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Horizontal bone augmentation

The Sausage TechniqueTM

02.04.2015
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The Sausage Technique<sup>TM</sup> makes it possible to regenerate horizontal bone defects without using a bone block or a non-resorbable membrane. An interview with the inventor, Prof. Istvan Urban.

Prof. Istvan Urban | Hungary

Professor Urban, you use granulate graft material for horizontal ridge augmentations. Why?

Prof. Urban: Today we prefer particulate graft materials for two main reasons: Firstly, our histological examinations show that they are easily vascularized, which is very important for graft incorporation and new bone formation. Secondly, the particles adapt to any surface irregularities.

 

What is the major challenge when using this technique?

Prof. Urban: We have to completely immobilize the graft and cover the granules. In the beginning, we used non-resorbable, titanium-reinforced membranes for both horizontal and vertical augmentations. The membranes worked well, but they were sometimes very demanding and not well accepted by many clinicians.

Then we asked ourselves why not use the remaining bony wall in a smarter way. We started to apply resorbable, rigid membranes for horizontal augmentations with good results. Today we are using a native collagen membrane, Geistlich Bio-Gide®.

 

Why have you called your approach the Sausage TechniqueTM?

Prof. Urban: We fix the collagen membrane with titanium pins into the bone walls and fill the space under the membrane to form a very stable graft. The whole graft looks like a densely filled sausage. Geistlich Bio-Gide® acts like an immobilized “sausage” skin during the early weeks of healing. 


What are your results?

Prof. Urban: We get very predictable results with this technique using a 1:1 mixture of Geistlich Bio-Oss® and autogenous bone particles. We can usually harvest enough bone using bone scrapers. The Geistlich Bio-Oss® particles incorporate well and help to reduce graft resorption. This has been nicely demonstrated both clinically and histologically in our recent prospective case series.1

 

What properties should a membrane have for this procedure?

Prof. Urban: First, I think a membrane should allow vascularization from the periosteum. This enables nutrient transfer, capillary in-growth and other potential stimulating effects. The elasticity of a membrane is also important, so that I can stretch it when I fix it with the pins and form the stable “sausage bone graft”. The membrane should disappear in a good prompt manner so that it does not interfere with bone maturation. I do not think a long resorption time is needed, and it may even slow down bone formation.

Geistlich Bio-Gide® has all these properties. The lack of titanium reinforcement can be overcome reliably by fixing the membrane both lingually or palatally and vestibularly. Today we use titanium-reinforced membranes exclusively for vertical defects.

 

What complications have you faced so far with the Sausage TechniqueTM?

Prof. Urban: In the past ten years I have had only one posterior mandibular case in which the patient developed a postoperative infection.1

Prof. Istvan Urban

Prof. Istvan Urban | Hungary

Department of Periodontology at the University of Szeged, School of Dentistry
Dental School at the Loma Linda University, California

References
  1.  Urban IA, et al: Int J Periodontics Restorative Dent 2013; 33(3): 299-307.

Interview by Claudia Bühlmann

Illustration Header: Alessandro Holler / Quaint

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