Horizontal Ridge Augmentation in the Anterior Maxilla

There is a paucity of information in the literature regarding stability of the bone and esthetic outcomes following horizontal bone augmentation in the anterior maxilla. Confounding variables include the vertical component of the augmentation, defect morphology, periodontal status of the neighboring teeth, number of missing teeth, position of the site, soft tissue characteristics, time between augmentation and implant placement, implant design and diameter, prosthetic connection type and material, and provisional prostheses.

Studies available in the literature were not designed for esthetic outcome assessment and included no decision criteria relating to the choice of a simultaneous or staged approach. Combined vertical and horizontal augmentation procedures should also be evaluated in the esthetic area.

• Horizontal bone augmentation in the anterior maxilla is a reliable treatment option to enable the proper placement of implants.
• Mean horizontal bone gain in the staged approach (measured at the time of implant placement) ranged from 2.2 to 5 mm. The included studies do not provide information about the long-term stability of horizontal ridge augmentation.
• There is not enough data available to indicate superiority of one method or material over another.
• Survival and success rates of implants placed in horizontally augmented bone were not different from those reported for implants placed in native bone with adequate width.

• In sites with inadequate ridge width, horizontal bone augmentation is indicated to enable proper implant placement. Ideally, a bone thickness of 2 mm should be achieved on the facial aspect of the implant.
• The primary aim of horizontal ridge augmentation procedures in the anterior maxilla is to optimize implant positioning in order to improve function and esthetic outcome. The position and the shape of the augmented bone influence the soft tissue profile, which should follow the contour of the neighboring teeth.
• Clinicians performing horizontal ridge augmentation in the anterior maxilla may choose from a wide range of treatment options, including particulate bone grafts for simultaneous and bone blocks for staged approaches with or without placement of resorbable and nonresorbable membranes.
• Soft tissue augmentation may be required as an adjunctive procedure to improve the esthetic outcome.
• Horizontal ridge augmentation with simultaneous implant placement is indicated when adequate soft tissue conditions are present and correct implant positioning with primary implant stability is achievable.
• If defect morphology is such that successful regeneration is unlikely to be achieved using the simultaneous approach, a staged approach should be used.
• In large defects precluding implant primary stability and proper three-dimensional implant positioning, a staged approach is recommended.
• In general, the choice of augmentation materials should assure the long-term stability of the bone volume created and should be based on solid documentation in the literature.