Dental Education
Online Dental Education Dental education lectures and videos Online dental ce Dental education articles Expert dental educators Dental products education Dental Community
 
Video Details
Autogenous Bone Graft - Part 3: Contouring & Fixation

Description:
In part 3 of this series, Dr. Michael Pikos demonstrates the techniques for contouring and fixation of a cortical autogenous graft harvested from the ramus buccal shelf. In addition, specific techniques and guidelines are suggested in ensuring tension free closure of the flap over the graft. Membrane use and PRP are also discussed

Date Added:
4/6/2009

Author(s):

Michael A Pikos, DDS Michael A Pikos, DDS
Dr. Michael A. Pikos Dr. Pikos is originally from Campbell, Ohio. He attended The Ohio State University where he graduated Summa Cum Laude and Phi Beta Kappa....
[read more]






Online Videos / Surgery / Bone Grafting / Autogenous Bone Graft - Part 3: Contouring & Fixation




Questions & Comments
Maurice Salama - (2/18/2015 9:29 PM)

I prefer doing the periosteal realeasing incision just prior to wound closure and final suturing when possible as it allows me to control graft positioning, contouring and membrane placement PRN as well as final stabilization of all of the above without having to manage bleeding and visibility at the same time.

michael abba - (1/22/2013 8:58 AM)

Dr korner, I agree about the periosteal incision , but I think it was done because of "filming purposes"

Robert Körner - (1/21/2013 1:38 PM)

Is there nobody out there who asks himself: isn´t this a case that could (or should) have been treated without augmentation?(or at the outmost a little lateral augmentation in the most medial area) Three Implants of at least 10mm length and sufficent diameter shouldn´t have been a problem.By the way - where are the guidelines for the "crown-implant ratio".Actually we do not really know much about the apropriate legth and diameter of the implants we use. Further I think that is prefareable to do the periosteal incision much more prior to woundclosure, because bleeding will have stopped,when you start suturing, and you have less risk of haematoma.

Michael Pikos - (4/20/2010 11:29 AM)

Hi guys,

Sorry I haven’t been more punctual with regard to being part of this blog. Allow me to address some of the questions and concerns that have been posted already regarding flap management for the RBS bone harvest. First, generally speaking, contouring a block graft prior to fixation is always indicated. There are times however where post fixation contouring still needs to be done and when this occurs it can be done predictably with a slow speed burnishing concept that I have shown. Yes, this can put the block at risk but not if it’s done properly. I do utilize particulate mineralized allograft (MinerOss) for any morticing that is necessary with these block grafts and especially when overcontouring is indicated. For the past 4 years now I utilize PRGF as opposed to PRP as a bioactive modifier with all of my bone grafting including sinus grafting from autogenous block grafting, ridge splitting, etc.

The importance of flap relaxation prior to closure of any bone graft be it block bone, mesh particulate, ridge split, etc. cannot be emphasized enough. This technique that I show is of course specific to the mental neurovascular bundle area which not too coincidentally happens to be the area (posterior mandible) where most bone grafts fail – due to incision line opening and / or vestibular dehiscence. More often than not the clinician is too conservative with flap relaxation in and around the neurovascular bundle. Hopefully this helps. Also, it is never a good idea to place implants simultaneously with block grafting in that the remodeling that will occur will result in graft compromise as Dr. Salama pointed out. Always best to stage implant placement with block grafting. Again, hope this helps clarify some points.

Best regards,

Dr. Pikos

Fadi Assaf - (4/19/2010 8:40 AM)

Would it be safer to use an electric motor?

Maurice Salama - (1/4/2010 12:10 PM)

Milind and Mohammed;
Thanks for the posts and questions. I do not believe leaving behind periosteum would have a negative effect on the healing but leaving soft tissue of any kind would be a negative. Denuding the bone as Dr. Pikos shows increases the bleeding of the recepient site allowing mesenchymal cells to emerge from the host bone allowing for better incorporation of the grafted bone.
As for placing implants simultaneously, I would avoid that as it increases the risk for a large failure of the grafted area. Better to graft and then come back 4-6 months later and place the implants when dealing with any kind of block graft autogenous, allograft or xenograft. As an additional comment, the biggest risk with these blocks is early flap dehiscence or fenestration. Always make sure to work in a thick tissue environment and gain tension free closure.
Hope this helps and welcome to the blog
Dr. Salama

mohammed shakeel - (1/3/2010 10:34 PM)

could u have placed implants at the same time??

milind saudagar - (1/3/2010 7:11 AM)

just watched the surgery. it was very good procedure. my doubt was the bone part which was fixed appeared to be completely denuded of all periosteum & blood. if some amount of tissue would have been present, will it affect healing in any manner?

