Boneharvesting: compromised donor Site

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Posted on By Markus Schindler In Bone Grafting

Todays Bone-rebuilding case:

The patient underwent orthodontic surgery (dorsal impaction of the mandible) 35 years ago, so we had nearly no linea obliqua to harvest a cortical bone block. The mobilization of the block was quite difficult without fracturing the very thin mandibula.
The augmentation followed the principles of Khoury's Technique.
To reconstruct the retromolar area i put one slice of the block back in the donor site to allow perfect regeneration.

How do you reconstruct the donor site?




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4 Comments

Really nice case! I normally don’t regenerate the donor site, a collagen sponge the most.
About replacing one of the thin bone blocks, although performed by Khoury and published in his book, I find no different in terms of regeneration. I think that the risk of infection or mobility although low are present.
That’s why I rather crush it into very small bone chips and use it as particulated bone or if not I try to extend the reconstruction a little bit more distally. As if I were going to place implants in the second molar position.
Thank you so much for sharing!
What instrument do you use for harvesting?
Keep us post it!

Jose Mompell


Reply

Impressive. What alternatives did you consider? Dr. Salama


Reply

Hello,

here is the update to the case, 4 months after augmentation:

We were able to place 2 Straumann Bonelevel Tapered Implants in the augmented area.
The donor site showed complete regeneration.


To answer your question:
1. we discussed patient customized allogenic bone blocks. The Patient decided for autologuous bone.
2. i use piezosaws by piezosurgery (Mectron) to harvest the blocks.

kind regards
Markus Schindler

DonorSite 4 Months post
Implants 4 Months after Augmentation


Reply

The histology of the bone cylinder shows vital bone tissue.

Histology after 4 Months


Reply


Brasseler
Salvin