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The International Journal of Periodontics & Restorative Dentistry

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269

Decision Tree for Vertical Ridge Augmentation

Alexandra B. Plonka, DDS, MS1 After extraction, the alveolar ridge


Istvan A. Urban, DMD, MD, PhD2 undergoes significant resorption.
Hom-Lay Wang, DDS, MS, PhD3 The estimated 40% loss of ridge
height presents a significant chal-
lenge to implant placement.1,2 Over
the long term, the prevalence of
Vertical ridge augmentation (VRA) procedures before or during dental implant peri-implantitis is high, affecting up
placement are technically challenging and often encounter procedure-related to half of all implants.3 Both implant
complications. To minimize complications and promote success, a literature position and history of regenera-
search was conducted to validate procedures used for VRA. A decision tree
tion increase peri-implantitis risk, so
based on the amount of additional ridge height needed (< 4, 4 to 6, or > 6 mm)
was then developed to improve the procedure-selection process. At each careful treatment planning is key.4
junction, the clinician is urged to consider anatomical, clinical, and patient- Options include rebuilding height
related factors influencing treatment outcomes. This decision tree guides using vertical ridge augmentation
selection of the most appropriate treatment modality and sequence for safe, (VRA) or placing a short implant.
predictable management of the vertically deficient ridge in implant therapy. This article introduces a guide for
Int J Periodontics Restorative Dent 2018;38:269–275. doi: 10.11607/prd.3280
successfully managing the vertically
deficient ridge.

Vertical Ridge
Augmentation Techniques

Strategies in this guideline for VRA


include distraction osteogenesis
(DO), onlay grafting (OG), and guid-
ed bone regeneration (GBR).

Adjunct Clinical Lecturer, Department of Periodontics and Oral Medicine,


1
Distraction Osteogenesis
School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA.
2Adjunct Clinical Professor, Department of Periodontics and Oral Medicine,

School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA; DO consists of surgical delineation
Private Practice in Periodontics and Implant Dentistry, Budapest, Hungary. of a bone segment followed by
3Professor and Director of Graduate Periodontics, Department of Periodontics and
slow separation from basal bone,
Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA.
allowing new bone fill.5 DO is lim-
Correspondence to: Dr Hom-Lay Wang, Department of Periodontics and ited to vertical augmentation.6 Due
Oral Medicine, School of Dentistry, University of Michigan, 1011 North University Avenue, to the complexity of DO, the au-
Ann Arbor, MI 48109-1078, USA. Fax: (734) 936-0374.
thors do not recommend this pro-
Email: homlay@umich.edu
cedure except for severe vertical
 ©2018 by Quintessence Publishing Co Inc. deficiencies.

