Oral Surgery & Maxillofacial Surgery Specialty Catalog - September 2013 - (Page 32)

BONE GRAFTING BONE GRAFTING Bone Grafting Essentials—An Oral Surgeon’s Perspective by Doron Kalman, DDS Doron Kalman, DDS Bone grafting has become a highly predictable procedure, resulting in a significant increase in the number of procedures performed. These procedures have become more prevalent and predictable due to the availability of a wide variety of reliable bone grafting materials. My practice is no exception and we now routinely perform bone grafting procedures for our patients. The selection of bone graft material depends on the type of procedure and the clinical situation. For instance, for ridge augmentation cases where only the width of the ridge requires augmentation, or where there is a concavity or an aesthetic defect, particulate bone graft material provides for good bone regeneration. In these situations, the results are consistently favorable with particulate material; sufficient soft tissue expansion can be obtained for the grafting procedure and the particulate material can be easily contained. Releasing the periosteum and placing a particulate allograft (such as alloOss), or a particulate allograftxenograft combination (such as alloOss/NuOss), and then using primary tension-free closure, results in good clinical outcomes. I have found that a ratio of 2 parts allograft to one part xenograft, or three parts allograft to one part xenograft, provides for a suitable mix of particulate bone graft and allows for the small particle xenograft material to function as a scaffold and prevent soft tissue from reinvading the area during bone regeneration. To overcome potential challenges in delivering particulate bone graft materials to the site, the particulate should be mixed with saline or sterile water to improve its handling characteristics. This makes the particles clump together making it easier to load into a syringe or onto a spatula for delivery to the graft site. My preference is for smaller particles as these absorb more water or saline, causing them to expand and bulk up more. This makes them easier to handle. Allograft material starts to resorb in 6–8 weeks versus 3–4 32 To Order: months for a xenograft which, since it remains in place longer, continues to maintain space after the allograft has resorbed and helps to enable full bone regeneration to take place in around four months. A Cone beam scan is then taken to ensure there is sufficient bone present for the implant site. Particle before and after mixing with saline/sterile water. In cases where augmentation of both the height and width of the ridge is required, space maintenance and bone regeneration are more complex and it is difficult to contain particulate material and to get enough soft tissue expansion. Therefore, for these cases, a block graft provides for the most predictable space maintenance and treatment outcome. An autograft harvested from the ramus and stabilized with cortical fixation screws is a suitable option in this situation. Block grafts resorb more slowly than other bone graft materials, which results in superior space maintenance while bone regenerates. In addition, packing particulate allograft material around the block autograft helps to obtain full bone regeneration for the desired ridge height and width. For comprehensive cases, combining the particulate allograft with xenograft and using bone morphogenic protein optimizes outcomes, while a titanium mesh (such as Titanium Micro Mesh) or titanium-reinforced nonresorbable membrane (such as ePTFE Barrier Membrane) provides for isolation and holds the graft materials in place. Using a titanium-reinforced membrane stabilized with a couple of screws can be advantageous compared to use of titanium mesh, as the latter can be difficult to remove due to the development of fibrous attachments to the adjacent tissue. In contrast to the considerable time involved and multiple scalpel blades sometimes necessary to remove the titanium mesh after bone regeneration, 1-877-460-5900 8am–9pm (et) • To Fax: 1-800-732-7023 24 Hours

Table of Contents for the Digital Edition of Oral Surgery & Maxillofacial Surgery Specialty Catalog - September 2013

Oral Surgery & Maxillofacial Surgery Specialty Catalog - September 2013
Henry Schein Dental Your Trusted Partner
Table of Contents
Pharmaceuticals
Anesthesia Supplies
Anesthetics
Article
Bone Grafting
Disposables
Education
Emergency Products
Equipment & Technology
Henry Schein Brand
Implants & Accessories
Impression Materials
Gloves
Infection Control
Instruments
IV Administration
Loupes
Patient Aftercare
Patient Assessment
Practice Marketing
Practice Solutions
Rotary Instruments
Scrubs
Software Solutions
Sterilization
Suction
Surgical Units and Handpieces
Sutures
Syringes & Needles
X-ray
Miscellaneous
Index
Terms of Sale

Oral Surgery & Maxillofacial Surgery Specialty Catalog - September 2013