Buccal contour enhancement with Palatal SECTG, stabilised using the Vertical mattress-sling sutures a-la Maurice Salama

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Posted on By narayan tv In Soft Tissue Enhancement

49 Y M, bilateral 1st premolars, mandible. On the right side, the distally tipped canine compromised the M-D dimensions
I’d done the extractions in 2014, after which the patient relocated to the USA
Clinically, there appeared to be a considerable facial defect, and I’d planned on doing a contour augmentation GBR after the clinical exam
The CBCT study however, showed adequate ridge width, so I decided to only augment soft tissue contour simultaneously with implant placement, albeit showing poor radio density
Crestal incisions were full thickness, followed by a split flap to the reflecting mucosa
The underlying bone topography was not accurately reflective of the CBCT picture. I decided to expand and place the implants sub crestal
Osteotomies were prepared with Densah burs in Osseodensification mode. On the right side, final drill was the 3.5mm, for a 3.6mm implant, on the left, the 4mm drill for a 4mm implant , both placed about 2mm sub crestal. This again emphasises the versatility of the drills- oversized osteotomies in poor density bone and excellent primary stability
After implant placement, a SECTG was harvested from the anterior palate, using 2 parallel incisions about a mm apart
The graft was deepithelialised, and split into 2 halves
The CTG was now stabilised on the periosteal bed using a Vertical mattress sling suture technique, something I learnt from Maurice Salama while helping out in his hands on course @DentalXP symposium 2018 -Thank you Maurice.




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7 Comments


Reply

Truly perfectly executed my friend. Please keep us posted on healing. I find this suture extremely important to my regenerative practice where coronal or apical positioning is required. Regards Maurice


Reply

Thanks Maurice. Will update as on the healing. I found the suturing technique to be simple and most effective in providing stability. Have been using it wherever possible.


Reply

Very nice and important post, Narayan.
Love the suturing technique and the drawing.
Thank you for sharing
Snjezana


Reply

Thank you, Snjezana.


Reply

Personally, best suture technique IMHO. Dr. S


Reply

Very nice case. Can you please clarify0 when you say that you used the Densah 4mm drill to place the 4mm diameter implant, are you referring to the 3545 drill which has an average diameter of 4mm? This seems oversized, compared to their recommendations? Obviously, you still achieved great stability. Just wondering if you routinely oversize the osteotomy to relieve excessive compression during implant placement?


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