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270

Onlay Grafting and small sample sizes hinders deci- cal approach such as short or tilted
sion making.6,14–16 More data exists implants should be considered for
An onlay graft is a bone block. on nonresorbable versus resorb- medically compromised patients. A
Complications include incision able membranes, but both types thorough clinical and radiographic
dehiscence, graft exposure, graft are comparable.15 A nonresorbable, examination should be performed to
loss, and sensory changes.7,8 Due Ti-reinforced membrane (PTFE-TR) evaluate the local anatomical factors.
to these complications, short im- may improve space maintenance Important soft tissue–related
plants should be considered as an and eliminate the need for tent- factors include keratinized mucosa
alternative.9 The greatest surgical ing screws used with absorbable (KM) width and vestibular depth. If
challenge in OG is maintenance of membranes.17–21 Extrapolating from soft tissue is deficient, its augmenta-
soft tissue closure.6 Allogeneic and the literature, GBR is a preferred tion should be performed after VRA
xenogenic block grafts are an alter- technique because it allows for si- to prevent scar tissue development,
native to autogenous blocks, but multaneous horizontal augmenta- which can limit flap extension and
evidence is limited.10,11 tion (not possible with DO), and has passive primary closure.21 Soft tis-
fewer complications than OG.15,16 sue augmentation after VRA helps
Guided Bone Regeneration GBR with PTFE-TR can yield close reestablish lost vestibular depth.21 A
to 100% success for VRA in all three combination approach of an apically
GBR has advantages over OG due to (small, medium, and large) elevation placed free gingival graft with cor-
avoidance of a second surgical site height groups.17,18,20–22 onally positioned free connective
and reduced complications. GBR tissue graft can increase KM width
uses barrier membranes for space Short Implants while maximizing esthetics.21
maintenance and exclusion of non–
bone-forming cells.12 GBR can be A short implant (< 8 mm) may be
applied at the time of implant place- preferred over VRA due to their low- The Decision Tree
ment or staged 4 to 9 months prior.1 er rates of complications and implant
Adherence to the principles of pri- failures.16,23,24 Short implants show This decision tree (Fig 1) is based
mary closure, angiogenesis, stability, similar marginal bone levels and on the amount of apicocoronal el-
and space maintenance (PASS) maxi- survival rates to ≥ 10 mm implants, evation needed for standard-length
mizes GBR success.12 Absorbable but the peak failure rate occurred implant placement (≥ 8 mm). Strat-
and nonresorbable barrier mem- at an earlier point (4 to 6 versus 6 to egies for small (< 4 mm), medium
branes are available. Collagen (CM) 8 years).25 Short implants decrease (4 to 6 mm), and large (> 6 mm) ver-
is a common absorbable membrane. treatment time (by an average of 4 tical ridge augmentation are pro-
Nonresorbable barriers include tita- months), and patients prefer them posed.
nium (Ti) mesh (Ti-mesh), expanded 100% over grafting.26,27 This guide
and density polytetra­fluoroethylene defines a short implant as < 8 mm. Small Apicocoronal Elevation
(PTFE), and Ti-reinforced PTFE Short implants are an option for all (< 4 mm)
(PTFE-TR). The most common com- stages of vertical deficiency if the re-
plication for GBR is membrane ex- maining bone is sufficient. GBR may be used to predictably
posure, which compromises the treat small vertical defects. Simulta-
amount of regeneration.8 neous implant placement and GBR
Survival is high for implants Systemic and Local Factors can be considered for 3-mm mean
placed after vertical GBR (93.75% to vertical gain.8 Both resorbable and
100%), and stability has been main- Prior to surgery, it is critical to ensure nonresorbable membranes may be
tained over 4 to 5 years.6,8,13,14 The good oral and systemic health of the used. CM performed similarly to
limited data on VRA, heterogeneity, patient. A more conservative surgi- PTFE membranes at buccal implant

The International Journal of Periodontics & Restorative Dentistry

© 2018 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
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271

Vertical ridge augmentation

Apicocoronal elevation needed

Small (< 4 mm) Medium (4–6 mm) Large (> 6 mm)


Onlay graft
(unpredictable)
GBR GBR Onlay graft GBR
Onlay graft
(unpredictable)
Distraction
Auto- osteogenesis
Staged Staged
(unpredictable,
Staged Staged
traumatic)
(preferred) (preferred) Allo-
Treat like Nonresorbable
Xeno- mild defect PTFE-TR
(preferred)

Absorbable barrier
± tenting screws
-Collagen membrane
-Acellular dermal matrix
-Others Short (< 8 mm) or tilted implants
could be alternatives to
vertical ridge augmentation for
managing the vertical defect
Nonresorbable barrier
-PTFE-TR
-Ti mesh ± tenting screws
-Ti membrane
± tenting screws

Fig 1  Decision tree for vertical ridge augmentation (VRA). The decision tree suggests procedures for managing the vertically deficient
ridge based on amount of apicocoronal elevation needed for standard (≥ 8 mm) length implant placement. Strategies for small (< 4 mm),
medium (4 to 6 mm), and large (> 6 mm) degrees of VRA are proposed. GBR = guided bone regeneration; PTFE-TR = titanium-reinforced
polytetrafluoroethylene; Ti = titanium.)

