Full arch reconstruction with Mini Khoury Bone Augmentation

281 Rating(s).


Posted on By Howard Gluckman In Bone Grafting

This is a case with severe maxillary resorption. We needed some bone grafting however the patient wanted to minimise the amount fo treatment. We decided to go with DENSAH drills and some grafting in areas that needed it. The one benefit of doing bone grafts and implants at the same time means you can limit the amount of bone graft needed. We harvested a single block 1cm x 1,5cm long from the rams and used Automax drills to harvest the remaining bone chip. we then did individual bone augmentation where we needed them which was more simple and specific. One could use many different techniques here and the choice is yours. Mine is always autogenous when possible and we will expose this case in 4 months. The Mini implants from Intralock are essential to take any pressure of the bone augmentation and the implants and gives the patient immediate improvement in retention of the denture.


ridge reduction with a safe scraper
Mini Implant opalcement prior to any other work using guides


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17 Comments

Here all the blocks are in place with a minimum of 2 x1mm screws and autogenous chip packed into the area


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PRF covering the bone and then sutured closed with continuous interlocking suture 6/0 Proline.


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The snap on caps with rubber rings placed on the mini Implants to be picked up in the denture. And the denture eased to sit passively in the mouth before adding acrylic and picking them up in the denture


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Denture with the caps in place. It is essential to have the mini implants parallel. This will make the removal and placement of the denture easier and will also mean less stress on the mini implants. angulated mini implants leads to early LOSS of the mini implants


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My man. Welcome back to the FORUM....we have missed your wonderful cases and discussions. Do you have any CBCT images to share? What are your thoughts on autogenous chips only WITHOUT plates and then cover with ti-reinforced membranes non-resorbable? My only concern here would be "pressure" even with the minim-implants on the plates and screws. regards Mo


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HI Mo. Good to be back. Auto genius chips with membranes especially non resorbable ones would work extremely well. I have not had a lot of experience with them as I have not needed them but the cases I see are awesome and would work here for sure. The use of the plates is the best option for me because of the blood supply and low risk of exposure. The screws are incredibly strong and you can lift the patient with the blocks attached. There is no BUC cal flange on the denture at all and a clear space between the ridge and the denture so the minis will definitely keep everything off the ridge in this case. Thanks for the question


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Have you ever had any issues with Versah on thin bone with little medullary, (as we see on your anterior implants)? They definitely do expand the site, but at the price of less vascularisation and possible overheating of the bone..


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I do not use them in cases without medullary bone. It is essential for expansion. Without it they don’t woke too well.


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Great concept here Howie,

But would you not be concerned about grafting outside of the bony envelope with autogenous only? Would you not expect it to resorb due to muscle activity?

Regards


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Not with this technique. The reason bone resorbs is because it cannot feel the implant. with the Khoury technique you have osteocytes and as a result you get good stimulation of the bone.


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They are not recommended to increase bone width in cases with no medullary bone. This is essential for the technique to work. IF all you have is cortical bone then you need to augment the buccal with the correct technique for this.


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Howie,
you never cease to impress. Well done and thank you for sharing with your wonderful documentation.


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Thanks Dean. Always appreciate it.


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Great case Howie. Would you have considered using palatal bone blocks in this case instead of ramus to keep the surgery to one site?
Regards, Naheed


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Always a possibility. However I needed a fair amount so I thought the rams was a better option.


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Great autogenous Howie case!
Howie, what do you think about fixed provisional bridge over the grafted areas? Twice I have witnessed disasters during prostho tried to remove a prosthesis, and everything stuck. Of course, if you are doing by yourself, you take a care. But still I think that fixed provisional is safer for the grafted areas (no presser with fingers when taking out the prosthesis...).
Thank you for sharing, all my best
Snjezana


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It works well for me but the critical issue is the parallelism of the implants. If one can do permanent then yes go for it. However this also comes with issues of cleaning and being able to visualise the incision lines. So both have their ups and downs. If the pros does not take care then I shoot them lol


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