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48 thoughts on “Case: Next Paradigm in Bone regeneration

    1. Hi CV , It is undergoing FDA approval at the moment , so will take a short while but DDSGadget sells some nice CS products which are FDA approved and follow the protocol that we have published ……

  1. Why are you not posting any X-rays 9 months after the implant insertion?

    I wonder if it is joined with the patient’s own tooth and if it is cement or screw retained restoration.

      1. To post more photos, simply post the case again with the additional photos and we’ll add the new photos to the case. Please be sure to use the same email you used when you first posted the case so we can identify you.

    1. Hi Will get to it just busy …. I never splint to other teeth and rarely/never splint Implants as function of implants makes bone better as long as the is no foreign matter in it we knew that 125 years ago with Woolfs Law ..

  2. Hi Peter
    In the case you show here, the palatal wall is still pretty good. If the palatal wall is also damaged like the facial wall, would the surgical protocol be still the same, ie simultaneous implant placement, NO membrane, loading at 10 wks?

    1. No Problem we have a video case or two here on this site with no palatal plate just graft prior to placement , no primary stability ( Not important ) no membrane ( a hinderance to healing ) and No Autogenous ( Dead stuff that the host needs to get rid of ) ….. can load in as little a 6 or 8 weeks but I am old fashioned so leave it to 10 and like to use Osstell

  3. What do you mean by “just graft prior to placement”? Don’t you have to screw in the implant first (even by just a few threads) and then graft around it?

    Also, please post a link to the video that show a case where both facial and palatal walls are missing. Thanks very much.

      1. No , but he is inspirational to us but remember these material and ideas have been used since 1890 in Medicine by Dressman …….
        Nothing new …. just a re-think and material improvement ..

        1. Thank you…I agree and furthermore, I feel that credit should be given him for his original landmark work with this material in periodontal regeneration, at least as an historical reference

  4. Have you used successfully this material (as opposed to a block graft) for a large vertical ridge augmentation where 4mm or more of ridge height is to be regenerated and 2 or more implants in a row are to be placed? If yes, do you place the implants simultaneously and use any membrane?

    1. Yes OMS and yes follow protocol that is published ( in Open Access as need free ability to Download ) ……. always removal 3 week healing the place and graft with no membrane ( have not used once in 3,500 grafts ) ….
      Vertical growth in the posterior mandible is case dependant …. and if extreme we have cad cam block of same material ………. place with a tunnel incision with particulate ….
      BUt the main issue is to return the host back to their previous state ……Healthy own bone …. like they would in Medicine.

    1. Depends where you are and what is available ? it is hard for me to comment on mixing as there are a lot of variables .

  5. Very interesting technique. I see that in most of the cases the implant is still within the boney envelope as the teeth were recently extracted. Can a variation of this technique be used for situations where there has been horizontal bone loss, for ridge augmentation or during placement of an implant when there may be some threads exposed coronally? Also, is primary closure critical and what happens if surgical site becomes exposed?

    1. I Agree ….. as these cases are slam dunks relatively , daily routine cases , more complex cases some placed in one walled situations are published but , I prefer for Dentists to start on the easier cases .
      Closure is helpful but not critical and we have published on soft tissue healing by secondary intention over a stable graft material ….
      We have a case published where we used this material in a socket graft and photographed it every day for three months to shows this ..

      1. Dr Fairbain,
        In more complex maxillary anterior cases where significant vertical and facial bone needs to be rebuilt to anchor implants, like in an auto accident where the wheel took out the maxillary central and laterals incisors (but some palatal and apical bone is still present but the palatal height is now reduced some), after flap reflection and de-granulation, can one use titanium tenting screws who’s head is placed to the ideal vertical height and the facial is placed 2 mm lingual to the “ideal facial boney dimension” desired, then fill cs+tcp (ethoss) all around the titanium tenting screw, up to the head of the tenting screw, do you think it will it frequently grow bone to the height of the tenting pin head, and all around it? 3 months later removed the tenting pin and place the implants? (I know it is a little slower than the way you do it, but I have my reasons…).
        Would you still use small size b-tcp in the ethoss mix, in even large defects?
        How do I find “a video case or two here on this site with no palatal plate just graft prior to placement , no primary stability”. No palatal plate? it it worked?
        I need help! Please help enlighten me,

      1. Yes I have used these materials for 14 years …… and they are great with new research showing us why ( Medical research with Impact factor 12 !! ) ….
        Have used a fait bit of Easygraft and have nice cases ….

