Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
ORAL AND MAXILLOFACIAL
SURGEON’S DAY
13’TH FEB 2014
ADVANCED SURGICAL
PROCEDURES IN IMPLANT
DENTISTRY
Dr Sejal K M (Reader)
Department of Oral and Maxillofacial Surgery
M.S. ...
CONTENTS
I. Alveolar socket
preservation
II. Principles of grafting
III.Hard tissue management
IV.Soft tissue management
V...
Alveolar socket
preservation
• Use of instrument like
periotome luxator and
physics forceps to aid in
preservation of alve...
Principles of grafting
1. Host bone regeneration
capacity
2. Surgical asepsis
3. Host site preparation
4. Optimization of ...
Types of grafts

Autogenous bone grafts  osteocompetent cells

Allogenic grafts  different member of the same
species , ...
Graft volume available for harvest
SITE

GRAFT VOLUME

Maxillary tuberosity

2cm 3

Lateral ramus

1.5x3cm3

Mandibular sy...
Graft volume available for harvest
from different site
SITE

CORTICOCANCELLOUS
GRAFT VOLUME

Tibia

25-40cm3

Anterior Ili...
Tibial Bone Graft
Iliac Bone Graft
Calvarial bone graft
GRAFTING PROCEDURES
Onlay grafting
Procedure
Interpositional bone graft
Sandwich osteotomy
It is used for increasing the vertical
height in severe atrophic maxilla &
...
Sandwich Osteotomy
Alveolar ridge split osteotomy
 Used to widen thin ridges of less than 3-4
mm and used to gain 2-3mm width
 Achieved thr...
Distraction Osteogenesis
Used for severe defects that
require more than 5mm expansion
in vertical or horizontal
dimension...
Sinus lift surgery
• Lateral window technique was
first demonstrated by Tatum
using a modified Cald wel Luc
approach
• 4 linear osteotomies w...
Superior horizontal osteotomy
performed at the level of the
planned augmentation height
Superior and inferior
osteotomies ...
Adjuncts to Bone Grafts
Xenografts
Bio Oss- anorganic bovine bone.
Coralline Hydroxyapatite
Adjuncts to Bone Grafts
Synthetic Calcium Phosphate
 Tetracalcium phosphate
 Hydroxyapatite
 Octacalcium phosphate
 ßT...
Adjuncts to Bone Grafts
Platelet rich fibrin (PRF) is a fibrin
matrix in which platelet
cytokines, growth factors, and
cel...
Choukroun and his associates were
amongst the pioneers for using PRF
protocol in oral and maxillofacial
surgery to improve...
Advantage of PRF over
PRP
1. No biochemical handling of blood.
2. Simplified and cost-effective
process.
3. Use of bovine ...
Bone Substitutes
Allografts
Demineralised freeze
dried bone with
hydroxyapetite.(
DFDBA )
Freeze dried bone
allografts (...
BARRIER MEMBRANE

Rigid (fixed with screws)
Nonrigid (secured
underneath the flap)

Resorbable
Non-resorbable
Recommended options for
defect reconstruction
Horizontal segmental defects
 Onlay bone graft with rigid
membrane
 Onlay ...
Vertical segmental defects
Onlay block graft with
membrane
Onlay particulate graft with
rigid membrane
Sandwich osteoto...
SOFT TISSUE COVERAGE
Preservation of adequate soft
tissue coverage is a very
important factor in the success
of bone grafts
Dehiscence of the m...
Scoring of the periosteum
Palatal Connective
tissue graft
Soft tissue Grafting prior
to Bone grafting
The acellular dermal matrix
(ADM) allograft seems to be a
good
substitute
for
...
Soft tissue coverage
Intra-oral soft tissue coverage can
be achieved with the help of
barrier membrane and PRF as
biomembr...
Tissue Expanders for oral
soft tissue
Post operative care
Antibiotics such as amoxycillin
or clindamycin for 7 to 10days.
Chlorhexidine mouth rinse for
first ...
Strict non chew diet for 6 to 8
weeks is recommended to
minimise the risk of fracture.
Autogenous block grafts should
he...
Complications of grafting
procedures
1. Perforation of the Schneiderian
membrane
2. Soft tissue dehiscence
3. Infection
4....
Acknowledgement
All Staffs and Post graduate students of
Department of Oral And maxillofacial
Surgery; MSRDC
Department of...
Thank you
Advanced Bone grafting procedures  in dental implant surgery
Advanced Bone grafting procedures  in dental implant surgery
Advanced Bone grafting procedures  in dental implant surgery
Advanced Bone grafting procedures  in dental implant surgery
Advanced Bone grafting procedures  in dental implant surgery
Upcoming SlideShare
Loading in …5
×

