Video Details
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Simultaneously Autologous Bone Grafting, Sinus Augmentation Procedure, Implant Placement & Immediate Provisionalization
Description:
A unique presentation of a combined surgical techniques and implants provisionalization, simultaneously performed, in the anterior maxilla. With the aid of computerized assisted guides, a surgical template and a temporary bridge for immediate temporization was prepared.
Under general anesthesia, combination of few surgical techniques and implants provisionalization were simultaneously used for rehabilitation of the right and anterior edentulous maxilla:
1. A pre-prepared computerized surgical template was used to place implants in the desired locations
2. Sinus augmentation procedure for vertical augmentation
3. Block grafts harvested from the mandibular ramus were performed for horizontal augmentation at the anterior maxilla
4. Platelets Rich Plasma and Platelets Poor Plasma were placed in the augmented areas
5. A pre-prepared computerized temporary bridge was adjusted.
Date Added:
4/2/2014
Author(s):
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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Online Videos / Surgery / Periodontic Surgery / Simultaneously Autologous Bone Grafting, Sinus Augmentation Procedure, Implant Placement & Immediate Provisionalization
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Questions & Comments
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filipe lopes - (4/14/2014 7:06 PM)
Thank you Devorah for the nice & fast paced presentation. Dear Laurent there is no scientific backgound on cortical perforation. Dear Devorah if you're using plat switch implants the distance between them can be as little as 1.5mm depending on the implant and abuttment characteristics. Thx for sharing. Filipe.
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Devorah Schwartz-Arad - (4/12/2014 12:26 PM)
Dear Paul,
The recommended number of implants in the posterior maxilla, were the quality/density of bone is compromised, especially when sinus augmentation procedure is needed (the available bone height and density are problematic) is: an implant per tooth. That was the ratio for placing 4 implants replacing 2 premolars and 2 molars. Nevertheless, one should keep at least 3mm M-D space between neighboring implants. In the anterior area, the spaces between implants at the right maxillary canine and central incisor, enable better esthetic results.
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Paul Boulos - (4/11/2014 6:17 AM)
great presentation, what is the rational of placing 4 implants in the right maxilla. why not two or three. what is the deciding factor.
thank you
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Devorah Schwartz-Arad - (4/8/2014 10:42 AM)
Please stay tuned to my forthcoming videos on "How to perform autologous Onlay Bone Graft in 10 stages".
Hereby the answers for your questions:
1. The procedure of onlay bone grafting, with autologous bone block, includes a stage of decortication/perforation at the recipient site with round surgical burr for better graft incorporation and adaptation. Nevertheless, in a compromised bone at the maxilla, when the cortical bone is thin and spongy, this stage can be excluded.
2. The donor site defect is filed with bone substitute (bovine) optionally mixed with PRP or BMA (bone marrow aspirate concentrate) covered with either with resorbable membrane or PPP (Platelets poor plasma)
3. Reverse engineering is a technology which transforms completely virtual design processes into customized prostheses. Reverse engineering implies designing the desired final outcome (the temporary bridge that resembles the final restoration), via CAD CAM technology, and then accordingly, designing number/location of implants and the surgical template and then, the required supporting surgery (bone grafting), needed to back up a long term and predictable treatment.
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laurent oiknine - (4/7/2014 1:23 PM)
A few questions;
1. I see no cortical perforations in the premaxilla prior to bone blocks. When do you feel that they are needed?
2. How do you manage the donor site in the ramus before closure? Autologus membranes alone?
3. What do you mean by reverse engineering?
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Maurice Salama - (4/6/2014 8:53 AM)
Remarkable technical skill and biologic rationale from one of the very best in the field of regenerative dentistry. Do not miss this short clinical video. Dr. Salama
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