dehiscence defects.28,29 A combina- brane devices, such as PTFE-TR or gain; however, complication rates
tion of autogenous and DBBM bone Ti-mesh, provide enhanced stability are higher than with GBR.8,32 While
may be ideal for long-term graft and space. Figure 2 shows a small autogenous grafts are considered
stability due to autogenous graft defect treated with GBR using a the gold standard, allogeneic blocks
shrinkage.30,31 When absorbable CM, tenting screws, and sandwich show high success rates in case se-
membranes are used, periosteal bone augmentation using a combi- ries.10 This strategy is recommended
vertical mattress suturing with ab- nation of autogenous and allogen- for mild maxillary VRA to avoid a
sorbable sutures are an alternative ic grafting (enCore, Osteogenics mandibular harvest site.11 Xenoge-
to fixation screws.21 Nonresorbable Biomedical). neic grafts show promising early re-
membranes have also shown suc- OG may be considered for an ports, but more evidence is needed
cess for VRA.17,18,20,21 Stable mem- average 4.75-mm vertical height to validate the findings.33

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272

a b c

d e f
Fig 2  Sandwich guided bone regeneration for small vertical ridge augmentation. (a) Initial defect with intrabony marrow penetration.
(b) Sandwich guided bone augmentation using cancellous and cortical particulate allograft (Puros Allograft Particulate, Zimmer/Biomet 3i)
and tenting screws (Neo GBR kit, Neobiotech). (c) Pericardium membrane placement (CopiOs Pericardium Membrane, Zimmer Biomet).
(d) Suturing with modified horizontal vertical mattress and simple interrupted sutures using 4-0 polyglactin 910 (Vicryl, Ethicon, Johnson
& Johnson). (e) Radiograph after 5 months of healing. (f) Radiograph of final restoration 2 months after implant restoration (Zimmer TSV
system, Zimmer/Biomet 3i).

a b c

d e f
Fig 3  Guided bone regeneration using nonresorbable fixed membrane for medium vertical ridge augmentation (VRA). (a) Initial defect.
(b) Intrabony marrow penetration and placement of titanium-reinforced polytetrafluoroethylene (PTFE-TR) membrane (Cytoplast Ti-250
Titanium-Reinforced, Osteogenics Biomedical) on the lingual aspect, secured with fixation screws (Profix, Osteogenics Biomedical).
(c) Grafting with combination of autogenous bone and deproteinized bovine bone mineral (DBBM) (Geistlich). (d) Fixation of PTFE-TR
membrane on buccal aspect (Profix Osteogenics Biomedical). (e) Suturing with horizontal mattress and simple interrupted 3–0 and 4–0
PTFE sutures (Osteogenics Biomedical). (f) Radiographic bone gain at 9 months. Approximately 5 mm VRA was achieved.

The International Journal of Periodontics & Restorative Dentistry

© 2018 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
273

a b

c d e
Fig 4  Guided bone regeneration (GBR) for large vertical ridge augmentation (VRA). (a) Initial defect exceeds 10 mm. (b) Grafting with
combination of autogenous graft and deproteinized bovine bone mineral (DBBM) (Geistlich). (c) Fixed (Master-Pin-Control Bone Management
System, Meisinger) nonresorbable high density titanium-reinforced polytetrafluoroethylene (PTFE-TR) membrane (Cytoplast Ti-250 Titanium-
Reinforced, Osteogenics Biomedical) PTFE-TR membrane overlaid by collagen membrane to improve tissue tolerance of fixation screws.
(d) Vertical ridge height gain > 10 mm 24 months after VRA. (e) Radiograph at 8 years after final implant-supported restoration (Brånemark
System, Nobel Biocare).

