Discussions on Bone Grafting

When using PRP – Platelet Rich Plasma – for surgeries, are you using bovine thrombin to coagulate the platelets?

CT images show some lingual bone loss and what I’m thinking is a crack.

I extracted this #18 and placed Nu-oss bone graft with membrane one week ago.

Two days post-operative, the patient experienced pain and palatal swelling that is firm to the touch.

How many people are placing membrane over lateral ridge grafts without tack/screw stabilization and what are thoughts and ideas about this?

Much of the membrane was exposed because of the large dimensions of the extraction site. Shortly after the graft procedure, the sutures broke and I was concerned that the membrane would be displaced.

The speaker was adamant that everyone should be placing the smallest possible implants and doing whatever bone grafting as necessary.

I have a patient who is treatment planned for an implant and free-standing single crown in the maxillary left central incisor site. He has a significant buccal concavity.

Considering treatment time, predictability and cost which grafting combination will yield the best results with the greatest chance of success and least chance of complications?

Which would provide a more predictable therapy to augment the zone of attached gingiva – a Free Gingival Graft or a Sub-Epithelial Connective Tissue Graft procedure?

I used Easy-Graft for the first time. The brochure that came with the product states that I could place implants again in 3-4 months because the graft will have undergone osseointegration.

I have learned about a new collagen matrix membrane product called Mucograft. The material is supposed to promote the regeneration of keratinized ginigva in association with grafting or tissue augmentation procedures.

The patient has returned now with the chief complaint of complete numbness of her lower lip on the side the surgery was done. Should I approach this from the perspective of a complication of the surgery or a complication of the graft material?

Have a patient who had GBR, everything was going well until I started preparing the osteotomy sites.

In general, how much bone graft volume – in cubic centimeters – is adequate for sinus graft procedure in the areas of #2,3,4?

How long do you leave in the non-resorbable membrane itself after you do the bone graft?

I am going to do a cortico-cancellous block graft in the anterior mandible. Is complete decortications of the recipient site absolutely necessary?

I have not been able to find specific guidelines for measuring and assessing the zone of keratinized tissue around potential implant sites.

I attended a course on implant site development where several lecturers from Europe recommend particulate or autograft mixed with particulate grafts stabilized with metal screws and covered with a titanium or Teflon/titanium supported membrane.

Are there any materials that can be mixed and applied over the graft to harden and contain the graft material? Is there a reasonable alternative to barrier membranes?

Bone grafting at the time of extraction adds the cost of the graft and membrane. But if later a block graft is required to develop the site for implant placement, that is even more costly and may entail two surgical procedures.

I have read about PRP and PRGF and have attended lectures on the subject. It seems like the literature establishes a strong case for the benefits of using these in bone grafts to enhance regeneration and healing.

What is the current thinking on grafting extraction sites? My understanding is that if the buccal cortical plate is intact there is no need to graft.

There is a bewildering array of different materials available for bone grafting procedures. How do you choose which bone graft material to use?

My surgeon has told me that after he does these procedures I will have to wait 9 -12 months for the bone grafts to completely heal before he can go in and place the implant fixtures.