CONTINUING EDUCATION

Volume 34 No. 10 Page 114

To Graft or Not To Graft?

Treating Vertical Bone Defects in the Aesthetic Zone

Authored by Craig M. Misch, DDS, MDS

Upon successful completion of this CE activity, 2 CE credit hours may be awarded

Opinions expressed by CE authors are their own and may not reflect those of Dentistry Today. Mention of specific product names does not infer
endorsement by Dentistry Today. Information contained in CE articles and courses is not a substitute for sound clinical judgment and accepted
standards of care. Participants are urged to contact their state dental boards for continuing education requirements.
 CONTINUING EDUCATION
To Graft or Not To Graft?
Treating Vertical Bone Defects in the
Aesthetic Zone
Effective Date: 10/01/2015 Expiration Date: 10/01/2018
About the Author
Dr. Misch received postgraduate degrees in
prosthodontics, oral implantology, and oral and
maxillofacial surgery as well as a master of dental
science degree from the University of Pittsburgh and St.
Francis Medical Center. He is board-certified by the
American Board of Oral and Maxillofacial Surgery, and
he is a clinical associate professor at the University of
Florida in the departments of periodontology and prosthodontics. He practices
as a dual specialist in Sarasota, Fla. He can be reached at (941) 957-6444 or
via email at omfs1985@yahoo.com.
Disclosure: Dr. Misch is a consultant for BioHorizons, Orapharma, Carestream
Dental, and DENTSPLY Implants.
INTRODUCTION
The management of vertical ridge defects in the aesthetic zone
can be one of the most challenging types of implant cases. An
aesthetic outcome is obviously of paramount importance. Often,
the surgeon must not only reconstruct the deficient ridge but
also mimic the natural appearance of the supporting soft tissues.
The restoring dentist is confronted with developing dental
symmetry and blending the prosthesis with the remaining
dentition. Surgical shortcomings, such as missing papilla or
residual vertical deficiencies, can create difficult prosthetic
dilemmas and poor outcomes. The implant team must
determine from the onset if it is better to attempt to reconstruct
the patient back to normal anatomy or forgo reconstructive
efforts and utilize prosthetic solutions. It is also important to set
realistic expectations for the patient. This article will address the
diagnosis and treatment planning for managing vertical ridge
defects in the aesthetic zone.
Vertical bone deficiencies in the anterior maxilla can result
from periodontal disease, extractions, ridge atrophy, trauma,
pathology, tooth impaction, congenitally missing teeth, and
implant failures. The facial cortex over the maxillary incisors is
usually thin, averaging approximately 1.0 mm.1 Following
anterior tooth loss, the greatest reduction of bone occurs facially
but some height may also be lost. As a result of horizontal bone
1
resorption, the ridge is usually palatal to the prosthetic tooth
position. Efforts to reconstruct the atrophic maxilla to its
original form will usually require 3-D bone augmentation.
Prosthetic replacement of the missing teeth can further lead to
further bone loss. The use of a soft-tissue-borne removable
prosthesis can cause continued ridge resorption throughout
time and additional loss of vertical bone height.2 Dental
implant failures in the aesthetic zone can leave devastating
vertical defects and often cause attachment loss on adjacent
teeth. The anterior aspect of the mouth is more subject to
trauma. The loss of teeth and their supporting structures can
result in significant vertical bone defects. Regardless of the
etiology of the maxillary defect, its reconstruction and
prosthetic replacement can be most challenging.
Diagnosis of Vertical Ridge Defects
An essential part of the patient examination for implant
therapy is an aesthetic zone evaluation including lip mobility,
prosthetic needs, and natural teeth bordering the defect. The
amount of tooth and gingival display is assessed with a full
smile and exaggerated lip movements. Facial photographs and
video of the patient are useful adjuncts for planning and
documenting the existing conditions (Digital Smile Design).
Vertical maxillary excess, excessive lip mobility, a short upper
lip, or high smile may expose the cervical aspect of the teeth
and gingiva. Aesthetic zone reconstruction of the anterior
maxilla can be especially challenging under these conditions.
Even when the lip camouflages the defect, many patients are
still concerned with the underlying appearance.
The surgeon and restorative dentist must determine if the
missing hard and soft tissue will be surgically reconstructed or
replaced with the prosthesis. Even when skillful surgeons
obtain a successful repair of the defect, the restoring dentist
and patient may find aesthetic shortcomings in the final
result.3 Longer prosthetic teeth, missing papilla, and lack of
facial contour are not uncommon flaws when reconstructing
larger defects. One significant limitation is the recreation of
interdental papilla. This is due to a lack of supracrestal gingival
fibers around implants compared to natural teeth. Efforts to
sculpt the tissue in pontic sites can produce a scalloped
appearance, but this may well fall short of an interdental
papilla. An alternative to surgical repair of the defect is to
replace the missing hard and soft tissues with the prosthesis.3
It is also important to determine if the transition area between
the prosthesis and the ridge is above or below the high lip-line.4
It is very difficult to make this transition zone appear natural.
In many cases, if it is not feasible to rebuild the ridge to obtain
normal tooth lengths, it may be preferred to reduce the ridge
 CONTINUING EDUCATION