Advanced Bone grafting procedures in dental implant surgery

6,724 views

Published on

Published in: Health & Medicine

Advanced Bone grafting procedures in dental implant surgery

  1. 1. ORAL AND MAXILLOFACIAL SURGEON’S DAY 13’TH FEB 2014
  2. 2. ADVANCED SURGICAL PROCEDURES IN IMPLANT DENTISTRY Dr Sejal K M (Reader) Department of Oral and Maxillofacial Surgery M.S. Ramaiah Dental College and Hospital Bangalore
  3. 3. CONTENTS I. Alveolar socket preservation II. Principles of grafting III.Hard tissue management IV.Soft tissue management V. Post operative care VI.Complications
  4. 4. Alveolar socket preservation • Use of instrument like periotome luxator and physics forceps to aid in preservation of alveolar bone • Use of inward fragmentation and apical transalveolar extraction techniques • Avoid compression of extraction sockets
  5. 5. Principles of grafting 1. Host bone regeneration capacity 2. Surgical asepsis 3. Host site preparation 4. Optimization of growth factor 5. Graft immobilization 6. Soft tissue coverage
  6. 6. Types of grafts Autogenous bone grafts  osteocompetent cells Allogenic grafts  different member of the same species , femur head (donors from tissue bank) Xenogenic bone  genetically dissimilar species (osteoconductive) scafold for creeping substitution
  7. 7. Graft volume available for harvest SITE GRAFT VOLUME Maxillary tuberosity 2cm 3 Lateral ramus 1.5x3cm3 Mandibular symphysis 10x30mm2 Coronoid process 1.8x1.7x0.5 cm block Zygomatic buttress 1.5x2 cm block
  8. 8. Graft volume available for harvest from different site SITE CORTICOCANCELLOUS GRAFT VOLUME Tibia 25-40cm3 Anterior Ilium 50cm3 Posterior Ilium 100-125cm3 Calvarium Minimal
  9. 9. Tibial Bone Graft
  10. 10. Iliac Bone Graft
  11. 11. Calvarial bone graft
  12. 12. GRAFTING PROCEDURES
  13. 13. Onlay grafting Procedure
  14. 14. Interpositional bone graft Sandwich osteotomy It is used for increasing the vertical height in severe atrophic maxilla & mandible Advantage of this technique include minimal bone resorption & stability as compared to onlay bone grafting Minimal soft tissue exposure to make a horizontal & 2 divergent
  15. 15. Sandwich Osteotomy
  16. 16. Alveolar ridge split osteotomy  Used to widen thin ridges of less than 3-4 mm and used to gain 2-3mm width  Achieved through a crestal incision with minimal reflection  Ridge is split with small osteotomies used in increasing size to force the direction of the initial osteotomised segments  Wound closed primarily
  17. 17. Distraction Osteogenesis Used for severe defects that require more than 5mm expansion in vertical or horizontal dimensions Osteotomy with minimal periosteal stripping Latency period – 3 to 7 days Distraction rate of 1mm/day Consolidation - 6 to 12weeks
  18. 18. Sinus lift surgery
  19. 19. • Lateral window technique was first demonstrated by Tatum using a modified Cald wel Luc approach • 4 linear osteotomies with a round bur • First inferior horizontal osteotomy as close to the floor of the sinus • Brushing stroke so as to not tear the schneiderian membrane
  20. 20. Superior horizontal osteotomy performed at the level of the planned augmentation height Superior and inferior osteotomies connected anteriorly and posteriorly with vertical osteotomies
  21. 21. Adjuncts to Bone Grafts Xenografts Bio Oss- anorganic bovine bone. Coralline Hydroxyapatite
  22. 22. Adjuncts to Bone Grafts Synthetic Calcium Phosphate  Tetracalcium phosphate  Hydroxyapatite  Octacalcium phosphate  ßTricacium phosphate  Dicalcium phosphate To be placed in gaps between the block graft or in the jumping distance.
