Choosing the correct bone graft material for implant surgeries: what are the criteria?
How do we know which bone graft material is best for each surgical situation? If we extract a tooth and fracture off the buccal cortical plate, what bone graft material and membrane would work best for socket preservation? If we do an immediate implant installation into a large extraction site, which bone graft material and which membrane should we use? Sinus Lifts? What are the reasons for choosing between allograft, alloplast and xenograft materials in these situations?
9 Comments on Choosing the correct bone graft material for implant surgeries: what are the criteria?
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CRS
8/5/2013
I don't think that are any absolutes in medicine, just building on the basic science, biology, bone physiology and clinical experience. If a doctor understands how the body works then the appropriate methods can be chosen to navigate th marketplace. It takes time and experience and being prudent in your surgical skills and limitations that's always kept me out of trouble and my patients safe.
dffdds@comcast.net
8/5/2013
Bone graft materials are pretty much equal except to maintain space. CaSO4 is perfectly adequate for most situations except where space maintenance is required. If the F plate is intact CaSO4 is fine or just blood. When the plate is absent then a membrane and particulate material is required and a membrane or CaSO4 mixed with the particulate will suffice without the barrier. A minimum of 2.0mm of facial bone is required for a long term esthetic and functional outcome. Ridge splitting is most appropriate.
Dennis Flanagan DDS, DABOI/ID, FAAID, FAO, DABGD, DICOI
Dr. Nitin Sharma
8/6/2013
In most the case prp can be a good choice, as socket preservation and membrane. Autogenous graft if possible is good choice. Otherwise freeze demineralised bone graft can be of use at any point
Baker Vinci
8/6/2013
I agree when one of the responders suggested that there is no absolute answer. If all walls are intact, anything but a xenograft will work in my opinion, as long as you are guiding the soft tissue away from the socket. If the buccal plate is missing, I'm going to use autogenous bone and will occasionally mix that with mineralized or deminedlized bone and more rigid membrane. If the defect is larger( > 3 teeth or destructive lesion ), I suggest using a blood derived enhancement product. B Vinci
Peter Fairbairn
8/7/2013
Anything that fully bio-absorbs to return the bone to its former healthy state which can thus turn over normally and is not foreign sclerotic material.
Read the Chan and Wang systemic review in the May/June JOMI.
Peter
Baker Vinci
8/8/2013
Even though Peter maybe referring to a xenograft, I agree, with the exception of the wall defect. You can probably get away with it, but I was suggesting what, in my opinion is the best material. Bvinci
christine
8/8/2013
I would just like to thank the folks who submit information and answers to people's questions. I do not place implants, but I have learned a lot from everyone on this site. It has all helped increase my knowledge base and better inform my patients. Thank you.
Dr.yaser
8/11/2013
Read - 20 years of guided bone regeneration- Daniel buser .
CRS
8/18/2013
I like your comment the trends have been to go to block grafting but I have switched back to particulate. I think we have to use what works best in our hands. I have had the privilege to use many products and have my formula. I have been both burned and pleasantly surprised with grafting materials. I think the danger is when speaking in absolutes when having a limited clinical experience. I call it the "best thing since sliced bread" theory. There are so many new techniques, classes and products out there one has to be prudent and stick to what you do best while expanding new skills slowly as our patients trust us. And Peter I have seen some really bizarre articles in JOMI as well as AAOMS but I always value your imput. I think our brains, judgement and skills are key. I had a wise instructor say "you can train a monkey to pull a tooth" but he doesn't understand. I'd like to expand this to implants! My credo is "a tooth is a humbling experience!"
