Mandibular posterior staged bone block grafting.

46 Rating(s).


Posted on By Monika Keča In Implants

Following cases on dental xp forum I have learned a lot so I have finally decided to post my case. I believe it can contribute to discussion about autogenous bone grafting and mambranes.

After first grafting PRF-A was used, after second only collagen membrane (Biogide) but I do not have a final foto documentation. Also I failed to remove apex during the socket shield preparation but I left it because there was no periapical lesion. After three months, at the same time as bone grafting I decided to extract it because of its mobility.

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19 Comments

Great video and result. Why do you feel that the soft tissue invsded space on 1st surgery? If Dentalxp helped get you tonthis level we are proud indeed. Thanks for sharing this. Dr. Maurice


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Dr. Salama,

Maybe it was improper sealing with bone chips that couldn't prevent the ingrowth of connective tissue. I think this might be a cause of failure? For successful integration of bone grafts the proper adaptation and compaction of bone chips is crucial. I have done the compaction perfectly at the second surgery but I used collagen membrane anyway because I won't see this is happening again.

Dentalxp is a great support in my every day clinical practise. I feel more comfortable with new approaches because all of you are shearing your experience and results.

Thank you for your kind comment.

Monika


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Monika, great surgery and video, both together very didactic, it`s Monika!
I am happy and proud that an another member of my team contributes actively to the XP Forum, the best place to learn, improve and share.
Looking forward to your discussions, knowing your passion for the literature and science!
warmly
Dr. Pohl


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Hello Monika. FINALLY! Very impressive and difficult case. Those Khoury plates aren't as easy as they look. Right? It is cases such as this that encourage me to pursue SPoT/PET protocol. That socket shield really caught my eye :-). Congratulations and welcome aboard! Warmly Chuck.


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Hello Chuck, I am a big fan of SPoT/PET protocol and I have other cases you would like more than this for sure. :) I like everything autogenous. Sometimes is inevitable to do bone blocks and Khoury might be a part of SPoT/PET protocol because of autogenous approach?

Thank you for the warm welcome!


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Monika. Yes Khoury or even Dentin plates being autogenous tissues are "SPoT worthy" regenerative techniques. However, SITE PRESERVATION first and foremost. I'll look forward to seeing more of your lovely work!!!


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:)


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Dear dr. Pohl,

Your mentorship has been an invaluable gift over the past couple of years. In the future I want to be inspiring mentor as you are.

Thank you!


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Monika, thank you. And YOU ARE already an inspiring mentor to our youngest team members!
Big hug, enjoy your time
Dr. Pohl


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Monikaaaaa..I rest my case..super,bravo,mI am proud of u..looking forward to Saturday 😋


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Thank you, my Mia, colleague and friend...


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Great Work!!!


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Thank you!


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Hi Monika,
nicely video and documentation!!
i have a doubt if in the first surgery you fill with chips or particulate graft the gap between the plates and buccal wall? or only you fixed the plates with membrane and PRF?
Thank for share
regards Vladimir


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Hi Vladimir,

I have done the same at both surgeries, but I don’t have a photo of the first surgery filled with bone chips. The PRF-A membrane was not fixated, only placed on the plates. The second is bone chips with Biogide only.
I am glad you like it.

Monika


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Bravo Monika, since I know your work and your amazing skills, I'm quite used to see impressive results of yours, but what I didn't know is that you are such a great video editor :)
I'm glad to have you (and the whole team Croatia :) ) as colleagues. I learn a lot from you!
Matko


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Matko,
you are like our mentor, dr. Pohl. Your enthusiasm is pushing us forward. Since you came to work with us we are growing faster. :)


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Monika,

Great to see you here- an expression of your talent. Few questions- As far as soft tissue invasion - you said compaction of chips- what about closure - tension on wound? No mater what the cause - I always say a "setback is an opportunity for a comeback". And the beauty of a second surgery to improve the first! What do you think shield loosened? No provisional right?
And my favorite question- will you splint all implants?

keep the cases coming- impressive display

Cheers,

Richard


Reply

Hello Richard,

I agree with you that passive primary soft tissue closure is extremely important. I haven't seen patient in postoperative healing period. He mentioned postoperative swelling and nothing else but I can't be sure. In my opinion when exposure happens the defects become larger than that. Patient’s mucosa is thick and easy to manage with. In the second stage I have to do soft tissue management.
No provisionals after grafting, no smoking and healthy patient. But provisional prosthesis was there after extraction, probably this caused SS loosening. SS was there three months before grafting.
You favourite answer - all implants will be splinted :)

Thank you for your comments and kind words.

Cheers

Monika


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