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Video Details
Severe Atrophic Anterior Maxilla: Advantages of Combined Therapy - Part 1 of 2

Description:
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". The combination of few augmentation procedures, enables better correction of the alveolar ridge in 3D (height, width and trajectory), which results in a better prosthetic and esthetics outcomes. Techniques that are described in this presentation should be considered a reliable, safe and very effective to obtain high bone graft survival rate following high long-term implants' survival rate. Moreover, we believe that PRP as an autologous source of growth factors, mixed with osteoconductive bone substitute (Bio-Oss) and covered with PPP as a biological membrane may offer a novel therapy with greater efficacy than any other combination or single therapies that were used in bone regeneration up to now.

Date Added:
9/18/2015

Author(s):

Devorah Schwartz-Arad, DMD, PhD Devorah Schwartz-Arad, DMD, PhD

Devorah Schwartz-Arad, DMD, PhD

A specialist in Oral and Maxillofacial Surgery (OMS), Ph.D. degree in cancer research, anatomy and embryology...
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Questions & Comments
Ahmed Boshra - (12/27/2015 4:26 PM)

great work

William Escobar - (12/24/2015 6:10 AM)

Dear Devorah, I really enjoyed your webinar and I have had a look to it , as I have a similar clinical case as the first one you describe on your presentation. I have a little question related to the implants this lady did have, as far as I see on your CT, the three implants supporting the provisional prosthesis had a bone lost of around 4 mm, is that right??? my question is if after doing the bone grafting , you did remove them or on the other hand you preserved them and you could be able to gain bone on their surface to be sure enough they were going to last in the time. Another little question, sorry to disturb you but I find your surgical skills just excellent, is how do you manage yourself to gain that kind of curvature on the bone block that stays in top of the maxillary bone ridge. Thank you very much once again, hope you have a very good Christmas, all the best, William

William Escobar - (9/25/2015 3:24 AM)

Thank you very much, again, it was a big pleasure, hope you present another webinar like this soon, best wishes

mohammed areekat - (9/20/2015 11:20 AM)

Wonderful case ...it was indeed a class apart procedure

Devorah Schwartz-Arad - (9/10/2015 3:53 AM)

Dear William, sorry for the delay in my reply to your question:
The only benefit of the Iliac crest as an extra-oral source of bone for bone augmentation in the deficient alveolar ridge prior to dental implantation, is the amount of bone that can be harvested. Nevertheless, the resorption is greater (some researches reports 50-75% of resorption in the first year), the morbidity is higher and also the skin scar. The Calvaria as an extra-oral source of bone, have better results-less resorption, hence, the disadvantage of morbidity and skin scar are much higher.
Harvesting bone from intra-oral source, has the advantages of less bone resorption, less morbidity and no skin scar. the main disadvantage is the amount of bone that can be harvested, it can be overcome by the presented technique: harvesting twice from the same donor site and grafting in layers (the multi-tier technique). Need one more procedure but have better results.

William Escobar - (8/8/2015 4:34 PM)

Dear Dr Schwartz-Arad,

Thank you for sharing this video, I have really enjoyed watching it and listening to you. Hope we can see more videos from you soon.
I would like to know if in these type of cases you prefer to take intraoral grafts rather than iliac ones.
Do you think with iliac grafting you could have reduce the interventions or on the other hand as it is a more porose bone you think it would have reabsorbed faster???

Thanks once again, it was a big pleasure,

William

Devorah Schwartz-Arad - (8/4/2015 2:09 AM)

The nasal membrane is more "friendly", nevertheless in case of nasal membrane rupture, one must suture the membrane preferably with 6/0 absorbable suture through the nose opening. The tip of the nose nor the septum are not affected by this procedure. It is a procedure that should be performed by skilled surgeons.

Maurice Salama - (8/3/2015 1:23 PM)

The skill and planning displayed in this presentation are simply outstanding. Regarding subnasal elevation and bone grafting, what are the possible complications? How does one respond to a tear in the mucosa here? How much does the lift in this area impact nasal tip projection or possible septal deviation? Thanks Maurice

Devorah Schwartz-Arad - (8/3/2015 8:00 AM)

The severe bone defect in the anterior Maxilla was reconstructed in 3D (vertical and horizontal) by using the anatomy (sub-nasal elevation procedure) and several surgical techniques (bone augmentation, soft tissue manipulation and implant placement) together with growth factors (PRP) and a biological membrane (PPP), in several steps. The horizontal upper lip wrinkle represents lack of upper lip support. The use of pink prosthesis can easily and very esthetically overcome missing papillae, nevertheless, the horizontal upper lip wrinkle can only be eliminated by supporting the upper lip in a much superior area, at the nasolabial area. In severe atrophy of the anterior maxilla, one has first to augment the missing parts (both hard and soft tissues) followed by accurate prosthesis that will overcome missing papillae and teeth.

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