Dr. S. asks:
Anyone have any experience with Tunnel Grafting for lateral ridge augmentation? I am interesting to know how many millimeters people feel is a reasonable expectation. Is it realistic to expect to achieve 5-6mm with this procedure? How many millimeters are considered a realistic expectation for this type of procedure? Are there any other grafting or augmentation procedures that are more predictable for this kind site development? I really would like to find out what other people are doing and what success they have had.
Tunnel Grafting for Lateral Ridge Augmentation: Comments?
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Have spoken with Dr. Heuckmann of Munich , who works with Prof. Benner and they have done 30-40 cases and shown 5 or so completed with core sample Histology. It was very impressive and we have now done some cases and await the results.
There are specific techniques that have to be adhered to , like a groove on the buccal plate and use of a graft material that is stable ( Easy-graft ).
He has written cases up so I suppose Google or Pub-med will help you.
All in all an interesting solution for difficult problem on the mandible.
Forgot to mention they are showing 4-5 mm of vertical height increase.
Would not suggest this procedure. We tried this years ago with very limited results. The graft material should be placed between the bone and the periosteum.
Lateral grafting by tunneling technique is quite tricky, firstly because you have to create enough pouching in the tissue to accommodate the volume of the graft and this will require quite a bit of undermining. Secondly the graft material will need to be well stabilized to minimize compression or micromovement so as to get integration. Thirdy it is difficult to decorticate or multiple drill puncture the cortical plate.
Tunneling is a great concept because it allows for a highly vascularized site with a relatively intact periostium and with remote incisions. Hilt Tatum is a strong proponent of this method but not too many people are as adept as he is at this technique so elevated flaps are probably are more suitable for the average grafting surgeon.
Meisinger sells a kit designed by them to help with with the procedure difficulties. Graft stability provided by Easy-graft properties.
But is technically difficult
Regards
I have been doing this for several years – especially for upper cuspids and central incisors with palpably large defects. I have not had a problem with access to the site at all, in fact when I first tried it was surprised by that. I only use it if I need a block graft to the site, otherwise I use the incision Sclaar uses. I just finished one and put a 4.7 mm screw vent in, so adding 4-5 mm of width is very reasonable.
Sorry, mis-spelled Sclar.
Dr. Larry Skoczylas,
Where can I read up more about this technique?.
Dr. Dinh: Thw Midwest Implant Institute offers an excellent DVD on the “Tunnel Technique”.