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Book Review

Horizontal Alveolar Ridge Augmentation in Implant Dentistry

A Surgical Manual

Misch, Craig M. DDS, MDS

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doi: 10.1097/ID.0000000000000546
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This book focuses on horizontal bone augmentation for dental implant placement. There are 40 contributing authors and the text is 340 pages divided into 7 sections: introduction, guided tissue regeneration, autogenous block grafting, ridge split, alveolar distraction, soft tissue grafting, and tissue engineering. In the preface, the author explains his desire to make this text a practical, user friendly, and clinically relevant surgical manual. Because of the broad scope of procedures available for bone augmentation, the author decided to split the material into 2 volumes—horizontal and vertical augmentation. This review will discuss the volume on horizontal bone augmentation.

Section I is composed of 8 chapters that cover the foundation for the text including diagnosis and treatment planning. Chapter 1 introduces a new classification for bone augmentation procedures. The classification is inconsistent and confusing. A table divides the procedures into (1) Inlay grafts; (2) Onlay grafts; (3) Distraction osteogenesis; and (4) Vascularized bone flaps. Areas of the table are highlighted in blue but the reason for this designation is not clear or explained. In the table, the onlay graft division (2) is divided into particulate and block grafts. The particulate section includes guided bone regeneration and “tent pole” techniques (including titanium mesh, screw, or implants). The term “tent pole” is not typically used to describe mesh-protected grafts. In the description of the classification system on the following page, the first 2 types of procedures are changed from (1) Inlay grafts; (2) Onlay grafts; to (1) Particulate bone grafting; and (2) Block bone grafting. Chapter 2 on applied surgical anatomy was written by Dr. Mohamed Sharawy. It is a good summary of surgical anatomy that clinicians will encounter while performing grafting procedures. Chapter 3 covers bone development of the jaws. It also discusses basic bone physiology. The inclusion of Atwood classification of ridge atrophy is incongruent and may have been better covered in chapter 7 on ridge classification. In chapter 4, Dr. Gary Morris does a thorough job of discussing the prosthetic evaluation of the implant patient. There are numerous good clinical photographs including prosthetic diagnosis and planning using cone beam computed tomography. Chapter 5 is on the use of orthodontics for implant site development. It discusses the protocol for forced eruption of teeth and includes indications, contraindications, and limitations. The drawings and case examples well describe this underutilized technique. Chapter 6 discusses the radiographic evaluation of ridges in implant dentistry. It is a good review focusing mainly on cone beam computed tomography and radiographic anatomy. A discussion of interactive planning using computer software for implant surgery is included. Chapter 7 on the classification of ridge defects was written by Dr. Patrick Palacci. He reviews historical classifications (Lekholm and Zarb, Siebert) and proposes his own classification. However, the Palacci-Ericsson classification is more applicable to the esthetic zone as it focuses on the papilla. In chapter 8, Dr. Alan Herford proposes an algorithm for ridge augmentation. It is a well-organized summary of augmentation procedures including advantages and disadvantages. It would have been helpful if the editor coordinated some consistency for the reader between the classification systems and terms used in chapters 1, 7, and 8 as well as in the entire text.

Section II is on the topic of guided tissue regeneration. Chapter 9 is a very brief review of the biology of regenerative materials used with particulate bone grafts. Chapter 10 discusses implant site development with particulate bone grafts including socket and implant dehiscent defects. There are good clinical photographs describing the techniques. Chapter 11 is on the use of titanium mesh and particulate grafts for horizontal bone augmentation. It is interesting that this topic is covered under the section on guided bone regeneration as mesh does not act as a barrier. Good clinical tips are provided on site preparation and flap management. Some examples of polytetrafluorethylene membranes are included in the clinical cases. Chapter 12 is a short summary on the complications associated with guided bone regeneration.