  6. I use a number of Implants as when lecturing on grafting , I like to show the use the sponsors implants in my talks ….
    But here using a DIO SM which I like and have been using Paltop as well , really like them as well ….

  7. There seems to be something different here. It just looks like the old TCB. I’ve used Tricalcium Phosphate before and was not that impressed compared to the use of even demineralize human bone for onlay grafts (I generally use mineralized with a membrane for onlay particulate grafts, because without the membrane most everything is enveloped by the connective tissue and mineralized sticks around longer). Usually TCP seems to be even less substantive than demineralized human bone… Is the “CS” an additive like recombinant BMP?


    1. Hi GB , yes there have been dramatic changes and understanding in these materials , this has been an orhtopeadic led over the years ……… but the past always lingers like a 70s Car compared to now .
      Unlike donor materials the changes can be dramatic ….. xenografts are the same as they were 20 years ago …………. progress through design and understanding has occurred ….
      I can post a real thought provoking video on here to really make the scale of this advance visible …………… host led regeneration with simple materials is a reality …. we just need to discover it in Dentistry..

  8. Hi Peter,
    Since this material is not yet available in US, I’m considering two options: mixing CS with an allograft OR mixing CS with a b-TCP (such as OsseoConduct, Cerasorb, Synthograft….). Which option do you think will produce better result? If CS+b-TCP is better, does it matter which b-TCP to be used?

    1. VD , sadly yes BTcP is very variable and is the important component …….not sure but maybe with allograft in the US as have had great results …

    1. Agree theoretically would be ideal but these patients are the issue …… always remove the crown put cover screw back on and let the gingiva heal over ….. then a month later flap and clean ( prophy jet ) and graft and allow to regenerate under the gingiva….
      Safest way for result


  9. Peter, could you please elaborate further on the role of the b-TCP component in your composite graft material? How is it different from other b-TCP such as Cerasorb or Osseoconduct…?

  10. No dr Fairbairn,
    I am a user of ethoss since last year, you said earlier about cad cam blocks of same material like ethoss. How can we get access to them; Alternatively can we use a block of b-TCP from medbone and ethoss particles to fill the spaces and give the shape of the ridge;
    2) in large cases can we use osteosynthesis plates to relieve the pressure and tension from the flap? Because from what I conclude in gbr the tesnsion and pressure from the flap is as important as the graft material

    1. Hi John , yes still working on the blocks ….. and finalising FDA for EthOss …. it always takes longer with regulation ……..
      But yes can use a Medbone Block …… and EthOss .
      We have been working on Tenting techniques using resorbable sutures with great results and will be publishing very soon …….I feel this is more exciting than blocks in many ways .
      But email me for the ideas with Sutures and update on blocks …
      Regulatory issues are always out of your hands ..

      1. I do believe that renting is more exciting than blocks… For the time being I am using osteosynthesis plates in the coronal part of bone in order to absorb pressure and tension from the flap and I do only horizontal incision in order to create a form of pouch. Do you have any cases with extended edentulism requiring 5mm of ridge augmentation either vertical or horizontal;

        1. Great idea and yes vertical on an extended edentulous area is tough without a block or Ti Mesh ……. the CAD/CAM blocks will be great as highly porous and BTCP but will take longer than we thought..

          1. So, if you have a case with an edentulous maxilla in which you have to gain 3-4 mm in height and 3-4 mm in width, that means you need a really 3d reconstruction what would you do? My option would be to place the implants, leave them exposed buccally and palatally and place osteosynthesis plates between the implants to help tenting and place ethoss. But I would like to know what would you do..

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