Is the Tunnel Technique More Effective Than Open Augmentation with a Titanium-Reinforced PTFE Membrane for Horizontal Ridge Augmentation?

• Published in: Journal of oral and maxillofacial surgery
• Main Authors: Deeb, George R., DDS, MD, Deeb, Janina Golob, DDS, MS, Wilson, Graham H., DDS, Carrico, Caroline K., PhD, Zafar, Usman, BDS, Laskin, Daniel M., DDS, MS
• Format: Journal Article
• Language: English
• Published: 2016
• Subjects: Surgery
• ISSN: 0278-2391
• DOI: 10.1016/j.joms.2016.04.031

Purpose Studies have shown that horizontal ridge augmentation with a non-resorbable membrane is subject to a relatively frequent occurrence of dehiscence and loss of the graft. This study was designed to compare the outcomes of a tunnel technique to an open technique using a titanium-reinforced PTFE membrane. Materials and Methods A retrospective cohort study, in which the data were collected by chart review, was designed to compare patients who had undergone horizontal ridge augmentation with a 1:1 ratio of mineralized freeze-dried allograft and particulate bovine hydroxyapatite using the tunnel technique with those who had an open technique with a titanium-reinforced PTFE membrane. The incidence of wound dehiscence or membrane exposure, the number of post-operative visits required, and the number of systemic antibiotic courses needed, as well as the number of grafted sites that subsequently were amenable to routine implant placement after graft maturation between the two techniques were compared. The differences in implants placed between the two methods were analyzed using Fisher’s exact test. The secondary hypothesis (wound dehiscence, number of post-operative visits, systemic antibiotics courses) was analyzed using a Poisson regression. Results The chart review revealed 52 patients with 21 treated by the tunnel technique and 31 treated with the open technique. Within six months after bone grafting, 18(86%) patients treated with tunnel technique grafts received dental implants, while 22(71%) patients treated with the open technique received dental implants. A greater proportion of ridge augmentations with the PTFE method developed dehiscence (52% vs 19%). There was a trend toward an increased number of courses of antibiotics prescribed for this group (p =0.11), as well as a significant increase in the number of postoperative visits required (p =0.003). Conclusion For horizontal defects amenable to either technique, the findings of this study demonstrate the tunnel technique is a more cost-effective option with similar success to the open technique.