Large 3D Bone Defect in Anterior Maxilla

510 Rating(s).


Posted on By Maurice Salama In Bio-modifiers: BMP-2 / PRGF

A patient presents after 2 failed autologous block grafts. Wants another alternative and wishes to avoid a donor harvest site. A Lazarus Graft was implemented utilizing Dr. Craig Misch protocol. Spinal bone + BMP-2 and drapeable Collagen barrier. Thoughts? Dr. Salama

Secured bone block
Preop

CBCT 3D
Flap design


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13 Comments

The challenge is always present and basic flap management is KEY.


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After two previous autogenous bone grafts failures , it is a really risky case.
According to your recommendations, I wonder why you did not start in such case with CT graft to enhance better soft tissues before performing the bone graft. Do you think that the use of BMP plated a big role in success of this case, or it is your magic hands Maurice ??


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As usual a perfectly executed case Maurice. Here is the publication on the Lazarus graft technique. BTW the article won the Ralph McKinney Award for best article of the year published in the journal Implant Dentistry. I continue to have excellent results with this method. Thanks for sharing!

Misch CM. Bone Augmentation Using Allogeneic Bone Blocks With Recombinant Bone Morphogenetic Protein-2. Implant Dent. 2017;26:826-831.


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Craig Misch;
I must thank you for your incredible contribution to regenerative dentistry. You continue to pave the way through thorough review of current methods as well as creative less invasive solutions to classic clinical issues. I have also had much early success with this procedure you brought to my attention and look forward to sharing my results with you in NYC this August. many thanks Maurice


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We need to add this discussion to XP-NYU Regeneration Summit.


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Definitely Maurice - I am so looking forward to this meeting!


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Thanks Craig, shaping the future of regenerative therapies. See you soon.


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Mo can you tell me about this flap design . Why did you choose it versus wider flap ? I see the vertical releases are in esthetic zone , what is your decision tree. ?


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Mark; a good question. when performing LARGE 3D reconstructions, vertical incisions are necessary. Where they are located to minimize pressure on flap is critical. We discuss this and much more at our Bone and Flap Management courses. regards Maurice


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Mo,

Great service to patient - Can you & Craig tell us why you think the combination of spinal bone works and how long are you waiting to restore ? Simple yet complex...

Cheers,

Richard


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Autogenous bone blocks are the gold standard until an alternative is found. I mean predictable working alternative and Craig Misch is doing a great job in order to find a predictable alternative protocol. Our patients would appreciate it very much.
Two failures of autogenous bone block in this case-why it happened?
Luckily, the bone on adjacent teeth is kept.
Istvan Urban, allograft in Khoury technique, SMART bone, Craig Misch protocol, lamina - there are some improvements..looking forward to get a comprehensive overview at DentalXP summit.
Almost forgotten - beautiful result after beautiful execution.
Best regards
Snjezana


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It is strange that Autogenous failed twice here. Would always be my go to in most cases. That being said if I had growth factors to use around my synthetics I may have a different approach. Craig I do remember thought that we had a discussion at the very first dentalxp conference where I spoke on palatal bone and you spoke on bone substitutes and you said autogenous is till the gold. Have your thoughts changed. dont answer now this is a question for the symposium I will ask


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Mo, great soft tissue management! What do you think about a detail...on distal incision I would do on MESIAL of the bicuspid in order to extend more and make a release more without having the problem of covering the bicuspid.
thanks for posting
Regards
Jorge


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