Bone Grafting for implants
Dept. of Oral and Maxillofacial Surgery, School of Dentistry, Wonkwang Univ.

Kwon, Kyung-Hwan
Diagnosis and Treatment Planning For Bone Augmentation
A complete intraoral examination
Radiographs and in select cases a CT scan
Neurovascular bundles must be avoided.
Paranasal sinus must be identified.
Study models
Clinical Examination
Minimal obtain 1 to 2mm of attached gingiva
Cross section of the alveolar depicting periodontal probe placement for “sounding the bone”.
To determine bone width
Cutting the study model in the exact vertical location
To Determine Bone Width
Radiographic Examination
Panoramic radiograph
20 to 30% distortion/magnification of the anatomic structures
Buccal to lingual width will not be appreciated
Alveolar bone height, adjacent teeth and anatomic structure
Study Models
Fabricate a surgical stent
Guiding to the exact site of implant placement
Diagnostic wax-ups
Arch form, tooth spacing, and bony contour
Types of Bone Grafts
Autograft
A graft taken from on anatomic location and placed in another location in the same individual(e.g., iliac crest)
Allograft
A graft taken from a cadever treated wit certain sterilization and antiantigenic procedures and placed into a living host
Alloplast
A chemically derived nonanimal material
Xenograft
A graft taken from a nonhuman host for implantation into a human host
Biology of Bone Grafts
Phase I
Osteogenesis: Immediate proliferation of transplanted osteocytes and subsequent formation of osteoid(immature bone)
Phase II
Osteoinduction: inducement of mesenchymal cells to produce bone(BMP)
Osteoconduction: framework or scaffold for the formation of new bone tissue
Mandibular Ramus
To create an incision starting on the lateral border of the ramus approximately 1.5cm above the mandiblular occlusal plane and ending at the mandibular second molar region
#9 Molt periosteal elevator: full thickness mucoperiosteal flap

Mandibular Ramus
Mandibular Tori as a Donor site
Grafting of the Extraction Socket
The teeth are extracted atraumatically preserving the buccal bone.
All granulation tissue is excised with the use of a surgical curette or a Rongeur.
DFDBA(deminerized freeze-dried bone allograft) + Gore Tex Mem.
Extraction Socket Grafting
Cortical Onlay Bone Graft
Inadequate buccal to lingual/palatal width
Autogenous bone: donor sites-mandibular symphysis, mandibular ramus, calvarium or iliac crest
Allografts: demineralized freeze dried bone allograft blocks, freeze-dried blocks, and/or particles
Bone Harvasting from the Chin
Buccal sulcus incision: canine to caine
Full-thickness mucoperiosteal flap
Avoid the mental nerve
Level approximately 5mm below the apices of the mandibular anterior teeth

Bone Harvasting from the Chin
Small curve monoplane osteotome
Hemostasis: Avitene(MedChem Products Inc., Woburn, MA)
3-0 Vicryle suture on a tapered needle
First approximate periosteum with multiple intterupted sutures being careful to maintain the mentalis muscle
그림
Interpositional Ridge Graft
The approximate depth of the osteotomy should be 1cm.
A bibevel chisel is used to gently outfracture the buccal plate and allow enough width for the proposed implant
Split ridge technique
Rigde split technique에 대한 그림
Sinus-Lift Procedure
Dept. of Oral and Maxillofacial Surgery, School of Dentistry, Wonkwang Univ.

