Categories (Cases/Videos)

Implant Therapy

Surgical (Regenerative)

Restorative

Comprehensive Dentistry

Other

Classifieds (76/0)
Patient/Consumer Inquiries (48/1)

Buccal Bone Augmentation using Khoury Bone plates Part 2

146 Rating(s).

Posted on 12.03.2015 04:20 PM By Howard Gluckman In Bone Grafting

Autogenous bone is the gold standard and has the quickest turnover time as well as the least complications. Although the increased morbidity is an issue informing your patients of the possible treatment options gives them a choice in which direction they want to go. This guy chose speed and least complications. Here we harvested bone form the rams and split the bone into 2 plates and then screwed them into place thus replacing the cortical lamina. Autogenous bone chip is then packed into the void to create the medulla. This case will be ready in 3 months for exposure and provisionalisation. The screws will only be removed if they are an aesthetic problem.

Respond to Case

Add a comment to the discussion on Buccal Bone Augmentation using Khoury Bone plates Part 2

Case has been added to your favorites.

Case has been removed from your favorites.

Thank you for your input. Your comment has been posted.

You are now following this member. You will get notified on any new topics posted by this member.

You are no longer following this member. You will not get notified on any new topics posted by this member.

Edit Comment

Comment has been updated.

23 Comments

Jorge Campos says on 12.03.2015 05:00 PM

Well done Howard. I like the approach and volume you gain instantaneously. My only concern is about the simultaneous implant placement.
Keep us posted!
Regards,
Jorge

Charles Schwimer says on 12.03.2015 06:42 PM

Howie. I am envious of your ability to consistently shape and position these bone plates with such perfection. It is my understanding immediate implant placement is a contra indication for the Khoury technique because it may interfere with blood supply to the grafted bone. However, IMO the rate of implant success is most directly proportional to the amount of NATIVE BONE (not grafted bone) utilized for initial stability at the time of implant placement. In addition, I believe any additional bone gained as a result of grafting is more protective rather than supportive for an implant long term. In some instances, an immediate implant can facilitate tissue repair by contributing to space and/ or clot stability. So when I am able to place an immediate implant in ideal restorative position and/ or in an environment conducive to tissue repair adjacent to the implant I do so. I love what you have done here. Thank you for sharing. All the best. Chuck

Howard Gluckman says on 12.04.2015 02:28 PM

Thanks Chuck. There is no contraindication to do simultaneous implants with Khoury technique. In fact it is ideal and better than a normal block. AS I mentioned to Jorge I have been doing it for more than 10 years and have a lot of long term follow up cases. I will cover this in the Hands on training that we do at Dental XP. Please see the post below with some pics and long term follow ups as well ask I will post another case here.

Maurice Salama says on 12.03.2015 06:39 PM

Howie; would you use the Botiss plates instead today? Beautiful surgical skills on display. Thanks for sharing. Mo

Howard Gluckman says on 12.04.2015 02:23 PM

Mo a good question and the answer here is you could use absolutely anything you want. However I give my patients options and share the pros and cons of treatment from increased morbidity to complication rate to costs involved and especially the healing time of the different GBR techniques. But for me Autogenous is still gold standard and for the most difficult cases I go that way. The botiss plates take a very long time to convert more than 3 years if they ever convert. They also do not get revascularised very well so the don't support the soft tissue as well as the autogenous blocks. But Titanium reinforced membranes also and option and the sausage technique.choice is the surgeons ideal I guess.

Howard Gluckman says on 12.04.2015 02:19 PM

Jorge we have been doing simultaneous bone block placement and implants for more than 10 years. It works like a bomb no different to normal GBR techniques. I have however found that you need to do the khooury technique as the solid blocks do resorb. Our 8 year data of palatal solid blocks confirms this. However our Khoury plates do not.