Medium Apicocoronal Elevation flap or screw exposure, so it may be augmentation procedures over 1 to
preferable to use PTFE-TR (Fig 3). 2 years, so short implants should be
GBR may be used predictably for For absorbable and nonresorbable considered.21
medium defects (4 to 6 mm) with barriers, rigid fixation maximizes sta- GBR using a nonresorbable
adherence to the PASS principles.12 bility. While VRA requires significant membrane with a Ti-reinforced
Implant placement should be staged flap advancement to obtain passive framework (Fig 4) may be the pre-
after 6 to 9 months to allow graft closure, free soft tissue grafting after ferred choice for large VRA.17,18,20–22
maturation.19–22 Nonresorbable sta- VRA may be used to reestablish ves- A challenging area for primary clo-
ble membrane devices are preferred. tibular depth and KM width.21 sure is the maxillary anterior. A
The combination of PTFE-TR, DBBM, Autogenous OG is another op- classification based on amount of
and particulate autogenous graft tion for medium VRA. Overall, OG VRA, presence of horizontal ridge
was used for a mean vertical gain of has a high complication rate, sec- deficiency, history of regeneration
5.45 mm with no complications.18 ond to DO (8.1%), although the av- performed, periosteum status (na-
Cases with a thin gingival bio- erage implant survival rate is high tive versus scarred), and vestibular
type may consider use of an ab- (96.32%).8 Clinician skill is key when depth guides flap management to
sorbable CM alone or layered over considering this technique. maximize success of GBR.20
a nonresorbable barrier to improve DO is another option for se-
tissue tolerance. Since CM are non- Large Apicocoronal Elevation vere defects, with the largest height
rigid, tenting screws may enhance gain (mean 7.08 mm) but the high-
space maintenance. However, screws VRA in large (> 6 mm) cases may re- est complication rate (22.4%).8,13
can create pressure spots, leading to quire extensive soft and hard tissue Complications include fracture,

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© 2018 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
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274

mechanical problems, hypoesthesia, es. This approach is case-specific: in   7. Misch CM. Comparison of intraoral do-
and implant failure.8 Despite these addition to anatomical factors, clini- nor sites for onlay grafting prior to im-
plant placement. Int J Oral Maxillofac
challenges, the implant survival rate cians must consider their own ex- Implants 1997;12:767–776.
is high and there may be less re- perience and skill level and patient  8. Milinkovic I, Cordaro L. Are there spe-
cific indications for the different alveo-
sorption than OG. This procedure preferences and health concerns. lar bone augmentation procedures for
should be reserved for the most se- This guideline allows judicious se- implant placement? A systematic re-
vere cases. lection of vertical augmentation view. Int J Oral Maxillofac Surg 2014;43:
606–625.
Finally, OG may be considered techniques for successful outcomes.  9. Aloy-Prósper A, Peñarrocha-Oltra D,
for large VRA.34 Due to donor site Peñarrocha-Diago M, Peñarrocha-Diago
M. The outcome of intraoral onlay block
morbidity, short implants should bone grafts on alveolar ridge augmen-
be considered.35 Long-term implant Acknowledgments tations: A systematic review. Med Oral
survival after OG was 93.4% over a Patol Oral Cir Bucal 2015;20:e251–e258.
10. Waasdorp J, Reynolds MA. Allogeneic
mean of 39.9 months.36 Based on Dr Urban and Dr Wang received honoraria bone onlay grafts for alveolar ridge
the drawbacks associated with OG, for lecturing from Osteogenics Biomedical. augmentation: A systematic review.
