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Guided Expansion Graft with Densah Burs utilizing Osseodensification

104 Rating(s).

Posted on 09.14.2015 11:20 AM By Salah Huwais In Bone Grafting

Patient is medically healthy. She presented with missing # 9. History of traumatic extraction with no site preservation has resulted in moderate to sever buccal plate deficiency. This is thin biotype case with high smile line.
Step1: Osseodensification was used utilizing the Densah Burs to expand ridge and create a contained 2-3 walls defect. Defect was grafted with a combination of FDBA 50/50 and Xynograft Cancellous particles. Membrane was utilized for GBR.
Step 2: After 12 wks healing, site was prepared utilizing osseodensification. Implant was placed with 50N/cm. After 12 wks healing, uncover was done with minimal modified roll,

Missing #9 with buccal bone deficiency

Osseodensification to create a contained defect

GBR to graft contained defect

12 wks re-entry. 8mm ridge width

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13 Comments

rocco mele says on 09.14.2015 11:54 AM

Dr Huwais

That is a beautiful procedure.
I got to get me some of those drills...and learn the technique.
Could the implant diameter been a little larger?

Thank you

Rocco

Salah Huwais says on 09.14.2015 12:35 PM

Rocco:

The idea for the guided graft brought to me originally by Dr. Mike Sonic. It works very well because we ended up preserving the ridge and enhancing it.
Yes indeed. I used 3.7mm in this case and I could use 4.5 easily. We ended up with adequate buccal bone thickness. I am just testing how much we can achieve. Thank you.
Salah

rocco mele says on 09.14.2015 02:24 PM

Dr Huwais

I spoke with the company and they will let me know if Veterinarians can purchase them. Always a little "red tape"

Thanks Again

Rocco

Salah Huwais says on 09.14.2015 02:39 PM

Rocco:

I will check into it soon and see what can be done. Thank you for willing to try.

Salah

Jorge Campos says on 09.14.2015 02:13 PM

Great case Salah!
I´m very impressed by the posibilities of this burs!
Today I used for a simple ridge augmentation
Thanks for sharing
Jorge

2 mm drill hole

3.3 expansion

Salah Huwais says on 09.14.2015 02:33 PM

Jorge:

Welcome to Osseodensification my friend. See you in Lisbon. Thank you

Salah

Jorge Campos says on 09.14.2015 02:24 PM

final pic with buccal bone grafting .

Maurice Salama says on 09.14.2015 05:03 PM

Great GBR result. Implant may be too labia and soft tissue thickness may be an issue. Jeep us posted. Dr. Salama

Salah Huwais says on 09.14.2015 05:31 PM

Maurice:
You may be right. I took slightly more buccal position. I had a compromised palatal wall and was limited by its thickness. Surgically, positioning looked better than the healing abutment view. Looking at it now with your comment, I may revisit with buccal tissue graft if needed. I will post the restorative phase when done. Thank you

I have posted a comparison shots showing that surgically I could not be any further palatally due to limited palatal wall. The healing abutment is 1.5 mm wider than the fixture.

Salah

Charles Schwimer says on 09.14.2015 05:18 PM

I have similar thoughts as Mo. The Densah burs work extremely well. Subsequently, Osseodensification may provide us with a "false sense of security" and lead us to placing implants further toward the Buccal than we normally would. I guess time will provide us with the "true benefits" of Osseodensification. As Jorge stated. There are many possibilities. Chuck

Salah Huwais says on 09.15.2015 02:27 PM

Chuck:

You are right on. I want to re-enforce that Osseodensification does not create the bulk, it does only preserve and enhance what is there. Even with Osseodensification we must follow the existing established surgical protocols of having at least 1.5-2 mm of sounding bone around the implant. In may hands I always graft the buccal if resulted buccal bone is less than 1.5-2 mm and I strongly believe in adequate soft tissue thickness to prevent bone loss.

Howard Gluckman says on 09.15.2015 05:16 PM

I am looking forward to trying these burs. They look very promising. great case

Salah Huwais says on 09.16.2015 08:55 AM

Howard:

Thank you. I will get in touch with you soon to get some burs for you to try.