Minimal invasive surgical procedure for socket grafting and ridge contour preservation

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Posted on By David Baranes In Bone Grafting

In the following case, the clinical appearance and the CBCT images represent hopeless tooth 19 (37). The tooth should be removed, the preoperative CBCT indicates that after extraction a missing buccal plate will be expected. The tooth was extracted and the socket debrides, thereafter the site was augmented with "Bond Apatite ”bone cement (Augma Biomaterials) surgical technique for BCS(biphasic calcium sulfate) bone cements were used in this cases for the socket and ridge couture augmentation procedure.

*Baraness technique suggesting a minimally invasive flap manipulation and is based on the flap being closed under tension concept which can be implemented when BCS bone cements are used.

Preoperative clinical and radiographic images

Bond Apatite bone cement in place Notice the short mesial vertical incision according To Baraness protocol
Soft tissue appearance 3 months post op


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11 Comments

Nicely done David. Do you have post-op CT?, i.e. prior to implant placement, of this case or ones like it. Thanks.


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Thanks Henry,
becouse you can load only 6 photos they are missing.
I'll now attached all the photos I have.

CBCT images 3 months post op


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Well done case...good fill of bone. How fast do you feel this material is resorbed and replaced with host bone. Thanks Dr. S


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Thanks, Maurice. in 3 months most of the material already transform into the patient own bone, at this stage, there is complete resorption and transformations of the biphasic calcium sulfate which is about 60% and the small and medium size of HA particles resorb as well in 3-6 months
the big particles will resorb in a longer time


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Nice result.
"Bond Apatite" is very easy to apply and surgeries are really minimal invasive. These days I am waiting for re entery of my Augma cases.
I follow the recommended protocol but I still don`t understand why flap closure with minimal tension?
I mean - is it like:"It doesn`t matter if there is some tension", or "Wound closure must be with tension".
Why?
Thank you for sharing
best regards
Snjezana


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thank you,
the flap should be with tension , not minimal tension or tension free as with other conventional bone grafting technique .here we take advantage of the BCS cement nature that gives us the ability to provides our patient with the most less invasive surgical protocols because we don't do horizontal dissections for release we just reflect the flap place the cement and close the flap by stretching it directly above the cement .so it is ten times faster than conventional techniques the petient has no pain no sweling and fast procedure ,and at the end he gains its own bone back .and of course no membrane should be used .


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David, I also am awaiting reentry of several cases. Hoping to get as good results as you have shown. Do you find similar outcomes with 3D bone composite grafts? Do you recommend rehydration of DFDBA before mixing with 3D material in composite graft protocol?(I usually re hydrate Puros for 7-10 minutes). Thanks, Joe


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joseph, i have no doubt that you will have similar results if you will work according to the protocol with flap under tension.
regarding mixing with other graft in the past I used to mix 3D Bond with different granules types before I had the option to use Bond Apatite, which is much simple and more predictable.
and i think that you definitely can enjoy it as well.
to your question, if you want to create your own cocktail you should not wet the particles during their introduction with the 3D bond powder just later on when you mix them together.


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Thank you for the response. I am unclear if the protocol includes intra marrow penetration prior to contour grafting of thin buccal plate over an implant or horizontal ridge augmentation. Trying to flatten the learning curve...appreciate the feedback.


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