Anterior Bone Reconstruction Split Bone Block Technique (Khoury's) + Ti Mesh

48 Rating(s).


Posted on By Jose Luis Dominguez Mompell In Bone Grafting

A 38-year-old man with an atrophic area involving central and lateral incisors and a Canine.
A technique using Khoury's concept of "Revascularizable Membranes" on the buccal side and titanium mesh of the palatal side. Only autogenous bone was used to fill the gap.
A colleague asked, why not everything with Ti mesh or Using the SBB technique?
After doing SBB on the anterior region, IMHO the most difficult part is to adapt the thin bone Block on the palatal side.
And when doing Recosntructions with Ti meshes sometimes we have found problems of partial exposure of the mesh or transparencies on the buccal side. Also the presence of muscular forces on the buccal side sometimes may act against us.
So we thought about a good combination of both techniques, bone stability on the buccal and easy to adapt on the palatal.
Please comment and tell us what you think.

Jose D. Mompell
Juan L. Chao
Madrid (Spain)

Bone Defect
Adaptation of the Ti mesh on the palatal side

Bone chips
Final view of the reconstruction. Thin bone blocks on the buccal (Autogenous Revascularizable Membranes)
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13 Comments

Incredible idea and execution.


Reply

Thanks a lot Maurice. Trying to use similar concepts in a diferent way. We already have several cases following this protocol and results are very interesting.
Lets see what our friends in DentalXp think about it...



Reply

Great idea. Would you consider a collagen membrane to cover the titanium mesh on the palatal side to get better cell occlusivity since the bone in the defect is autogenous bone chips? Love the term revascularizable membrane!!! Regards. Naheed


Reply

Thanks for your comment my friend! It could be a possibility for sure, but we have found no differences between using then and not. We have tried both ways, under the Ti Mesh and above it, and not big difference between this two approches and not using them.
We haven't tried, but maybe, some PRP, PRGF... Could be considered.

J.Mompell


Reply

Dear Jose,

Just amazing as usual, did you think about the possibility of placing one of the thin bone plates on the palatal side?? were both plates necessary on the buccal side??? anyway, let me tell you that the case is perfectly executed, my sinceres compliments
big hug!!!


Reply

Hi William!
Yes, Khoury's technique as you already know and perfectly describe is with another thin bone block on the palatal side. In this particular case it was not a matter of bone quantity, it was a matter of facilitating the procedure.
We have done several cases with buccal and palatal bone blocks, but when involving the canine or more than 3-4 teeth we found some difficulties when placing the palatal block due to the arch.
Our first choice is always buccal and palatal, but this alternative is giving us very good results and facilites the Bone augmentation procedure.

The image below shows the reconstruction as described by Khoury, this could be considered a "modification" of the technique. We are trying to merge the advantages of both, Split bone block technique and ti mesh.
Thanks for your comment

J. Mompell

Bone Plates
Final reconstruction


Reply

How did you do to close the soft tissue in a tension free condition ?
Best regards
Salim


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ok I fully understand, thanks very much for your explanations, once again, sinceres compliments, your surgical skills are just excellent, all the best


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I beg you, please post soon a webinar related with these kind of procedures???


Reply

Dear William, very very soon You will have full access to some presentations about this technique and how to performe it, step by step. Horizontal and vertical Augmentations!
Those presentations are already in "DentalXp Oven"!! Hehe


Thank you so much for your kind comments

Jose Mompell


Reply

Jose and Juan,
love your approach. Although both of you master perfectly Khoury technique and we have already seen your cases dealing with buccal AND palatal defect, you are trying to simplify the procedure. Who says that Revascularizable Membranes on buccal can`t be combined with Ti-mesh on palatal? It`s difficult to fix bone plate palatal, Ti-mesh tends to transparency on buccal. It makes sense, your approach, a lot of sense.
There are so many other techniques were we can combine and simplify. Like tunnel and VISTA technique: I usually combine access from sulcus with the access from vestibular incision to mobilize the tissue...
Warm regards, thank you for sharing, Merry Christmas
Snjezana


Reply

Thank you Snjenaza! You are rigth! Sometimes the combination of different techniques can report some great results!
Merry Christmas to you too!!


Reply

Hi Salim!

That's a great question! In this particular case, free tension closure was achieved by releasing periostium on the buccal side. If tension closure couldn't be achieved with no tension a rotated palatal flap would have been performed.
Tomorrow I will upload the II part of this case.

Thanks for your comments!

Jose Mompell


Reply


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