Sandwich Bone Augmentation for Predictable Horizontal Bone Augmentation

Abstract

There is much evidence in the literature to support the success and predictability of guided bone regeneration. Multiple techniques have been introduced using various types of membranes and bone grafting materials. The clinician is now faced with having to select the most predictable guided bone regeneration technique put forth within this extensive literature. Within this context and in addition to its demonstrated success, the "sandwich" bone augmentation technique creates an environment that mimics native bone and promotes regeneration. Its concept is based on a sound biologic rationale while providing flexibility in the selection of biomaterials. This article discusses the principles, the complications, and a step-by-step protocol of sandwich bone augmentation.

Using Cone Beam Computed Tomography Angle for Predicting the Outcome of Horizontal Bone Augmentation

“…In recent years, the sandwich bone augmentation (SBA) technique was introduced through which GBR was done with simultaneous implant placement . This technique allows the clinician to maximize the treatment outcomes of GBR by utilizing the properties of various bone grafts . First, autogenous bone, because of its ability for de novo bone formation, is used to cover the exposed implant surfaces.…”

“…Lastly, a barrier membrane is used to protect the underlying bone graft and also to serve as a barrier to exclude undesirable nonregenerative cells such as the epithelial and gingival connective tissue cells. Having multiple layers of bone grafts over the exposed implant surface recreates the native bone composition, thus allowing for the reconstitution of lost bone around the implant . Previous studies have evaluated the effectiveness of the SBA technique for the correction of buccal dehiscences on implants.…”

Management of Dehiscence During Implant Placement With Sandwich Technique: A Case Report.

“…In addition, a second surgical procedure to remove the membrane is eliminated, increasing patient satisfaction while reducing site morbidity, attachment loss, and treatment time. 27 Regarding mechanical implant stability, the bone-to-implant contact may not necessarily be as informative as commonly believed. 28 In trabecular regions or in studies where implants with a wound chamber design were used, the initial bony coating may be very thin and may therefore not contribute greatly to mechanical implant stability.…”

“…22 Layering the mineralized cancellous and cortical bone allografts take advantage of the creeping and reverse creeping substitution healing processes and also mimics the macrostructure of native bone. 23 The present case we used synthetic material instead of allograft as synthetic bone grafts should aid in osteointegration, osteoconduction, and ideally should be biocompatible, show minimal fibrotic reaction, undergo remodeling and support new bone formation. From a mechanical point of view, it should have a similar strength to that of the cortical/cancellous bone being replaced.…”

Periosteal Releasing Incision With Diode Laser in Guided Bone Regeneration Procedure: A Case Series

“…1,2 Tension-free primary closure of soft tissue flap is a prerequisite for successful GBR. [3][4][5] On the other hand, failure to maintain primary closure usually results in flap dehiscence and membrane exposure and may lead to reduced quantity and quality of the regenerated bone. 6 Periosteal releasing incision (PRI) is the most common method to ensure tension-free primary closure.…”