Vertical 2: The Next Level of Hard and Soft Tissue Augmentation

Vertical 2: The Next Level of Hard and Soft Tissue Augmentation
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Описание книги

In the author's bestselling first book, Vertical and Horizontal Ridge Augmentation: New Perspectives, published by Quintessence in 2017 and translated into 12 languages, the guided bone regeneration (GBR) technique was described in detail. This new publication, Vertical 2: The Next Level of Hard and Soft Tissue Augmentation, is a continuation of that book but at a more advanced level. Now, the author delves into the details where the devil lives, and shares information that has never been revealed before on the topic of vertical ridge augmentation. It is important to read this book armed with the knowledge from the first book as you will need it on this second journey with him.
A major part of this book comprises full-color, step-by-step images of patient cases. At times, reading it is like watching a surgical video, where the author 'stops the video' to discuss with you, the reader, what he is thinking and doing at that step, what his next step will be, and the reason for it.
Included again are the well-appreciated 'Lessons learned' sections, where the learning objectives are emphasized and further notes given, including ways to further improve the techniques. The section on the mandible is more detailed in this book, with the focus on larger defects and the different surgical steps in native, fibrotic, and scarred tissue types around the mental nerve during flap advancement.
In addition, light is shed on the detail in treating the anterior maxilla, which has not been published previously. It includes treatment options such as the fast track, the safe track, and the technical track of soft tissue reconstruction in conjunction with bone grafting as well as papilla reconstructions after bone regeneration. The section on the posterior maxilla hopes to resolve issues such as the management and complications of combined ridge and sinus grafting, including difficulties such as the lack of buccal, crestal or nasal bony walls of the posterior maxilla before bone grafting.
In this must-have new publication, the procedures are kept simple, repeatable, and biologically sound. The techniques presented are not overcomplicated; they are simple treatment strategies with lower complication rates and more predictability in the final outcome.

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Istvan Urban. Vertical 2: The Next Level of Hard and Soft Tissue Augmentation

Vertical 2

Preface

Acknowledgments

Contents

Introduction. 1. The biology of vertically and horizontally augmented bone

The histology of polytetrafluoroethylene (PTFE) membranes in an in vivo setting

Bone growth using a xenogenic bone graft

Dense versus perforated membrane

I. Dense vs perforated membrane using bone morphogenetic protein-2 (BMP-2) as a graft

II. Perforated vs non-perforated membranes using an osteoconductive graft material

III. The effect of the use of a microdose of BMP-2 in combination with an osteoconductive xenograft

Conclusion

Reference

Additional reading

2. Scientific evidence of vertical bone augmentation utilizing a titanium-reinforced polytetrafluoroethylene mesh. Introduction

Materials and methods

Inclusion and exclusion criteria

Surgical procedure

Postsurgical procedures

Data collection

Statistical analysis

Results. Patient characteristics

Bone gain analysis

Influence of baseline vertical deficiency on absolute and relative bone gain

Influence of defect location on absolute bone gain: maxilla vs mandible

Influence of defect location on absolute bone gain: anterior vs posterior

Influence of defect location on absolute and relative bone gain: anterior vs left posterior vs right posterior

Postsurgical complications

Discussion

Agreement with previous studies

Distinctive findings

Limitations and recommendations for future research

Conclusions

Representative case examples of ridge augmentation using a perforated d-PTFE membrane

References

Additional reading

The extreme vertical defect of the posterior mandible. 3. Reconstruction of the extreme posterior mandibular defect: surgical principles and anatomical considerations

Introduction

References

Additional reading

4. Reconstruction of an advanced posterior mandibular defect with scarred tissue

The ‘pawn sacrifice’

Biologic healing potential of this defect

Type III buccal tissue: completely scarred periosteum

5. Reconstruction of an advanced posterior mandibular defect with narrow basal bone

Reference

6. Reconstruction of an advanced posterior mandibular defect with incomplete periodontal bone levels: the ‘pawn sacrifice’

Reference

7. Reconstruction of an advanced posterior mandibular defect with the Lasagna technique using low-dose bone morphogenetic protein-2

Anterior mandibular vertical augmentation. 8. Reconstruction of the advanced anterior mandibular defect: surgical principles and anatomical considerations

Reference

Additional reading

9. Reconstruction of the advanced anterior mandibular defect: considerations for soft tissue reconstruction and preservation of the regenerated bone

