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Palatal Bone Block Graft to Augment a Deficient Ridge

Last Updated: Mar 29, 2016

Case from Dr. Howad Gluckman, of Implant & Aesthetic Academy.A classic case in a missing lateral with a thin ridge and an even more severe deficiency mid and lower body. This is a case that can be treated with many different protocols from resorbable membranes, which in my hands would achieve a very small increase in bone, to a non resorbable titanium reinforced PTFE or Titanium Mesh which would achieve outstanding results. I chose the PBBG (Palatal Bone Block Graft) as there was a ton of palatal bone which was easily accessible as well as a Thin Gingival morphotype. I do not generally do non-resorbable membranes in thin gingiva whereas a bone block has been shown to work excellently in thin morphotypes. The turn over of the bone to natural bone is 3 months and will be exposed at that time. The screws will be left unless they become an aesthetic problem. This case case also features a new design Bone Block Holder available soon from Helmut ZEPF.

7 Comments on Palatal Bone Block Graft to Augment a Deficient Ridge

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Dr KG

3/29/2016

Good Job Dr. I would do 2 stage implantation.though, because there was barely vertical solid bone.

Dennis Flanagan DDS MSc

3/29/2016

This case could have also been treated with a flapless ridge split and expansion with immediate placement. With sufficient insertion torque immediate loading could be considered. Dennis Flanagan DDS MSc

Howard Gluckman

4/6/2016

Dennis this case could not be treated with ridge split at all. The defect in the id bone area is pure cortical bone there was no medullary bone at all. All that would have happened is that the bone would have resorbed after treatment. We want 2-4mm of buccal bone over an implant

Peter Fairbairn

3/30/2016

Or just a layer of synthetic for true host bone in a few weeks and great long term result with a bonus of improved attached keratinised soft tissue ........ not heroic , just work with host healing .... I have not used autogenous for 13 years in last few thousand grafts ......... as I do not have Howies skill set so need the host to heal itself. Good stuff , very impressive work , enjoy India. Peter

Gary OMS

4/6/2016

I agree. You can do the same thing with bone substitutes. If you like to put in screws, for whatever reason, use the bone layer technique. I only use screws in trauma surgery, orthognathics and block grafts ( although these are becoming rare ).

Hows

4/6/2016

all techniques are possible here but Autogenous still remains the gold standard and the Khoury technique will allow the maintenance of bone in these areas. The harvesting from the palate allows one site surgery, which has an extremely low morbidity as there is no pain or swelling from the palate.

Dennis Flanagan DDS MSc

4/6/2016

Yes I agree, there needs to be 1.8-2.0mm minimum for a long term functional and esthetic result. The B-L-M-D space in this case probably requires a 2.5mm diameter implant for a ridge split. Dennis Flanagan DDS MSc

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