SMART Technique: A Revolution in Bone Grafting?

The subperiosteal minimally invasive esthetic ridge augmentation technique, or SMART, has been developed as an alternative to traditional guided bone regeneration procedures. SMART TM was developed by Dr. Ernesto Lee. The technique includes the use of a laparoscopic approach to deliver a growth factor/xenograft combination into a subperiosteal pouch. No flap elevation, cell-occlusive membranes, space-maintaining devices, or decortication procedures are used. The goal is to provide superior outcomes with less pain, less swelling and fewer complications than traditional bone grafting procedures. A recent case report on the SMART technique concluded that it:

Demonstrated predictable and consistent bone regeneration. The average gain in ridge width for all treatment categories was 5.11 mm (SD 0.76 mm), which compares favorably with previously published reports. Morbidity and complication rates were consistently reduced as well. Human histology results show xenograft particles surrounded by newly formed bone. 1

Read the Full Abstract Here

What are your thoughts on this new technique? Courses for the SMART technique start this June.

1. Int J Periodontics Restorative Dent. 2017 Mar/Apr;37(2):165-173. Subperiosteal Minimally Invasive Aesthetic Ridge Augmentation Technique (SMART): A New Standard for Bone Reconstruction of the Jaws. LEE EA,

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4 thoughts on “SMART Technique: A Revolution in Bone Grafting?

  1. This is nothing new…a tunneling technique using particulate bone for ridge augmentation has been described in the literature by a number of clinicians for many years. There are several significant drawbacks to this technique…this is why many surgeons stop using it. The main draw back is getting the particulate bone to stay at the alveolar crest. The bone tends to migrate apically, requiring additional grafting. After having done many of these tunneling procedures, I still prefer to open them…much more predictable in getting crestal bone in one surgery.

    BTW, putting a catchy name and claiming to be the inventor to sell a course and instruments is distasteful. The first paper on this is by Mike Block in 2004 and the technique revised in 2013 :
    Michael S. Block, Mark Degen, DDS, MD. Horizontal ridge augmentation using human mineralized particulate bone: Preliminary results. JOMS 2004
    Michael S. Block, Brian Kelley, DDS, MD. Horizontal Posterior Ridge Augmentation: The Use of a Collagen Membrane Over a Bovine Particulate Graft: Technique Note. JOMS 2013

    1. Dr. Lee is a very well-regarded practitioner and educator, so presumably he has made some improvements to the tunneling technique, you mentioned. He is giving a lecture about the SMART technique at the AO meeting this week, so I guess he will elaborate further then and address the issues you rightfully bring up. In terms, of catchy names etc., I don’t see anything wrong with that. It’s called smart marketing and it’s now commonplace in all of medicine, for better or worse. As long as science and experience back it up, not sure what the problem is. Certainly a course is worth taking, if the technique holds up to scrutiny.

  2. This technique is the best for minor Horizontal ridge defects. However a laparoscope doesn’t add anything to the technique, other than better visualization. Compared to the open flap techniques SMART is definitely a cool and feasible technique. You may perform in your practice and then comment. Thanks

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