Osteograf Low Density HA graft: Long delay for implant placement?

The big question is how much natural bone will fill in the spaces between the HA. Early sinus lifts were almost all HA (a la Dennis Tarnow) with implant placement. The patient will get a stable ridge for denture support and a locator retained prosthesis to take advantage of the stability of the HA which will never go away. We used this back in the day for ridge augmentation. What does your periodontist colleague suggest? Literature search? The prosthesis design is key, using the ridge stability of the HA as an advantage with an implant retained not supported denture vs a disadvantage. During the healing period the denture will be less likely to cause bone resorption a plus! This is where a team approach is also key, you are in charge of the treatment plan if handled appropriately you will have a very satisfied patient. At implant placement with the aid of a clear denture for reference I would core out the areas of implant placement and place autologous bone if I did not feel there was enough bleeding bone sort of a secondary graft, primary or secondary implant placement judgement call. Could you post a panorex to see how dense the HA is? If the implant placing surgeon is experience they hold be able to help, united front for the patient. If the ridges are great you may need very little implant retention . A film would help! All is not lost!! I actually had a case where I places allograft only and had a lot of bone resorption while the implants were integrating and wished I had used some Bio OSS since wearing the prosthesis may have contributed to the resorption. Sometimes a "mistake"cn have a positive outcome, I call them happy accidents!

This product is resorbable but can take up to year, I don ' t like synthetics in my implant practice since I don't like the "feel " of the "bone" too grainy not much bleeding and poor lock in of the implant.I gave you the worse case scenario above with overly dense non-bleeding bone. Each practioner has their own preferences and I don't have your treatment plan for the final prosthesis so take my comments with a grain of salt or HA!

It will depend on how heavily you condensed the HA. If there is no space for bone to grow between the particles then 1 year. If light condensation then 4months.

you may still have enough bone to place the implants in between the sockets and then no matter what happens to the allograft inside the sockets

Depending on what bone is available, I tend to think that not much was there for harvest. I use mineral used bank bone and have had good lunch with that, provided that I have had as much primary closure. I'm conservative, and I also think that when I'm out of this bone I am going to switch to corticocancellous bone. Protection of the graft sites is mandatory. No pressure. And I tend to wait a little longer. I haven't used mini's giraffes support though there is merit to that in my view. Look at your grafts on a pan or better yet a CBCT. See what you have. If it isn't enough, some simple bone spreading my be just fine for some of the sites and you can stagger placement times. One last thing- encourage your patient to remain patient for something expecting to last a long time. A few extra months isn't really a long wait for a reasonable person. JM2C. Hope that helps. Bill

You are wise to seek help in this case. There is no replacement for experience. In this case you will be wise to consult with someone in your area who is experienced in placing implants and restoring implant retained overdentures. In most of these extraction cases alveloplasty is done during the extraction procedure. So, much of the bone you have grafted will probably need to be taken away anyway. (Alveloplasty gives you prosthetic clearance). Sinus augmentation procedures are done with Cadaver (Irradiated cancellous) bone so implants may be placed in the cuspid and premolar areas for proper prosthetic angulation. Not in the anterior. The palatal trajectory gives you improper implant angulation and inadequate clearance for an overdenture. You need to learn alveolar bone development procedures. Your implants will be much more stable and predictable long term in stable alveolar bone. Your mistake was not with the grafting of LD300. Your mistake is planning a procedure without adequate training. The periodontist has a point, but if you had training you would not even be asking the question about grafting materials. Oh, BTW, don't use synthetics in any graft that you intend to place an implant. It is not a wise choice. Some Drs say they get away with it, and companies sell the stuff with compelling promises. At the end of the day, synthetic particles do not direct bone growth in the proper shape for implant thread geometry. Get training and take care of your practice. You know your patients better than anyone else. The AAID is a good place to start.

So the HA bone grafts are old one it is better to remove old graft and insert autologous graft ,to be sure that with HA graft you will never have more than 20-30% healed natural bone even after 8 years ,so do it as soon as possible ,before the patient get angry with you

Dear Poster OsteoGraf LD 300 is non resorbable and it will be present forever. I can assure you that there will be no difference between 6 months and one year. With OsteoGraf LD 300 you will have normal bone between the graft particles. This is better that an allograft because in that case you only have sclerotic bone between the unresorbable cadaver particles and the bone will have little to no vascularity or osteoblasts in response to the foreign proteins contained in the cadaver bone. The body does its best to spit out the cadaver bone so the only time I will place an implant in a site grafted with an allograft or xenograft is when I can see that the body has been successful in expelling the majority of graft particles. In those cases I place the implant so it is at least partially in normal bone. It sounds like you are working with a skilled surgeon. I suggest that the implants be placed in 6 months and positioned interproximally where the implant will be primarily in natural bone. Oh by the way OsteoGraf LD is an alloplast (synthetic) not an allograft (cadaver). In addition cadaver bone is not osteoinductive. I think you intended to say osteogenic but allografts are not osteogenic either. Don't worry about the misuse of terms because if you were talking about composites I would have no idea what you are talking about. Greg Steiner Steiner Laboratories

Dense HA does not resorbe. Synthetics, such as OsterGen perform very well, as do other synthetics. If compounded with autogenous bone or PRP and one follows the eleven keys of bone grafting as presented by Misch, you will have success. As for grafting sockets, I do it. I don't want to lose a good site and I don't trust bone to always jump the gap. I've been disappointed several time, so I like to stack the odds in my favor. I've heard several clinicians that I respect, say they don't graft sockets. This is not a big bone of contention. Like I said above, I like to know that I will have a decent site for implant placement.