JIACD
The Journal of Implant & Advanced Clinical Dentistry
Autogenous Bone or Bone Allografts what are you getting better results with?
Wed, 12/09/2009 - 13:35 — Logan MD DMD
Being an oral surgeon I tend to do more block grafts from the ramus, chin, skull or hip. Lately, I see many people at lectures getting really decent results with bone allografts and xenografts. I am curious what people are using and why for reconstructing ridge defects for implant placement? Is there any special techniques you do? What membrane do you use?
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Comments
Autogenous Bone or Bone Allografts : Puros bone all the way
I do way more Bone grafts using puros rebuilding ridges. Great handling and consistent results every time.
I always use a membrane either biomend extend or ace membranes.
I use a mixture of cortical and cancellous puros and layer it in so I have cortical on the top with a mixture of cortical and cancellous in the defect.
Í have not used autogenous bone in years
No need for autogenous bone in my opinion. I can reconstruct just about any defect with allograft or xenograft. FDBA and Bio-Oss are my grafts of choice. I quit using DFDBA entirely. Have not done a chin or ramus in over 3 years now. Quite frankly, I am getting better results with ridge splits. If the defect is large, I ridge split if possible. If ridge split is not possible, I use block allografts. Sometimes, the situation dictates use of a Ti-ePTFE membrane or tenting screws. In any event, allograft/xenograft + a little growth factor and you will be set.
Grafts of choice
I have gone away too from autogenous bone especially as sole grafting material due to two reasons;
1)Resorption which is unpredictable
2) Patient morbidity
My preference for a simple defect is an allograft covered with a resorbable pericardial membrane.In cases where there is a vertical defect I would use tenting screws or titanium reinforded cytoplast membranes.
In larger defects I would use Regenaform-the best material to my opinion-oseoinductive tested clinically.
xENOGRAFT I use for sinses or as a sadwich to protect the buccal plate.
Question for Ziv and Mental foramen
I myself use alot of autogenous bone. I dont see the morbidity and resorption doesnt seem to be an issue.
Ziv what do you like about regenaform and what kind of results do you get?
Mental what kind of results are you getting with the tenting screws? What screws do you use?
Autogenous Bone
Over the years, I too have seen significant resorption with autogenous bone. I've seen it with ramus grafts, chin grafts, and especially with hip grafts. In fact, there is one guy in town here who loves to do hip grafts...I have gotten many referrals to fix these cases after the fact and usually end up having to re-graft about 1/3 of his cases due to significant bone resorption.
I use LifeNet FDBA and Bio-Oss. That's it. I combine with some growth factors when needed. I am perfectly happy with the results I get and have rarely found a case where I could not create enough bone for implant placement.
When I do see a case that requires more bone than I think I can create, I present the options to the patient and am happy to refer to OMFS for larger grafts. I am not a pig. If something is beyond my capabilities, I refer. I think this concept is getting lost amongst some of our younger colleagues. It is ok to refer when the situation call for it.
I agree with Ziv on Regenaform
I have had great results with Regenaform RT, I agree with Ziv that this is one of the best products on the market at this time for GBR. I use tenting screws, pack Regenaform around them, then cover with Ossix Plus membrane. Sometimes I mix some Bio-oss in with the regenaform. I have had only one case that resorbed but I still got enough to place the implant (pt had medical problems). Most cases show nice wide ridge. I have done alot of Block autografting, mostly Ramus, and the bone quality is softer than this, but no added morbidity.
Block allografts work in the anterior maxilla. Other areas (esp posterior mandible) they are not predictable.
I also have had good results with ridge splits. Must have enough width to split in cancellous, won't work with very very thin ridges.
I too have seen autografts break down long term. That's why I've been mixing Bio-oss in with grafts...stays around long-term to support the ridge and prevent resorption. Also according to numerous studies the bio-oss particles don't contact the implant surface when it's all healed/integrated...namely article by Valentini.
For Logan: Ridge defect reconstruction
I have not used autogenous in about 7 years; I mainly use allogeneic bone namely 100% PUROS cancellous large particle along with a titanium reinforced non-resorbable membrane. As long as the membrane well fixated and primary closure is done without tension, the results for me have been very good.I have reconstructed pretty large defects like that.
For large defects tenting under your membrane will only help, but tension free primary flap closure is paramount.
Finally I always let my patient know that there is a chance of shrinkage and that some type of corrective surgery might be necessary i.e a second round of graft;getting the exact amount of bone you want is not possible all the time.