Ramus vs Symphysis block grafts

Sun, 02/15/2009 - 11:54 — DrTimberlake

I go to many different conferences and I hear speakers talk about doing ramus and symphysis block grafts. In reality I dont think people do as many as they say, I think you can get the desired results with GBR with less risk. That being said, if one is choosing to do a block graft I feel that there is less complications doing a ramus vs a symphysis based on what I read in the literature. I do feel that obtaining a symphysis graft is easier then obtaining a ramus graft. Opinions?

Block Grafting

Sat, 06/05/2010 - 16:29 — Mike Hollister DMD

Ramus vs Symphysis vs Tibia: I select Tibial Grafts

I usually choose Tibia over ramus. Less patient issues. I can usually get a nice volume of bone from the ramus.

A cone beam ct is a must to avoid complications.

To compare tibia grafts offer even less issues then oral block. The bone can be easy obtained in an in office procedure. I can obtain even more bone from the tibia then orally.

The patient does well afterwords and works out with a small dressing and a couple of stitches. Usually see very little pain.

Mike

Sat, 07/10/2010 - 16:18 — mightymouse

Mike what are the risks with Tibia grafts

Mike I do a fair amount of particulate grafts but dont do blocks or tibia grafts.

What are the risks with tibia grafts?

Wed, 07/14/2010 - 04:59 — Mike Hollister DMD

Tibial Graft Risks and Complications

In general they are minimal.

Here is a great article:

Br J Oral Maxillofac Surg. 2009 Jan;47(1):20-2. Epub 2008 Aug 3.

Retrospective review of donor site complications after harvest of cancellous bone from the anteriomedial tibia.
Walker TW, Modayil PC, Cascarini L, Williams L, Duncan SM, Ward-Booth P.

Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex, RH19 3DZ, United Kingdom.

Abstract
Donor site morbidity is important in deciding the site for harvest of cancellous bone for alveolar bone grafts. Many studies have supported the view that tibia is safe with few complications in the short term. We know of no studies on the long-term complications to the donor site after tibial bone grafting in children with alveolar clefts. The casenotes of 40 children who had had tibial bone grafts for alveolar clefts were studied retrospectively, and parents or patients were contacted by telephone and a standardised questionnaire was used to assess any long term complications at the donor site. We found none. We found no evidence of long-term complications at the donor site in children who had had proximal tibial bone grafting for secondary repair of alveolar clefts. We conclude that the proximal tibia is a safe site from which to obtain cancellous bone graft for alveolar clefts in children. This study is preliminary, and highlights the need for a randomised trial.

Fri, 05/21/2010 - 02:52 — shazlovely

Ramus vs Symphysis block grafts

I choose Ramus over symphysis block grafts. Less complications to deal with.
Take the pikos course on block grafting.

Mon, 05/03/2010 - 05:46 — Logan MD DMD

Ramus Block graft and infuse.

I have used infuse and the results are good, but you still need block grafting.

Ramus grafts are very effective with limited complications. Those that poo poo them should talk to those that do them routinely.

Fri, 04/30/2010 - 06:59 — OrthoKing

Infuse instead of block grafting

I have used infuse before and have had good results. You do get a massive amount of swelling.

I dont think it will replace block grafting. I think you need to have all the tools needed to handle any complex situation.

Brooke

Mon, 04/26/2010 - 13:16 — Dr. Musin Silver

Infuse BMP2 is eleminating the need for blocks in my practice

BMP2 and ti mesh are eleminating the need for blocks. I can achieve nice augmentation with infuse. The only issue I have is auto exposure of the mesh so you must improve the soft tissue profile prior to the bone augmentation.

Sun, 04/18/2010 - 12:35 — Oliver Queen DDS

Ramus vs Symphysis block grafts: Dont see the need

I dont see the need to do an invasive procedure such as a chin graft when I can achieve the same results with a putty graft or block allograft.

Thoughts?

Tue, 03/23/2010 - 19:41 — Dr Chace Heatly

Ramus vs Symphysis block grafts

As I said Ramus grafts are the way to go. Even the article showed less complications over a chin. I usually can get a nice volume of bone from the ramus.

Fri, 03/05/2010 - 06:35 — Dr. X

Ramus Vs Symphysis: Article answers all

Very nice article in this months issue. Props to Toscano, Shumake, and Holtzclaw. Very well done and goes over everything you need to know.

http://www.nxtbook.com/nxtbooks/specops/jiacd_201003/#/46

Read it well worth it.

Xavier

Sun, 01/24/2010 - 19:45 — Dr. Cohen

Ramus vs Symphysis block graft....my opinion

Ramus vs Symphysis block graft. Both have there advantages and disadvantages. There are more complications with the chin then the ramus. The chin does have better access and you can get a larger volume of bone from the chin as oppose to the ramus.