Lingual soft tissue grafting

Lessons learned

10. Reconstruction of the advanced anterior mandibular defect: importance of horizontal bone gain

Posterior maxilla. 11. Long-term results of implants placed in augmented sinuses with minimal and moderate remaining alveolar bone

Sinus grafting using the sagittal Sandwich technique

Clinical characteristics and demographic profiles

Implant placement

Healing of the sinus grafts

Marginal bone loss

Comparison between Mk III and Mk IV

Survival rate

Peri-implantitis

References

Additional reading

12. Difficulties and complications relating to sinus grafting: hemorrhage and sinus septa

Hemorrhage

Sinus septa

Classification of sinus septa

References

Additional reading

13. Difficulties in sinus augmentation and posterior maxillary reconstructions: missing labial sinus wall and ridge deficiencies. Missing buccal bony wall: the Island technique

Combination of missing buccal and nasal bone in addition to a ridge defect

Crestally missing bone: the Atomic Bomb design

14. Sinus graft infection and postoperative sinusitis

Diagnosis of sinus graft infection

Surgical intervention to treat graft infection

Systemic pharmacologic treatment of infection

Sinus graft infection with concomitant sinusitis

Representative case of sinus graft infection with concomitant sinusitis and ‘purulent backflow’

Untreated sinus graft infection

References

Additional reading

15. The reconstruction of an extreme vertical defect in the posterior maxilla

Long-term follow-up after an extreme posterior maxillary vertical ridge augmentation

Reference

Additional reading

Anterior maxillary vertical augmentation. 16. Introduction and clinical treatment guidelines. Introduction to the anterior maxilla

Clinical guidelines: surgical treatment of an advanced anterior maxillary vertical defect

Representative case of an advanced vertical and horizontal deficiency

Additional reading

17. Complex reconstruction of an anterior maxillary vertical defect

Anterior maxillary defect. 18. Extreme defect augmentation in the anterior maxilla

Soft tissue reconstruction in conjunction with bone grafting. 19. Reconstruction of a natural soft tissue architecture after bone regeneration. Introduction. Goals and strategies

Treatment strategy. 1. Hard tissue grafting

2. Soft tissue grafting

Treatment schemes for soft tissue reconstruction of mucogingival distortion

Representative case of a free connective tissue graft placed around natural teeth

Treatment scheme for soft tissue reconstruction

References

Additional reading

20. The labial strip gingival graft. Labial strip gingival graft for the esthetic reconstruction of mucogingival distortion

Surgical intervention

Study outcomes

Data analysis

Results

Bone regeneration, reconstruction of the interdental papilla, and a labial strip graft in combination with a collagen matrix

Labial strip gingival graft in combination with an open healing connective tissue graft and a collagen matrix

Discussion

Conclusions

References

21. The double strip graft

The double strip technique

22. Large open-healing connective tissue graft

Reconstruction of the interimplant papilla. 23. The double connective tissue graft

24. The Ice-cube connective tissue graft

Additional reading

25. The Iceberg connective tissue graft

Case 1

Case 2

Case 3

Interproximal bone and soft tissue regeneration. 26. Vertical periodontal regeneration in combination with ridge augmentation

Additional reading

Ultimate esthetics. 27. Reconstruction of the bone and soft tissue in conjunction with preserving the mucogingival junction. Avoiding mucogingival distortion after ridge augmentation

28. Complications

Case 1

Case 2

Postoperative infection

Case 3

Case 4

Some of the author’s personal experiences with other types of exposures. Exposure of a titanium mesh

Case 5

Case 6

Conclusion

Reference

Отрывок из книги

Istvan Urban

Vertical 2

.....

In these cases, < 100 µg BMP-2 was used, either inside the graft or just simply placed on top of the graft. The former is called the Sandwich technique and the latter the Lasagna technique. A pure xenogenic bone graft was used. The layered BMP-2 (Lasagna) developed excellent bone formation, which was better than the internally placed BMP-2 (Sandwich) graft, which failed to form a complete ridge (specifically in the middle of the ridge). Even though the Lasagna configuration only had BMP-2 placed on top of the graft, the bone was more evenly formed throughout the entire new ridge. This investigation again demonstrated the importance of the periosteal connection, especially with a growth factor. Note that the Lasagna configuration resulted in excellent new ridge formation throughout the entire ridge (Figs 1-43 and 1-44).

The final case demonstrates the Lasagna technique, where a low dose of BMP-2 was used on top of the graft to improve and accelerate the bone formation (Figs 1-45 to 1-49). Note the complete vertical bone regeneration and the excellent bone quality with minimal smear layer that was regenerated.

.....

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