Large 3D mandibular anterior defect management with FGG and Khoury Plates

518 Rating(s).

Posted on By Maurice Salama In Bone Grafting

Patient presents follwoing healing from a horse accident where she lost her mandibular anterior teeth. Severe 3D bone defect with vertical/horizontal loss and lack of KT as well as muscle pulls and lack of vestibular depth. Treatment first with FGG and Vestibuloplasty followed by 3rd molar removal and Ramus harvest simultaneously to harvest bone for Khoury plates in anterior region. Thoughts, Dr. Salama

Anterior mandibular 3D defect
FGG with monofilament sutures

FGG at 5 months
Ramus Harvest and 3rd molar exposure

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Autologous Plates and particulate

Defect Before
Defect After autologous chips placed between plates


Autlogous bone placed

Plates in position
After Autologous chips placed


Closure of case

Fibrin over Bone Graft
Mattress and running sutures


Before and After surgical therapies.

Before Defect Site
After Bone Graft Surgery


Maurice, which cases you use BMP2 ? Gregory


I would only use BMP-2 with my mesh cases when I do bot have access to enough autologous bone. See you in NYC. Regards Maurice


Simply PERFECTION !! Very tough case !!

My complements Dr Salama on everything start to finish.
Why didn't you consider the chin as a donor site for this case?

Thanks for sharing,


Thnx Ehab. I struggle with the choice of Chin vs. Ramus. As we extracted 3rds at same surgery we decided to harvest there instead. I do prefer ramus as a general rule. Regards Dr. S


Definitely prefer Ramus. Makes a lot of sense to go there since wisdoms were being taken out.
Love this case 🙌🙌🙌




Nice work- What will your restorative plan be - And did you provisionalize with?

Removal of thirds..... Maaaann!




Essix retainer and I got a tooth business Richard man.


Beautiful case, how long do you wait for tissue healing before the bone graft??


Andoni; I typically wait 3-4 months prior to 2nd Sx. Thanks Dr. Salama