To Graft or Not To Graft? Treating Vertical Bone Defects in the Aesthetic Zone
height and hide the prosthetic transition area under the lip.4
The need for lip support may also be a concern when multiple
teeth are missing. This is more significant when a fixed
prosthesis, without a flange, is planned. A diagnostic try-in
without a flange can be used to assess the need for lip support.5
The soft tissue in the edentulous span and around the
adjacent teeth should be evaluated, including the amount of
keratinized tissue, gingival biotype, and mucosal thickness.
Thin tissue may be more prone to graft perforation, titanium
mesh exposure, or gingival recession around adjacent teeth
from flap elevation. Thin tissue may also contribute to
recession defects on bordering teeth and marginal bone loss
around implants.6 It is often better to plan the correction of
soft-tissue deficiencies prior to bone augmentation. This may
help reduce soft-tissue complications (ie, wound dehiscence)
and improve graft incorporation. Autogenous-free gingival
grafts from the palate may be used to increase the amount of
keratinized tissue along the ridge and adjacent teeth. Con-
nective tissue grafts from the palate can also be used to correct
dental recession defects and enhance mucosal thickness in the
edentulous span, enhancing the graft coverage. Allogeneic
dermis may also be considered for this purpose (Alloderm
[BioHorizons] or Perioderm [DENTSPLY Implants]). Soft-tissue
corrective surgery should be performed at least 8 weeks prior
to bone augmentation. This allows the vascular network
within the tissues to re-establish. Vertical bone augmentation
will require a periosteal release incision at the base of the facial
flap to allow tension-free closure. The surgeon should be aware
that facial flap advancement over a bone graft will move the
mucogingival junction more palatal. The keratinized gingiva
can be repositioned during subsequent surgical procedures or
connective tissue grafting can be performed.
The teeth adjacent to the edentulous span should also be
evaluated prior to grafting. The marginal bone height on the
roots bordering the ridge defect will determine the level that
may be achieved with vertical bone augmentation. In some
cases, it may be prudent to remove teeth with marginal bone
loss to improve the ability to reconstruct the ridge. It is usually
preferred to extract compromised teeth 8 weeks prior to the
bone graft surgery and allow soft-tissue healing over the site.
Prosthetic Planning
It is important to define the prosthetic goals prior to the
maxillary reconstruction. The design of the final prosthesis
determines the number of implants required and their ideal
positions. If there is inadequate available bone for implant
placement in the desired locations, then bone augmentation is
considered. This concept has been termed prosthetic guided bone
2
augmentation.7 Computed tomography (CT) is extremely useful
in assessing the maxillary anatomy, ridge deficiency, and
volume of bone augmentation required.8,9 Many surgeons have
CBCT machines in their offices (CS 9000 3D System [Carestream
Dental]). CBCT exposes the patient to less radiation and allows
an immediate assessment of the patients condition. A radio-
graphic template fabricated from a diagnostic setup of the
planned tooth positions is worn during the scan. A radiopaque
medium, such as barium sulfate, is mixed into the acrylic or
painted on the tooth areas of the template. Radiopaque denture
teeth can also be set for a wax try-in (SR VivoTAC [Ivoclar
Vivadent]). The patient wears the template during the CT scan,
allowing the clinician to evaluate the prosthetic tooth position
in relationship to the atrophic ridge.7 The high can also be
identified in the scan by inclusion of a wire that outlines the
inferior border of the lip. The CBCT scan can also be used to
produce a stereolithographic model of the maxilla (Anatomodel
[Anatomage Dental]). The 3-D model is helpful for patient
education and surgical planning for the reconstruction. The
model can also be sterilized and used during surgery to aid in
fitting bone blocks, titanium mesh, or Teflon membranes.
Additionally, dental implant planning software can be used with
the CT scan to precisely evaluate implant sizes and positions as
well as the augmentation needs of the patient (SimPlant
[Materialise Dental]).8,9
However, the actual implant surgery is staged after healing
of the bone graft. Guided surgery for dental implant placement
into the grafted site may also be considered.10 This is especially
helpful in cases where implants need to be placed to avoid the
transition zone of the prosthesis.
It is difficult to provide absolute guidelines for the number
and distribution of implants to support the fixed prosthesis.
Some generalizations may be made based on biomechanical
support and the vertical dimensions of soft tissue around
implants.11 When there are 2 missing adjacent teeth, the
clinician must decide on placing 2 implants for individual
crowns or one implant for a cantilevered bridge. The soft-tissue
profile around the implants may guide this decision. The
average papilla height between 2 adjacent implants is
approximately 3.5 mm.12 As the average papilla height between
natural teeth is 4.5 mm, a shorter papilla between 2 implants
may create an overall asymmetry in the soft-tissue profile. This
problem can be avoided if one implant is used to support a
cantilevered pontic. However, there are mechanical risks of
cantilevering, and the patients occlusion must be evaluated to
consider this type of prosthesis.13 When more than 2 teeth are
missing, an implant bridge is often preferred rather than
individual implant crowns. If the plan is to surgically
 CONTINUING EDUCATION