  23. 23. Adjuncts to Bone Grafts Platelet rich fibrin (PRF) is a fibrin matrix in which platelet cytokines, growth factors, and cells and can serve as a resorbable membrane. rh BMP and rh BMP available as powder mixed with sterile water and carried to the recipient site 2 7
  24. 24. Choukroun and his associates were amongst the pioneers for using PRF protocol in oral and maxillofacial surgery to improve bone healing in implant dentistry. Autologous PRF is considered to be a healing biomaterial.
  25. 25. Advantage of PRF over PRP 1. No biochemical handling of blood. 2. Simplified and cost-effective process. 3. Use of bovine thrombin and anticoagulants not required. 4. Favorable healing due to slow polymerization. 5. More efficient cell migration and proliferation. 6. PRF has supportive effect on immune system.
  26. 26. Bone Substitutes Allografts Demineralised freeze dried bone with hydroxyapetite.( DFDBA ) Freeze dried bone allografts (FDBA) It is preferred when large particulate graft is required and patient is not willing
  27. 27. BARRIER MEMBRANE Rigid (fixed with screws) Nonrigid (secured underneath the flap) Resorbable Non-resorbable
  28. 28. Recommended options for defect reconstruction Horizontal segmental defects  Onlay bone graft with rigid membrane  Onlay particulate graft with membrane  Sandwich osteotomy Horizontal deficiency of the entire arch  Onlay block graft with membrane  Onlay particulate graft with rigid membrane  Onlay particulate mineralized graft
  29. 29. Vertical segmental defects Onlay block graft with membrane Onlay particulate graft with rigid membrane Sandwich osteotomy Sandwich osteotomy and rigid stabilization Vertical deficiency of the entire arch Onlay block graft with
  30. 30. SOFT TISSUE COVERAGE
  31. 31. Preservation of adequate soft tissue coverage is a very important factor in the success of bone grafts Dehiscence of the mucosa and early exposure of the grafted bone are the most common etiological factors that may lead to graft failure. One of the possible etiological factors is the presence of thin soft tissue coverage around the block.
  32. 32. Scoring of the periosteum
  33. 33. Palatal Connective tissue graft
  34. 34. Soft tissue Grafting prior to Bone grafting The acellular dermal matrix (ADM) allograft seems to be a good substitute for the connective tissue graft (CTG), having been used successfully for soft tissue augmentation. Saudi Med J 2013; Vol. 34 (6): 609-615
  35. 35. Soft tissue coverage Intra-oral soft tissue coverage can be achieved with the help of barrier membrane and PRF as biomembrane. Hydrogel expansion of the periosteum is an applicable method to achieve a surplus of soft tissue to cover bone grafts.
  36. 36. Tissue Expanders for oral soft tissue
  37. 37. Post operative care Antibiotics such as amoxycillin or clindamycin for 7 to 10days. Chlorhexidine mouth rinse for first 2 to 4 weeks. To avoid pressure on the wound, in patients where hardware has been placed. Use of nasal decongestants following sinus lift procedure.
  38. 38. Strict non chew diet for 6 to 8 weeks is recommended to minimise the risk of fracture. Autogenous block grafts should heal for approximately 4 months before placement of implant.
  39. 39. Complications of grafting procedures 1. Perforation of the Schneiderian membrane 2. Soft tissue dehiscence 3. Infection 4. Exposure of GBR membrane 5. Mobilisation of the graft 6. Graft resorption 7. Cyst formation 8. Transmission of diseases like
  40. 40. Acknowledgement All Staffs and Post graduate students of Department of Oral And maxillofacial Surgery; MSRDC Department of Prosthodontics; MSRDC Department of Periodontics; MSRDC
  41. 41. Thank you

×