Many patients with adjacent missing teeth in the “esthetic zone” present to us with less-than-ideal alveolar ridge form due to severe hard and soft tissue loss. While many techniques offer excellent results for reconstruction of these defects, few can be said to guarantee success.  A bone or soft tissue augmentation procedure to correct a ridge defect in the esthetic zone that is not fully successful in correcting the defect often ensures the use of prosthetic pink. This leads to the treatment dilemma: “if we have to use a little pink, why not use a lot of pink” and spare the patient the painful augmentations in the first place? The aim of this lecture is to critically evaluate the current evidence to determine the predictability of various bone augmentation techniques for vertical ridge defects for implant placement and when to consider more conservative alternative treatment options. A series of cases have been gathered to illustrate risk assessment and predictable management of various critical size defects ranging from moderate to severe defects.

Objectives

• Describe the anatomic basis and principles of vertical hard tissue grafting for implant site development.
• Describe a simple diagnostic parameter to assess the risks involved in the treatment of each individual patient.
• Apply practical methods of handling the vertically deficient ridge