hello and welcome to chairside live I'm your host Megan strong today's show is all about
bone grafting when insufficient bone threatens to shut down your implant treatment plan socket
regeneration and other grafting procedures might just save the day in this episode dr. Timothy
Kaczynski is using bone grafting material to aid in successful dental implant therapy so
let's throw it over to dr. Kaczynski jump right in hi this is dr. Tim Kaczynski from Bingham Farms
Michigan and today we're going to talk about bone grafting the essential indications and techniques
in implant dentistry case number one let's look at case number one which is socket regeneration
we see that our patient presented with a nine restorable mandibular first molar the tooth had
received prior endodontic treatment and displayed infection and severe recurrent decay we see that
we suction the tooth mesial distal e using a long 557 surgical burr and the existing crown was
removed the individual roots were a traumatically extracted using the golden dent physics forcep
although the truth was removed in a manner that minimized trauma to the extraction socket a large
facial defect was present and noted necessitating a socket grafting procedure to prepare the site
for future implant placement the socket was then aggressively curated to remove any granulation
tissue and evaluate the facial defect after extraction a digital radiograph is always taken
to confirm complete removal of the tooth roots because there was some crustal bone loss due
to the infection of the tooth a simple envelope flap was made facially and lingually to expose the
defect note the that vertical incisions were not necessary in this case we then placed a newport
biologic resorbable collagen membrane from well direct and this membrane was cut to a proper size
and positioned to a minimum of two millimeters beyond the facial defect this is critical this
ensures a passive placement where the membrane is not easily dislodged to maximize control and
mold ability of the grafting material within the large defect and socket site Newport biologics
bone graft potti mineral collagen composite was selected for the procedure the mineral collagen
composite was hydrated and then packed firmly but not condensed into the extraction socket
and facial defect we see that the resorbable membrane was folded over the grafted socket site
to engage two millimeters of lingual bone the technique of passively placing the membrane is
critical to ensure predictable integration of the grafting material note that when no facial defect
is present at the extraction site the membrane is positioned directly over the crystal aspect we see
that several villas plus sutures from River Point Medical were placed to close the site and maintain
the membrane which serves to prevent invagination of epithelium during the healing phase when the
membrane remains intact for a minimum of six weeks the graft will heal predictably the Newport
biologics membrane used in this case was selected for its drape ability strength and ability to last
three to four months in Chorley which makes it an ideal product whether or not primary closure is
obtained we see that the post-operative radiograph indicates an adequate fill of the extraction
socket following placement of the grafting material a four month follow-up radiograph
confirms successful regeneration and maintenance of bone within the extraction socket illustrating
proper bone turnover from the apex to the crest over time in Figure thirteen we see that with
adequate ridge with created and height established a Hahn tapered implant from glide will direct was
flapless Lee placed in figure fourteen we see a post placement radiograph showing properly
positioned implant with ample space available in the apical coronal and mesial distal dimensions
in case report number two we're going to look at an immediate implant with a facial defect we see
this patient who visited my office seeking treatment for a fractured maxillary right
central incisor note the severe soft tissue irritation around the badly damaged to digital
radiographs and a CBC T analysis confirmed a hopeless prognosis for tooth number eight note
the facial defect caused by the route splitting implant treatment was proposed and accepted by the
patient with immediate implantation preferred if indicated following the extraction of the
tooth the untreatable tooth was carefully and a dramatically removed and the socket
site was carotid to remove any granulation tissue and to evaluate any bony defects in
or Vann knife and this was used to create an envelope flap eliminating the necessity of
vertical incisions this allowed for visualization and examination of the facial defect prior to
moving forward despite the presence of a facial defect sufficient bone was available to proceed
with immediate implantation with the aid of cortical cancellous allograph material and we
see that we use the newport biologic mineralized cortical cancellous allograft blend and this was
wetted with sterile saline and the resorbable membrane was cut to proper size to cover the
defect and lay passively over the attention we simply started our implant placement procedures
and a pilot drill was used to make the initial penetration into the bone the preparation was
not made directly into the socket but rather three millimeters palatal to the facial aspect
of the adjacent teeth engaging the palatal walls helped increase the initial implant stability
the Hahn tapered implant was then threaded into position and was remarkably tightened
to the final torque of 45 new in centimeters a cover screw is placed into the implant prior to
bone grafting and membrane placement Newport biologic allograph material which provides an
osteoconductive matrix for revascularisation and structural integrity for the regenerated bone was
positioned in and around the facial defect then the resorbable membrane was passively positioned
and sutured into place our post-operative period book or radiograph and CB CT sagittal
view illustrates properly positioned implant and grafted defect thank you for that dr. Kaczynski
well that about wraps it up for this episode of chair side lives on behalf of everyone here
at Gladwell laboratories thank you for watching and I'll meet you right back here next time you
you