Section III covers block bone grafting for horizontal augmentation. Chapter 13 was written by Dr. Devorah Schwartz-Arad on autologous intraoral block bone grafts. The chapter primarily focuses on grafting the maxilla and includes adjunctive procedures such as sinus and nasal floor augmentation. The author presents data for clinical cases documenting the effectiveness of this method. Chapter 14 discusses autogenous extraoral bone grafts including the calvarium, iliac crest, and tibia. The authors mainly focus on the harvesting of bone from these donor sites. The clinical cases included are mostly larger reconstructions of mandibular continuity defects and sinus grafting but not horizontal deficiencies. Chapter 15 is on the use of allogeneic blocks and autogenous tuberosity bone grafts. The section on allogeneic blocks is thorough and well-presented including excellent drawings and good clinical photographs. The tuberosity donor site is described with a case report.

Section IV includes 8 chapters (16–23) on ridge-split procedures with the majority authored by Dr. Tolstunov. This section is the pinnacle of the text. He begins by setting the foundation with a very thorough review of diagnosis and treatment planning. Next, he methodically explains the surgical principles of ridge splitting. Chapter 18 focuses on a 2-stage approach for expanding the mandible including many surgical pearls, whereas the next chapter is on maxillary ridge expansion. Chapter 20 gives examples of various advanced ridge-split techniques, and chapter 21 compares ridge splitting with block grafting. In the last chapter of this section, Dr. Tolstunov reviews complications of the technique and provides the reader with his “10 commandments of success” for ridge splits.

Section V is on horizontal ridge expansion using distraction osteogenesis. I am surprised this topic was segregated into a separate section in the book as it is similar to ridge splitting and a much less used approach. Chapter 24 is on diagnosis and treatment planning for horizontal ridge distraction. It explains the different horizontal distraction devices available and the protocol for their use. In chapter 25, they discuss the use of a specific manufactures device. Chapter 26 presents a method to use a local cortical block bone graft repositioned laterally to widen the ridge. This procedure does not fit in the section on distraction osteogenesis as there is no dynamic movement of the bone. In addition, this technique is a variation of Dr. Fouad Khoury's split cortical graft but his well-published work is not referenced. The section is completed with a short chapter of horizontal distraction complications.

Section VI covers soft tissue grafting for implant site development. Chapter 28 written by Dr. Edgar El Chaar discusses the diagnosis and treatment planning for soft tissue grafting. The anatomical differences between teeth and implants are well explained. Esthetic considerations and a discussion on biotype are included. In chapter 29, Dr. El Chaar covers various techniques for soft tissue grafting around dental implants. In the next chapter, he reviews the soft tissue management of implant complications such as periimplantitis. A greater coverage of preimplant soft tissue procedures in preparation for horizontal augmentation would have been appreciated.

The last section of the book is on the topic of tissue engineering. In chapter 31, Dr. Robert Marx expertly discusses the use of recombinant bone morphogenetic protein 2 (rhBMP-2). He covers the biology of the growth factor and its clinical use with titanium mesh for ridge augmentation. There are good clinical photographs and histologic samples included. Chapter 32 is a review of growth factors used in bone augmentation. However, it only covers the use of rhBMP-2. Chapter 33 written by Dr. Joseph Choukroun is on platelet rich fibrin. He reviews the biology, preparation, and clinical use of this specific platelet concentrate. The last chapter looks at the future possibility of using stem cell therapy to regenerate teeth or provide an artificial “bio-hybrid” dental implant.

I was intrigued that the publication was referred to as a manual. A manual is defined as a conveniently handled book of instructions for learning a subject. After reviewing the text, I can see why the author chose this reference. This manual is a collection of numerous authors that share their various clinical approaches to horizontal ridge deficiencies. However, the print size is noticeably small and somewhat straining to read. The print size may have been limited to reduce the pages and make the text more conveniently managed. There are many well-known clinicians that contributed to the text. The chapters are well referenced and include several good quality color photographs and figures to describe the clinical techniques. This manual would be a welcomed addition to the library of clinicians interested in expanding their surgical repertoire. The topic of bone augmentation is voluminous and providing a text that is all encompassing is very difficult. Dr. Tolstunov stated in the preface that he would consider himself a happy man if the reader learned clinical techniques that would benefit their patients. I think he should be a very happy man.

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