BIOBRIEF

Horizontal Ridge Augmentation with a Layered Allograft-Xenograft Approach

Eswar Kandaswamy, BDS, MS

Amber Kreko, DDS

THE SITUATION

The patient presented to the clinic for a dental implant in the tooth #12 location. Clinical evaluation revealed a ridge deficiency. A Cone Beam Computed Tomography (CBCT) scan was taken, confirming insufficient ridge width for implant placement. As a result, the site was treatment planned for horizontal ridge augmentation.

THE RISK PROFILE

	Low Risk	Medium Risk	High Risk
Patient’s health	Intact immune system	Light smoker	Impaired immune system
Patient’s esthetic requirements	Low	Medium	High
Gingival biotype	Thick – “low scalloped”	Medium – “medium scalloped”	Thin – “high scalloped”
Infection at implant sight	None	Chronic	Acute
Bone height at adjacent tooth	≤ 5 mm from contact point	5.5 – 6.5 mm from contact point	≥ 7 mm from contact point
Restorative status of adjacent tooth	Intact		Restored
Soft-tissue anatomy	Intact		Compromised
Bone anatomy of the alveolar ridge	No defect	Horizontal defect	Vertical defect

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THE APPROACH

Horizontal ridge augmentation was performed using a horizontal layering technique. An inner layer of demineralized freeze-dried bone allograft (DFDBA), featuring vallos^® demineralized cortical particles (to promote osteoinduction), was followed by an outer layer of deproteinized bovine bone, Geistlich Bio-Oss^® (to maintain space and volume). The graft was contained with a native bilayer collagen membrane, Geistlich Bio-Gide^®, and secured with titanium pins (tacks).

Image 1a depicts the pre-operative situation, while the inset shows a cross-sectional view of the deficient ridge in area #12.

Pre-operative view, post-flap reflection.

An inner layer of vallos® demineralized cortical particles (allograft) was applied to the defect.

An outer layer of Geistlich Bio-Oss® (xenograft) was applied on top of vallos® (allograft).

Bone grafts covered with Geistlich Bio-Gide® and secured via tacks

Final sutured closure over the bone grafts covered with Geistlich Bio-Gide® and secured via tacks

Four-week post-operative image demonstrating good soft tissue healing.

Sequential CBCT imaging comparisons, from pre-operative to 6 and 9 months post-operative, confirm the re-establishment of horizontal ridge width achieved through bone augmentation.

Comparative CBCT cross-sectional analysis of pre-operative (left) and 6-month post-operative (right) images reveals an increase in horizontal ridge width.

“By horizontally layering two distinct bone graft materials (Geistlich Bio-Oss^® and vallos^®), the procedure aimed to leverage their respective beneficial properties.”
— Eswar Kandaswamy, BDS, MS

THE OUTCOME

The 6-month post-operative CBCT evaluation demonstrated sufficient ridge width for restoratively driven implant placement, a result achieved through the utilization of vallos^® and Geistlich Bio-Oss^®bone graft materials.

The incorporation of vallos® demineralized cortical particles, leveraging its reliable osteoinductive properties, was paramount for achieving predictable and successful bone regeneration in this case.”
Eswar Kandaswamy, BDS, MS

The patient required horizontal ridge augmentation for successful placement of a dental implant.”
Eswar Kandaswamy, BDS, MS

Eswar Kandaswamy, BDS, MS

Dr. Eswar Kandaswamy, BDS MS, is an Assistant Professor at Louisiana State University Health Sciences Center, School of Dentistry. He earned his Dental Degree from Sri Ramachandra University, India, and practiced general dentistry for two years. He then completed his specialty training in Periodontics and a Master of Science at The Ohio State University.

Amber Kreko, DDS

Dr. Amber Kreko, DDS is a third-year Periodontics resident at Louisiana State University School of Dentistry, soon to earn her Master of Science. With a foundation in dental hygiene and six years of clinical practice in Southeast Louisiana,she returned to LSU for her DDS. Her comprehensive background enriches her approach to periodontal care. Upon graduation, she will transition to private practice.