To Graft or Not To Graft? Treating Vertical Bone Defects in the Aesthetic Zone
reconstruct the defect back to normal anatomy, then
CASE 1
pontic sites can be planned between the implants in an
attempt to provide more soft-tissue height. The vertical
soft tissue of an implant next to a pontic can approach
5.5 mm.4 This greater soft-tissue thickness can create
the illusion of interdental papilla. If the plan is to
replace the missing hard and soft tissue with the
prosthesis, then biomechanical support overrules the
need for soft-tissue height. In this scenario, implant
Figure 1. Preoperative view of patient Figure 2. Diagnostic denture tooth
positioning in relation to the teeth is less critical and
following traumatic tooth loss from a try-in.
the number of implants is determined by prosthetic
support. It is imperative to prevent loading of the car accident.
grafted site during healing. A fixed provisional
prosthesis is preferred over a temporary removable
partial denture.
Small-diameter temporary, or transitional,
implants can also be utilized for provisional bridge
support. The transitional implants should be placed in
native bone and not within the bone graft. A removable
vacuum-formed or Essix retainer (DENTSPLY Raintree
Figure 3. Radiopaque denture teeth Figure 4. The 3-D reconstruction from
Essix) is another excellent option for cosmetic tooth
replacement during graft healing, as it is supported by used for radiographic template. the CBCT.
the teeth and does not place any pressure on the site.
Another option is a removable prosthesis that fits over
the remaining maxillary teeth with pontics in the
edentulous span (Snap-On Smile [DenMat]). A special
dental resin is processed over a cast of the dentition so
the prosthesis is retained by the teeth and prevents soft-
tissue loading in the edentulous area.
Prosthetic replacement of the missing tissues can
Figure 5. The 3-D model fabricated Figure 6. Reconstruction of the
be accomplished with gingival colored porcelain,
from the CBCT. maxillary defect with a corticocancellous
acrylic, composite (GRADIA [GC America]), or
zirconium silicate microceramic (Ceramage [Shofu block graft from the iliac crest.
Dental]). Composite application can be accomplished
chairside and customized to the patient but requires
periodic maintenance and reapplication. Dental
ceramics offer a more durable solution, but the
aesthetics are often determined by the skill of the
dental technician.