Rand Ollerton - (4/26/2009 4:30 PM)

Very nice description of buccal release in such a way as to not violate the inferior alveolar nerve.

Related Videos
Autogenous Bone Graft - Part 1: Flap Management Premium Member Content

Autogenous Bone Graft - Part 1: Flap Management
Detailed treatment planning and flap management.

Presented By:: Michael A Pikos, DDS
Presentation Style: Video
Community Rating:
 
Watch Now>>
Autogenous Bone Graft - Part 2: Site Preparation Premium Member Content

Autogenous Bone Graft - Part 2: Site Preparation
Demonstration of site preparation for autogenous bone harvesting.

Presented By:: Michael A Pikos, DDS
Presentation Style: Video
Community Rating:
 
Watch Now>>
Autogenous Bone Graft - Part 4: Suturing and Tension Free Closure Premium Member Content

Autogenous Bone Graft - Part 4: Suturing and Tension Free Closure
Suturing and tension free closure in bone augmentation.

Presented By:: Michael A Pikos, DDS
Presentation Style: Video
Community Rating:
 
Watch Now>>
Autogenous Bone Graft - Part 5: Case Review Premium Member Content

Autogenous Bone Graft - Part 5: Case Review
Detailed Case Review of a ridge augmentation case utilizing autogeneous bone harvested from the ramus buccal shelf.

Presented By:: Michael A Pikos, DDS
Presentation Style: Video
Community Rating:
 
Watch Now>>
Biologic Strategies to Enhance Clinical and Aesthetic Success in Oral Implantology Premium Member Content

Biologic Strategies to Enhance Clinical and Aesthetic Success in Oral Implantology
This webinar will discuss clinical strategies for treatment of the complex implant site involving bone grafting and implant placement. Our understanding of cellular pathways, and our ability to control the wound response, expands our capacity to effect better aesthetic outcomes and compress treatment time. The reduction of the inflammatory phase of tissue regeneration speeds up osseointegration, prevents crestal bone loss, maintains papillary form, increases the density of peri-implant bone and increases tissue biotype. This enhanced tissue response allows us to predictably treat even the most complex surgical cases, compress time to final reconstruction, and to maintain these favorable tissue outcomes over an extended period of time. The use of dental implants with advanced biologic features and the incorporation autologous growth factors will be demonstrated.

Presented By:: Robert J. Miller, DDS, FACD, DABOI
Presentation Style: Video
Community Rating:
 
Watch Now>>
Managing 3D Shape and Space in Bone Augmentation: Putty Assisted Regeneration. Premium Member Content

Managing 3D Shape and Space in Bone Augmentation: Putty Assisted Regeneration.
This presentation will demonstrate the utilization of Novabone in several different applications to include ridge preservation and sinus grafting and immediate implant placement.

Presented By:: Richard Martin, DDS
Presentation Style: Lecture
Community Rating:
 
Watch Now>>
Severe Atrophic Anterior Maxilla: Advantages of Combined Therapy - Part 1 of 2 Premium Member Content

Severe Atrophic Anterior Maxilla: Advantages of Combined Therapy - Part 1 of 2
Anterior maxillary alveolar bone deficiency, can prevent implant placement for fixed rehabilitation and jeopardize the esthetic outcome. Clinical case of severe atrophy of anterior maxilla, due to loss of implants, is described: A combination of sub-nasal procedure and intra-oral autologous onlay bone graft were used for ridge augmentation and dental implant placement in steps procedure, combined with Bio-Oss saturated in Platelets Rich Plasma (PRP) and covered with platelets-poor-plasma (PPP) as a "biological membrane".

