Severe Bone Resorption: Block Bone Graft Opinions?

I prefer autogenous. Usually I harvest with piezo blocks from thr ramus. Since your already in the area harvest from the symphysis. Simply move the block coronally.

Do we actually need a graft here???

You don't need a bone graft reduce the ridge to your 5 mm crest and place 3 .3 mm implants. The length is very favorable Harvesting in the symphysis is a little painful post op and complications of the soft tissue can be a headache if the tissue is thin crestally

I see no requirement for a bone graft here. I'd advise a compromise to that protusive long axis, though. You could do the more vertical up through the singulum, or maybe halfway between the two with a Synthograft layer to cover the emrgent 1/3 or so. You have a large volume of bone and can place implants qithout graft easily. Remember that this is a highly resorptive Labial plate area and any bone you put in will be subject to those forces for a lifetime. You can countersink Bicon 4.0x5.0 o 4.5x6, or standard set 3.5x8 or 3.0x8 mm implants without bone grafting.

The length of the green and yellow vectors depends on how wide the mouth is open. Therefore, X-ray obtained after establishing a central jaw relation (with wax rimes or current removable dentures) is the only correct measurement. Because the image does not contain the traces of the appliances, I assume the calculations are wrong and the amount of augmentation material might to be mistakenly inserted.

How about j grafts from ramus or zimmers allograft blocks which can be shaped to fit as a j block so u can get both vert and horizontal augmentations

place the implants taking care of direction always thinking of the future prosthetic restoration an hybrid prosthesis is the best slution ´cos volume increases as the need in this case is very difficult to obtain. do not go for single crowns you will fail !!!!

If this was you would you block graft ? I doubt it . There is more than enough bone , keep it simple and take pity on your patients , they are not the proverbial "sack of potatoes ". Slight ridge expansin and particulate ( fuulty bio-aborbable ) will easily be great . If it was really a resorbed ride the you could use Ti Mesh etc. Most of the more experienced block graft exponents I know seem to be reducing the number of blocks they do as the Lawyers like them as well. Peter

Block grafting is tricky. I would like to see radiographs of the posterior areas.

I would not graft, it appears as though there is plenty to work with.

some doctor advice to install implant without bone graft but how could get good aesthetic results without grafting. Occlusal clearence is around 20 mm, so its really hard to get good outcome without restore vertical height. Opinion please.

Alex is spot on. It is better to scan the patient using a lower scan guide copied from a temporary prosthesis with the correct vertical and horizontal components. The scan guide will guide the patient to close in centric. The true extend of the problem can then be measured accurately. No information is provided about the state of the rest of the dentition ( eg. bone level and restorations on the adjacent teeth), patient's expectation, smile line, biotype and span of the edentulous ridge. Treatment should be planned from the top down. Grafting is not necessary if you use more pink (gum) or a hybrid denture design. Growing bone vertically is not easy and if you have no experience, refer the patient out to an omfs. Distraction osteogenesis is an option.

what kind of restoration are you planning?

This is far from " severe resorption". Take the advice of those who suggest a minor ridge flattening procedure and implants. If you are asking the questions; can I use banked bone, where should I get the bone, I'm not sure if you should be doing any grafting procedures, yet. If you are trying to get an appropriate ridge relationship, then you should consider an osteotomy for the patient, but I am not suggesting this. Place some implants( 2-3-4 ), and let this patient go. Over treatment is a recipe for disaster. I would place nothing smaller than 4.1 mm diameter fixtures. Bv

You have plenty of bone for a 4 or 5 on the Floor over denture restoration whether you use Zest Locator snaps or UCLA fixed/removable abutments. I take a dim view of onlay grafting for vertical development. We will be teaching vertical vascular osteotomy techniques at the AAID meeting in Washington DC in October. You can learn how to predictably develop resident-natural vertical alveolar bone for stable implant restorations. This case does not require it.

If the plan is for an over denture, then this case will be ideal for Mini Dental Implants. Why make life complicated?

2mm implants work well in the mandibular senior patient when you have 1. basal bone only 2. atrophied musculature and 3. over denture opposing a maxillary denture. Other wise it is wise to stay with implants of at 3mm or larger that engage cortical bone. I do not offer fewer than 4 implants in any over denture case. It's human nature to gravitate toward any "cheaper" alternative. So be careful about offering something that will not work well. You will eat it.

Agreed, this is not the time for " cheaper "!! Bv. Vinci Oral and Facial surg. Baton Rouge, La.

Tim, sound words of wisdom.

This case, according to the radiographs, has enough bone for narrow body implants up to 3.75 mm wide. So the need for block grafting is moot. Expansion could be considered. Notice I suggest narrow body, not minis.

I fully agree with Robert Dunn, you have adequate bone for placing standard implants and placing four mini implants from OCO 3MM X 11.5 OR BTLOCK 3MM X 11.5 without raising a flap will be able to support and over denture. Have been doing such cases routinely .In severly resorbed cases with D1 bone and little or almost negligible medullary or cancellous bone you can use the Delayed OR Two stage Osteotomy technique which we developed in Malaysia. You do not need to use bone graft or block graft and the procedure is simple and with little complications and easily carried out by most general practicing dentist. Thanks.

Did you say the sliding osteotomy was developed in malaysia? I'm gonna suggest that albeit, a good technique, it is far from a standard procedure and not one to be tossed out as something that is routine for the everyday restorative dentist. Based on this ct, this patient would be best served with 4.3 x 10 or 12 mm implants. I'm my opinion, 2 is plenty and probably all this patient can handle. Every tooth has been lost. This is not coincidental. Bv

You obviously have no financial constraints. So, a good treatment plan is 4 implants anterior to the mental foramen that support a Fixed/Removable hybrid overdenture. That restoration will compensate for the AP problem. I am not a fan of implants smaller than 3.0mm, so minis are out as far as I am concerned. This case can probably use 4.0s.