Bone Augmentation Procedures

Figure 7. Placement of 4 dental Figure 8. Final PFM fixed implant bridge

There are many methods available to vertically
implants 4 months after graft (Dr. Katherine Misch, Root Dental Lab,
augment the anterior maxilla, including guided bone
regeneration, block bone grafting, nasal floor bone healing. Leawood, Kan).
grafting, interpositional grafting (osteoperiosteal flap),
titanium mesh grafting, and distraction osteogenesis. The the morphology of the osseous defect, type of prosthesis, and
choice of a particular graft material or augmentation technique clinician or patient preferences. Regeneration and repair of an
will depend on several factors, including the degree of atrophy, osseous defect primarily originates from the surrounding bony

3
 CONTINUING EDUCATION

To Graft or Not To Graft? Treating Vertical Bone Defects in the Aesthetic Zone

CASE 2

Figure 9. Preoperative view of maxillary defect Figure 10. Preoperative view of the full
from a horse kicking accident. smile. Note the occlusal cant following a
mandible fracture malunion.

Soft-tissue corrective surgery should be performed at least

8 weeks prior to bone augmentation.
Figure 11. Full-face view used to determine
the occlusal asymmetry.

Figure 12. Denture tooth set up to plan Figure 13. 3-D model fabricated from the Figure 14. The maxillary defect is
for maxillary reconstruction and prosthetic CBCT. reconstructed with rhBMP-2/mineralized
correction. bone allograft in a titanium mesh.

Figure 15. Dental implants are placed into the Figure 16. Final screw-retained PFM fixed Figure 17. Full smile with the final implant
BMP graft after 6 months healing. implant prosthesis (Dr. Katherine Misch, prosthesis.
Advantage Dental Design, Tallahassee, Fla).

walls. As such, the morphology of a bone defect should influence require materials and/or techniques that offer greater biologic
the choice of material or technique. Sites with fewer surrounding activity and regenerative capacity. As a general rule, vertical onlay
osseous walls and greater jaw atrophy are more demanding and bone augmentation is more biologically and clinically challenging

