Gold Standard Autogenous Bone grafting with Khoury Plates

707 Rating(s).


Posted on By Howard Gluckman In Bone Grafting

Autogenous bone is definitely the gold standard. The best and most predictable way to get solid bone is to use Khoury plates to recreate a buccal and palatal block that will allow the new growth of bone from the autogenous chip that rapidly converts to new bone in about 4 months.




Add to Favorites
Add a comment to the discussion on Gold Standard Autogenous Bone grafting with Khoury Plates


Upload photos
1.  Photo Title:

2.  Photo Title:

Would you like to follow this post?
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
1.  Photo Title:
Current Image:   Delete Image
2.  Photo Title:
Current Image:   Delete Image
Comment has been updated.

34 Comments

Autogenous bone chip filling the void


Reply

You can see some of the Emdogain sticking out above the bone graft

Rotated palatal flap to enable double closure technique of the bone graft


Reply


Reply

Remarkable clinical skills. I saw you do this in Brazil and was very impressed. My ONLY question is the mesial papilla on the lateral incisor? If we bone sounded there it appears the IHB was several millimeters away from the papilla height....How the graft rebuilds this critical area will be very important. Did you root prep on the dehisced portion of the lateral root? Keep us posted. regards Mo


Reply

MO this was a big concern for me as I could see it on the CBCT. I spent a lot of time discussing the loss of the papilla with the patient. I unfortunately forgot to take one important picture and that was the use of PRefgel and Emdogain but I will show it in the video of this case. I did not want to put bone against tooth without any root conditioning. The other issue is where the bone peaks where. They were both buccal and palatal which kind of made it a intrabony lesion so I am fairly hopeful about the result. However there is still biology to deal with I can only hope I have covered all the bases


Reply

The Master !!! Simply amazing. You make it look so simple. Incredible case. Nice clean surgery. Did you use the Frios microsaw for the vertical and apical cuts? Regards, Naheed


Reply

Thanks Naheed yes I did to split the bone but a piezo to remove the bone


Reply

Maaan, Perfect execution of every single step !!
I especially love the plate positioning and closure. Your'e THE MAN Howie.
When do you decide to extend one tooth for the verticals Vs not extending?
Any particular treatment to the root surface?

Thanks for sharing this awesome case.
Ehab


Reply

Thanks my friend Always appreciate your kind words. The positioning of the plates in this case is key to ensure I can get bone on the root surface. WE treated the surface with Prefgel and then with Emdogain. Im hoping for a great result here but I have peeped the patient for papilla loss from the start


Reply

Impressive as always !

Great case , masterfully handled !

The same question as dr Salama about the bone on the lateral incisor mesial part of the root.
Could the aesthetic final result be more predictable if this tooth would have been strategically extracted before bone graft and rebuild the area from 13 to 21 ?

Thank you !


Reply

Outstanding surgical execution. As to the issues and suggestions for the mesial deficiency of the lateral incisor, we have traditional utilized orthodontic eruption to bring the mesial peak bone coronally. This can be done before surgical intervention, during the 4-5 months while the graft is maturing or even, as necessary, after an implant is placed and temporized in the central incisor grafted site. Obviously, there are many different ways to manage the different challenges in this very complex case. I'm very much looking forward to seeing the case progress. Well done Howie.


Reply

Thanks Henry. I appreciate the kind words. I think everything hinges on that tooth and how it will be stable. There are a few issues that I'm hoping willl keep everything there. If you look at the initial photo there is excellent papilla on that tooth. There was no pocketing there at all so there is a chance that the sharpens fibre are still there. I believe the bone on the buccal and palatal which extended slightly into the mesial were keeping the papilla in position. Therefore the use of Emdogain and the bone graft hopefully will get a close to perfect result. If not then I would go for the extrusion to get the papilla to fill the space and he is a great patient so I believe it will be possible