Presented By:: Devorah Schwartz-Arad, DMD, PhD
Presentation Style: Video
Community Rating:
 
Watch Now>>
Related Courses
Current Concepts in Bioactivity and Regeneration Premium Member Content

Current Concepts in Bioactivity and Regeneration
In this lecture, tips on how to deal with the different types of extraction socket, mostly infected, will be presented. The use of plasma rich in growth factors and the Endoret® (PRGF®) fibrin membrane is a key factor to enhance socket regeneration, post-operative recovery and minimize/treat complications.

Presented By:: Eduardo Anitua, MD, DDS, PhD
Presentation Style: Online Self-Study Course
CE Hours: 1 CEU (Continuing Education Unit)
Watch Now>>
Achieving Stable Esthetic Results with Implant Supported Restorations Premium Member Content

Achieving Stable Esthetic Results with Implant Supported Restorations
We will discuss basic concept regarding immediate implant placement and guided bone regeneration procedure related to the esthetic zone before focusing on the soft tissue management. We will describe the prosthetic procedures which are performed before, during and after the surgical procedures. Provisional restorations, impression techniques, prosthetic profiles and restorative materials will be presented. The purpose of the presentation is to provide a check list that will guide the clinician developing a proper analysis and diagnosis for the successful esthetic result with implant supported restoration.

Presented By:: Gianluca Paniz, DDS, MS, FACP;Luca Gobbato, DDS, MS
Presentation Style: Online Self-Study Course
CE Hours: 1 CEU (Continuing Education Unit)
Watch Now>>
Challenges & Management of Peri-Implant Pink Esthetics in Anterior Implant Therapy Premium Member Content

Challenges & Management of Peri-Implant Pink Esthetics in Anterior Implant Therapy
When considering implant therapy in the esthetic zone, replicating the natural soft tissue frame may present challenges for the treating clinician. A harmonious gingival form and architecture are not only fundamental for achieving adequate peri-implant pink esthetics, but also for simulating a natural emergence for the future restoration. This presentation will highlight different clinical scenarios in which the lack of hard and soft tissue volume may pose difficulties in achieving ideal peri-implant esthetics, in addition to available clinical strategies on how to manage and minimize hard and soft tissue deficiencies when dealing with implant therapy in the esthetic zone.

Presented By:: Sherif Yousri Said, BDS
Presentation Style: Online Self-Study Course
CE Hours: 1 CEU (Continuing Education Unit)
Watch Now>>
Related Articles
The safety of bone allografts used in dentistry

The safety of bone allografts used in dentistry
Recent media reports concerning “stolen body parts” have shaken the public’s trust in the safety of and the use of ethical practices involving human allografts. The authors provide a comprehensive review of the safety aspects of human bone allografts.

Author(s): Dan Holtzclaw, DDS, MS;Nicholas Toscano, DDS, MS;Lisa Eisenlohr, PhD; Don Callan, DDS
View Article>>
Peridontal Osseous Surgery and Root Resective Therapy

Peridontal Osseous Surgery and Root Resective Therapy
Historically, osseous surgery was performed to eliminate infected bone. Early in the 20th century clinicians realized that periodontally affected bone was not actually infected. Instead of an invasive bacterial infection, chronic inflammation was responsible for bone destruction. This finding changed the rationale for periodontal therapy and led to modern concepts of osseous surgery. Currently accepted approaches are based on guidelines, parameters, and definitions published by many highly respected…

Author(s): Lee H. Silverstein, DDS, MS, FACD, FICD;David Kurtzman, Sidney H. Stein, Marc E. Moskowitz, Jerry J. Garnick
View Article>>
Screw "Tent-Pole" Grafting Technique for Reconstruction of Large Vertical Alveolar Ridge Defects Using Human Mineralized Allograft for Implant Site Preparation

Screw "Tent-Pole" Grafting Technique for Reconstruction of Large Vertical Alveolar Ridge Defects Using Human Mineralized Allograft for Implant Site Preparation
The purpose of this study was to evaluate the effectiveness of using titanium screws in combination with particulate human mineralized allograft, in a “tenting” fashion, to augment large vertical alveolar ridge defects for implant placement.

Author(s): Bach Le, DDS, MD, FICD;Michael D. Rohrer, DDS, MS; Hari S. Prassad, BS, MDT
View Article>>
Contact Us | Privacy Policy | Terms of Use
©2019

Preferred Language: English Flag
Contact Us · Login ·