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Case Study
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Alveolar Ridge Augmentation using a Double-Layer Technique

A Case Presentation

Learning Objectives:

This study describes a two-barrier technique for guided bone regeneration associated with implant placement. Upon reviewing this study, the reader should:

  • Understand the importance of the alveolar ridge to successful implant aesthetics.
  • Recognize the clinical benefits associated with two different types of collagen membranes.


Endosseous implants have been documented to be a successful treatment option for restoring missing or failing teeth. Implant success, as measured through fixture osseointegration and restoration of function, has been reported to be high and stable over time. The predictability of implant procedures and the maintenance of long-term implant stability in function are directly related to the quality and quantity of the available osseous tissue for implant placement. Implantation of endosseous devices in areas where the dimensions of the alveolar bone are equal to or less than those of the implant results in parts of the implant surfaces and/or threads not being covered by bone. In the dental literature, it is still unclear whether exposed implant threads hamper the long-term prognosis of endosseous implants. 

With respect to dental aesthetics, uncovered implant threads may be seen in concordance with the observations made following facial displacement of a tooth and can lead to soft tissue recession, which is subsequently followed by an aesthetic failure of the fixture. For an optimal outcome, several authors recommend at least 2 mm of bone structure on the buccal aspect of the implant shoulder.  In the aesthetic zone, however, the anterior alveolar ridge is often devoid of this amount of bone structure. Therefore, in many instances, the bone structure on the buccal aspect of the implant shoulder has to be created using augmentation procedures. 

The most widely used technique to increase the alveolar ridge width is to exclude the invasion of nonosteogenetic soft tissue cells by guided bone regeneration (GBR). The efficacy of the GBR technique both in rebuilding the atrophic alveolar bone prior to implant placement and around exposed implant surfaces has been well established in the literature. 

This case presentation demonstrates a modification of the conventional GBR concept. The modifications involve the application of two different kinds of bioresorbable collagen membranes in combination with a xenogenous bone substitute. As the biodegradation of the membrane might be regarded as too rapid for bone regeneration, a long-lasting osseous membrane with a biodegradation of up to six months was mounted above the bone substitute, but beneath the membrane. With this concept, the ideal behaviour of the membrane towards soft tissue and the lasting durability of the osseous membrane can be combined.


*Clinical Associate Professor, Department of Operative Dentistry and Periodontology, Albert Ludwigs University, Freidburg, Germany; Clinical Associate Professor, University of Texas, Dental Branch, Houston, TX; private practice, Munich, Germany.


Related Reading:

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