Khoury plate and immediate implant

3 years post op bone showing excellent bone stability

Jorge Campos says on 12.05.2015 01:58 PM

Thanks Howard! Very interesting. I usually do "one miracle at a time", and a staged approach.
I also like what you say about covering the plate in order to get better bone, because I think that your concern is due to the conective tissue invasion on the bone particles that may diminish the bone quality.
Thanks again-
Jorge

snjezana pohl says on 12.04.2015 07:21 AM

Great, great surgical skills. The thin bone plates and precision in screwing make me envious.
Why have you placed a membrane? Khoury does not use any membrane, sometimes Fibrin from PRGF. Using membranes is recommended for allograft block - and here I would like to hear if you and other experts have some experience with Botis Cortical Plate?
Thank you for sharing - you set a bar very high!
Snjezana Pohl

Howard Gluckman says on 12.04.2015 02:32 PM

Thank you snjezana. The membrane is definitely not needed here and Khoury does not use them at all. I wanted to see what I would get when I open. Sometimes I get a softer bone on the occlusal surface and I want to see if this si any different with the membrane. With regards to the Botiss Blocks you definitely do need the blocks that is not a debate as you get very poor bone growth if you do not use them. I have actually found that I get better bone if you use an allograft with the botiss plates and a membrane and then leave for 6 months minimum.

Joseph Choukroun says on 12.04.2015 12:40 PM

Howie, very nice case. as usual.. Do you recommend to use a collagen membrane as Fouad is not using any collagen barrier ? All my best.

Howard Gluckman says on 12.04.2015 02:32 PM

Joseph I don't generally and you are right Khoury does not But I want to see if there is a better hardness of bone when I use it.

Maurice Salama says on 12.05.2015 09:06 AM

#Xperts interacting on the Forum for ASLL to BENEFIT!!
Thanks Mo

Ehab Moussa says on 12.05.2015 10:35 AM

Hello Howie,

I must agree with Chuck on the fact that your skills in 'sculpting bone' are extraordinary. Your cases are truly a delight to view, as are your skills.
How do you maintain the distance between your block and the implants in a distal extension case, when there are no adjacent prominences to support the block? are the screws you use self tapping?
Is your data on palatal blocks published, so that i can get it?

Thank you for sharing and all the best to you my friend :)

Ehab

Howard Gluckman says on 12.05.2015 10:44 AM

Thank You Ehab you are too kind. The screws must always be self tapping and as a result you can easily screw the through the bone by any amount first before you penetrate the host bone. So if you want to leave it 5mm away you screw it through about 5mm and then only contact the host bone.

The data on the palatal bone is being collected as we speak and I hope to publish it next year.
Thank you for your comments
regards
Howie

Peter Fairbairn says on 12.05.2015 03:06 PM

Hi Howie yes nice work , as you know I have not used autogenous in my last 3,000 grafts for better long term outcomes . I prefer to remove the dead stuff to help host healing , this technique looks good in your hands ...
Skilled stuff as usual
Peter

Howard Gluckman says on 12.06.2015 03:14 AM

Thanks Peter. Autogenous remains the gold standard in my hands. Until we develop a new gold standard This will remain my technique of choice. However as you see from our videos and stuff I will always use what is in the best interests of the patients. I feel it is important to have many different arrows in the quiver. Thanks for your comments

Peter Fairbairn says on 12.07.2015 10:38 AM

Looking forward to seeing you here in London in March .
Keep up good work
Peter

Howard Gluckman says on 12.10.2015 05:41 AM

Looking forward Peter.

richard martin says on 12.09.2015 01:02 PM

Howie,

fantastic as always- see you in Feb

Cheers,

Richard

Howard Gluckman says on 12.10.2015 05:41 AM

That my friend I am looking forward to. Definitely gonna buy you a drink

Tyler Binner says on 12.10.2015 04:37 PM

Howie, this case was so good I'm going to buy EVERYONE drinks on Thursday night from 6-7:30pm in the exhibit hall & then AGAIN on Friday night at the 2016 Dentalxp Global Symposium!!
Looking forward to seeing everyone in February!

Howard Gluckman says on 12.11.2015 04:28 AM

I wasn't going to come but now that you are buying drinks I will be there like a bear. Looking forward to seeing you all again. Have a good christmas and new year dude.

Tyler Binner says on 12.11.2015 03:46 PM

Haha sounds good! Look forward to it as well my friend and happy Chanukah!