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Video Details
Autogenous Bone Graft - Part 4: Suturing and Tension Free Closure

Description:
In part 4 of this video instructional series of a cortical autogenous graft harvested from the ramus buccal shelf, Dr. Michael Pikos demonstrates the surgical techniques for suturing and tension free closure which are absolutely required for successful osseous augmentation procedures.

Date Added:
4/21/2009

Author(s):
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Online Videos / Surgery / Bone Grafting / Autogenous Bone Graft - Part 4: Suturing and Tension Free Closure




Questions & Comments
edward shapiro - (8/26/2014 11:21 PM)

dr. pikos. very nice closure. do you prefer blunt dissection for release of flap in this area? what is the success rate of vertical growth and how much height was regenerated? thanks for the video.

yazad gandhi - (2/5/2010 9:34 PM)

Thanks Maurice,

Have taken a biopsy specimen lets see. Will keep you posted.
As regards the sterility breakdown that should not be the cause as it was done in the OT under strict asepsis.

Yazad Gandhi

Maurice Salama - (2/4/2010 6:25 AM)

Dr. Gandhi;
A very rare case failure. Very difficult to assess the reason. Did you take a culture or biopsy of the fibrous tissues and black bone? It would be needed to see what type of bacteria was present. Did the patient have a significant medical history or did the patient have any post surgerical illness? Without this information it would be a guess as to why this may have occured. Without flap breakdown or significant medical issues, I see no reason for the failure other than sterility breakdown. The resorption of the bone, especially the Bio-Oss is almost impossible at 4 1/2 months? Do a oral gingival culture and a blood test on this individual and have an ENT to evaluate the health of their Sinus before performing any other surgical procedures.

Dr. Salama

yazad gandhi - (2/4/2010 5:39 AM)

Dr.Pikos and Dr.Maurice,

Would like to know the reason for the failure of a case.
Did a Corticocancellous block graft fixation in the maxilla (iliac bone) in a case of Ectodermal Dysplasia. B/L sinus grafts were done using Autogenous & BIOSS 50:50 with biomend extend membrane. No perforations were there in the membrane which was tough n fibrous.
4 n 1/2 mths later the maxilla displayed fibrosis and upon reentry the graft had almost totally disappeared n left behind soft black bone as appears in aseptic necrosis. Almost all of the sinus graft has resorbed whichn has never happened with me till date and the membranes B/L are thinned out and perforated. All this despite there being no infective foci around.
Please comment on the possible causes.
Thanx

Maurice Salama - (8/11/2009 11:47 AM)

Leonardo;
Difficult situation. If there is exudate the block is probably not going to do well and should be removed, irrigated and sutured before coming back to regraft at a later date. Would prefer grafting soft tissue prior to 2nd surgery to make sure you have good quality tissue to cover the bone graft. If the block was secure with no exudate, I prefer to grind the exposed bone down until I see a bleeding surface and see if we get epithelialization over the top. Normally, we lose the exposed portion at the least.
Good luck
Dr. Salama

Leonardo Diaz - (8/10/2009 7:37 PM)

would like to know what colud I do with a patient with a deshicence in anterior maxilla after bone grafting.

I sutured tension free with dermis membrane alloderm the right site bone block is ok, but the left site is open with a little exudate after 15 days Post-op.

I take off partially the alloderm because a half was loose and the oter half fixed and sensitive pain.

i need to take a defenitive treatment, so could i do the flap again and a new alloderm leaving the bone block or taking this out.

Sean Peng - (4/30/2009 1:04 AM)

Nice and smooth surgery.
I’m looking forward to see some videos about complication management during surgery, such as soft tissue bleeding, intra bony bleeding and sinus membrane perforation. I know it’s hard to collect that kind of video, but it makes Dentalxp different from other similar website. I think we should be able to manage complications comfortably before becoming a good surgeon.

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