Howard Gluckman - (11/20/2012 3:36 PM)

@ Jeremy. I dont understand as the osteotomy is done before the bone block is placed. THe block is only placed when the implant is in position. So I dont understand the question about better osseointegration. You are correct about the placement of bone from the bone collector as well as the xenograft in a sandwhich technique over the autogenous block. I have changed a little these days in that I only use autogenous bone and I dont use membranes at all any more I dont find it necessary and I get better flap closure this way. I dont understand the 3rd question can you eplain this one to me as well. With regards to question 4 I always try and use a provisional partial acrylic denture as I can easily control the pressure on the bone and the flap. One can easily remove it and check that the flap has closed well. thanks for the question

Howard Gluckman - (11/20/2012 3:26 PM)

@Faez. THanks for the kind words. THis is not ideal for immediate placement as one would like to have the soft tissue close first. I usually wait 8 weeks which gives good soft tissue closure but very little bone remodelling. With regards to implant insertion torque you can definitely do as you say but I dont find it necessary unless the torque goes way too high. In this case one does not need the primary stanility as one is not going to immediate load or do single stage surgery it will get a cover screw and primary closure will take place. I hope this answers your question

Howard Gluckman - (11/20/2012 3:21 PM)

@Farhan. Primary closure is essential for any successful bone augmentation. Flap management is taken care of at the begining when the flap is raised. One will do a periosteal release of the flap immediately so that any bleeding will subside before you do flap closure. THis will reduce the haematoma formation. Making sure you have enough pereosteal release so that there is no flap tension. I hope this answers your question and thank you for the compliment

jeremy amzalag - (9/16/2012 6:50 AM)

Hi Dr Gluckman, very nice case! I have got a few questions: 1. Why do not you do osteotomy before placing the block grafts? Do not you think the blocks would be better osseointegrated? 2. Are you using a mix of autogenous particle bone taken from the bone collector plus a xenograft particle bone after you place the block grafts? 3. Once you will reenter would not be easier to leave bone-free the top of the implant screws? 4. How are you going to temporize it?

faez amirabadi - (8/15/2012 6:34 AM)

superb Dr Gluckman, was this case indicated for immediat case ? . while placing the implant you went over 50 and then uscrewed the implat to avoid pressure necrosis, is it not risking the primary stability ,is it not better to increase the osteotomy a bit then place the implant.

FARHAN DURRANI492 - (7/27/2012 2:46 PM)

excellent augmentation how do you get good closure

Howard Gluckman - (6/8/2012 6:37 AM)

@ Muhammad The scores we use come from Helmut Zepf they are a german company. If you can get 1mm screw they are even better as the ones I use are 1,2mm. We place the bone over the top in this case as they are ankles implants which allow stability of the buccal bone due to the cone connection. If you are using an implant that is not platformed switched or one that has no cone connection like and internal or external hex then there is no point as the bone will resorb.

Howard Gluckman - (6/8/2012 6:34 AM)

Hi Rob. these type of incisions are typically called papillae saving incisions and have been used for years in perio surgery. they do not lead to loss of the papillae at all as long as you do not cut into the papillae themselves as this may lead to collapse of the papillae from cutting of the periodontal fibres that support the papillae

Muhammad Saleh - (6/7/2012 9:49 AM)

A really great video step by step, but i have 2 questions that i hope you answer them. 1-What type of fixation screws are you using. 2-What is the significance of placing bone graft right on the top of the implant.