Placing an implant with simultaneous bone graft at the implant neck: recommendations?

I have treatment planned a patient for installing an implant and doing a bone graft at the same time. The problem is that the alveolar ridge will require augmentation in both vertical and horizontal dimensions. I plan on installing the implant in the residual alveolar ridge and then building up the bone around it and covering with a membrane. I have three questions regarding this. It is unlikely that I will be able to gain primary closure over the membrane with soft tissue so much of the membrane will be exposed. Is there a particular brand of membrane that you recommend for that circumstance? Secondly how far above the residual alveolar ridge can I place the implant platform and then pack the bone graft material around it? Lastly if I wanted to use a transmucosal healing abutment for a one stage surgery how would I prepare the membrane for fitting around the healing abutment while covering the graft?

10 Comments on Placing an implant with simultaneous bone graft at the implant neck: recommendations?

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CRS

10/10/2013

How many millimeters do you need? Also don't attempt this without primary closure or transmucosal healing abutments it won't work you'll lose the graft. A better approach would be expanding the ridge for width and packing with PRGF/bone and a tenting screw or sonic weld for height. Your treatment plan is asking the body to do to many things at once. Grafts need primary closure sorry it will need to be staged otherwise you may end up with an intergrated implant with exposed threads which is impossible to fix. Is this an anterior or posterior area?

10/12/2013

I have one similar case that has advanced vertical bone defect n horizontal bone defect in UR canine with deep bite. I did bone grafting about 5 months ago. Bone level is now at 2-3 mmm below its normal position. Patient has low smile line. Plan to go for a long crown instead of trying to go for vertical bone augmentation. Is it possible for the vertical bone augmentation in this case? For a deep bite, any possible issues?

Peter Fairbairn

10/13/2013

WE do this on a daily basis but have had a bit of practice so think about what you are doing and what you want to achieve . I always ask an audience as to the best or "gold standard" graft material , I feel it is the Implant itself...... This was mentioned in Schropp in his much quoted research of 2003 , "placement of the implant as early as possible after extraction to maintain bone dimensions " All the best Peter

CRS

10/17/2013

Implants integrate well in host bone and well healed grafted bone which has had time to resorb the graft and regenerate. Most of these posts and recipes can be misleading without the clinical picture, morphology of the defect, clinical situation, infection and health of the patient. Many reasons for using a technique can be mechanical, i.e. a membrane to contain a loose graft or to protect it in a thin biotype etc vs primary closure. My point being one needs to understand why a technique is being used to have success. An implant is an inert foreign body not a living bone, however if it it surrounded by healthy adequate bone it is great. Placing an implant does decrease the amount of graft necessary but contact with host bone is what makes it integrate. And yes I like pushing and spreading the bone at implant placement vs coring it out when a graft was needed. In short it is all about understanding the physiology of integration, not having a good dental technique.Thanks for reading!

Baker Vinci

10/17/2013

If you are trying to create vertical bone, you will need primary closure. The " tenting " procedure works well. We do, with great results, graft circumferential defects, without primary closure and resorbable membranes, but remember, wherever you have a membrane, there will be a period of time that the covered graft material is devoid of a nutrient supply. Vertical augmentation is the second most challenging grafting paradigm.

Peter Fairbairn

10/24/2013

Hi CRS and BV agreed the vertical area is a challenge but newer materials have changed things positively. I will be showing some cases ( with associated personal research ) where we have achieved 5 to 7 mm vertical in the posterior mandible which involves a new protocol ( I have worked on for 10 years ) in London in 2 weeks . The anterior maxillary area is easier especially with adjacent teeth but again this protocol needs learning . Regards Peter

Richard Hughes, DDS, FAAI

10/25/2013

Peter this sounds exciting. The atrophic posterior mandible is difficult at best. I admire those that can obtain vertical height on a predictable basis. Please keep us posted.

Richard Hughes, DDS, FAAI

10/25/2013

Baker and CRS. You both made excellent and well stated comments. I hope the others are reading your comments on this topic.

peter Fairbairn

10/25/2013

Hi Richard yes been an interesting time , but new problems now finding the Implant under mm of new bone at least a good source for core samples ! Peter

Bruno Nicoletti

11/20/2013

Insert a fibrin block matrix into situ of implant first then implant Coat the implant with fluid content from the matrix block...... Its the autologous medicine all in one, for GBR, anti_infection, pain killer.....