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Video Details
Reconstruction of Large Post-Extraction Defects within the Esthetic Zone

Description:
In this lecture, Dr. Miguel Stanley discusses the reconstruction of large post-extraction defects within the esthetic zone involving both bone and soft tissue deficiencies. The presentation includes a new surgical approach utilizing solid cortical autogenous grafts to plug, augment and stabilize extraction sites in conjunction with a soft tissue graft to create a socket seal. In addition, considerations for thin biotypes are also provided.

Date Added:
2/22/2010

Author(s):

Miguel Stanley, DDS Miguel Stanley, DDS
Dr Miguel Stanley, graduated as a DDS in 1998. He is trained in implant surgery and cosmetic dentistry. For the last eight years he dedicates most of this tim...
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Online Videos / Surgery / Soft Tissue / Reconstruction of Large Post-Extraction Defects within the Esthetic Zone




Questions & Comments
dentimp huang - (12/24/2010 1:13 PM)

Dr.Stanley :Excellent Work ! You mentioned the bone core is at least 2.5 mm in depth , why 2.5 mm ? how do you pick the depth for each case ? I mean is there any differences in deciding the core depth ? THank you ! Dr. Huang TAIWAN

miguel stanley - (2/25/2010 12:19 AM)

The Cortical block,is round in shape. the alveolar socket is not. It's more triangular, if you will. the graft is slightly wider than the socket, and so it is wedged into place. like a cork. there is no movement at all. great comment at is the single most important thing to achieve success with this technique.

hugo leitao - (2/23/2010 5:37 PM)

Once again I would like to thank you for your answer. A proof that this is a very interesting topic is the number of questions/comments you're having. In what concers to my second question, I feel it was somehow incomplete. When I mentioned the vascularization it was not only the phenomenom of vascularization itslef that I wanted to ask. I was also concerned with the block fixation and the way that it gets vascularized. The basic keys of success for bone regeneration are space maintenance and graft stability. It has been stated that micromovement has much has 20 microns could jeopardize the success of grafting, resulting sometimes in fibrous tissue Encapsulation. A good idea for your next lectures could probably be, getting some trephine cores and submit it for histomorphometric analysis. Best regards

miguel stanley - (2/22/2010 11:46 PM)

Dear Hugo and vijailakshmi , thanks for your kind comments. i hope to be able to keep a constant flow of cases here on Dental XP in the future. As for the vascularization of the cortical graft. Remember that it is at least 2,5 mm thick, and although there is a cortical surface , underneath there is the more porous cancellous bone. As the normal socket preservation techniques regenerate, the normal vascularization also "works" on the graft. I have yet to experience no integration of this grafting technique, this also goes for the tissue graft. As for the young age of the patient. I would have to agree with Dr. Garber and Dr. Salama, it's always best to study the Biologic Maturity. The patient in question was quite developed in this sense. However i Look forward to a 2-3-6 year follow up.

David Garber - (2/20/2010 10:53 AM)

Dear Hugo i saw your comments and would agree - it is a great presentation by Dr Stanley - - in response to your third question I think like you Dr Stanley would agree that it appears best to wait until the young implant patient reaches BIOLOGIC maturity and stops growth - as opposed to purely age evaluation - - Dr Salama likes to look at hand /wrist radiograph &/or sequential cephalometric images

hugo leitao - (2/16/2010 8:24 PM)

First of all I would like to congratulate dr. Stanley for his brilliant presentation. I have some questions that I'd like to adress: 1)In your oppinion where does the vascularization for this cortical bone graft comes from? 2) As far as socket seal procedures the literature reports failures around 40%, mainly because of lack of vascularization. Have you experienced the same? 3)According to your 3rd case , how prudent do you consider to place implants in 16 years old patients? Literature has shown consistently that vertical growth cessation varies from person to person and is seldom related to a specific age. Thank you very much

vijailakshmi acharya - (2/13/2010 11:07 PM)

Thank you Dr.Stanley for great idea of esthetic buccal flap .It makes all the difference .One question --is it ok to do this procedure as early as 16 yrs of age?

VITALII OMELIANCIC - (2/13/2010 3:49 PM)

Thank you! It was very good and helpful presentation!
Vitalii

miguel stanley - (2/10/2010 8:36 AM)

Hi guys, thanks for the feed back. it appears that the thin biotype is an issue regarding the EBF(esthetic buccal flap). You can see Dr. Steigmann's work on this he brilliantly presents many cases. In my opinion, i use creative thinking when i suture, always a 5-0 plypropelyne suture and always include periosteum in suture for better "grip".
Its imperative to have no tension in these cases.

i never use surgical cement!

I have done a few cases with a collagen plug and results are interesting, however i do lose a bit of height. it all depends on the biotype i guess. I mean is some cases doing nothing we get great results, but its predictability we are after here.

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