Horizontal ridge augmentation using lamina

107 Rating(s).


Posted on By snjezana pohl In Bone Grafting

This is my first re entery of the ridge augmentation done using lamina. Lamina is made of cortical bone of heterologous origin.
Particulate graft is 2/3 autogenous bone harvested with bone scraper and 1/3 xenograft.
First impression: nothing compares to 100% autogenous, but it may be a good alternative for the patients asking for a less invasive surgery.




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15 Comments


Reply

you are right nothin is the same as autogenous. I always worry when I see this kind of bone what it really is. How much bone is actually in there. Do you think leaving it longer would have made a difference. great case as always


Reply

Howie, we think the same. Nothing compares to autogenous bone. The only one hard tissue graft besides autogenous bone that looks and feels like bone after few months is dentin graft - autograft.
I think that longer time for maturation would have been beneficial for this augmented area.
Thank you for your comment
Cheers
Snjezana


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with 2/3 autogenous not sure why it would make much difference here. Great skills on display here. thanks for sharing Maurice


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Thank you for your comment.
Even because 2/3 autogenous I re-entered the site in 5 months. As I prepared the implant sites, the hard tissue seemed not completely consolidated...
Best regards, looking forward to see you soon in Madrid!
Snjezana


Reply

Snjezana beautiful case as usual from you. I agree with yours and Howie's comment on Autogenous Bone Grafting. How long will you wait before loading?
Does your loading protocol varies if it is grafted with autogenous vs. xenograft or allografts?
Prosthetically do you think that placing 2 implants for a bridge on the posterior mandible would make a difference on the long run vs placing 3 implants and 3 crowns?
Very nice case and I really like your delicate management of the tissues and results.
Thanks for sharing,
Best regards my great friend!
Manuel


Reply

Dear Manuel,

After ridge augmentation in Khoury technique i wait 3 months before implant placement. Afterwards the loading like at not augmented sites.
We don`t have allografts, so if I don`t perform Khoury technique, I add xenograft and wait longer before implant placement. I augment regularly in sandwich technique to have only autogenous bone around implants and xenograft superficial to prevent resorption and keep the volume.
Sometimes, like in this case, I try other approaches. Istvan Urban uses 1:1 autogenous to xenograft for his sausage technique, no layering, and I tried how it works and looks like.
Since many years I place 2 implants for a bridge in posterior mandible, no issue.
Thank you as always for taking your time to discuss
Warm regards, see you in February at XP Symposium
Snjezana


Reply

Hi Snjezana,
Beautiful outcome and great skills as usual. I use the same bone graft complex very often with also same ratio. I started using this protocol following Dr Massimo Simmion who uses 50:50 and he recently published long term promising results on the stability of vertically augmented sites.
I do find that when using allograft and xenograft for large augmentations waiting 6-9 months gives me better and more stable results. However, using 2/3 autogenous I would consider 5 months to be adequate ??
However not sure how Lamina factors in here as I've never used it.
Regardless, fabulous result my dear friend!!

Ehab,


Reply

Dear Ehab,
thank you for your valuable contribution.
I recently started with lamina and I like handling. It is soft (gentler to the tissue than titanium mesh) and with pins it can be nicely shaped to keep a distance to the bone. So I don`t use tenting screws in combination with lamina any more.
1/3 xenograft is a maximum that I add to autogenous and if I could re - do this case I`ll do it in sandwich technique. Autogenous is so vital!
Depending on lamina thickness, recommended times are 5,6 or 9 months.
Best regards, my friend
Snjezana


Reply

Snjezana beautiful case as usual!
Why not only autogenous under the lamina?
Would lamina work as a space holder and autogenous particles do the job? Then Xenograft at second stage as a veneer for long term ridge dimensions stability?
I am asking because Xenografts have been very unpredictable in my hands for building "true bone".

Thanks for sharing, always learn from your posts :)

Ioannis


Reply

Dear Ioannis,
you`ll receive a very unscientific answer: this patient who didn`t want bone block surgery didn`t like a bone scraping at all. At some point I simply had to stop.
As I answered to Manuel, I always apply xenograft in sandwich technique. In this case I already made an exception and instead of Khoury used lamina, so I wanted to see with my own eyes how does it look like if a simple mixture is used.
Always good to hear from you! See you soon at JTI in Madrid!
Warmly
Snjezana


Reply

Hi Snjezana, nothing compares with the "real thing" I agree. But here, the outcome, looks great. I wish I have the same results allways...
The case will be perfectly managed: you plan the bone volume and Plantilla planned the space between implants! Thanks my dear.
See you soon at PORTO!
Regards
Jorge


Reply

Thank you, Jorge.
Plantilla Clinicae is a great help in a daily praxis.
See you soon!
Snjezana


Reply

Congratulation Dr. Snjezana for another amazing case. I love lamina ! Very good result ! I cannot wait for my cases to return, I have a 2 years folllw up bilateral post of mandible to return for implants. Patient took oral biphosonates and waiting now for a while. It should be interesting to see the results. Congrats again !


Reply

Very nice case! Did you ever used the lamina hard? What ist the product name of your titanium pins?


Reply

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