The Cortical Lamina Technique: Restoring advanced bone loss in maxilla

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Posted on By Roberto Rossi In Bone Grafting

A female patient 46 YO referred to the clinic to seek a solution for her mouth. She had aggressive periodontitis with severe bone loss and after initial therapy a ridge (in the upper right quadrant) 2 mm thin and 5/6 mm high. The area was reconstructed by using the cortical lamina technique (a collagenated porcine curved bone lamina) supported by two tenting screws 7 mm long and a graft composed of autogenous bone mixed with GenOs (porcine collagenated bon graft) and the patient's blood clot. 8 months after augmentation 3 implants (3,5 by 10 mm) were inserted in the reconstructed bone and later restored to re-establish function and esthetics

CBCT of the initial situation
After initial therapy

tenting screws in place
cortical lamina in place


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8 Comments

Roberto; Compliments. Why no Hybrid restoration here? When do decide on vertical augmentation? When will the cortical lamina be available in the USA? Thanks for sharing, we continue to wait on your next presentation. regards Maurice


Reply

Hi Maurice ! Thanks
No hybrid because she has a low lip line and does not show. In this case she can clean much better. God only knows when someone will take charge to take care of FDA. For sure this summer I will present it in Harvard, Buffalo and BU ........ people will start craving for it


Reply

Hi Roberto,

Great regeneration here.

I have used this Lamina in about 6 cases, and always find it very difficult to fix with pins. It's a semi rigid membrane, it's not elastic, and often times the pins pierce the membrane and tear it, having to change the position of the pin and inserting it a bit less to avoid a new tear.

How do you stabilize the lamina? Have you had this problem I'm describing?


Thanks


Reply

Hi Andoni, I try to stabilize the lamina with local anatomy. I myself hardly use pins for the reasons you mentioned. Once you master the technique you will overcome the problems. Lamina should be dry until sutures that is one of the Keyes of success. If it soaks with blood or saliva losses a lot of its power. If you use horizontal mattress sutures that helps too. I have cortical bone pins made CAD CAM from the company that helps a lot because they integrate


Reply

Hi Roberto,

I feel more comfortable fixing them with pins. I've had very nice results with it.

Should the membrane turn into bone, or it's replaced by soft tissue?

Regards


Reply

What you do with the pins is correct for that kind of soft Lamina.
I use the curved version that is stiff and quite rigid. Only in rare cases needs that kind of stabilization


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The lamina is collagenated bone and fully transforms into new bone


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In USA yet? FDA approved? Very interesting material. Dr. Salama


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