Vertical ridge augmentation (VRA) with the use of a cross-linked resorbable membrane, tenting screws, and a combination grafting technique: A report of three cases

Objective: The purpose of the present study was to present vertical ridge augmentation (VRA) with the use of cross-linked resorbable membrane, tenting screws, and a combination grafting technique. Report: Three cases are presented. Case 1: A 67-year-old ASA II patient required VRA at the areas of the mandibular left second premolar and first molar. Flap manage ment was performed with the use of periosteal release on the buccal aspect and 23 mm of mylohyoid muscle release on the lingual aspect. VRA was completed with the use of four self-tap ping tenting screws, and 1:1 mix of anorganic bovine bone matrix (ABBM) and particulate mineralized bone allograft. A cross-linked resorbable membrane was placed over the buccal and lingual aspect, and a double line of suturing was per formed to secure the tension-free closure. Twelve months post operatively, 4 mm of VRA was confirmed with CBCT. Two im plants were placed with >35 Ncm primary stability. Case 2: A 64-year-old ASA I patient required VRA at the area of the max illary first premolar. Flap management was performed with the use of periosteal release on the buccal aspect and VRA was performed with a 9-mm self-tapping screw, 1:1 mix of ABBM and particulate mineralized bone allograft, a cross-linked re sorbable membrane, and a double line of suturing. Twelve months postoperatively, VRA of 6.2 mm on the buccal aspect and 7.9 mm on the lingual aspect were confirmed with CBCT. An implant was placed with >35 Ncm primary stability in com bination with horizontal ridge augmentation. Case 3: A 70-year-old ASA II patient required horizontal and VRA at the area of the mandibular left canine. Following extraction, a lateral pedicle sliding flap was completed to enhance the soft tissue volume of the site. After 6 weeks, flap management was performed with the use of buccal periosteal release, VRA was completed with two self-tapping screws, 1:1 mix of ABBM and particulate mineralized bone allograft, a cross-linked resorbable mem brane, and a double line of suturing. Eight months postopera tively there was 5.3 mm of bone regeneration on the vertical dimension and 3.9 mm on the horizontal dimension. An im plant was placed with primary stability of 45 Ncm. Conclusion: Successful VRA can be achieved with proper flap management to achieve tension-free closure, a cross-linked collagen mem brane, tenting screws, and a combination grafting technique. The VRA ranged from 4.0 to 7.9 mm.