In addition, Dr Urban received honoraria for Int J Oral Maxillofac Implants 2010;25:
GBR is a preferred choice in manag- 525–531.
lecturing from Geistlich Pharma. This paper
ing this specific clinical situation. 11. Monje A, Pikos MA, Chan HL, et al. On
was partially supported by the University of
the feasibility of utilizing allogeneic bone
Michigan Periodontal Graduate Student Re- blocks for atrophic maxillary augmenta-
search Fund. The authors reported no con- tion. Biomed Res Int 2014;2014:814578.
Conclusions flicts of interest related to this study. 12. Wang HL, Boyapati L. “PASS” principles
for predictable bone regeneration. Im-
plant Dent 2006;15:8–17.
Limited evidence is present regard- 13. Fiorellini JP, Nevins ML. Localized ridge
ing vertical ridge augmentation. References augmentation/preservation. A system-
atic review. Ann Periodontol 2003;8:
When considering vertical ridge 321–327.
augmentation, the authors urge   1. Fu JH, Wang HL. Horizontal bone aug- 14. Clementini M, Morlupi A, Canullo L,
mentation: The decision tree. Int J Agrestini C, Barlattani A. Success rate
the clinician to evaluate pertinent of dental implants inserted in horizontal
Periodontics Restorative Dent 2011;31:
anatomical (KM width, tissue thick- 429–436. and vertical guided bone regenerated
ness, anatomical structures), clinical   2. Araújo MG, Lindhe J. Dimensional ridge areas: A systematic review. Int J Oral
alterations following tooth extraction. Maxillofac Surg 2012;41:847–852.
(surgeon skill and experience), and An experimental study in the dog. J Clin 15. Jensen SS, Terheyden H. Bone augmen-
patient-related (local and systemic Periodontol 2005;32:212–218. tation procedures in localized defects
 3. Daubert DM, Weinstein BF, Bordin S, in the alveolar ridge: Clinical results
health, preferences) factors. GBR is with different bone grafts and bone-
Leroux BG, Flemming TF. Prevalence
generally preferred due to its high and predictive factors for peri-implant substitute materials. Int J Oral Maxillo-
predictability and low incidence of disease and implant failure: A cross- fac Implants 2009;24(suppl):s218–s236.
sectional analysis. J Periodontol 2015; 16. Esposito M, Grusovin MG, Felice P,
complications. OG should be re- 86:337–347. Karatzopoulos G, Worthington HV,
served for patients resistant to allo-   4. Monje A, Galindo-Moreno P, Tözüm TF, Coulthard P. The efficacy of horizontal
Suárez-López del Amo F, Wang HL. Into and vertical bone augmentation proce-
geneic and xenogenic graft sources. dures for dental implants—A Cochrane
the paradigm of local factors as con-
Due to its high complication rate, tributors for peri-implant disease: Short systematic review. Eur J Oral Implantol
DO should only be used in cases communication. Int J Oral Maxillofac Im- 2009;2:167–184.
plants 2016;31:288–292. 17 Urban IA, Jovanovic SA, Lozada JL. Ver-
of extreme vertical ridge deficiency  5. Ilizarov GA. Basic principles of transos- tical ridge augmentation using guided
and with high operator experience seous compression and distraction bone regeneration (GBR) in three clinical
osteosynthesis [in Russian]. Ortop Trav- scenarios prior to implant placement: A
and skill. retrospective study of 35 patients 12 to
matol Protez 1971;32:7–15.
This guideline offers an ap-  6. Keestra JA, Barry O, Jong L, Wahl G. 72 months after loading. Int J Oral Max-
proach based on available evidence Long-term effects of vertical bone aug- illofac Implants 2009;24:502–510.
mentation: A systematic review. J Appl
and the authors’ clinical experience Oral Sci 2016;24:3–17.
to achieve safe, predictable man-
agement of vertically deficient ridg-

