Combined approaches for complete oral reconstruction.

127 Rating(s).

Posted on By Wahib Moussa In Bone Grafting

Hello all,

A lady patient age 65 presented to our center for complete rehabilitation of the oral cavity .
Clinical examination revealed hopeless teeth in the upper and lower Jaws.
CBCT examination indicated close approximation to the inferior dental nerve in both site of the mandible.
Treatment plan was:
-Grafting of the right site of the mandible by titanium mesh .
-Extraction of all remaining teeth .
-Socket shield approach in suitable upper & lower anterior teeth .
-Preparation of Auto graft from extracted teeth to be used was allograft .
-Treatment plan was conducted , titanium mesh produced a positive result and wide ridge
-Implants were inserted &zirconium bridge was constructed .
Patient follow up after one year indicated good prognosis and happy patient.
Thoughts and comments are welcomed.
Wahib Moussa

5-Titanium mesh was allograft in the right site of the mandible.
1-Preoperative Clinical view &Preoperative CBCT.

2- Implant procedures , ridge splitting was done in certain areas.
3-Expanders were used , auto grafting and collagen membrane.

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7- Post operative CBCT and final zirconium .


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Good result with the GBR and the titanium mesh. Thank goodness there was adequate keratinized tissue to insure primary closure long term. To accomplish the vertical growth, did you use the dentin along with allograft? No autogenous bone scrapings? No Xenograft? A couple of observations as it is difficult to interpret the panoramic films. It appears that we are looking at 16 total implants, 8 maxillary and 8 mandibular. Is that correct? Did you load all of them? Can you comment on why you selected this approach vs the All-On- Four approach. Can you comment on the implant spacing? Thank you!


Terry…..Thank you for your comment and questions. -In vertical grafting I have used allograft particles (alloss allograft) cortico / cancellous particulate. with both titanium and GBR. -Autograft (dentin particles used only in socket preservation).no autogenous bone. -CBCT images were used in all treatment phases. -No of implants 1s 16 in both arches. All were loaded successfully. -Aim not a fan of all four - on –approach, and is not in my treatment options. - Implant Spacing ranges from 3-5mm at least .this case may reflect some crowding but clinically was ok.. Thanks and regards. Wahib

CBCT upper


A little bit of everything. Well done.


Dr. Salama Thank you very much for your kind comment ... regards . Wahib


Very nice a little bit of everything - high level implantology as usually from you.
I have four questions:
Why not dentin autograft for GBR?
Do you have some bad experience with all on four?
For dentin graft: do you utilize only the roots or also the enamel?
Are there buccal and lingual socket shields?
Thank you for sharing this fantastic case and for your time to answer my questions!
Best regards


It is always a pleasure to hear from you Dear dr . Snjezana , Thank you very much for your kind comment & questions . 1-As for dentin grafting for GBR , I really have no objection of using it with GBR . 2-AS for all on four you can say I am inclined to classical protocol , why risk the case if I have a safer approach . 3-In dentin grafting I use both roots and enamel . 4-Yes , there was Buccal and lingual socket shield . Thank you again for commenting on the case and you valuable questions . Regards , Wahib