Kwon, Kyung-Hwan

Sinus-Lift Procedure definition
Taum OH(1977)
Introduced crestal approach to the sinus membrane
In 1986, modified Caldwell-Luc lateral window
The grafte material is inserted between the antral floor and the Schneiderian membrane(lining of the maxillary sinus floor)
Evaluation of Sinus
Fixture failure will result because of the downgrowth of antral epithelium aroud the fixture rather than by the superior growth of oral epithelium
Protocol of Sinus Lifting Indication
4 mm below: Lateral window technique
4-6mm :Summer’s Osteotome technique
6mm above: Simultaneous implant with bone grafting
Graft Material for Sinus Lift
Autogeous Bone
Hip/ Tibia/ Symphysis/ Ramus/ Maxillary tuberosity
Allograft(obtained from human cadavers)
Freeze-dried bone/DFDB
Xenografts(Bone from nonhuman species)
Bovine bone(Bio-Oss)
Alloplastic(Natural and synthetic bone substitute)
Hydrozyapatite/ Tricalcium phosphate(TCP)/ Bioactive glass ceramics
Time Tables
Waiting between 4 and 9 after grafting for implant placement and an additional 4 to 6 months before placing final restoration
In my clinics, Simultaneous implantation study show result of 95% success rate. but, case by case
Surgical Protocol
Surgical Protocol
Round diamond #6 burr
Surgical curette is place in the edges of the inferior osteotomy between the bone and the antrum and gently used to peel away the membrane from the inside wall of the sinus
Perforation of membrane: CollaTape used
Leave sutures in place fo 7 to 10 days
Antibiotics, analgesics and decongestant coverage
Sinus lifting 그림
Principles of Implant Surgery
Essential Critical Factors-Implant placement success-
Minimal trauma
Biocompatible material
Buried and untouched for 3 to 4 months before prosthetic loading
Copious internal or external irrigation to minimize thermal bone demage
Precious attachment of implant and prosthesis
Relative Contraindications
Uncontrolled diabetic patient
Significant smocking history
Jawbone irradiation less than 1 year before implant placement
Acute psychotic disorders
Severe bone resorption in patient who refuses bone grafting
Minimal Dimensional Parameters
At least 1mm of excess bone: both the lingual and buccal or labial side
At least 2 mm of bone: implant and any adjacent tooth or implant
Vertical ridge height must ideally provide a 1- or 2 mm margin of safety from the inferior alveolar mandibular canal, maxillary sinus, and other adjacent vital structures
Adequate vertical space: minimum of 8mm
Implant Work-Up Protocol
Appropriate X-rays
Panoramic film
Periapical X-rays
CAT scan(if deemed necessary)
Lateral cephalogram(when indicated in edentulous lower arch)
Models of upper/lower arches
Mock wax-up of missing teeth on mounted upper/lower casts
파스텔톤
Bone Grafting for implants
Dept. of Oral and Maxillofacial Surgery, School of Dentistry, Wonkwang Univ.

Kwon, Kyung-Hwan
Diagnosis and Treatment Planning For Bone Augmentation
A complete intraoral examination
Radiographs and in select cases a CT scan
Neurovascular bundles must be avoided.
Paranasal sinus must be identified.
Study models
Clinical Examination
Minimal obtain 1 to 2mm of attached gingiva
Cross section of the alveolar depicting periodontal probe placement for “sounding the bone”.
To determine bone width
Cutting the study model in the exact vertical location
To Determine Bone Width
Radiographic Examination
Panoramic radiograph
20 to 30% distortion/magnification of the anatomic structures
Buccal to lingual width will not be appreciated
Alveolar bone height, adjacent teeth and anatomic structure
Study Models
Fabricate a surgical stent
Guiding to the exact site of implant placement
Diagnostic wax-ups
Arch form, tooth spacing, and bony contour
Types of Bone Grafts
Autograft
A graft taken from on anatomic location and placed in another location in the same individual(e.g., iliac crest)
Allograft
A graft taken from a cadever treated wit certain sterilization and antiantigenic procedures and placed into a living host
Alloplast
A chemically derived nonanimal material
Xenograft
A graft taken from a nonhuman host for implantation into a human host
Biology of Bone Grafts
Phase I
Osteogenesis: Immediate proliferation of transplanted osteocytes and subsequent formation of osteoid(immature bone)
Phase II
Osteoinduction: inducement of mesenchymal cells to produce bone(BMP)
Osteoconduction: framework or scaffold for the formation of new bone tissue
Mandibular Ramus
To create an incision starting on the lateral border of the ramus approximately 1.5cm above the mandiblular occlusal plane and ending at the mandibular second molar region
#9 Molt periosteal elevator: full thickness mucoperiosteal flap

Mandibular Ramus
Mandibular Tori as a Donor site
Grafting of the Extraction Socket
The teeth are extracted atraumatically preserving the buccal bone.
All granulation tissue is excised with t

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