the most predictable method would be autologous block bone grafts. you can expect 3-5 mm of horizontal gain (this is the average. You can gain more if you take thicker blocks). However, expect 5-10% resorption of whatever width you are placing. Hydroxyapetite in various forms are also effective. The granular form of hydroxyapetite are better when compared to powder form (CaPo4 bone cements) as the powder form has a tendency to flow even with minimal bleeding. Granular form is good to fill defects but not god enough to BUILD the width. You may also refer - Int J Oral Maxillofac Implants 2014;29(suppl):14–24. doi: 10.11607/
jomi.2014suppl.g1.1
1. Autobone blocks
2. 3D-printed TCP or OCP blocks
3. any HA or CPh granular bone substitute with autobone crumbs in the ratio 50/50 + membrane with prolonged biodegradation (double layer of the collagen membrane, pericardium, etc.)
It all depends on the available width..... try to keep additional procedures as minimal as possible.... if smallest implant not fitting keeping in mind the emergence profile ( in esthetic zone) ridge split, available bone dust ( taken from drills or suction) bone scrapings. and lastly, block grafts..... I would like to avoid allografts to a large extent.
To my experience and researches, it may be classed depending on the nature of pristine bone on alveolar crest. 1. enough cortical bone supported by cancellous bone : ridge split. 2. cortical bone destruction: Autobone block and more.
These are the agreement with Dr. Christopher to be as minimal as possible based on the concept of biologic envelope and boundary.
GBR with xenograft/autograft 75:25 or 50:50 and collagen membrane (pericardium CopiOss or bovine Creoss), very well immobilized with tacks, is a predictable solution to increase the width with less morbidity for horizontal deficiencies.
The best thing is autologous bone graft from calvarium, with minimal rate of absorption.I have done many with little absorption.
Regards
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