Tunneling techniques for bone grafting: is it successful?

I have seen tunneling techniques [subperiosteal tunneled flap with particulate bone graft material] for grafting between molars and premolars. This procedure looks very simple. Is the buccal bone decorticated or scored? How successful is this technique?  What are the potential complications?

20 thoughts on “Tunneling techniques for bone grafting: is it successful?

  1. CRS says:

    Sounds like the old Hydroxapatite non resorbable graft technique done years ago. The tunnel was to keep the graft from going everywhere. This was for ridge augmentation for dentures. You can make a nice subperiosteal pocket for a graft but it is difficult to decorticate the bone without tearing or stretching the tunnel. Do you have a reference that I could look up online to be sure what you are talking about? Thanks

  2. Peter Fairbairn says:

    Yes CRS these were done years ago in Hannover Germany but from about 4 yeasr ago there has been a bit of a resurgence with my good frined , Karl Heinz Heuckkmann and Professor Benner ( doing the Histology ) of Munich in co-operation with Meissinger . They have shown some very Impressive results but as with all things that “look ” easy it is NOT.
    There is a Meissinger Kit specificcaly for the procedure to help in Troughing the buccal plate yet not damage the soft tissue . Google them to see it .
    The choice of particulates is critical as the graft needs stabilty and their surgery was done using Easygraft ( not in US at moment ) from Sunstar.
    Strangely I did one last week but as said seems easy but to get desired results is as usual not and skill is needed.
    Peter

      • CRS says:

        Peter checked out on UTube (Ihave no life!) seems a lot easier than the old HA augmentation, do they ever use a soft splint to mold nd protect the material as it integrates, that way you can control the result. I used to wax the model exactly how I wanted it the make a soft splint to hold the material for 1-2 weeks, helps prevent collapse and th patient manipulating it. But that was with particulate HA which moved all over th place. Can you tell me about the graft material and can implants be placed after it heals? You could not with the old HA. I would just be concerned with collapse, I like to use a Teflon reinforced membrane or osetowrap with an open technique but this could be a simpler way when you already have the instruments and skill set. Thanks.

  3. Dr. Ajay Vikram Singh says:

    yes friend,

    The tunneling technique can be very successful in several bone augmentation cases.
    It is least invasive with minimal post operative complications. To perform this technique, one should be aware of the type of bone defect and the graft material is used. Because it is a blind technique so the 3D ct planning should be done to evaluate the bone defect. It is success full in lateral as well as vertical bone augmentation procedures. I have very successfully been performing this technique since many years and have described this technique with the step by step diagrammatic presentation followed by several clinical cases in my Implant book title “CLINICAL IMPLANTOLOGY” recently published with the “Elsevier”
    You will also be able to learn various other advanced implant techniques in this 670 pages hard cover book.

  4. Dr. Ajay Vikram Singh says:

    to perform this technique successfully, you should make a small vertical incision at the distant position from the defect and with the subperiosteal tunnel you should create a subperiosteal pouch over the defect. For the predictable success you should mix the bone substitute with the PRP/PRGF/PRF because the platelet rich preparations not only enhance the new bone growth potential of the graft but also bind the graft particles together to keep them localized over the defect. Deposit the graft under the pouch through the tunnel. It takes little more time to form new bone than the usual open grafting techniques (where you can decorticate the host bone to receive nutrient supply).

  5. Richard Hughes, DDS, FAAIP, FAAID, DABOI says:

    Yes the bone has to be scored. You need more than the blood from the periosteum. You also need blood from the bone. If you do not penetrate the bone you will probably get a boney bridge on the outside and nonunion between the graft and bone. Fabricating a stent to protect the site is also advised.

  6. Peter Fairbairn says:

    Hi CRS , yes the key is the material as stability is critical . The material , again you can google is BTcP ( classic ) and Ha and BTcp , 60/40 ( Crystal ) which is coated with a pol-lactide which when wet using a bio-linker ( N2 MP) , becomes sticky when you inject the material into the tunnel and literallt mould it proir to it setting .
    the coating breaks down over 3 weeks which can be varied with varied mixing.

    As you saw there is a whole kit but with difficulty it can be done without.
    I will be in US in 2 weeks to talk .
    Regards
    Peter

  7. G.Bobier says:

    Michael Block published this technique in JOMS and OMS Clinics of North America. I have done at least 50 cases. Very easy-needn’t score bone. Proper technique facilitates containment. I use Puros and wait 4 months. Most applicable in mandibular bicuspid and molar areas.

  8. Jaroslaw Pospiech says:

    I have over 2 years experience in tunnel method of ridge augmentation. I agree it is not a very easy method but has a lot of advantages if it used properly.
    As a graft material I use mostly HA/ beta TCP 40/60 always mixed with PRF or bone marrow aspirate. I use a special surgical surgical protocol with bone activation prior the main surgery.
    The results are very promissing.
    I have developed a a set of instruments produced by Aesculap/CHIFA called MILA-T
    More information ( movie and catalogue) you will find on infini-ti.com

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