Bone Block Graft: options besides removing flange?

I will be placing two bone block grafts in the area of 6-11 on an edentulous patient. The blocks will be placed 2-3 mm below the alveolar crest. Previously when doing this, I shell off the entire buccal flange from the patient’s denture during healing. Does anyone out there have experience with relieving the denture and placing a soft liner instead of removing the denture flange?

8 thoughts on: Bone Block Graft: options besides removing flange?

  1. Oleg Amayev says:

    Just remove the flange. I tried both ways, removing flange much better way to go.
    Placing soft lining will still cause pressure and it will rub against the area. Don’t remove the whole flags, remove only in the area of grafting otherwise denture will be loose.

  2. Ajay says:

    Remove the flange over the graft area. Patient will be able to keep the denture in place with denture adhesive applied in posterior palatal area. Soft reline loses softness very quickly because the dibutyl pthalate leaches out in presence of saliva. Over time it starts rubbing against the labial flap, may open up your sutures prematurely. You can only be safe if the entire flange , canine to canine is gone.

  3. Timothy C Carter says:

    Definitely remove the flange. My question would be “Why a block graft”? With all of the options available and Ti reinforced Teflon membranes a particulate (any of your choice) would be much easier and less traumatic. I have actually had good success using a fixation screw for “tenting” and particulate allograft with a tacked collagen membrane. Just my opinion.

  4. Timothy C Carter says:

    Another option to secure a flange less denture would be some MDI temp implants. Shatkin still makes one that would do fine.

  5. Robert Wolanski says:

    The point of removing any pressure on a block graft is to prevent the movement of the block. ANY MOVEMENT CAN BE CATASTROPHIC TO THE BLOCK. Other things to consider are : using as many fixation screws as reasonably possible, do not error by minimizing screws. Patient must go onto liquid and soft diet. Yes to the removal of flange. If you use mini implants to support the denture be very careful to follow those implants up carefully and frequently. If they become loose and get infected this can spread to your block graft with disastrous results. Get primary closure. Make sure patient does not drink alcohol for first few weeks, especially hard liquor as the alcohol can get under the flap and kill osteocytes. Good cases to consider PRF if you use it at all.

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