Bone bending with Khoury Plates

91 Rating(s).


Posted on By Howard Gluckman In Bone Grafting

This case required both buccal and palatal grafting. instead of doing the two plates buccal and palatal I went for an occlusal plate that gave me the bucco-palatal dimension of the bone and then used a woodworking technique called Kerfing to bend the buccal bone into place. The results are self evident 4 months later which is how fast autogenous bone blocks heal. The second issue here is how vascular the bone is due to the complete conversion of the bone to new medullary bone rather than relying on the creeping replacement that takes place with solid bone blocks and which can take years if it happens at all. Exposure to come soon




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17 Comments

Soft tissue and bone healing 4 months later. Exc Ellen and fast healing due to autogenous bone healing


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Beautiful bone healing with excellent bleeding bone after 4 months of healing


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Utilising R2 gate guided surgery to mark the osteotomies and then finishing of the osteotomies with the Densah burs to further develop the bone with osseodensification.


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2 Megagen nay ridge implants placed in position. They are placed about 2-3mm below the crest to allow for any bone resorption that may take place as a result of raising a flap and the cortical nature for the crestal bone which is dead and may resorb over time. Exposure will take place in 3 months with some soft tissue grafting and a pontic shield of the upper left lateral. a final bridge will be placed or possibly another implant.


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Great case and surgical skills! looking at wear on adjustment teeth and discoloration on abutment teeth did you check patient's occlusion prior designing this case?


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hi greg that's an interesting question how do you feel occlusion will change your treatment planning in this case. Perhaps more implants, the tooth 10 is to be extracted once we have completed treatment. We had to convince this patent with a microscope video that the bridge was pretty shot. How would your occlusal analyses change the treatment plan.


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Looking at discoloration and wear on adjacent teeth it seems to me that patient has a constricted bite ( envelope of function is right but teeth on a way). If this is a case position of teeth have to be different and consequently position of implants. I hope it make sense.


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Not really. How re you diagnosing an occlusal problem on a single adjacent tooth and im not sure how the functional issue will affect the position of the teeth aunt eh implants. He has had a bridge for 45 years. It finally gave way and we are replacing. He does not want or need in my opinion any bite adjustment so im still confused as to how it would affect his tooth position. Maybe you can shed some light on it for me.


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I am not saying he has occlusal problem, just speculating. he has a bridge for 45 years and we agree something happened that it failed . Looking at discoloration on on abutment tooth it was cement wash out, if we look at #11 the wear goes from MIP to crossover and look at how it proclined compare to adjacent tooth. I always look at the case: Why bridge failed, what is a primary cause. Your surgical skills are excellent but I look from restorative perspective as I am restorative dentist. I hope I am not offending you. Best regards. Gregory.


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If we add implants in to the framed do you not think it will change the whole concept of force and distribution thereof. Bridges fail for many reasons Im not sure the one can look at this case and speculate. I suppose the second part is how will it affect or change you treatment and treatment plan. If they are a bruxer then perhaps more implants and splinted crowns. What is your opinion on this.


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Gregory. If I were to speculate on the difference of tooth discoloration, I speculate it is more a by product of Endodontic and restorative materials rather than occlusion.


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Howie this is a whole new level of bone repair! Congratulations!


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thanks Buddy


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Just fabulous Howie. Just explain Kerfin to me ;) I notice some cuts in the inner aspect of buccal plate. How does it work? Thanks


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Thanks Andoni. Kerfing is a woodworking technique we use to bend wood or any solid object. THe way we do it is to make small cuts of equal distance and depth along the portion that needs to be bent. THe more cuts you make the more it will bend. One would ideally like to make equal depts and cuts. THis is not always simple as the block is a variable thickness. However even with the in exact way I have done it I have managed to bend the bone very nicely. If you are not sure watch a video on your tube about Kerfing


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Professor Howie,

Masterful technique- excellent outcome- I now apply your Kerfing technique when I can - Bravo



Cheers,

Richard


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awesome Rich. Thanks buddy would love to see one of your cases when its done


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