Oral implantology :: Surgical methods to avoid the need for plastic surgery on the jawbone

Surgical methods to avoid the need for plastic surgery on the jawbone…

… Or what is the view of the Germans about these things and how they do bone grafts?
During my specialty in implantology at the Mussinger Company in Munich, Germany, I learned very effective methods for implanting in unfavorable areas of the jaw called "bone dissection" and for original methods for grafting own bone.
Because I do not have the photo and film material of my captured cases, I will provide to your attention videos that the company provided during the course, accompanied by my comment.

Bone dissection




Crest - Control
It is the alveolar ridge of the bone. These are cases in which the apex of the alveolar bone is relatively thin and at its base is of sufficient thickness. In general, such an area cannot be implanted normally. The top is cut to create a "plateau" with the required thickness, but in this case the bone height is reduced. The clip shows a method of splitting the bone of a two plates with the help of cleverly designed clamps. Then we make bone beds in the normal way and put 1, 2 or as you saw in the case 3 implants. Once the clamps are released and removed, the bone opening is filled with substitute bone.




Split - Control
These are the same clinical cases. We still have a bone cleft, but the difference is that we use special screws and when we screw them into the bone, we set the two bone plates at a distance and then we can place implants. Again, the bone defect is filled with a bone substitute.
 



Horizontal - Control
These are the same clinical cases, but in a smaller area, such as here, where only one tooth is missing. We drill a hole into the bone only through the incision of the gum without making a mucoperiosteal flap. With a special cutter, we scrape the vestibular bone plate  to weaken and then we move horizontally with the "L-shaped" lever, thus opening the implant site.



Vertical - Control
These are cases where we have bone thickness and no height. Instead of grafting, we use this method, lifting the bone through a special one, I would call it a "mini-jack" and when the bone heals, we implant.

Bone grafts
Transfer
Horisontal augmentative graft




These are cases where the tip of the bone is thin, but also there is not enough bone and under it, so splitting will not help. With a special cylindrical borer, we make a bed for the future graft. With a special trepan-borer of the same diameter, we take the graft from the donor site, move it and place it in the bed already formed. We fix with an osteosynthetic screw. After integrating the graft, we remove the screw and insert the implant.

Vertical augmentative graft – These are cases of loss of more than one tooth and when the bone is thick but has no height. Similarly, we build up the bone in height..



Transfer – ring Control
These are cases of loss of a tooth, where we have bone thickness but no height. We take a ring from the donor place with trepan borer. With a special cutter, we make a bed in the bone, where we move it and transplant it. Once it integrate, we place the implant.



Transfer – ring Control, direct implant method
These are analogous to the above cases, where we make an open for the implant in the annular graft. We transfer the graft on the new place where we make the same hole and place the implant directly.

Here is how before I went to this specialization, at the time when I was doing training courses in Sofia, I was teaching bone auto grafting.





Fixed graft - top view.



The work of another student with more precise manufacture. To see a clinical case, go to Multimedia. There the graft we fix with ligature wire - the other way of fixing. My movie shows the old method of grafting, ie. through multiple bone perforations. Now this we do either with special purpose rotary instruments (trepan - borers), or with piezo surgery, very elegant and atraumatic.

Contact pfhristov@yahoo.com for more details

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