Palatal Bone used for Khoury Plate Augmentation

154 Rating(s).


Posted on By Maurice Salama In Bone Grafting

Patient presents after failed implant with large 3D Volume defect in Maxillary anterior region. A Palatal Bone Harvest (Acteon Cube) allowed for complete 3D Augmentation with Khoury Plates (Meisenger Screws 0.9mm, Autogenous Bone harvest from palate with ACM drills (JK Dental Group-Neobiotech) and chisels, aPRF-iPRF (Choukroun) and Xmphony Collagen Membrane (Salvin). Closure with PTFE sutures (OMNIA). Thoughts? Dr. Salama

Palatal Bone Harvest
Securing Plate with Meisenger Screws

Autogenous Bone Chips from ACM used here
Labial View of Graft


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16 Comments

Preop CBCT images of defect

3D CBCT preop
Sagital View preop


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Donor site on CBCT

Axial View of Donor Site
Sagittal view 3D


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Preop Clinical Views..

Preop Clincial
Preop Clincial


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Hi Maurice, Very nicely executed as always. I really liked the fact that u used the palate for harvesting instead of opening another site... I did a similar case today in the Upper Right canine area and i used tenting screws instead...food for thought for my next case ;-) Thank u for sharing!


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Stavros; Thanks, we all learn here together. I agree, and there is very often more bone here than we all realize. All of this bone graft and particles was harvested from the palate. Autogenous. regards Maurice


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I love this approach Maurice, not as easy as it seems to harvest in palatal, but very predictable. Khoury's technique is done without a membrane, what is your opinion on this? Can't wait to see the result! Regards


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I prefer Fibrin and a drapeable barrier to ensure the cellular selectivity. regards and happy thanksgiving. Maurice


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Hi Mo, excellent idea to harvest from pallate. As you say there is usually a good brick waiting to be collected. And postop is generally good because we don´t do a vertical discharge. Healling is usually uneventfully. I´ve done some cases and I allways try to collect from the same area, as you. Regards, and see you at Chile!!


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Great case my friend. regards Mo


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Simply magnificent, beautiful surgery and documentation. How do you handle the donor sites when root exposures occur, and how easy or hard is it to detach the block. Happy thanksgiving!


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All about CBCT....if you see sections above there was ample bone available. As for ease, piezo and chisels work very well or ACM drills.


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Thank you!!


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Great donor area choice and beautiful execution, as always. Neat and clean, I could tell it’s your case even if I hadn‘t seen the name.
Do you expect some papilla mesial on the adjacent lateral incisor?
Thank you for sharing and congratulations!
Snjezana


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Snjezana; Thank you. Good Eye, yes the mesial of the lateral incisor is going to be the tough area for complete healing. Most likely a reduced papilla height there following healing and implant placement. If needed, ortho extrusion will provide a solution. regards Maurice


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