Dental Bone Graft – Tunnelling

Here is a great technique to use when augmenting horizontal ridge deficiencies prior to implant placement. Dr. Block published an article (…
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23 Responses to Dental Bone Graft – Tunnelling

  1. t5e2 says:

    functional matrix theory FTW!!!

  2. Luis Carlos Leal Santana says:

    Among all materials used in this type of procedure, everyone needs a
    previous bone preparation to render graft/bone stability/protection, growth
    factors, oxygen, bone cells, in a favorable environment. What are the
    possible benefits when you skip all that steps?

  3. All Things Dentistry says:

    I haven’t. Let me touch on periosteum – which is fairly important when
    using this technique. My understanding from lengthy discussions w/ oral
    surgeons and periodontists is that, like many other things, the use of a
    membrane is opinion based. Yes, for the black and white situations, it’s
    fairly solid in the literature that you need a membrane, however, in other
    situations, you may not.

  4. Marc Schmidt says:

    Great idea! How about scratching the bone a bit to get a better connection
    between bone and bio-oss putty?

  5. All Things Dentistry says:

    I’m not sure about using synthetic bone (this is using human and some
    bovine…cow…bone) and it does work for folks without molars. However,
    it’s key that there is enough bone top to bottom (ie vertical height) for
    this technique to work. This technique is only good to increase the width
    of bone.

  6. Engin Kilic says:

    without membran ??

  7. benzacai says:

    can you show the implant placement stage?

  8. SamerDDS says:

    Thank you Mark for the reply and all the great videos…I am planing to
    start using Dynograft putty to fix those implant fenestrations/dehiscence
    areas…haven`t used the material before…but hope it will work better
    than particulate….I didn`t always get the best results with
    particulate+membrane…..keep up the graet work on youtube!

  9. All Things Dentistry says:

    @SwimmerTy1 Great question. The short answer is no. Currently, we don’t
    have a protocol regarding CT scans and postoperative treatments.
    Essentially, we are guided to use the following mantra – “if a CT scan will
    affect your treatment outcome, then take one”. In this situation, (as
    described by Dr. Block as well), you will be able to palpate the “hardness”
    of the ridge. The preoperative CT scan is extremely useful for determining
    length of implant (we’re not using guided implants).

  10. All Things Dentistry says:

    That being said, in a fenestration situation, there probably isn’t a
    periosteum over that implant spot (I could be totally wrong on this) –
    hence, I”m thinking that the tunnel may not work as well as you may want it
    to. I’ve also seen folks repair fenestrations without a membrane. My
    understanding is that the tunnel technique works b/c of a healthy, intact,
    periosteum – which is essentially a membrane in itself. In those situations
    were the periosteum may be compromised, you may not end

  11. Lisa Lewis says:

    I would use Cerasorb it forms beautiful bone.

  12. All Things Dentistry says:

    Same day grafting with implants is a common procedure and is completed for
    a variety of reasons including some of the implant is not totally covered
    by your own bone and some is “packed” onto the side of it to cover
    “exposed” implant threads. There are many others….Hope that helps, Ashley

  13. wrightdental says:

    ….Mark, what are your thoughts regarding prior “osteogenic activation”?

  14. Lisa Lewis says:

    Also I would like to see the CT scan after 8 months. I also want to know
    how you prepare the site. I usually tell drs to use a #8 bur to get the
    blood going. Have you ever tried OsteoWrap to gain an extra 1mm of space

  15. All Things Dentistry says:

    Thanks for the comment. This tunnel technique was developed to increase
    vertical height using hydroxyapatite – it didn’t work. In a brief search of
    the literature, I couldn’t find anything that supports a tunneling
    technique and vertical augmentation w/ today’s particulate materials. There
    are a few that I know of, including, distraction osteogenesis, e-PTFE
    membrane (GBR), autogenous onlay block graft – to name a few. Cheers

  16. giovani ilia says:

    its a great technique but i have a question: you achieved a horizontal
    augmentation. what about vertical. do you think its possible to achieve?
    thank you

  17. giuseppe marinaci says:

    Hi Mark,I use that technique as well with some little differences.How long
    do you wait for placing implants.I experimented that at least 12 months are
    necessary.Have you tried the technique for vertical augmentation?I’m trying
    it,but I need to wait about 5 months more fort the first result.Let me know
    about your experience. Thank you.Giuseppe

  18. Corey Scott says:

    So you put a synthetic bone thing inside would this work for people w no
    molars? what do you know about same day fine grafting with implants?

  19. All Things Dentistry says:

    up with the result you hope for – and just increase the size of the
    fenestration by fiddling around in that region (after 1-2 years). Hope this
    helps. Ashley

  20. wrightdental says:

    Marc Schmidt, I agree w/ the reasoning behind your comment

  21. All Things Dentistry says:

    @SwimmerTy1 Hence, the reason I did not take a postoperative CT scan. I
    felt it would be irradiating the patient without any benefit. I hope this
    helps, Ashley

  22. SamerDDS says:

    Hi Mark, have you ever tried to do this graft to treat any “existing
    implant” fenestration bone lesions?? thanks

  23. DrSamMarkzar says:

    I think in all fairness, you should take a scan, or picture of re-entry ,
    or pictures at implant placement time (at some point)..from this case or
    similar cases… I ‘d like to see how much of the BioOss will remain
    attached to basal bone, and how much of it will be separated by a
    connective tissue layer. The “radiation safety” doesn’t seem strong enough
    of a reason to be wishfully thinking that the Bio-oss particles would stay
    put and integrated after 3 months . thanks

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