Palatal Bone Harvest & Ti-mesh Part 2

310 Rating(s).


Posted on By Maurice Salama In Bone Grafting

Patient presented with anterior bone defects bilaterally in lateral incisor areas. Autogenous bone harvested from palate with ACM harvest drills. I-Gen Ti-mesh secured on implants and then covered with PRGF Fibrins. Another way....what way for most here? Dr. Salama

Palatal harvest sites
ACM drills

Autogenous Bone
I-gen ti-mesh


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24 Comments

One month out...

4 weeks
4 weeks


Reply

Love it! Minimally invasive bone harvest - using the recipient site as the donor site. I have not tried ti mesh with implant placement but this looks like a well designed system. Thanks for sharing Maurice.


Reply

Craig, thnx much of what I utilize today is a conglomeration of tools and concepts I learned from esteemed colleagues like yourself. Many thanks and I look forward to see you in NYC in August at Dentalxp-NYU Regeneration Summit. Lot's of new ideas to discuss together there. Got a Lazarua graft next week....wait til I send you Abby's final case and prosthesis. She cried. Regards Maurice


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Mo,
Nice work- what diameter implants did you use how long will you wait to restore and what is your interim prosthesis ?


Cheers,

Richard




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15mm long by 3.4mm diameter Interim prosthesis is an Essix retainer vacuform.
Regards Mo


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Is the Ti-mesh difficult to remove? Do you have to expose the whole site?


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Not difficult to remove and often can be done with mini flap. Regards Maurice


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Great approach Maurice! Alternatively, I would place a porcine bone lamina, over the graft, fixed by fibrin sealant.
A hug
Enzo


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No bone lamina available in USA. How would you fix the lamina? Would you pack autologous bone or xenograft as well?
Regards Maurice


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Very efficient approach Dr. Salama! Love the way bone harvesting was carried out. What brand of harvest drill did you use? Did you stabilize the membrane with covering screw of the implant or used adapter of the membrane? Thank you for sharing! Rustam.


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ACM from Neobiotech. There are other brands but this was the original and still the best in my hands. Fixed membrane to implant. The I Gen is a Megagen product but is available for other implant systems.


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Hi Dr. M great case !
few questions though,
Does detaching the nerve from incisive canal from palatal flap cause later Sensory issues , how worrysome to you is it to detach it ?
Ive noticed that upon closure of the implant sites on one side u preformed a cross suture and on the othe side just interrupted, why?
Tnx again for great learning case
Aryeh


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No problem typically with detaching nasopalatine bundle from flap....No real reason regarding sutures....both work. It depends on length of incision line. regards Dr. Salama


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Hi Dr Salama, do you ever experience excessive bleeding when you seperate the incisive canal ( and artery) from the flap?Would there be an advantage to suturing, and tying off the canal before
separating it. ? Kindest regards Hans Zeltmann


Reply

Hans; See my message above. The remnants of the canal typically retracts up into the canal and rarely causes excessive bleeding. If it does, local anesthesia 1:100,000 does the trick or place hemostatic coverage. Thank you for your comments. Dr. Salama


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HI DR SALAMA.

I HAVE DONE SIMILAR CASES WITH IGEN MANY TIMES. I HAVE FOUND THAT PLACING A MINISCREW IN THE FREE END OF THE MEMBRANE GETS RID OF ANY MOVEMENT IN THE GRAFT SITE POST OP AND YIELDS A BETTER FILL OF THE GRAFT AREA. THE DISADVANTAGE IS HAVING TO RETRIEVE THE SCREW BUT I FIND THE RESULTS WORTH THE EXTRA EFFORT.

REGARDS

DR PAUL BETTS


Reply

I’ve had the IGen sometimes perforate through tissue giving me mixed results. Adding a mini screw apically as Dr Betts suggests is a good idea to prevent mobility of the membrane but can prove difficult or impossible to do if the bone graft is done with simultaneous implant placement ..


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HI LAURENT I USUALLY PLACE THE IMPLANT AND GRAFT SAME TIME. I THEN JUST PLACE THE SCREW IN THE MESIAL OR DISTAL PART OF THE APICAL EXTENT OF THE IGEN. IF YOU GET TENSION FREE PRIMARY CLOSURE AND A LAYER OR TWO OF PRF OVER THE IGEN THEN PERF IS UNLIKELY. IT EXPOSES WHEN THERE IS TENSION ON THE FLAF OR THE IGEN MOVES WITH LIP MOVEMENT IN DAILY FUNCTION. REGARDS PAUL BETTS


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Sorry...trouble with camera at uncovering but got some images of tissue and implants..

Occlusal view
Labial view


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At uncovering, did you punch, tunnel and CTG, or is it it PRF? Do you get same results uncovering that way rather than a mini roll as far as attached gingiva and thickness of tissue?


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Healing and Invisalign

Temps
and now Invisalign to move teeth and close spaces


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Brilliant out the box case Mo. Perfect execution on all fronts as usual. Love it.


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Loved the case as whole ....specially the flap design preserving the central papillae ... i would always prefer that the nearest donor site is the best for autogenous bone harvesting....in the anterior region palatal bone is perfect... i sometimes use the nasal spine as well


Reply

Thnx Howie and Emad, Howie bioened my eyes to this as a harvest site years ago RIGHT HERE in XP. Thnx Mo


Reply

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