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| 2012/8/2 15:31:15 | Majid Rahmani | | horizontal bone graft and 2 open sinus graft | | Dear Drs Firoozeh and Misch
Thank you so much
I enjoyed and learned a lot | | Register For Free To Reply |
| 2012/8/1 8:52:18 | Alireza Firouzeh | | horizontal bone graft and 2 open sinus graft | | Certainly I didnot recommend my patient to wear his denture for at least 40 days to stabilize my graft.I decide to wait 6 months for graft consolidation and then I will place 8 implants throughout the upper jaw to have a fixed implant supported prosthesis. | | Register For Free To Reply |
| 2012/7/16 18:12:32 | Shane Claiborne | | horizontal bone graft and 2 open sinus graft | | Did this patient wear a denture during healing phase? If not how long did you ask them to go without a denture? What is the long-term prosthetic design? 6,8 or 10 implant fixed or removable? | | Register For Free To Reply |
| 2012/7/28 14:32:36 | tural ismayilov | | horizontal bone graft and 2 open sinus graft | | i think it will be great if u used bone block or from botiss bone builder..thnk u | | Register For Free To Reply |
| 2012/7/14 13:10:10 | Alireza Firouzeh | | horizontal bone graft and 2 open sinus graft | | It is my pleasure to have Dr Misch comment.Honstly speaking,I didnot mention that I am disagree with bone blocks!!! and I accept the whole points Dr misch nicely considered about bone blocks.Each techniques have their benefits and disadvantages seperately for example one of the advers post surgical symptom of a GBR tech with Titanium reinforced membrane or mesh is its risk of exposure which increases the graft contamination.In my previous case that I shared it befor,two weeks after surgury I face with membrane exposure so I clean the wound surface with cholorhexidine gel for at least 5 min and then covered the exposed area with sutures.I will post the photography that I took a few days ago.The patient hadnot wear the temporary prosthesis and the flap was compeletly tension free!!!!
My question in regarding to case is that did I perform the correct procedure about this case???Might it happen again and if occures what should I do next time?
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| 2012/7/24 3:25:40 | neamat kolahquchi | | horizontal bone graft and 2 open sinus graft | | thanks dr misch for your excellent comment. | | Register For Free To Reply |
| 2012/7/14 11:08:40 | Craig Misch | | horizontal bone graft and 2 open sinus graft | | A nicely documented case and well executed. However, please allow me to comment on your “opinions” about block bone grafts. Particulate bone grafts may revascularize faster than blocks but this difference is not critical in graft incorporation. Block grafts revascularize along the existing haversian channels within the bone graft. There is some evidence that membranous bone grafts (ie. intraoral) actually revascularize faster than endochondral grafts (ie. ilium). Block grafts may be cortical or corticocancellous – both work well and it would be difficult to argue one type is clinically superior. There are numerous articles in the literature detailing the healing of cortical grafts and their successful use for ridge augmentation. The advantage of corticocancellous grafts is they can be larger (ie. ilium) to treat severe defects. They do contain more cells but not necessarily more growth factors (there is more BMP in cortical bone). Osteogenic cells are helpful with more challenging defects. Your case of a thin maxillary ridge could be well treated with cortical block bone grafts from the ramus (if cortical bone “does not have enough cells and growth factors” them why did you harvest cortical bone and add it to your grafts?). I do not know where you are getting your reference to the statement “due to lack of vascularity the bone block failure occurs regularly”. I could not disagree more with such an “opinion” as there is abundant literature/studies to support bone blocks. I think you are correct in your statement that bone blocks need surgical experience for both harvesting and placement. However, an experience surgeon can achieve equal success with blocks compared to GBR techniques. In addition, the cost of blocks is lower, the healing time is shorter (only 4 months) and the healed bone quality is usually denser. Your statement on exposed blocks requiring removal is true – but this is true of any graft. If the incision opens and a graft gets exposed any graft will have a high risk of failure. I apologize for the lengthy response but felt compelled to set the record straight on block bone grafts. In my opinion the reason many dentists do not use blocks is a lack of training/experience. | | Register For Free To Reply |
| 2012/7/13 13:36:24 | Alireza Firouzeh | | horizontal bone graft and 2 open sinus graft | | Hi dr shirani
Utilizing the bone block is another method to enhance the bone width and is a very popular procedure among the surgeons but in my opinion there are some reasons why I am not eager to do that.Firstly,I think that in particulated bone we could expect a better vasculariztion than bone block ,however ,the main point about the block is that it should be corticocancelous form .Corticocancelous bone contains cells and growth factors which is mandatory for bone regeneration whereas the cortical bone has not enough.Secondly the size of block,handling and shaving and also fixating the block needs more experience and time consuming.Finally, in some area like posterior of mandible due to lack of vascularity the bone block failure occurs regularly and exposed blocks have to remove. | | Register For Free To Reply |
| 2012/7/13 7:55:30 | amir shirani | | horizontal bone graft and 2 open sinus graft | | Hello my dear doctor. Case presented was very good. Why you did not use the block graft from external oblique Ridge? remove a larger piece was not possible?thank you | | Register For Free To Reply |
| 2012/7/13 6:52:31 | neamat kolahquchi | | horizontal bone graft and 2 open sinus graft | | nice treatment."pass"principles for bone regeneration ,that is means:1-p=primary wound closure.2-angiogenesis.3space maintenance.4-stability of the wound. | | Register For Free To Reply |
| 2012/7/13 4:57:44 | Alireza Firouzeh | | horizontal bone graft and 2 open sinus graft | | Hi
As you know there are 3 important keys to have a high success in bone regeneration ;vessel growth/cells and growth factors.But now the growth factors such as BMP2 are very expensive in the market and many patients could not afford the costs so it is not a routine procedure in our daily surguries.Certainly I believe that applying growth factors during surgury could accerelate healing and enhance the bone maturation.
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| 2012/7/12 13:58:06 | Maurice Salama | | horizontal bone graft and 2 open sinus graft | | Very nice technique for space maintenance for GBR.
Would you consider bioactive modifiers to promote bone in growth? BMP-2, PRGF, Gem-21 etc.etc.
Dr. Salama | | Register For Free To Reply |
| 2012/7/12 10:12:54 | Alireza Firouzeh | | horizontal bone graft and 2 open sinus graft | | Hi
This is a complicated case with severe horizontally bone loss in anterior zone of maxilla and sinus pnematization in both sides which determines to use open sinus graft in posterior areas.I did the bone surfaces decorticated and placed 4 scerw perpendicular to buccal plate.I harvested the autogenous bone from external oblique ridge in an Audi design with trefine and crushed it into paticulated form and mixed with xenograft 50/50.After applying it around the screw the graft was covered with a titanium reinforced membrane and fixed.Simultaneously,I performed two open sinus lift in both sides and grafted them with xenograft and then covered the windows with collagen membranes.
It would be grateful to know your comments about the case.
best wishes
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