Gap Between Graft and Ridge: What Should I Do?
Anon. asks:
I performed a ramus block graft for a young male 4 months ago on the upper left central incisor area [#9]. At the time of the graft, I placed 2 bone screws to immobilize the graft. I took the two bone screws out for a CT scan last week. The bone graft was firm when I pushed it with a perio probe. A CT scan was taken yesterday and a gap was seen between the graft and the ridge, approximately 0.5mm wide.
Is it a fibrous tissue in-growth or osseous tissue that has not yet fully mineralized? The patient is scheduled for dental implant placement in 2 weeks. What should I do if about this gap formation? Should I wait longer before placing the implants? Any advice would be appreciated.
3 Comments on Gap Between Graft and Ridge: What Should I Do?
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Dr. J
9/5/2007
Unfortunately, you can't do anything until you get back in there. You may want to prep the patient to the possibility of more bone grafting. But unless you get back in the site you won,t know what you have. Next time make sure that you prep your bed and your graft to have intimate contact and decorticate the buccal plate. I usually combine this procedure with GBR (membrane and particulate graft) and get very good results.
Good luck,
hj
Peter Fairbairn
9/6/2007
What particulate material did you use with the block, Autogenous,Allograft, xenograft or alloplast.There could be soft tissue ingrowth as you suspect maybe best to open again and check and clean and do gbr with a particulate.Difficult to say without visual..
Stu Lieblich
9/6/2007
The gap may not be significant if the bone graft is indeed firmly attached to the host bed and shouldn't require separate grafting (see below). You do have a risk of the graft de-laminating from the host bed since it may be more attached to your buccal flap than the host bed. When you do your flap to expose the site for the implant placement, keep it limited in the buccal dissection. Prepare the implant site slowly with using the dense bone drills than come with most kits. You need to keep pressure on the graft to be sure its not peeling off as you insert the implant. If it starts to break away, you need to back off the fixture and enlarge the osteotomy. The 0.5 mm gap will fill in with bone after the fixture is placed since you will now have opened the marrow space on both sides.
