Ridge defects reconstruction: What protocol or material are you using to get the best results?

Sun, 01/24/2010 - 19:45 — inveptirrinia

Horizontal and vertical ridge defects are encountered every day in the implant practice. With so many materials to choose its hard to know what you can get the best or consistent results with.
My question is what material or protocol are you getting consistent results for in building out a ridge/bone regeneration for future implant placement?

Comments

Mon, 01/25/2010 - 14:53 — Sammy Noumbissi...

Ridge Defects Reconstruction and Materials

The reconstruction of a ridge defect and the materials used mostly depends on the extent, shape and size of defect, the patient's health and oral habits is also a factor.I find in my practice that block grafts are a good option if there is more than 3-4 mm to gain horizontally and vertically; however I have not used blocks in a very long time and I have augmented many large sites with mineralized particulate (PUROS Cancellous Large Particle),a Ti-reinforced non-resorbable membrane and primary closure with Goretex sutures. Recipient bed preparation is also very important.
I allow for approximately 5 months of healing time

Mon, 01/25/2010 - 19:25 — Tim Grant

Ridge reconstruction materials that work great....Sammy I agree

I use lifenet FDBA and calcium sulfate for simple defects and extraction sockets.

For larger defects I use regenaform or block grafts.

I use ossix, bioguide, and biomend extend.

I usually wait 6 months on large defects 4-5 on small defects for healing.

Sammy I agree with you ti membranes are nice but how do you handle when they expose early?

They can be problematic.

Mon, 01/25/2010 - 20:44 — Sammy Noumbissi...

For Tim: Early exposure of Ti-reinforced membrane

Well that is why I spend a lot of time and care trying to get primary tension free closure. Also case selection and proper fixation of the membrane is very important.
However when exposure happens early,you now have to nurse the site. I have the patient come in twice a week for at least three weeks and rinse the exposed membrane with peridex and one capsule of tetracycline dissolved in saline, I use a curved tip syringe. After that they come in once a week for about a month. What I have observed is that by the third week I can definitly see soft tissue start to creep over the exposed membrane, but the coverage never seems to be 100% maybe 90% to 95%.
I practice in an area where there are a lot of health conscious people for whom antibiotics and other chemicals are not an option or the last resort. In such cases I have used an herbal mouthwash which main active ingredient is Gotu Kola. This ingredient is known in Ayurvedic medicine for its healing properties, it enhances the ciculatory system, eases inflammation and its saponins have a beneficial effect on collagen in the repair of skin and soft tissue.

Mon, 01/25/2010 - 22:39 — GV Black

Ti ePTFE Exposure

Sammy is correct. When using titanium backed gore tex membranes, tension free primary closure is a must. However, if the biotype is not thick, the ti-backed membrane is still likely to expose after a while. It's just the nature of thinner tissue with a rigid underlying material.

When the Ti-backed membranes exposes, I pretty much follow the same protocol that Sammy is offering. I keep a close eye for exposure of the membrane edge. If the membrane is not exposed on its edge, you can nurse it along. However, if the edge exposes, you need to think about removing the membrane. This is basically what I do...I nurse the membrane along with Perides swabs until such a time comes when the edge exposes. I don't like to do this longer than 4 weeks.

Simion et al 1995 showed that bacterial contamination of the inner surface of gore tex membranes will occur after 4 weeks, even if chlorhexidine is used.

Hope this helps.

Wed, 01/27/2010 - 09:33 — Dr. Wentkel

Ridge defects reconstruction: Puros and Pericardium as of late

I started using Puros and Pericardium and have some great results. Very nice properties on the puros. Handles well.

I also use block allografts for very large defects from premolar foward.

Sat, 01/30/2010 - 12:09 — Sammy Noumbissi...

Puros and Pericardium

I agree with Wentkel, I use Puros pericardium above both blocks and particulate cancellous Puros bone and I have been getting very good results. However the cost and availability of Pericardium can sometimes be a challenge.
For large defects I still prefer Ti-reinforced e-PTFE; if it is a block and it is well fixated then pericardium works very well too.

Sat, 01/30/2010 - 15:15 — Oliver Queen DDS

Sammy what results have you got with Puros?

Sammy I thought about switching to puros but would like to know what results people get? What kind results have you seen with puros? How does it handle?

Sat, 01/30/2010 - 15:17 — Oliver Queen DDS

Wentkel Why Pericardium?

Dr. Wentkel why do you like pericardium? Is collagen cheaper and you get the same results?

Sat, 01/30/2010 - 20:52 — Sammy Noumbissi...

To Oliver Queen: Results with Puros

I have been using Puros for almost ten years and in all its forms i.e. particulate, cortical,large/small size particle, J-block, pericardium etc. The bone handles very well especially when mixed with saline or blood.
The results in my experience are very good and there is a lot of litterature out there to back it up; I first started using it for sinus graft and compared it to the widely used 50/50 BiOss/DFDBA mixture in maxillary sinuses.
If you want to read about my findings read the following article: Clinical, histologic, and histomorphometric evaluation of mineralized solvent-dehydrated bone allograft (Puros) in human maxillary sinus grafts. Noumbissi SS, Lozada JL, Boyne PJ, Rohrer MD, Clem D, Kim JS, Prasad H. J Oral Implantol. 2005;31:171-179.).
With sockets the quality of bone is excellent, I experience the same results with ridge augmentations.