Fortoss Vital: Can This Be Used for a Patient with a Severe Buccal Concavity Over his Upper Central?

Dr. G. asks:
I have to place an implant in the #8 area [maxillary right central incisor; 11]. The patient has a pronounced concavity on the buccal that seriously compromises the available buccolingual bone volume. The buccal defect would best be corrected by a block graft. I was wondering if I could use the synthetic bone graft material [alloplast] Fortoss Vital. [The manufacturer describes this material as “… bi-phasic calcium composite bone graft material having a negative surface charge which attracts the key proteins and cells for rapid osteogenesis and bone repair. Fortoss Vital is fully resorbed by osteoclastic processes and replaced by bone…”]. I would prefer to use a synthetic graft if possible. I would like to be able to re-enter the graft at 6 months to place the implant. Is the resulting bone formation derived from such a synthetic material, like Fortoss Vital, sufficient enough for implant placement or is a bone block inevitable?

4 thoughts on “Fortoss Vital: Can This Be Used for a Patient with a Severe Buccal Concavity Over his Upper Central?

  1. For the type of defect you described, I would use an autogenous block. These synthetic materials have a place in implant dentistry, no doubt. But for the case you described the block (ramus or symphysis) is the sure thing.
    Remember that the manufacturer is trying to sell you a product. They will not be there when you do the case, or open your site to place the implant.
    With a block graft, there is no doubt what you will have when you open the case. (when done correctly of course)

  2. Dear Dr. G , I have not used autogrnous or a traditional membrane in my last 900 cases over the last 8 years or so. This is mainly due to Vital as it is its own membrane and as such does not impede the periosteal blood supply to you graft site allowing for improved angiogenesis.
    The product is as has been FDA approved for 10 yeaRS and has been used in hundreds of thousands of cases in Spinal and Orthopeadic surgery under the name of GENEX.
    I suspect that this market is of more importance at the moment.
    ALWAYS place the implant at the time of defect repair or concavity expansion , then graft as per manufacturer instructions.
    I have as I said manycases now from 7 years ago and there has been little or no loss of profile.
    Finally I do not work for these companies and pay for all my graft materials from the main supplier Swallow dental.
    Regards
    Peter

  3. Dear Dr G and SB Oral Surgeon,
    As the manufacturer I would wish to ensure that a professional and credible offer was presented to a prospective clinician as any business (product or service related) is going to struggle if it chooses to make open promises it cannot fulfil.
    I trained in the Pharmaceutical arena and have been surprised by the lack of regulatory control and woolly” marketing within the Dental field. Tighter regulation, improved professionalism allied to better clinician knowledge will enable a more thorough appreciation of a products capability.
    Many would dispute the Gold Standard tag attributed to autogenous bone. One must have enough of it, possess the skills to collect and place it and it must be of sufficient quality to be osteogenic. If not it is no more a scaffold than one from a bottle and may present a resorption profile that is weaker.
    The “ideal” bone graft does not exist but with advancements in synthetic technology and the emerging availability of growth factors we may be getting there. An interesting case history by Dr Anthony Bendkowski using Fortoss VITAL where an auto bone graft would have been considered is accessible on the following link: http://www.biocomposites.com/dental/PPD_supplement.asp
    A case by Dr Peter Fairbairn can also be accessed via the same link.

  4. I just completed implant placement at time of graft in this same upper right central incisor area using Synthograft, bovine Collagen Membrane, and a 4.5 x 8.0 Bicon implant.

    The fibrous tissue was cleaned out of the undercut showing only a ridge edge of 3 mm and a “y” shape bone cross section with the leg of the “y” as the thin palatal bone plate overhang and the top of the “y” as the basal bone area.

    A trough was prepped into the palatal bone allowing almost half the diameter of the implant to covered along the incisal 1/2 and the apical third of the implant was lcoked into the basal bone. A third point of solid contact, achieved by the hand preparation instruments allowed a 3 point “locked in” positoning of the implant.

    A thin collagen membrane was supported by dual loops from the apical periosteum to the palatal tissue to hold the graft material in place and maintain a “bulge” over the implant. Small, vertical rows of cortical plate penetrations allowed the undercut to become a three walled defect in a fashion.

    The flap had been taken from the palatal, to include a 2-3 mm strip of the tough palatal tissue and repositioned “apically” (on top of the ridge, positioned from palatal to facial) about 5-6 mm.

    The facial membrane came completely over the top of the implant and the patient’s own bone was placed atop the inmplant, under the membrane.

    A final Collaplug section was then sewn over the newly created ridge top opening to guide the healing tissue over the top of the site. This gives one an extra 5-6 mm of tissue with which to work.

    Of course, the papillae were left attached to the adjacent teeth with a thin slice of tissue and the attached tissue incisions had to be parallel to allow repositioning.

    This same patient has now had 3 of these identical procedures done with great success and she is happy with the new bulbous ridge and tissue shapes where there was once deep hollows.

    John

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