Vertical and Horizontal Ridge Augmentation

As the title describes, this book is on horizontal and vertical bone augmentation for dental implant placement. The entire publication was written by Dr. Istvan Urban. The book is 390 pages divided into 22 chapters. In the introduction, the author states that he wrote the book to help clinicians achieve better outcomes for their patients. Over the years, he has scrutinized his own work and developed treatment approaches that are biologically sound and scientifically proven. He has focused on minimally invasive, simple, and predictable treatment options. Chapter 2 is on patient selection, preparation, and surgical set-up. Communicating realistic expectations for the patient is an important first step. Exclusion criteria are defined including the need for smoking cessation. Medications and postsurgical care are reviewed. In chapter 3, membrane selection and graft materials for guided bone regeneration are discussed. The benefits of a native collagen membrane for horizontal augmentation are described. Vertical augmentation necessitates a form stable (titanium reinforced) nonresorbable polytetrafluoroethylene or teflon (PTFE) membrane. The use of particulate intraoral bone mixed with an organic bovine bone mineral is the preferred graft mixture under the membrane. Chapter 4 describes the harvesting of intraoral autogenous bone from the symphysis and ramus. The surgical anatomy of the floor of the mouth is reviewed in chapter 5. This information is useful for soft tissue management and flap closure over the grafted mandible. The principles of ridge augmentation in the posterior mandible are further discussed in chapter 6 including flap design, bone preparation, membrane adaptation, and flap release and advancement. Dr. Urban's unique surgical approach to lingual flap mobilization is described in detail with excellent clinical photographs. Chapter 7 briefly reviews the various methods for vertical ridge augmentation. Chapter 8 covers specific details for vertical augmentation in the posterior mandible. The rationale for stage augmentation and implant placement is discussed. Clinical cases are used to document various soft tissue augmentation procedures around dental implants. Augmentation of the anterior mandible is outlined in chapter 9. The chapter mainly focuses on flap management with clinical cases. In chapter 10, ridge augmentation of the posterior maxilla for partially edentulous patients is well demonstrated with patient examples. Flap design and sinus grafting are addressed. Horizontal ridge augmentation using the “sausage technique” is the topic in chapter 11. This unique technique uses particulate autogenous bone mixed with bovine bone mineral in combination with a resorbable collagen membrane that is stretched over the site and tacked to the ridge to immobilize the graft. The rationale for using a native collagen membrane is reviewed. Data on ridge augmentation gains are presented. Chapter 12 is a short introduction to address subsequent chapters on the anterior maxilla. In chapter 13, the treatment of single tooth defects is highlighted. Clinical cases are used to describe papilla reconstruction and vertical augmentation. A new classification of flap designs for anterior maxillary vertical defects is introduced in chapter 14. This information is invaluable for managing straightforward to complex cases in the esthetic zone. Lateralization of the nasopalatine nerve is discussed in chapter 15. This technique is proposed to avoid neurosensory deficits. The topic of mucogingival surgery is reviewed in chapter 16. This is an important step in reconstructing the esthetic zone after ridge augmentation and implant placement. Vestibular depth needs to be re-established in combination with increasing keratinized gingiva. A connective tissue graft is used over the facial of the ridge with a strip of free gingival graft apically. Impressive results are shown with clinical cases. Chapter 17 offers an alternative to harvesting connective tissue grafts for soft tissue reconstruction using a xenogeneic collagen matrix. In chapter 18, the author offers a new perspective on crestal bone maintenance after ridge augmentation. He proposes placing a layer of bovine bone mineral over the reconstructed ridge and covering it with a collagen membrane at the time of implant placement. Chapter 19 uses a clinical case to discuss developing gingival architecture around single implant crowns, replacing multiple missing teeth in the esthetic zone. Reconstruction of the edentulous resorbed maxilla is covered in chapter 20. Sinus grafting and guided bone regeneration is recommended to develop sites for 6 to 8 implants, supporting a fixed prosthesis. Chapter 21 reviews complications of guided bone regeneration including membrane exposure, infection and issues, implant placement and maintenance. The use of recombinant growth factors (rhPDGF, thBMP-2) for ridge augmentation is presented in chapter 22. Although the use of growth factors shows promise, caution is advised because long-term follow-up is lacking. This text encompasses the philosophy of Dr. Urban in the management of ridge deficiencies for dental implant placement. He introduces many unique and new perspectives that offer clinicians the ability to achieve more predictable results. His goal is to keep procedures simple, repeatable, and biologically sound. In many of the chapters, he includes “lessons learned” from clinical cases. These reflective comments are invaluable pearls of wisdom that the author shares with readers. Dr. Urban states that the book is not only about how to regenerate lost hard and soft tissue but also how to preserve these tissues thereafter. The high-quality clinical photography is excellent and well documents the procedures. The figures are also well done and compliment the clinical cases. In my opinion, this volume of work is one of the most significant contributions to the field of implant dentistry. My only issue with the book is that the only bone augmentation technique used is guided bone regeneration, and other procedures are discouraged or not discussed in detail. Dr. Urban says that he wished somebody would have given him a book like this 15 years ago. I agree that this text is a must read for all clinicians who perform ridge augmentation procedures and for students learning these techniques.