Editorial Type:
Article Category: Letter
 | 
Online Publication Date: 01 Apr 2018

Sequential Ridge Augmentation Protocol for Hard and Soft Tissue Grafting in Alveolar Ridge Deficiencies: A Proposed Evidence-Based Algorithm

BDS, MS, MPH and
BDS
Page Range: 153 – 160
DOI: 10.1563/aaid-joi-D-17-00165
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  <sc>Figure</sc>
  1
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Figure 1

Implants demonstrating inadequate keratinized tissue, strong frenal pull, and plaque accumulation.


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  <sc>Figure 2</sc>
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Figure 2

Sequential ridge augmentation protocol. Figures in parentheses refer to citations, which justify each step in this evidence-based protocol.


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  <sc>Figure 3</sc>
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Figure 3

Site nos. 20 and 21 assessed prior to implant placement using the sequential ridge augmentation (SRA) protocol revealed inadequate keratinized tissue (less than 2 mm); howeverm, the soft tissue defect was minor. The alveolar width was adequate for planned implant diameter and did not require augmentation. The applied SRA protocol is described in detail in Figures 4 and 5.


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  <sc>Figure 4</sc>
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Figure 4

Sequential ridge augmentation protocol applied to sites 20 and 21.


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  <sc>Figure 5</sc>
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Figure 5

(a) Implant placement was performed first. (b, c) After 3 months at the time of implant uncovery (second stage), soft tissue augmentation with a free gingival graft was done. (d) Final restorations placed 10 weeks after second-stage surgery, showing adequate keratinized tissue around final restorations.


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  <sc>Figure 6</sc>
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Figure 6

Sites 18 and 19 assessed using the sequential ridge augmentation (SRA) protocol revealed inadequate keratinized tissue (less than 2 mm) and strong frenal pull at the planned implant site. The available alveolar width was inadequate for a restoratively driven implant placement as seen on cone-beam computerized tomography (range, 3.8–4.6 mm). The applied SRA protocol can be seen in detail in Figures 7 and 8.


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  <sc>Figure 7</sc>
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Figure 7

Sequential ridge augmentation protocol applied to sites 20 and 21.


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  <sc>Figure 8</sc>
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Figure 8

After application of the sequential ridge augmentation protocol, (a) free gingival graft was done first to get adequate keratinized tissue at the implant site. (b) After 6 weeks, guided bone regeneration was performed to increase the buccal-lingual dimension of the ridge to allow implant placement in the resotratively determined implant position. (c) Implant placement was done 3 months after guided bone regeneration using a surgical stent. (d) Excellent soft and hard tissue profiles were seen at 3 months after implant surgery at the time of recording implant-level impressions.


Contributor Notes

Corresponding author, e-mail: drneel1@gmail.com
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