Horizontal alveoalar ridge augmentation in implant dentistry

Koštani defekti čeljusti mogu nastati kao posljedica ekstrakcije zuba, traume, parodontne bolesti, cista i tumora čeljusti, nekroze čeljusti izazvane lijekovima ili zračenjem, a mogu biti kongenitalni ili uzrokovani sistemskim oboljenjima . Pravilno je pozicioniranje implantata postava implantata u trodimenzionalnu poziciju koja je nužna da bi se ostvario funkcijski i estetski ishod terapije i smanjile mogućnosti komplikacija. Da bi se ostvarili preduvjeti za pravilno pozicioniranje implantata, ponekad je prije implantacije ili za vrijeme implantacije potrebno nadoknaditi izgubljeni koštani volumen i meko tkivo jer zatečeni uvjeti ne dopuštaju postavu implantata u pravilan položaj. Primjena biomaterijala u augmentaciji koštanog grebena omogućuje obnovu izgubljene alveolarne kosti. Biomaterijali za augmentaciju kosti mogu djelovati osteogenetski, osteoinduktivno i osteokonduktivno. Horizontalna je augmentacija indicirana kada nema dostatne širine alveolarnog grebena, a visina grebena dostatna je za pravilno pozicioniranje implantata. Osnovne tehnike za horizontalnu augmentaciju koštanog grebena uključuju : 1. vođenu regeneraciju kosti (GBR, engl. guided bone regeneration) 2. koštani blok-transplantat (engl. bone block grafting) 3. Ridge-split tehniku 4. distrakcijsku osteogenezu (DO, engl. distraction osteogenesis). Zajedničko je svim tehnikama horizontalne augmentacije grebena da ako se augmentirano područje optereti protetskim radom koji pritišće ranu, dolazi do dehiscijencija mekih tkiva i resorpcije augmentiranog područja s mogućnošću infekcije. Važno je da se rana primarno zatvori bez tenzija, osim kod ridge-split tehnike kod koje se rana ne mora primarno zatvoriti. Ugradnja implantata indicirana je samo ako je moguće postići primarnu stabilnost implantata prilikom augmentacije alveolarnog grebena.Jaw bone defects develop due to various causes, including tooth extractions, trauma, periodontal disease, jaw cysts and tumors, and jaw osteonecrosis induced by medications or radiotherapy. The origins of jaw bone defects can also be congenital or due to systemic diseases. Correct implant placement, i.e. implant positioning in a three-dimensional relationship with surrounding structures is necessary for functional and aesthetic treatment results, as well as to reduce the risk of complications. To fulfill the prerequisites for correct implant placement, a preoperative or intraoperative compensation of the lost bone volume and soft tissues is required. This is the case in patients whose current oral situation does not allow a proper three-dimensional implant positioning. The use of biomaterials for alveolar ridge augmentation enables regaining the lost parts of alveolar bone. Biomaterials for bone augmentation exert osteogenic, osteoinductive, and osteoconductive effects. For correct implant horizontal ridge augmentation is used when handling alveolar ridges that are insufficient in width but sufficient in height placement. Basic techniques for horizontal ridge augmentation include the following: 1. Guided bone regeneration 2. Bone block grafting 3. Ridge-split technique 4. Alveolar distraction osteogenesis. The common issue concerning all of the horizontal ridge augmentation techniques is related to the loading of the augmented area by prosthetic structures and pressure application on the wound, which may lead to the dehiscence of soft tissues, resorption of the augmented site, and the risk of infection. An important requirement for preventing complications is a primary wound closure with no tension, except for the ridge-split technique, which does not necessitate a primary wound closure. Implant placement is indicated only if primary implant stability can be attained through alveolar ridge augmentation