The procedure of horizontal and vertical bone augmentation
Horizontal and vertical ridge augmentation is a complicated surgery both for the patient and the staff performing it, requiring thorough preparation both on the patient’s and the staff’s part. In the present article we aim to give a step-by-step description of the procedure in an attempt to dispel fears and doubts.
The preliminary steps of horizontal and vertical augmentation:
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Preparation of a CBCT scan in order to examine the bone in 3 dimensions.
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Medical consultation during which the surgeon draws up a treatment plan and quote.
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Signing of medical documentation required prior to surgery (informed consent form, treatment plan).
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Starting on antibiotics on the day prior to surgery.
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Professional tartar removal and closed curettage on adjacent teeth in the event of periodontal disease.
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Bone graft can only be performed once the periodontal disease has been treated.
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For reasons of hygiene it is advisable to shave off moustaches and beards for the surgery.
In the course of surgery, a number of instruments, machines and materials are used, the preparation of which is a time consuming process. The below are required prior to surgery:
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Thorough brushing, cleaning the tongue with a tongue scraper.
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The use of a mouth rinse with chlorhexidine.
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Administration of sedatives (in the event of conscious sedation) by an anaesthesiologist.
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Anaesthesia.
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Blood specimens for the PRF procedure.
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Collection of autogenous bone with a bone scraper and trephines. Following the collection of an adequate quantity of bone, the area is sealed with sutures.
Image no. 1: Devices used for bone collection: bone mill, bone trephine, bone scraper
Image no. 2: The finished sinus window and the elevation of the sinus membrane (Schneiderian membrane) by means of a SA-320 Piezomed, W&H instrument
Image no. 3: Autogenous bone (the patient’s natural bone) and the bone graft material (bovine bone, e. g. Cerabone, BioOss) are mixed and the mixture is placed underneath the lifted sinus mucosa. This is followed by bone widening
Image no. 4: The bone-grafted area is covered with a membrane (Cytoplast, Lyoplant) and secured by means of pins (Master Pin Meisinger).
Image no. 5: Close-up image of the membrane fastened with pins
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The surgical area is sealed with sutures. Non-resorbable sutures are required for strong retention and the prevention of the build-up of plaque and bacteria.
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In case of conscious sedation, the patient awakens.
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The patient and their attendant remain at the office for 30 minutes for observation.
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Preparation of a panoramic radiograph.
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The patient receives ice gel and medications.
The table below provides the average duration of the particular phases of the surgery, with room for individual deviations.
|
Treatment |
Duration of treatment (approx.) |
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The preparation of the patient (conscious sedation, anaesthesia, blood specimen collection, etc.) |
30 minutes |
|
Collection of autogenous bone |
30 minutes |
|
The creation of a sinus lift window |
30 minutes |
|
The placement of bone graft material, membrane and pins |
30 minutes |
|
Sutures |
30 minutes |
|
Awakening from conscious sedation, discussion of the surgery, medical advice, follow-up, panoramic radiography, etc.) |
30 minutes |
The table above demonstrates that horizontal and vertical bone augmentation is a surgery lasting upwards of 3 hours. (By comparison, an average sinus lift surgery lasts about 1 hour). This is trying for all involved, such bone grafts are therefore carried out in the morning to provide our patients our level best.
Foreign patients are required to plan for a stay of at least 10 days, so we can carry out daily monitoring and remove the non-resorbable sutures. Following horizontal and vertical bone augmentation the patient is required to rest for at least 1 week.
Image no. 6: Panoramic radiograph of the bone-grafted area
Image no. 7: Panoramic radiograph of the horizontal and vertical bone augmentation
Image no. 8: CBCT scan clearly displaying the width and height of the bone-grafted area in 3 dimensions
Bibliography
I. Urbán: Vertical and Horizontal Ridge Augmentation: New Perspectives. Quintessence Publishing, 2017.