Choice of Bone graft material after cyst and loss of buccal bone?

Not if you want True bone and true GBR , might make some hard stuff but to make Bone we need a fully bio-absorbed material .......... We need to think about biology and Look at tissue quality and not just quantity of hard tissue as it is living tissue ... Peter

If your patient is healthy without any medical issues and it has been longer than 8 weeks I personally would consider removing it. If you have all sides of the socket I would remove old graft and clean the site completely making sure the bone is healthy and placing Perioglas. Perioglas is a synthetic particulate that has worked very well for me. I have used it in similar situations and have had good results. I use it for my lateral sinus elevations as well. Read the published studies.

You are getting good advice from the previous posters. When cadaver bone produces mineralized tissue it is scar tissue that is very low in vitality and in the US I believe that the biggest reason for implant failure is implants placed is sites grafted with cadaver bone. I would remove it as soon as possible because the the immune response that isolates the cadaver bone from the host will also compromise the surrounding native bone. Bio-Oss is worst yet because the host immune response to animal proteins is more severe that the host immune response to human proteins. Bio-Oss produces more intense scarring and even lower vitality. I don't want to come off overly critical but BMP2 has not performed well in studies. Like Peter says you want to use a graft material that if fully resorbed and produces normal bone. The only bone grafts that will do that are the resorbable synthetics and in my opinion the best are the beta tricalcium phosphates. Greg Steiner Steiner Biotechnology

And Biologically that is about it , Greg , we are in the business of healing our patients and returning to a healthy state not changing them . Bone is a living tissue which needs to turn over not a block of wood and hence we need think more about the quality of regenerated tissue not merely quantity.. Hope you are well Greg Regards Peter

My choice of bone graft material has always been autogenous first and then mineralized or demineraled bone, based on some pretty good science. Most of the time, I let the patient tell me what they want and I will still occasionally get the ; "I only want my bone". Well I just uncovered one of these cases that was an immediate extraction and placement of implants at 21 and 22. I over grafted the area and contained it with my favorite resorbable barrier. The integration phase was unremarkable and the 3 month panoramic had the patient and I gleeming, until I began the second stage procedure. The cover screws were exposed, so we chose to proceed without local and the patient immediately began to experience pain and before I knew it both Nobel fixtures were resting on the mayo stand, requiring little more than hemostats to retrieve. There was no bone on either fixture and the implant sites were completely epitheliaized and looked as if I had just non surgically extracted the teeth; until I scanned him. The scan looked as if a bomb went off and while the entire inferior cortex and lingual plate were intact, it left us in utter disbelief. This would be # 8 and 9 failure in 22 years. Since the patient was asympyomatic and there was no purrulence to send for micro., I sent him on his way with a 3 week supply of penvk and continued anti microbial rinse, with the consideration that I had an osteomyelitis. I will post pics of the pan, pre-op and post-op scans and any pertinent information. So Greg, I currently don't have an answer. I have had one graft just all out fail in the past and it was done with a mineralized material that was later recalled; the recall of which probably had little to do with the failure. I have become a bit less dogmatic, about arrested Perio dz. and even smokers and success rates have not changed much. This latest case was an arrested Perio case who was practicing excellent home hygiene. I saw the case 10 days before uncovering and encouraged gentle brushing of the adnexal tissues, just to condition the gingiva so that his restorative Doctor could get moving a bit more quickly. I expect you all to take no prisoners and in the end, help me figure out what may have been our problem. I am concerned that he may have functioned on the covered fixtures subconsciously, even though our follow up is rigorous. Excuse me for butting into your question, but I have never presented a case and did not realize this would take so long to describe. Photos to follow. Baker k Vinci