Reply

thanks Cristian and a great question. The reason I did not and decided to build was that I had bone both buccal and palatal of the root and it created a intrabony defect. the position of this gives me hope that I will get a good result and with Emdogain perhaps it will all grown nicely. Time will tell and I will either be a hero or a zero


Reply

Howie, the only one problem with your cases is that we can admire a lot and discuss very little.
Awesome clean surgery.
Regarding mesial papilla on the lateral incisor: do you think that Emdogain could help?
Congratulations, admiration
Snjezana


Reply

Thanks SNjezana. Yes I do and I used it with Pref gel except I forgot to take a pic of that part however I did do a video so it will be there in the video. Lets see how it pans out cos its great to show the initial work but its only when the crown is on that it can really be judged.


Reply

Howie your grasp of the surgical skills needed as well as the biology of the periodontium and wound healing makes this a very lucky patient.....in great hands. regards Mo


Reply

Howie. WOW! Spectacular surgical planing and skill on display. If anyone can pull this on off it is you. Personally I agree with Henry would "stack the deck"'with orthodontic eruption. It is the pure biologic solution that stands the test of time regardless of your regenerative powers. Still not too late. Bring it home my friend. All the best. Chuck


Reply

Thanks Chuck. I appreciate the kind words. Let me explain why I would not do extrusion at this point and rather wait for a later stage. Firstly there is a 10mm defect in bone on the medial side HOWEVER there are excellent bone peaks that extend into the medial section both buccal and palatal and hence the maintenance of the papilla. If I was to extrude now it would mean I have to extrude and devitalize the lateral as well as possible lose it at a later stage. With the current protocol I am giving it even chance of regeneration and hopefully with the bone peaks I am able to reestablish a ligament with the Emdogain or at least some growth which may mean a few mm of extrusion to bring the papilla down which could mean no revitalization and no tooth loss.


Reply

I agree with Howie, wait for regen results and ortho only after healing....Mo


Reply

Love seeing your work, Howie! The rare combination of brains AND skills AND the ability/willingness to teach and share... you're like a unicorn, my friend. I agree that this patient is in excellent hands and look forward to the results.


Reply

Thanks Dave Kind words indeed form you much appreciated


Reply

What more can I add to all the comments above?!
Outstandingly amazing are the only words I can think of to admire your surgical skills. Looking forward to seeing the video.
All the best.
Mark


Reply

Thanks Mark. coming soon to a theatre near you


Reply

The LOVE on this FORUM is truly unusual...no jealousies or arrogant comments...just people who appreciate skill, hard work, and want to learn. Thanks to ALL. Mo


Reply

Howie,

You know what I would like to say but will just leave it at fleecy!n Emdogain I think key here ( yes I know what it is)
Few quesations- vertical incisions - resurface down the road?
Interim prosthesis is....

Video must have music

Cheers,

Richard


Reply

Fleecy indeed Rich. The interim prostheses is an essex retainer so as not to put any pressure on the palatal bone. The vertical incisions are not my favorite but wanted to keep away from the papilla with no bone so yes its a compromise here


Reply

Howard,
very well done execution for khoury technique and great documentation you would obtain nice results!!
Thanks
best regards
Vladimir


Reply

Thanks Vladimir. the success will be when I open and find excellent bone. time will tell


Reply

How your grasp of the surgical skills needed as well as the biology of the periodontium and wound healing makes this a very lucky patient.


Reply

In hindsight ONLY, would you ever consider TUNNEL approach to mesial of lateral incisor and single vertical instead to avoid potential blunting of papilla?? regards Mo


Reply

Unfortunately the tunnel technique is only possible for 2 teeth or more. There is generally not enough space for this and if there is massive defects in the bone it is also not a viable option. You can also get good closure with a single tooth space which is not always possible with multiple teeth


Reply

Thanks for your kind words


Reply

Superb case Howie. I agree with you, if needed, a late ortho will do the rest.
Excellent case and documentation of every step. Is now easy to follow you (lol)
Big hug my friend
Jorge


Reply

Ye definitely possible


Reply


Salvin
Dentalxp