4
 CONTINUING EDUCATION
To Graft or Not To Graft? Treating Vertical Bone Defects in the Aesthetic Zone
than horizontal bone augmentation. In addition, vertical bone de-
fects inside the bony contour (intrabony) are much easier to
reconstruct than onlay augmentations required outside the
osseous contour (extrabony). Explanations for this difference
would include fewer osseous walls and more difficulty obtaining
graft stability, soft-tissue coverage, and space maintenance during
healing. In addition to bone repair, soft-tissue augmentation is
often needed in the aesthetic zone. Soft-tissue grafting can be used
to improve the gingival biotype, thicken the soft-tissue flap, and/or
improve the soft-tissue profile around teeth, implants, and pontics.
Although there are no studies to document that one technique
is superior for vertical bone augmentation, the surgeon should
strive to select a method that offers predictable results for the
presenting clinical situation.14 Depending on the degree of
atrophy, some techniques offer a greater amount of bone
regeneration than others. Extrabony vertical defects measuring
greater than 5.0 mm are more biologically and clinically
demanding. If guided bone regeneration is used, then a titanium-
reinforced Teflon membrane should be considered. The particulate
graft used with the barrier membrane should either contain
particulated autogenous bone and/or a growth factor with the bone
substitute to enhance bone formation. Autogenous block bone
grafts have proven to be another predictable method for
reconstruction of vertical defects. The iliac crest is often utilized,
as this donor site provides the amount and quality of bone needed
for larger defects.15 Titanium mesh grafting is another technique
that may be considered for vertical augmentation. The mesh
provides a scaffold to protect the graft and provide space
maintenance during healing. In the past, autogenous cancellous
bone was traditionally used as the graft. More recently,
recombinant bone morphogenetic protein-2 (rhBMP-2) has been
utilized with titanium mesh as an alternative to bone harvest
(Infuse Bone Graft [Medtronic]). This growth factor is chemotactic
for mesenchymal stem cells and induces their proliferation and
differentiation into osteoblasts. The growth factor is applied to a
collagen sponge as the carrier and mixed with mineralized bone
allograft as a matrix for bone replacement (MinerOss [BioHori-
zons]). The composite graft mixture is placed within the titanium
mesh and fixated to the maxilla with screws (Salvin Dental).
Significant vertical bone gains have been found with this
approach.16 Dental implants are placed after the bone graft has
incorporated. A staged approach to implant placement allows for
graft remodeling and assessment of graft incorporation.
CASE REPORTS
Case 1
A 22-year-old female was referred to our office following an
ejection injury suffered in an automobile accident. She had
5
multiple missing teeth and a large vertical bone defect in the
right anterior maxilla (Figure 1). Although her lip covered the
area, she desired reconstruction and prosthetic replacement
without artificial gingiva. A diagnostic denture tooth setup was
used to assess the tooth position and maxillary defect
(Figure 2). Radiopaque denture teeth were used to fabricate a
radiographic template worn during the CBCT (Figure 3). The CT
scan template is visible in the 3-D reconstruction from the
CBCT (Figure 4). A printed 3-D model was fabricated to aid in
planning the bone augmentation (Figure 5). The maxillary
defect was reconstructed with a corticocancellous bone graft
from the iliac crest (Figure 6). The patient wore an Essix retainer
during healing of the bone graft. Following a 4-month healing
period, 4 dental implants were inserted (Figure 7). Upon
integration of the implants, she was restored with a cement-
retained PFM fixed implant bridge (Figure 8).
Case 2
A 53-year-old female was referred to our office following a facial
injury suffered from a horse kick. She fractured her mandible and
lost several maxillary and mandibular teeth (Figure 9). She
presented with a malunion of the mandible fracture that resulted
in development of an occlusal deviation (Figures 10 and 11). A
denture tooth setup was used to plan the maxillary
