Double Khoury Plates for 3D Bone Reconstruction

434 Rating(s).


Posted on By Maurice Salama In Bone Grafting

Patient presents after failed surgery and large bone and soft tissue deficiency. An attempt at 3D Reconstruction included autologous harvest from the Ramus using Piezosurgery, Khoury plates secured to labial and palatal aspects with 0.9mm Meisenger screws, bone chips with PRF fills the defect and then addition of multiple fibrin layers followed by rotated palatal pedcile CTG over the top of extraction site sutured with PTFE OMNIA sutures. Thoughts and comments welcomed. Dr. Salama

Bone Plates fixed
3D Defect

Harvest Site
Flap


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24 Comments

Bone graft completed.

Filled with autologous chips
covered with A-PRF fibrin


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Closure of wound.

Sutures
PTFE sutures


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10 Days healing...

10 days
10 days


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10 Days healing of soft tissue

Day of Sx occlusal view
10 Days occlusal view


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Hi -excellent case as usual which I hope will be a complete success
Can I ask your thoughts on sonic weld as this could be used here as Khoury technique without the need to harvest bone from a separate site with the potential increased morbidity.
Would value your opinion


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Great and beautiful management Mo.
Regards


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You will get an amazing result here Maurice! Just a few questions. Did you use screws for the palatal plate? Or engaged the plate using the buccal screws? Please explain the incision design, it's not what you show usually :)) Beautiful work


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Andoni; Keen eye...yes separate palatal screws. Yes, incisision design quite different for me ONLY when attempting significant vertical augmentation. WIDE Trapezoidal incison at line angles....I will do split thickness here to gain overlap at vertical on closure. Thnx Dr. S


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Thanks Omid.


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Beautifully and perfectly done by best hands ....love this technique....


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Thank you Emad...we all get better together!!


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The master at work. Perfectly executed case. My compliments Dr Salama.

Ehab


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Thnx Ehab....all learning and improving together.


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The king the king at work!!! Amaazing!! I can tell you changed your incision design? But it offers a great amount of coronal mobilization of the flap what say you?


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Good eye, needed vertical at distal of central...so BROAD BASED vertical at that location with beveled and split thickness. Dr. S


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By the way Maurice that's an outstanding plate you harvested, access and visibility can be though in that region.


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Thnx my friend, the Salvin Pikos ramus retractors work great here.


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Great case, beautifully executed! Surgery was performed with great care on detail, and this usually leads to excellent results.


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Great case! (as always...) Two questions though, Does the use of the palatal pedicle graft allow you to avoid full closure on crestal aspect or it is the prf sticking out? ,( of course that gaining full closure in such an augmentation is challenging...) The autogenous bone chips that you used, were they harvested from bony plate or marrow? Beautiful case Tnx for sharing Aryeh


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PArt of what you see is the rotated palatal pedicle tissue "peeking" through at suture line. This maximizes closure "insurance". All Bone used was harvested from Block via bone scraper. Thanks Dr. S


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Hey Mo
What an outstanding case in every way. from bone harvesting to flap management. So my question to you is this. DO you still feel this is AS difficult as it seems or was it a natural progression for you


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Howie; I believe you answered clinical questions during our LIVE events which made this transition "easier" for me as I had much GBR & Block harvest experience to begin with....so the transition may be easier for me. Thanks and see you tomorrow in Brazil! Mo


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Class Surgical Work. Any plans for Prosthetic space management . Regards, A


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Ashok; Will not be an issue, tissue will shrink back some and implants have depth allowing vertical space of 7+mm. regards Dr. Salama


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