Ridge Augmentation for Implants: Block Graft vs. Particulate Bone Grafts?

In my hands, block grafts work the best and more predictable. Particulate grafts for me have been hit or miss in the beginning. I only do block grafts now. Hope this helps.

Particulate is very very unpredictable! Block is the only hope...and even this can be unpredictable. Good luck!

I've moved away from the blocks and use almost exclusively Allograft putty.It is predictable providing space maintaining and pressure free environment.It is also much better regarding patient's morbidity.

Particulate works great depending on what you're try to do. For vertical augmentation, you should use a titanium reinforced PTFE membrane with primary closure of the wound. An alternative is to place the fixture and scrape or otherwise harvest some autogenous bone from the same surgical site and place against the nude threads. Then place a xenograft like NuOss, then a titanium reinforced membrane on top of it, again with primary closure. At the last AO meeting, Craig Misch showed some good stuff using titanium mesh. Basically, the meeting showed a lot of old school being modified to provide conservative treatment options to patients. 4 mm of vertical should predictable. The main downsides to particulate are early exposure of the membrane, and 9 months of healing time. When you place the fixture AND do the augmentation simultaneously, the 9 months is worth it. Sascha Jovanovich is the guru in the US (UCLA), and there are others who have consistently good results.

The world moves forward and newer synthetics ( fully resorbable) that set allow us to achieve predictable results. There has been some work done ( Heuckman of Meisinger ) recently using tunnel grafting on the posterior mandible where up to 4mm of verticle height has been achieved and all the cases have had Histo done at Munich Uni ( Prof Benet) showing amazing results. No complex treatment , no donor site morbidity. We have used membrane and autogenous free grafting now for 5 years with hundreds of recorded cases with very predictable results. Soon there will be a new synthetic block ( completing animal testing now) , the future is I think in this direction and with more products to be released it is exciting and more patient "friendly". It was good to see Zivs lecture the other night here in London

Obtaining verticle ridge height is difficult at best. Protection of said graft is essential. You do not want any dehisence etc. and the list goes on. One may also consider "vital segmented osteotomies". This requires a thought shift. I believe this should be another tool in the box. Dr. Hilt Tatum is teaching this technique.

Richard, I saw Dr. Tatums work in this area at the AAID meet in Dublin in 06 and it was impressive but requires a very skilled operator (as he is ).

Peter, I agree, but one can learn these techniques. Tatum Surgical teaches the "vital segmenyeg osteotomy". Take baby steps and you will master the material.

You may want to consider a sinus lift. You most likely don't need it for the first premolar, likely for the second, but make sure there is enough grafting there if you change your mind about premolar occlusion and would like a first molar. It's very predictable.

the entire title is absurd. this isn't a one or the other topic. it is which is most appropriate for the problem at hand. it is more predictable to gain width than it is to gain height, particularly with particulate. but particulate is the material of choice for sinus augmentation (see steve wallace work). the surgeon may need to do a combination graft here to gain the height and width you need. i suggest you speak with him and ask him what his rational is. there are by the way "block grafts" available from ace surgical and from zimmer. not as effective as autogenous, but avoids the donor surgery. gary

Community Tissue Services (CTS) is the best option out there for all allografts to use for bone grafting. They are a world class tissue bank and have the best pricing in the industry...minimum 30% savings in cost. They have particulate for this procedure and block grafts of all kinds. They have a J Block graft (J Platform) which is being produced as we speak that will definitely put ACE and ZIMMER to shame in cost. And I agree with Gary...it will take away from having to harvest it from the patient...Good Luck!

Peter - which is the new synthtetic block graft under development? Is this from biocomposites who make vital and when is the release date? Any case studies available? Thanks

autogene bone has osteogene effect but resorbs about 18,3% while when mixed with bio-os the resorbtion is 9,3%. the goal standard now is for bio-os which is osteoconductive and resorbs lately and is considered now as non resorbable.in such defect (4mm)it is better to use both autogene bone and bio-os, covered with a resobable membrane like paroguide.the important thing is the stability of the graft and epithelial coverage of the wound without tension that's why you should do periosteum decharge.

Wleed, I cannot comment too much on it but has done animal testing and will be doing initial clincal with it soon but looks and feels good ( flexible ).Are other interesting things out soon and some very good research papers to be show soon. Regarsd Peter

Question for NJHamp. Can you give me the website/contact info for Regenetix?. Try to Google it, but not much luck. Thanks

Peter, a few questions about Fortoss Vital. If you have a lets say 3-4 threads showing at the neck of a implant can it placed over autogenuos particles overlying the exposed thread /or can it be applied directly over the exposed threads - would both work, which is most predictable?. Does it tend it to resorb quickly and do you have to overbuild the defect and the manufacturers recommend a dry field for placment of the graft, how do you best achieve this in a surgical site? Many thanks.

Hi Wleed ,in the last 5 years , over many cases to get back to the 1st thread is not the norm but can happen and is dependant on the shape of the defect created by the bone loss .Mostly we see improvement of a few threads but most importantly in all cases there has been no purulent discharge and a firmly attached gingiva post op ( some cases are 5 years now). You can generally see if new bone has formed by merely probing the area as far as we know soft tissue cannot attach to an implant. The material has generally been fully resorbed at 6 to 9 months depending on the patients physiology . The process of the resorbtion is not fully understood and oteoclasts are only seen at the remodelling stage.The negative charge on the material and the Ca sulphate matrix are proving to be of more importance than initially thought (new Research to be published). As to the techniques excess blood hinders the material setting and must be controlled , but as these areas involve infection the blood is more of an issue. Go and have a cup of tea , time to let the body assist to bleeding cvontrol. Easygraft (Beta tri Ca with a polylactide coating and a Bio linker to enable it to set) can be used where control is difficult ,which have used extensively as well. Place the graft material directly on the implant ,blast clean with a prophy jet (acid etch) prior to placement. As to Autogenous I rarely use it anymore (last 4 years)for three main reasons , Donor site mobidity , leads to osteoclastic activity early on and finally I speak on these materials and the audience may assume that the results are due to the autogenous graft. I am not sure where you are from , but I will be speaking this year in Zurich , Antwerp , Beirut , Nothern Ireland and twice here in the UK maybe we could meet up to discuss. Regards Peter

Thanks Peter, what I meant was 3 to 4 threads exposed on initial placement of the implant, lets in the aesthetic zone due to a dehisence after soft tissue healing to 8 weeks after extraction. Would it be predictable to place Vital directly over the implant surface for bone regeneration. Look forward to meeting you during your uk lectures, when and where will you be lecturing? (I'm based in Shropshire)

Hi Wleed, yes we do that type of repair twice a week and show cases of repair of defects up to 10 mm ( 8 threads) by 6mm wide both buccal and palatal so extreme repairs can be predictably achieved. Some cases we have raised a flap to show the regeneration of the bone at 3 months then at 5 months but generally prefer to probe and scan to assess results. The more we have used these materials the more we see results that have often been very impressive.Regards Peter

Gary, relax.....its just a title.