Bone Block with Puros Allograft and Biomend Fails: Recommendations?

I do a lot of autogenous block grafting and have very few problems. I did one puros block graft a few years ago when the material was new. I had a terrible result. When I went in six months later to remove the fixation screws and place the implant, the block moved. It seemed to be encased in a fibrous layer of tissue even though it was fixated well at the time of placement. I cannot explain this result. Maybe it was bad luck, but it scared me away form the material forever. I have heard mixed results from others. I now use peizo-surgery to harvest my blocks. The procedure is quick, clean, and much less invasive than the old school rotary instrument technique. The patients do very well from the harvest site. So I have little to no resrevation in opening a site to harvest autogenous blocks. The most important things during block graftting are: (and it sounds like you know this) 1. Tension free primary closure of a well vascularized flap 2. Good stabalization by site prepration (which induces bleeding) and block fixation. If you have had these with your cases, and are comfortable with your surgical experience, I would try an autogenous graft for your nest case.

Dr J: In order for the block graft to be turned over into vital bone, it first has to be infiltrated by microvasculature, and the necessary cytokines that will attract bone precursor cells that will turn into osteoclasts and osteoblasts and start the process of bone removal and replacement. The reason sb oms is successful besides experience and good technique, is that he has cells in his graft and you do not. Your graft is only a scaffold, and the greater the thickness of that graft the more likely that the necessary factors will not be present for the graft to be replaced by live bone. I agree with sb oms that maybe you should try autogenous.

if you read my question,i didnt say the graft is not attached to the old bone . there is blood when we remove the screw which mean we have vital bone . my question is that we notice that the periostum is not attaching to the cortical surface of the block . which will might be the casue of flap dehsciency during the healing process or jepridize the prognosis of the implant later on. my question is that, why this happen could be due to high smooth surface of the block and to increase the sucess rate do we need to roughenn the surface or to cover the bone block with other graft granules like bioss to enhance the attachment of the periostum to the cortical surface.

Dr. J- I would not add bio-oss to the mix. This will only make your probelm of flap dehiscence worse. Bio-oss has it place, but not here. I think there may be a basic mis-understanding of biology here. Flap dehiscence is an early wound complication. It the flap eventually closed, and your graft was not infected, your result is the best you will get. It sounds to me like in your cases the body is treating the block like a well toleratied foreign body. AGain, my suggestion would be autogenous grafting. You asked if roughening up the surface will help the periosteum attach? The answere is yes, the body likes surface area. However, the body still may treat the block like a roughened up foreign body. I perforate my block grafts many times to roughen it up and make channels for blood vessle growth. As Dr. Boudet mentioned, re-vascularization = bone graft success.

In my opinion unresorbable Bio-Oss has not a place in a human bone. Bones from a cow are mostly used for a good soup. Which person is so crazy and wants to have a cow inside the head? Geistlich has its roots in manufacturing animals edible gelatin and manure for farmers. This company knows nothing about pharmacy in the past. ...just been away in India lecturing on exactly that , Bio-oss will NEVER bio-resorb , Geislith is very economical with the truth in many different areas ( they say there is no organic component to Bio-Oss which is another hard to believe story , which I will have some news on shortly). I try to tell other dentists to beware and always have a Geislich representative in the room who is noting what I say which is a bit excessive...

thanks

Mr Truth,MrX whoever you are( link to German website!) ... Any time Bio Oss is mentioned in this forum you repeat the same old statements. Have you had it placed in your jaw in a failed procedure?? Do you know someone with BSE?

my question has been diverted to disscusion of bio-ss i really interested to know about allograft block and method to enhance soft tissue attachment to the allograft bone block not discuss the bone soup and share market.

Dr J, I had the same experiences with my first couple of block grafts. The thick cortical plate of the block graft is the culprit. I like to use prp, not sure scientifically how much it helps but it gets blood nicely into the block, and remove almost all of the cortical plate along with many small perforations. This works better, but these days I prefer using bone putty with membranes and tacks.

i used corticocancellous allograft+prf and week later had an exposure what should be done next?

The reason why sb oms has success and why this graft failed is related to the difference in materials and possibly not so much technique. While an autograft will be resorbed and remodeled and converted into your patients own bone that never happens with an allograft. It is a common misconception that allografts are resorbed and then transition into normal bone. Allografts are never resorbed and produce only sclerotic bone. The best you can hope for is for your block of allograft to be bonded by the base of native bone but it will never be remodeled and never become normal. Most everyone reading this will take offense to my claiming that allografts never resorb whether they be granules or blocks but in over 200 published on allograft histology all studies report residual particles and no one has ever found an osteoclast in a resorption lacuna on an allograft particle. In science you must see something before you can say it exists. Until someone can show that resorption of allografts exists it does not exist. Greg Steiner Steiner Biotechnology