Hydroxyapatite for alveolar ridge augmentation: indications and problems.

The increased use of hydroxyapatite for augmentation of residual alveolar ridges has created some problems in the subsequent fabrication of complete denture prostheses. Although hydroxyapatite appears to be an effective substitute for resorbed alveolar ridges, its use is not indicated for all patients. In addition, the premise that "if a little is good, a lot is better" does not apply. The following conclusions can be drawn. Augmentation should not be considered if vestibular extension will provide acceptable results. Placement of hydroxyapatite should improve the contour and amount of the residual alveolar ridge. Use as little as possible to accomplish the goal. Preprosthetic surgery should permit vertical as well as horizontal extension of the denture. Augmentation should not result in the need to use lining mucosa to support a complete denture. Vestibular extensions are indicated for most augmented alveolar ridges. The relative strength of the strong arch should not be increased in prognathic or retrognathic ridge relationships. Preprosthetic surgery should be a combined surgical-prosthodontic treatment endeavor. If a foundation is created that cannot be used effectively for the support, retention, and stability of an intended prosthesis, little benefit is provided for the patient. Small variations in intended treatment can significantly increase success of the prosthesis (Fig. 13). Unfortunately, the relative ease of hydroxyapatite placement has led to its use in patients who do not require augmentation and augmentation in amounts and regions that are not conducive to improving denture success. A coordinated effort between the surgeon and the prosthodontist will usually result in treatment that provides the best potential foundation for a specific patient.