Horizontal augmentation with autogenous cortical bone plate with simultaneous implants placement

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Wow, Cristian, you master all kinds of horizontal ridge augmentation! Great case. Each step is done perfectly!
No questions.
Best regards
Snjezana

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Hi, Snjezana !
Thank you for the nice comment and the words of appreciation.
Best regards to you too !

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Christian
don't worry pictures aren't too bloody at least from the OMSstandpoint case looks great , implants look solid. I do have a few question, do you have any post imaging? being that you do not have too many threads exposed do you think that you could handle this with the GBR technique. I know the ridge was somewhat thin but it looks like you have two thirds of the implants covered in bone. In the anterior aspect of platr did you place a bit more autogenous chips in there to fill it up and as far as the harvesting of the graft- do you have piezo or sagittal saw maybe save you a little bit more bone on the mandible for autogenous harvest- I love the periosteal flap as membrane - key to healing

Cheers,

Richard

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Hi, Dr Martin.
Thank you for your comment. I am glad you, with an OMS eye, dont find this too bloody, as probably others will :))

I dont have a CBCT in my practice and i dont usually recommend patients taking one immediately after surgery, as i dont see any benefit in this for me or the patient. I do however recommend a CBCT after 4-6-8 months to see the healing and amount of bone achieved , If i have enough or if i have to do minor corrections when re-entering. So, CBCT after 4 months :)
This is a GBR technique with the cortical bone plate acting as a rigid barrier. If you are asking if i would use resorbable membrane here, i would not. In my hands, i dont get predictable and constantly good results using resorbable in this situation. Too little bone achieved. I prefer using a rigid barrier, like titanium meshes or cortical bone plate.
The plate was a little off center :) it was positioned too much to the distal. Looking now, i would have liked it too be a little to the mesial . I only saw that i needed more autologous chips to pack mesial when placing it into the gap at the end and i didnt have any place left to harvest more at that time. I didnt want to use any bottle bone as this would imply using a colagen over it.
I find myself constantly using lindemann burr more, despite the piezo. I dont like the special saw from dentsply for harvesting bone. Me liking and choosing the burr more is probably a reminiscent of my OMS training when i was using a lot of burrs in the hospital :)
Thank you again and hope that i answered all you questions.
Best wishes !

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Christian. Your surgical skills are impressive! Bleeding may be bad for pictures, but good for healing. Well done! Thank you for sharing. Best regards. Chuck

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Hi, dr Schwimer !
Thank you for your nice words !
I agree about the bleeding :) and i hope for a very good result here :))
Thanks again.
I wish you all the best !

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Cristian,
This is a master application of Khoury technique.
Surgical execution simply perfect either technically and on biological point of view.
Do you believe that the this technique works in both cases with and without implant same way?
It will be great to see the follow-up up of the case.
Armando

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Hi , dr Ponzi !
Thank you for your comment and nice words !
I think the end result should be the same in regards to bone gain. The only difference is the length in time of the treatment.
By placing the implants( if you have enough bone to stabilise them) in the same procedure with the bone graft, you will shorten the treatment duration but your loss will be greater if something goes wrong.
By doing them separately , first bone graft and then implants one is choosing to stay in the safe side. I often choose this alternative when i feel i am pushing it too much.
Thank you again for you kind words !
I wish you all the best !

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Christian

you answered my question perfectly the only thing I meant by GBR was more so making a subperiosteal pocket and just packing your cihips against Bone in tunnel or possibly using your split periosteal technique you like to do as a membrane.

Blood is the liquid of life!!

Cheers,

Richard

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Dr Martin,
i understand now what you meant .
Sorry for not getting it the first time :))
I think it is a possibility. If one can maintain the volume for the graft, with no pressure on it, why not ?
Thanks again !

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Nicely managed....I had similar questions as Richard Martin and they were already answered. Well done and thank you for continuing to add your beautiful material, skill and experience to our FORUM community at XP....please continue and hope to see you in Las Vegas in February. regards Dr. Salama

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Thank you, dr Salama for your nice words !
I will try to bring some of my cases to this forum, where great clinicians exchange their knowledge almost everyday, in a very friendly and relaxed atmosphere. Love it !
I wish you all the best !

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Hi Cristian, great job and documentation. Thanks for sharing. We can understand,Drilling screw holes with the handpiece perpendicular to the bone as we go distal is really challenging, you have done it beautifully. You have shown great results with Ti reinforced mesh for horizontal and vertical augmentation, why did you preferred autogenous plate in this case. Thanks.

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Hi, dr Gowda !
Thank you so much for you comment regarding my case !
I presented 2 treatment alternatives to the patient, that in my hands are most predictable when done simultaneously with implant placement. The ti preformed mesh and bone plate. When discussing the advanteges and disadvantages of each technique, patient didnt want to take any risk with the ti mesh possible complications and the risk of early exposure and all the consequnce of it.
So , we decided to go with the autologous approach, despite having to harvest the bone from a donor site.
Thanks again !
Best regards !

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