The International Journal of Periodontics & Restorative Dentistry

© 2018 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
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275

18. Urban IA, Lozada JL, Jovanovic SA, 24. Esposito M, Grusovin MG, Felice P, 31. Jung RE, Benic GI, Scherrer D, Hämmer-
Nagursky H, Nagy K. Vertical ridge Karatzopoulos G, Worthington HV, le CH. Cone beam computed tomogra-
augmentation with titanium-reinforced, Coulthard P. Interventions for replacing phy evaluation of regenerated buccal
dense-PTFE membranes and a combi- missing teeth: Horizontal and vertical bone 5 years after simultaneous implant
nation of particulated autogenous bone bone augmentation techniques for den- placement and guided bone regenera-
and anorganic bovine bone-derived tal implant treatment. Cochrane Data- tion procedures—A randomized, con-
mineral: A prospective case series in 19 base Syst Rev 2009;(4):CD003607. trolled clinical trial. Clin Oral Implants
patients. Int J Oral Maxillofac Implants 25. Monje A, Suarez F, Galindo-Moreno Res 2015;26:28–34.
2014;29:185–193. P, García-Nogales A, Fu JH, Wang HL. 32. Rocchietta I, Simion M, Hoffmann M,
19. Urban IA, Monje A, Lozada JL, Wang HL. A systematic review on marginal bone Trisciuoglio D, Benigni M, Dahlin C. Ver-
Long-term evaluation of peri-implant loss around short dental implants tical bone augmentation with an autog-
bone level after reconstruction of se- (<10 mm) for implant-supported fixed enous block or particles in combination
verely atrophic edentulous maxilla via prostheses. Clin Oral Implants Res 2014; with guided bone regeneration: A clinical
vertical and horizontal guided bone 25:1119–1124. and histological preliminary study in hu-
regeneration in combination with sinus 26. Nisand D, Picard N, Rocchietta I. mans. Clin Implant Dent Relat Res 2016;
augmentation: A case series with 1 to 15 Short implants compared to implants 18:19–29.
years of loading. Clin Implant Dent Relat in vertically augmented bone: A sys- 33. Simion M, Rocchietta I, Dellavia C.
Res 2017;19:46–55. tematic review. Clin Oral Implants Res Three-dimensional ridge augmentation
20. Urban IA, Monje A, Nevins M, Nevins 2015;26(suppl):s170–s179. with xenograft and recombinant hu-
ML, Lozada JL, Wang HL. Surgical man- 27. Pistilli R, Felice P, Cannizzaro G, et al. man platelet-derived growth factor-BB
agement of significant maxillary anterior Posterior atrophic jaws rehabilitated in humans: Report of two cases. Int J
vertical ridge defects. Int J Periodontics with prostheses supported by 6 mm Periodontics Restorative Dent 2007;27:
Restorative Dent 2016;36:329–337. long 4 mm wide implants or by longer 109–115.
21. Urban IA, Monje A, Wang HL. Verti- implants in augmented bone. One-year 34. Chiapasco M, Casentini P, Zaniboni
cal ridge augmentation and soft tissue post-loading results from a pilot ran- M. Implants in reconstructed bone: A
reconstruction of the anterior atrophic domised controlled trial. Eur J Oral Im- comparative study on the outcome of
maxillae: A case series. Int J Periodon- plantol 2013;6:359–372. Straumann tissue level and bone level
tics Restorative Dent 2015;35:613–623. 28. Jung RE, Herzog M, Wolleb K, Ramel implants placed in vertically deficient
22. Urban IA, Lozada JL, Wessing B, Suárez- CF, Thoma DS, Hämmerle CH. A ran- alveolar ridges treated by means of
López del Amo F, Wang HL. Vertical domized controlled clinical trial com- autogenous onlay bone grafts. Clin Im-
bone grafting and periosteal vertical paring small buccal dehiscence defects plant Dent Relat Res 2014;16:32–50.
mattress suture for the fixation of re- around dental implants treated with 35. Peñarrocha-Oltra D, Aloy-Prósper A,
sorbable membranes and stabilization guided bone regeneration or left for Cervera-Ballester J, Peñarrocha-Diago
of particulate grafts in horizontal guided spontaneous healing. Clin Oral Implants M, Canullo L, Peñarrocha-Diago M. Im-
bone regeneration to achieve more pre- Res 2017;28:348–354. plant treatment in atrophic posterior
dictable results: A technical report. Int J 29. Moses O, Pitaru S, Artzi Z, Nemcovsky mandibles: Vertical regeneration with
Periodontics Restorative Dent 2016;36: CE. Healing of dehiscence-type defects block bone grafts versus implants with
153–159. in implants placed together with different 5.5-mm intrabony length. Int J Oral
23. Monje A, Chan HL, Fu JH, Suarez F, barrier membranes: A comparative clini- Maxillofac Implants 2014;29:659–666.
Galindo-Moreno P, Wang HL. Are short cal study. Clin Oral Implants Res 2005; 36. Schwartz-Arad D, Ofec R, Eliyahu G,
dental implants (<10 mm) effective? A 16:210–219. Ruban A, Sterer N. Long term follow-up
meta-analysis on prospective clinical tri- 30. Llambés F, Silvestre FJ, Caffesse R. Verti- of dental implants placed in autologous
als. J Periodontol 2013;84:895–904. cal guided bone regeneration with bio- onlay bone graft. Clin Implant Dent
absorbable barriers. J Periodontol 2007; Relat Res 2016;18:449–461.
78:2036–2042.

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© 2018 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
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