reconstruction (Figure 12). A CBCT scan of the maxilla was
obtained and a 3-D model was fabricated to aid in planning the
surgery (Figure 13). The vertical defect was so severe that an
implant prosthesis with artificial gingiva was planned. The
maxillary defect was reconstructed with rhBMP-2 mixed with
mineralized bone allograft and platelet concentrate in a titanium
mesh (Figure 14). Following a 6-month graft healing period, the
mesh was removed and 4 implants were inserted (Figure 15).
Upon integration of the implants, the patient was restored with
a screw-retained fixed implant prosthesis. Gingival-colored
porcelain was used for prosthetic replacement of the missing
hard and soft tissues (Figures 16 and 17).
CONCLUSION
The decision to graft or not to graft the deficient anterior maxilla
is contingent upon a thorough diagnostic evaluation of the
patient. The clinician must also consult the patient on his or her
preferences as well as educate the patient on the advantages and
limitations of surgical versus prosthetic solutions. Proper
planning can help the team attain the patients aesthetic goals
and better manage this challenging problem.!
References
1. Vera C, De Kok IJ, Reinhold D, et al. Evaluation of buccal alveolar
 CONTINUING EDUCATION
To Graft or Not To Graft? Treating Vertical Bone Defects in the Aesthetic Zone
bone dimension of maxillary anterior and premolar teeth: a cone
beam computed tomography investigation. Int J Oral Maxillofac
Implants. 2012;27:1514-1519.
2. Tallgren A. The continuing reduction of the residual alveolar
ridges in complete denture wearers: a mixed-longitudinal study
covering 25 years. J Prosthet Dent. 2003;89:427-435.
3. Coachman C, Salama M, Garber D, et al. Prosthetic gingival
reconstruction in a fixed partial restoration. Part 1: introduction
to artificial gingiva as an alternative therapy. Int J Periodontics
Restorative Dent. 2009;29:471-477.
4. Salama M, Coachman C, Garber D, et al. Prosthetic gingival
reconstruction in a fixed partial restoration. Part 2: diagnosis
and treatment planning. Int J Periodontics Restorative Dent.
2009;29:573-581.
5. Misch CE, Misch-Dietsh F. Preimplant prosthodontics: overall
evaluation, specific criteria, and pretreatment prostheses. In:
Misch CE, ed. Contemporary Implant Dentistry. 3rd ed. St.
Louis, MO: Mosby Elsevier; 2008:233-275.
6. Linkevicius T, Apse P, Grybauskas S, et al. The influence of soft
tissue thickness on crestal bone changes around implants: a 1-
year prospective controlled clinical trial. Int J Oral Maxillofac
Implants. 2009;24:712-719.
7. Misch CM. Use of a surgical template for autologous bone
grafting of alveolar defects. J Prosthodont. 1999;8:47-52.
8. Ganz SD. Cone beam computed tomography-assisted treatment
planning concepts. Dent Clin North Am. 2011;55:515-536, viii.
6
9. Tischler M, Ganz SD. The CT/CBCT-based team approach to
care. Part I: Identifying the implant patient and prosthetic
options. Dent Today. 2012;31:74-79.
10. Pikos MA, Magyar CW, Llop DR. Guided full-arch immediate-function
treatment modality for the edentulous and terminal dentition
patient. Compend Contin Educ Dent. 2015;36:116-128.
11. Misch CE. Treatment planning: force factors related to patient
conditions. In: Misch CE, ed. Contemporary Implant Dentistry.
3rd ed. St. Louis, MO: Mosby Elsevier; 2008:105-129.
12. Tarnow D, Elian N, Fletcher P, et al. Vertical distance from the
crest of bone to the height of the interproximal papilla between
adjacent implants. J Periodontol. 2003;74:1785-1788.
13. Kim P, Ivanovski S, Latcham N, et al. The impact of cantilevers
on biological and technical success outcomes of implant-
supported fixed partial dentures. A retrospective cohort study.
Clin Oral Implants Res. 2014;25:175-184.
14. Chiapasco M, Casentini P, Zaniboni M. Bone augmentation
procedures in implant dentistry. Int J Oral Maxillofac Implants.
2009;24(suppl):237-259.
15. Misch CM. Maxillary autogenous bone grafting. Dent Clin North
Am. 2011;55:697-713.
16. Misch CM, Jensen OT, Pikos MA, et al. Vertical bone
augmentation using recombinant bone morphogenetic protein,
mineralized bone allograft, and titanium mesh: a retrospective
cone beam computed tomography study. Int J Oral Maxillofac
Implants. 2015;30:202-207.
 CONTINUING EDUCATION

