitally planned methodologies, with or without surgical guides to achieve the desired bone level based upon the desired position of the implants with regard to the restorative outcome. The objective of this paper was to scrutinize the literature regarding the practice of bone reduction in conjunction with implant placement, and to review different types of bone reduction surgical guides. Results: The literature reveals different protocols that provide for bone reduction with a variety of bone reduction methods. The digitally-planned surgical guide based on Cone-Beam computerized tomography (CBCT) scan reconstructed data can improve accuracy, reduce surgical time, and deliver the desired bone level for the implant placement with fewer surgical and restorative complications. The clinician's choice is based on personal experience, training, and comfort with a specific guide type. Conclusions: Bone reduction, when required, is an indispensable step in the surgical procedure to attain suitable width of bone in anticipation of implant placement ideally determined by the desired tooth position and required restorative space based on material selection for the chosen framework design, i.e., hybrid, monolithic zirconia. Additionally, bone reduction and implant placement can be accomplished in the same surgical procedure, minimizing trauma and the need for two separate interventions.

Keywords: alveolar ridge reduction; bone reduction; bone reduction guides; ostectomy; surgical techniques guided surgery.

Figure 1

Flowchart depicting the selection process for included studies.

Figure 2

Example of a case using bone reduction guide: (a) Pretreatment clinical situation. Frontal view of mandibular arch; (b) Scans of the initial clinical situation of the patient. Horizontal arrow shows the bone level after extraction, vertical arrow shows the desired bone level after reduction; (c) Computerized virtual mandibular alveolar bone reduction surgical guide and the bone level after reduction; (d) Computerized virtual for implant position after bone reduction; (e) Acrylic resin bone reduction surgical guide in position after tooth extractions, prior to bone reduction; (f) Alveolar ridge reduction according to virtual plan and surgical guide; (g) Second surgical guide used to insert dental implants according to pretreatment virtual plan. Anchoring pins secured guide in the right position after bone reduction; (h) Post-operative panoramic radiograph of implants and definitive prosthesis.

Figure 2

Example of a case using bone reduction guide: (a) Pretreatment clinical situation. Frontal view of mandibular arch; (b) Scans of the initial clinical situation of the patient. Horizontal arrow shows the bone level after extraction, vertical arrow shows the desired bone level after reduction; (c) Computerized virtual mandibular alveolar bone reduction surgical guide and the bone level after reduction; (d) Computerized virtual for implant position after bone reduction; (e) Acrylic resin bone reduction surgical guide in position after tooth extractions, prior to bone reduction; (f) Alveolar ridge reduction according to virtual plan and surgical guide; (g) Second surgical guide used to insert dental implants according to pretreatment virtual plan. Anchoring pins secured guide in the right position after bone reduction; (h) Post-operative panoramic radiograph of implants and definitive prosthesis.