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Achieving predictable results with intra-oral bone grafting and oral soft tissue grafting procedures requires advanced training and experience.

To begin with, the implant surgeon must fully comprehend:

  • The biology, principles, and material science related to bone grafting and guided bone regeneration procedures,
  • The importance of soft tissue management,
  • The role that the quality and volume of the reconstructive soft tissue envelope plays in the long term maintenance of bone graft volumes, and
  • Bone grafting biotechnologies, including:
  • Instrumentation that facilitates site preparation,
  • Graft harvesting biotechnologies,
  • Graft immobilization biotechnologies, and
  • Biomaterials that enhance grafting success.

Case selection is a very important factor.

Guided bone regeneration procedures can be accomplished simultaneously with implant placement with predictability only when the implant is placed within the alveolar housing (implant emergence lingual or palatal to the emergence of adjacent teeth).

Guided bone regeneration procedures become less predictable when the implant will be placed outside the alveolar housing.

When restorative-driven placement dictates implant placement outside the alveolar housing, staged reconstruction is indicated prior to implant placement, and the surgeon will need to perform block grafts or supported membrane procedures.

In addition to the above, the surgeon must understand the principles for successful bone grafting including:

  • Proper aseptic technique,
  • Appropriate flap design to allow passive closure over the graft and barrier membrane complex,
  • Site preparation to expose marrow elements in order to facilitate graft integration by taking advantage of the regional acceleratory phenomenon (RAP),
  • Use of autogenous cancellous marrow grafts because they provide the highest cellular density and osteogenic potential of all autogenous sources,
  • Achieving intimate adaptation and immobilization of particulate and block grafts at the prepared recipient sites,
  • Isolation of the graft with a barrier membrane, and
  • Use of platelet rich plasma as an aid to:
  • Immobilizing particulate grafts and barrier membranes,
  • Improving cellular conduction within the graft during healing,
  • Potentially delivering an increased concentration of native growth factors, and
  • Protecting the site from micro-motion in the postoperative healing period.

Failure is likely whenever any of the above principles are ignored.

Wound dehiscence, graft exposure, infection, partial resorption of the graft, or complete graft failure are likely to occur whenever any of the above principles are ignored or violated. Consequently, I recommend that doctors who desire to achieve predictable results with bone grafting procedures seek advanced training that includes a detailed didactic program enhanced by video surgery presentations and hand-on training that will allow the doctor the opportunity to develop the necessary psychomotor skill required for successful implementation of these procedures within their practice.

With this teaching methodology in mind, I have designed the Esthetic Dental Implant Site Development Surgical and Prosthetic Protocols Course, one of our Intensive Sclar-Center Immersion Courses for clinicians with Intermediate and Advanced experience in dental implants. Case planning exercises will help participants develop suitable implant site development treatment plans according to the type of ridge defect present and other individual case factors known to influence esthetic outcomes. Video surgery footage and live surgery observations will clearly illustrate the details of individual site development procedures and identify and contrast the case scenarios that are amenable to simultaneous hard and/or soft tissue site development at the time of implant placement from those that require a series of soft and hard tissue procedures prior to implant placement. Hands-on exercises will allow participants to sharpen their surgical skills for soft and hard tissue esthetic implant site development procedures.

We have also dedicated a full day to Hard Tissue Development in our annual comprehensive dental implant surgery course (ISTM). During the third day of ISTM, we will cover the principles, procedure details, material science, and indications for performing guided bone regeneration, block bone grafting, lateral window and crestal approaches for sinus lift bone grafting as well as bone expansion and ridge splitting procedures for horizontal and vertical hard tissue augmentation at implant sites. An optional, limited-attendance hands-on surgical workshop is available.

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