Mandibular Anterior Defect...Which Bone Graft??

561 Rating(s).


Posted on By Maurice Salama In Bone Grafting

Patient presents with Large Mandibular anterior defect following trauma. How would you treat a similar case? Thoughts and suggestions on the treatment performed. Options? Solutions.
Dr. Salama

Anterior Defect
Block harvest

Block Fixation
Occlusal View


Add to Favorites
Add a comment to the discussion on Mandibular Anterior Defect...Which Bone Graft??


Upload photos
1.  Photo Title:

2.  Photo Title:

Would you like to follow this post?
Case has been added to your favorites.
Case has been removed from your favorites.
Thank you for your input. Your comment has been posted.
You are now following this member. You will get notified on any new topics posted by this member.
You are no longer following this member. You will not get notified on any new topics posted by this member.
Edit Comment
1.  Photo Title:
Current Image:   Delete Image
2.  Photo Title:
Current Image:   Delete Image
Comment has been updated.

28 Comments

Anyone ridge split this one?
Dr. S


Reply

Tough to split but I would need to see Scan-and lingual reflection of tissue. Also did you prep bone to receive inset?

May have considered splitting graft in 2 and putting side by side with gap in middle so only had to put particulate in midline

may have considered putting superior and infterior "slat" of bone like siding on a house

could have considered smartbuilder mesh from hiossen-
at the end of the day need a rigid solution due the muscle pull in area

I m sure Dr Howie Gluckman has a few ideas!

my thoughts...


Reply

Richard; nice technical ideas here. I like your suggestion of splitting graft. Maurice


Reply

Great case. The block graft is positioned in a restorable position considering the curvature and somewhat restricted space between 22 and 27. The labial alveolar housing has been developed well.Are you concern about a possible lingual undercut and if present how would you manage the implant placement? Also, are you placing two or three implants and will you use cemented or screw retained prosthesis and why?

Thanks for the sharing of the knowledge

Vincent M Carey


Reply

Vince; How are you? Will use 2 implants here with screw retained prosthesis. Hope to see you somewhere soon. Warm regards my friend.
Dr. S


Reply

Why not BMP with titanium mesh?


Reply

Terry, not a bad option but I believe this technique has much longer track record, less healing time and less expensive.
Dr. S


Reply

Block graft like very nicely shown above or placed like laminate (Khoury tech).

The most difficult part in this case for me, is to over come the muscle pull and maintain primary closure.

ERE: not favorable ridge shape, ridge width and bone density to split. Thus, it is a no for me in this case.

Yiannis


Reply

Yiannis; we did utilize a modified Khoury technique here by slightly "floating" the graft off host bone by 1.5 mm. Then grafting particulate around and inside gap.
Dr. S


Reply

Hi Mo
Why didn´t you harvested chin bone block?
Due to poor área seen at the CBCT or muscular debridement postop pain?
Thanks.


Reply

Jorge; Both, further dissection into mentalis muscle, post-op pain, CBCT narrow bone and the additional bleeding in the field which I would then have to work.
regards Maurice


Reply

Splitting + GBR and simultaneous implant placement - less predictable than this bone block but if the ridge is thick enough (3-4mm and above) it is always a possible and patient friendly option in the lower jaw. In my opinion one should try to avoid conventional GBR in lower front. Blocks always work fine. We will get a ggod and predictable result in this case. Thanks for sharing.


Reply

Hana; I agree with assessment BUT failure with a ridge split here could be catastrophic leading to loss of all thin cortical bone as a scaffold.
I do agree that GBR here is often challenging.
thanks Dr. S


Reply

I agree with that Maurice. ridge split could be disastrous.


Reply

Maurice, Well done. As you know, the anterior mandibular region is difficult to regenerate. I agree you have chosen the best solution for augmentation. It is hard to tell from the images, but were 3.0 mm implants and pink porcelain an option? Thank you sharing yet another thought provoking case. Chuck


Reply

I think you know how I would treat this maurice.


Reply

Howie; please do tell us how exactly you would have handled the situation. Thanks Maurice


Reply

Howie would use a palatal block graft with simultaneous implant placement !!!


Reply

RIchard Im not sure I would use the palatal block here as one needs a fair amount of bone and Im not sure you would be able to get it there. However a scan would give us more information. I think I would have done it very similar to the way Maurice has done it with a few tweaks. If there was enough bone apically to place the implants in the correct position then yes I may have placed the implants at the same time. I think for me I would have split the bone plates with a micro-saw that would have meant that I would have had 2 plates rather than one. I would then have leave a gap of about 5-7mm between the plate and the residual bone and filled the gap with autogenous chip harvested with the safe scraper. Then PRF membrane over and left for 4 months. The bone quality that one gets with this is amazing. I will post a similar case which is completed which will better show than my words. But saying all that I think this case will end up with outstanding bone and the implants will be able to be placed in an ideal position. A great case.


Reply

Howard. Very logical and biologically sound approach. I look forward to seeing your case. Chuck


Reply

The case is posted have a look


Reply

Howard,

I was joking a bit but I did expect you to place implants at same time as know that you are a fan of dr khoury and his techniques that were way ahead of their time and built on solid biologic principles- i think now with the addition of fibrin we are looking at the re-emergence of blocks-
I still use my frios microsaw that is almost 10 yrs old !

Cheers,

Richard


Reply

Guys love the "usual suspects" on this Forum. The "Love of the Game" is there with all of you. We all strive to get better informed and become better clinicians for our patients. Howie, I think a split here would have been very risky? Otherwise, love your approach and always love your input. Rich, Howie and Chuck.....thanks for the exchange.
Your friend Maurice


Reply

Mo we all have to thank you and the XP vision for opening up the world to us!

Richard


Reply

Yes indeed. Dentalxp (and Maurice) continue to enhance my KNOWLEDGE and ENTHUSIASM for Dentisry. I am very appreciative. Chuck.


Reply

Very appreciated....Richard and Chuck, your both up. time to share a case on the Forum. you are overdue. Mo


Reply

Nicely done Mo. We can also consider simple ridge augmentation using Stickybone and simultaneous implant placement . If there is severe vertical defect, sandwich osteotomy can be considered without harvesting ramus bone. Thank youDS


Reply

https://youtu.be/PDFdsCt3n0o thank you


Reply

Related Posts

11 Rating(s)

Augma Bio
PET Kit