I dont see the need to do either these days as I usually can obtain what I need with particulate.

If I had to do one I would do a ramus graft.

Wed, 11/11/2009 - 05:19 — Dr90210

Ramus Versus Symphysis block graft

I think you need to be able to do both. Both have there advantages and disadvantages. Ramus is usually primary cortical in nature where the chin you get more of a cortical/cancellous block. You usually can obtain more from the chin then the ramus.

There is more complications with the chin then the ramus but they can be avoided.

Sat, 10/31/2009 - 10:43 — Dr Chace Heatly

Ramus Block grafts

In my opinion, ramus is the way to go. Less complications and issues. I almost always have patients tell me there lower teeth feel funny after a chin graft.

Ramus is a none issue.

Thu, 10/29/2009 - 12:22 — Dr90210

Ramus versus Symphysis block grafts

I use both the Ramus and Symphysis. If you do a full thickness flap for the chin vice a vestibule approach you have way less complications. Easy to harvest the chin.

Thu, 10/08/2009 - 04:11 — Perioplasticsurgeon

Ramus Block Grafts

Since my last post I am definitely doing more Ramus grafts then chin block. Its about 5 to 1. Especially now since I started using piezo, makes the ramus harvest easier. I definitely say Ramus complications are far less then chin blocks.

Any other opinions?

Wed, 03/18/2009 - 19:55 — Ti Doc

Ridge Splits...Nice

I have been getting phenom results with ridge splits. I used to do ramus, but most patients don't want a chunk of bone cut from their jaw. GBR works well, but the ridge splits have been giving me my best results. Using a piezo, you can make very precise cuts. I use Salvin ridge splitters. Routinely expaning 4mm ridges to 8-9mm. Very nice. Try it.

Wed, 03/18/2009 - 13:24 — N Shumaker DDS MS

Intraoral Block Grafts vs GBR -- Same outcome likely

I have a good bit of experience in both these block techniques (ramus and symphysis) as well as GBR. Ramus is my preference because less morbidity and less postop pain. Symphysis is good for bone quantity and quality, but many patients end up with "wooden" feeling lower incisors and a numb spot the size of a pencil eraser just over the block harvest site. Chin ptosis is not a concern as long as you don't go beyond the inferior border and you manage the mentalis muscle well. As far as considering GBR vs. intraoral blocks for quantity of ridge augmentation you can get, most will only give you an average of 3-5mm augmentation regardless of technique. Go back an look at classic studies and reviews by Buser, Feulle and Mellonig, Misch, Pikos and Widmark on both ramus/symphysis grafts. Range for blocks is 1-7mm with average 4mm augmentation width increase and GBR (particulate) is 1-5mm with average 3-4mm. In the end there is very little difference. BUT (the big BUT), the advantages of blocks are 1.) better bone quality when you go back to place implant and 2.) Faster integration--can place implants in 4 months vs 6-9 months with GBR. Long term studies on block are few to none...we know the osteocytes in the block do NOT survive and the block is turned over by creeping substitution. We know resorption is 0-25% between block graft and implant placement, but I would be interested to see how much resorption occurs between implant restoration and 5-10 years out. Noone knows at this point, at least not published beyond simple case reports, no RCCT's. GBR has a few long term studies that show pretty favorably, Nevins/Mellonig, Buser, etc.

Sat, 03/14/2009 - 10:47 — OrthoKing

Ramus Grafting: less risk and very predictable

I tend to air on going for the Ramus as opposed to the chin. I think there is less post op issues with the ramus. Autogenous block grafting in general is very predictable. However, I am more of a GBR girl, I have trouble selling my patient on taking a block of bone.

Mon, 03/02/2009 - 15:31 — Perioplasticsurgeon

Ramus vs Symphysis Blocks

I usually favor Ramus grafts as there is less complication reported in the literature, but that being said you can minimize most of the symphysis complications by your flap design.

Pikos advocates doing a full thick flap approach instead of a vestibular incision. This will negate the risk of chin ptosis.

Sun, 02/22/2009 - 13:57 — calincioban

Ramus Block Graft: Easier and minimizes risk

for me is easier to obtain a ramus block bone. it also eliminates the risk of injury the frontal incisors.

Wed, 03/04/2009 - 22:11 — Richard Hughes DDS

Block grafts ramus vs symphysis

This depends on you and your patient and how much bone you need as well as your clinical skills. They both work well. You have to follow some basic principles ie. stability of the graft, tension free closure, no infection, protection of the graft, sigma, blood supply etc.