Thickening of labial bone using "Sausage" technique with Jason membrane and Cerabone

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Posted on By Howard Gluckman In Bone Grafting

The ideal buccal bone width around an implant is 2-4mm in order to maintain soft tissue and aesthetic stability over the long term.(Grunder 2005). Accepting a small amount of bone on the buccal of the implant without further grafting is a recipe for long term disaster. In this case we use a sausage technique with Jason membrane ( a pericardium membrane) with xenograft in order to further augment the buccal bone thickness. The sausage technique was described by Istvan Urban.

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27 Comments

Beautiful as always! What was interim restoration? Gregory


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Thanks Gregory. She has a provisional acrylic partial denture


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Howard, very nice surgery. I liked all the steps and procedures. May be I would recover drilled bone or better, osseodensified implant sites.
Thanks for posting such interesting case!
Jorge


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Howie. Outstanding display of surgical skills and technique. As Jorge mentioned, I believe Osseodesnifation site preparation will simplify and optimize your result in a case such as this. I look forward to seeing you in Florida. I am registered for your course, so I will not miss you this time:-). Cheers. Chuck


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Charles I think the jury still has to decide on whether the Densah burs will make a big difference but I agree it is what I would try next time as I have them now.


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Howie. I think you will like the Densah Burs. Using them will not change diagnosis and treatment, but it can simplify and optimize what ever treatment modality you choose. The most significant difference you should notice is the precise drilling in either direction. In addition, initial implant insertion torque is consistently higher unless you decided to reduce by operating in forward direction. However, if it is a priority to harvest bone from your osteotimy site these burs probably won't be as efficient as " conventional" extraction drills. I Look forward to your verdict. Best wishes. Chuck


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thanks Chuck. I tried them for the first time yesterday so the jury is still out. I think there is a learning curve that I need to get past before I see the big benefit but I will persevere. regards
Howie


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I understand completely. To accelerate your learning curve drill a conventional pilot 7-10mm. Then use at 1100 -1200 rpm in reverse with maximum irrigation. Only drill 1-2 deeper at a time INCREMENTALLY WITH PUMPING MOTION. At a certain point you feels"grab and sink in". To me it feels best beyond the 7mm marking. Personally I have developed a mild addiction in using these burs.


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Thanks Jorge. I did not have the Densar burs yet so agreed next time I will do that however I would still graft over. Belt and breaches approach


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Howard as always very nice surgical technique. What did you use to grind the harvested bone plugs and what ratio when mixed with Cerabone? Also it looks like you employed "sticky bone" what type of tubes did you use and what where the centrifugation parameters utilized?


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Thank you Jerome. The bone is pure sticky bone and there is no added autogenous bone to the cerabone. The tubes for sticky bone are the I-prf and they are spun I think for 3 min at 800rpm. This is then mixed with the A-prf and the xeno. The plugs are harvested from the tuberosity with trephines and they worked really well as we gained a fair amount of bone.


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What an absolutely fantastic display of skill and flawless execution.

What type of tack system do you use for the membrane?


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Thank you Michael. These tacks are from Helmut Zepf.


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Fantastic . Like watching an orchestra !


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Outstanding display of skill as usual Howie !! I love the sausage technique, and I think that it works very well.
What are your indications for using the tuberosity socket seal technique?

Thanks for sharing my friend :)

Ehab


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Ehab thank you. You are too kind. The only time I would use them is if I am going to do some kind of socket preservation(which I do not do often) and there is some bony defect in the extraction site. Then the next criteria is that there is good bone and soft tissue in the tuberosity site. Both are critical.


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Grazi Mark


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Beautiful surgery. Thank you for sharing. What did you insert in the socket extractions?


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Thank you Marc. They are bone and soft tissue cores taken from the maxillary tuberosity that we have harvested with a trephine


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Impressive as always Howie. I am sure we all appreciate your sharing these well done cases. I know you put a lot into them. Happy Holidays and see you in February!


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Thanks Mark and to you. Looking forward tot he meeting that is for sure.


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Fantastic case Howie!

Love this approach.

One question, aren't the tacs just on top of the adjacent teeth? Are you concerned of damaging them??

Regards


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Thanks Antoni. They are just next to the teeth. You can quickly see if you hit teeth as they do not penetrate. I have hit one or 2. But you can generally see where the roots are to make sure you miss them


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Howie; Outstanding my friend. What other options do you feel were worth considering outside of this approach? Why the laser? What were the advantages? Scissor for flap release? No hemostat or sharp dissection? This video is simply outstanding like you my friend. Thanks for sharing it. It deserves a voiceover. regards Mo


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Thanks Mo. Very kind words. Really appreciated. I think with regards to what could we have done here I think anything would be possible. Ridge split, Any type of membrane, Any block. Really anything but I felt that because we wanted to augment a rise what was on the border of OK that I would go for the simplest treatment option with the least amount of possible complications or increased morbidity.

With regards to the laser, I like to use it as it reduces the bleeding when doing a periosteal release. The waterless also does not char the tissue like the CO2 or the Diode so kinder to the tissue.

I hope this answers your questions.

thanks again


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Howard, Why don't you perform socket preservation?


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Thanks Howie. Perfect. Mo


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