To Graft or Not To Graft? Treating Vertical Bone Defects in the Aesthetic Zone

POST EXAMINATION INFORMATION

To receive continuing education credit for participation in this educational activity you must complete the program post examination
and receive a score of 70% or better.

Traditional Completion Option:

You may fax or mail your answers with payment to Dentistry Today (see Traditional Completion Information on following page). All
information requested must be provided in order to process the program for credit. Be sure to complete your Payment, Personal
Certification Information, Answers, and Evaluation forms. Your exam will be graded within 72 hours of receipt. Upon successful
completion of the post-exam (70% or higher), a letter of completion will be mailed to the address provided.

Online Completion Option:

Use this page to review the questions and mark your answers. Return to dentalcetoday.com and sign in. If you have not
previously purchased the program, select it from the Online Courses listing and complete the online purchase process. Once
purchased the program will be added to your User History page where a Take Exam link will be provided directly across from the
program title. Select the Take Exam link, complete all the program questions and Submit your answers. An immediate grade report
will be provided. Upon receiving a passing grade, complete the online evaluation form. Upon submitting
the form, your Letter of Completion will be provided immediately for printing.

General Program Information:

Online users may log in to dentalcetoday.com any time in the future to access previously purchased programs and view or print
letters of completion and results.

This CE activity was not developed in accordance with AGD
PACE or ADA CERP standards. CEUs for this activity will not
be accepted by the AGD for MAGD/FAGD credit.
POST EXAMINATION QUESTIONS
1. Surgical shortcomings, such as missing papilla or
residual vertical deficiencies, can create difficult
prosthetic dilemmas and poor outcomes.
a. True b. False
2. The facial cortex over the maxillary incisors is quite
thick, averaging approximately 2.5 mm.
a. True b. False
3. The use of a soft-tissue borne removable prosthesis
can cause continued ridge resorption throughout time
and additional loss of vertical bone height.
a. True b. False
4. When skillful surgeons obtain a successful repair of
the defect, the restoring dentist and patient never find
aesthetic shortcomings in the final result.
a. True b. False
5. Thin tissue may contribute to recession defects on
bordering teeth and marginal bone loss around
implants.
a. True b. False
6. If there is inadequate available bone for implant
placement in the desired locations, then bone
augmentation is considered. This concept has been
termed prosthetic guided bone augmentation.
a. True b. False
7. As the average papilla height between natural teeth is
2.0 mm, a longer papilla between 2 implants may
create an overall asymmetry in the soft-tissue profile.
a. True b. False
8. Autogenous block bone grafts have proven to be
another predictable method for reconstruction of
vertical defects. The iliac crest is often utilized as this
donor site provides the amount and quality of bone
needed for larger defects.
a. True b. False

7
 CONTINUING EDUCATION

To Graft or Not To Graft? Treating Vertical Bone Defects in the Aesthetic Zone
PROGRAM COMPLETION INFORMATION PERSONAL CERTIFICATION INFORMATION:
If you wish to purchase and complete this activity
traditionally (mail or fax) rather than online, you must Last Name (PLEASE PRINT CLEARLY OR TYPE)

provide the information requested below. Please be sure to

First Name
select your answers carefully and complete the evaluation
information. To receive credit you must answer at least
Profession / Credentials License Number
6 of the 8 questions correctly.
Street Address
Complete online at: dentalcetoday.com

Suite or Apartment Number

TRADITIONAL COMPLETION INFORMATION:
Mail or fax this completed form with payment to: City State Zip Code

Daytime Telephone Number With Area Code

Dentistry Today
Department of Continuing Education

Fax Number With Area Code

100 Passaic Avenue
Fairfield, NJ 07004
Fax: 973-882-3622 E-mail Address

PAYMENT & CREDIT INFORMATION:

Examination Fee: $40.00 Credit Hours: 2
ANSWER FORM: VOLUME 34 NO.10 PAGE 114
Please check the correct box for each question below.
Note: There is a $10 surcharge to process a check drawn on
1. o a. True o b. False 5. o a. True o b. False
any bank other than a US bank. Should you have additional
questions, please contact us at (973) 882-4700. 2. o a. True o b. False 6. o a. True o b. False
o I have enclosed a check or money order.
o I am using a credit card. 3. o a. True o b. False 7. o a. True o b. False

My Credit Card information is provided below. 4. o a. True o b. False 8. o a. True o b. False

o American Express o Visa o MC o Discover

PROGRAM EVAUATION FORM
Please provide the following (please print clearly): Please complete the following activity evaluation questions.
Rating Scale: Excellent = 5 and Poor = 0
Course objectives were achieved.
Exact Name on Credit Card
Content was useful and benefited your clinical practice.
/ Review questions were clear and relevant to the editorial.
Credit Card # Expiration Date Illustrations and photographs were clear and relevant.
Written presentation was informative and concise.
How much time did you spend reading the activity and
Signature completing the test?
What aspect of this course was most helpful and why?

This CE activity was not developed in accordance with AGD

PACE or ADA CERP standards. CEUs for this activity will not What topics interest you for future Dentistry Today CE courses?
be accepted by the AGD for MAGD/FAGD credit.