Horizontal augmentation with autogenous cortical bone plate with simultaneous implants placement

79 Rating(s).


Posted on By Cristian Rotaru In Bone Grafting

This is a case of a female patient in her 40s who came to us with a desire for a restorative plan that include implants suported crowns in the lower right quadrant.
After analyzing the CBCT it was obvious she needed horizontal bone augmentation for placing implants. We decided to go with a simultanenous approach for implants placement and bone augmentation, done at the same time using cortical bone plate ala Khoury technique.
This is an autologous membrane alternative to the preformed titanium membranes i often use for this type of situations.

P.s. I apologize for the bloody pictures, but the patient was bleeding from every corner of the surgical field. Very difficult to take a clean and clear shot.




Add to Favorites
Add a comment to the discussion on Horizontal augmentation with autogenous cortical bone plate with simultaneous implants placement


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.

19 Comments


Reply


Reply


Reply


Reply


Reply

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


Reply

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


Reply

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


Reply

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 !


Reply

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


Reply

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 !


Reply

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


Reply

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 !


Reply

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


Reply

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 !


Reply

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


Reply

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 !


Reply

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.


Reply

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 !


Reply


Ritter
Magnetic Mallet