From the Guidelines
Vertical periodontal bone preparation is generally preferred over horizontal preparation due to its more conservative nature and lower morbidity, as evidenced by the use of growth factors such as BMP-2 in combination with diverse carriers, which have shown several advantages such as decreased surgical time and lower morbidity 1.
Key Differences
The main difference between vertical and horizontal periodontal bone preparation lies in their approach to bone regeneration. Vertical preparation involves creating a more conservative removal of bone structure, whereas horizontal preparation requires a more invasive approach, creating flat surfaces perpendicular to the long axis of the bone.
- Vertical preparation preserves more healthy bone material and is often used for smaller defects or when minimal intervention is desired.
- Horizontal preparation provides better resistance to occlusal forces but requires removing more bone structure, making it typically used for larger defects or when additional structural support is needed.
Clinical Decision-Making
Clinical decision-making should be guided by a comprehensive assessment of relevant evidence and local and systemic variables, leveraging a comprehensive diagnostic process to appraise different treatment options 1. The choice between vertical and horizontal preparation depends on factors such as the size and location of the defect, the type of restorative material being used, and the occlusal forces the bone will need to withstand.
- Remaining bone height is a crucial factor in determining the need for maxillary sinus floor augmentation and the probability of achieving implant primary stability 1.
- The use of growth factors such as BMP-2 has been recognized as a potent growth factor to induce bone regeneration, particularly in combination with biomaterials, and has been FDA approved for orthopedic and oral surgery applications 1.
Treatment Options
Several therapeutic options can be considered for the rehabilitation of the posterior edentulous maxilla, including:
- Standard implants
- Transalveolar maxillary sinus floor augmentation with simultaneous implant placement
- Maxillary sinus floor augmentation via lateral window with simultaneous or delayed implant placement
- Short implants
- Tilted implants
- Distal cantilevers The most appropriate treatment option should be determined based on a comprehensive evaluation of the patient's specific needs and anatomical variables, with a focus on minimizing morbidity and maximizing bone regeneration 1.
From the Research
Periodontal Bone Preparation
The difference between vertical and horizontal periodontal bone preparation is not directly addressed in the provided studies. However, some studies mention vertical preparation in the context of tooth preparation for prosthetic restorations.
Vertical Preparation
- Vertical preparation is a technique used in tooth preparation for fixed prosthetic restorations, as mentioned in 2 and 3.
- It involves preparing the tooth without a defined margin, also known as a feather edge preparation, as described in 2.
- The Biologically Oriented Preparation Technique (BOPT) is a type of vertical preparation that has been proposed for periodontally healthy teeth, as discussed in 2 and 3.
Horizontal Preparation
- There is no direct mention of horizontal periodontal bone preparation in the provided studies.
- However, horizontal integration is mentioned in 4 as a concept related to healthcare, where it involves peer-based and cross-sectoral collaboration to improve overall health.