title: Is the Tunnel Technique More Effective Than Open Augmentation With a Titanium-Reinforced Polytetrafluoroethylene Membrane for Horizontal Ridge Augmentation?
abstract: OBJECTIVE
  Studies have shown that horizontal ridge augmentation with a nonresorbable 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 versus an open technique using a titanium-reinforced polytetrafluoroethylene (PTFE) membrane.
  
  
  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 by the tunnel technique with patients who had undergone an open technique with a titanium-reinforced PTFE membrane. The incidence of wound dehiscence or membrane exposure, the number of postoperative 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, were compared between the 2 techniques. The differences in implants placed between the 2 methods were analyzed with the Fisher exact test. The secondary hypothesis (regarding wound dehiscence, number of postoperative visits, and number of systemic antibiotic courses) was analyzed by Poisson regression.
  
  
  RESULTS
  The chart review found 52 patients, with 21 treated by the tunnel technique and 31 treated with the open technique. Within 6 months after bone grafting, 18 patients (86%) treated with tunnel technique grafts received dental implants whereas 22 patients (71%) treated with the open technique received dental implants. Dehiscence developed in a greater proportion of ridge augmentations with the PTFE method (52% vs 19%). There was a trend toward an increased number of courses of antibiotics prescribed for this group (P = .11), as well as a significant increase in the number of postoperative visits required (P = .003).
  
  
  CONCLUSIONS
  For horizontal defects amenable to either technique, the findings of this study show the tunnel technique is a more cost-effective option with similar success to the open technique.
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, VA. Electronic address: gdeeb@vcu.edu.
authors.forename: George R
authors.initials: GR
authors.lastname: Deeb
authors.affiliation: Chief Resident, Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, VA.
authors.forename: Graham H
authors.initials: GH
authors.lastname: Wilson
authors.affiliation: Assistant Professor, Department of Research Administration, Virginia Commonwealth University, Richmond, VA.
authors.forename: Caroline K
authors.initials: CK
authors.lastname: Carrico
authors.affiliation: Student, School of Dentistry, Virginia Commonwealth University, Richmond, VA.
authors.forename: Usman
authors.initials: U
authors.lastname: Zafar
authors.affiliation: Professor Emeritus, Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, VA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Laskin
authors.affiliation: Assistant Professor, Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA.
authors.forename: Janina Golob
authors.initials: JG
authors.lastname: Deeb
mesh_terms: D000293:Adolescent; D000328:Adult; D000540:Alveolar Ridge Augmentation / Q000379:methods*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D016025:Bone Transplantation / Q000379:methods; D003758:Dental Implantation, Endosseous / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008567:Membranes, Artificial; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000209:etiology; D014025:Titanium
chemical_list: D000900:Anti-Bacterial Agents; D008567:Membranes, Artificial; D011138:Polytetrafluoroethylene; D014025:Titanium