Autologous tissue for hard and soft tissue augmentation

188 Rating(s).


Posted on By snjezana pohl In Bone Grafting

Local, organic, sustainable, renewable:) You know this type of patient: tall and skinny, tooth roots prominent, thin buccal bone, and advanced ridge atrophy after extractions. On the right side socket shield for the canine, delayed implant placement. The socket is grafted with cortico-cancellous piece of tuberosity bone. This graft material is shown to result in bone fill for the sockets with socket shield. Sinus window bone plate was utilized for the Khoury technique, for the horizontal ridge augmentation. Sinus was elevated. Buccal sliding palatal flap (BSPPF) for the wound closure, avoiding major buccal flap coronal advancement. Teeth supported provisional. After 4 months implants with healing abutments were left to heal submerged (guided soft tissue augmentation), again BSPPF was utilized. Simple implant uncoverage.
On the left side: BSPPF and GBR for the ridge with horizontal atrophy plus implant placement, modified roll flap for implant uncovering procedure.




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16 Comments


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Beautiful management, I hope your patient appreciates the huge service and minimally invasive approach you took!


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Just incredible and CLEAN surgery. Thanks for sharing.


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Thank you, Maurice, very much appreciated!
Best regards
Snjezana


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Thank you! Yes, he does, very much. These days he gets the definitive prosthetics, I’ll update the case.
Best regards
Snjezana


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Just LOVE IT!


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Love to see your comment, Chuck! Many thanks!


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Fascinating case here. Was the window covered with anything above the Khoury plate or was the plate simply moved apical and re secured with micro screws and autogenous bone placed directly over the schledarian membrane? Did you just brush the periosteum or did you also score the periosteum above the lateral window? Did the bone scrapings all come from the same site or did they come from the tuberosity distal to the molar in the same site? Thank you for posting! Ben


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Dear Ben,
Thank you so much for your excellent questions! 1. Khoury plate was simply relocated and fixed. In the cases with a very thin sinus plate (<1mm), I use to place a layer of xenograft on the top of the autologous bone particles, below the plate, for contour maintenance. 2. In the cases where sinus elevation is performed simultaneously (majority of the cases), I add autologous bone in the window area and cover it with the collagen membrane. If the sinus is not elevated, a collagen membrane only. 3. I usually score the periosteum and brush afterwards in complex surgeries because of the time factor. 4. Particulate bone is scraped from the tuberosity. A cortico-cancellous tuberosity bone is utilized for the socket with socket shield grafting (please see https://doi.org/10.11607/jomi.8581)
Looking forward to meeting you very soon!

Snjezana


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I'm thinking about expanding my practice and need a dentist that has experience working with complex cases.


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It will be a difficult task, since Melbourn is in lockdown all the time, with no end in sight...
Best
Snjezana


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Great surgical skills, and greatly performed case, than You


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Thank you, very much appreciated!
Best regards, Snjezana


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