Dental Bone Graft - Tunnelling

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Here is a great technique to use when augmenting horizontal ridge deficiencies prior to implant placement. Dr. Block published an article (www.ncbi.nlm.nih.gov/pubmed/15...) describing the technique presented in this video.
It is the horizontal augmentation of an edentulous ridge using a subperiosteal tunnel and osteoconductive, particulate bone graft. There is a significant decrease in the postoperative pain/swelling as compared to other horizontal ridge techniques, and it can be completed under local anesthesia within 30 mins. The patient was prescribed antibiotics and analgesics post operatively. This technique will not allow for the vertical augmentation of edentulous ridges. Thank you Dr. Block and to my OMS mentor, Dr. Kris Hart.
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4 авг 2024

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Комментарии : 32

@renaissanceman21c 6 лет назад

I'm assuming that the periosteum prevents epithelial cells from growing into the graft material? Is that correct? Also, without making perforations into the cortical bone, doesn't that greatly decrease the likelihood of the graft taking?

@israeldentist 7 лет назад

This technique does not grow bone in any predictable way. Research (one 5 case study paper) does not at all support this technique's use as a regular type of graft technique in your practice. You need cortical perforations and membrane for most cases. Many have tried this way and failed!

@AllThingsDentistry 12 лет назад

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

@arunkhatri3767 7 лет назад

great work....

@SamerDDS 12 лет назад

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!

@renaissanceman21c 5 лет назад

Why does this not require a membrane? Without a membrane, won't you get epithelial cells growing into your graft material?

@mgsmuc 11 лет назад

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

@AllThingsDentistry 12 лет назад

@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

@AllThingsDentistry 12 лет назад

@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).

@AllThingsDentistry 12 лет назад

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.

@ramirez30 10 лет назад

Excellent . What is the bone quality that you have found using this tech. Does it stay where you want it to.... Is it predictable ? Does the material get encased at all in the soft tissue does it form a distinct compartment. Does the biotype change the success at all.

@droscar1970 3 года назад

Hi Doc ! I have a question, how do you preform the periosteal tension free ? Regards !

@wrightdental 11 лет назад

....Mark, what are your thoughts regarding prior "osteogenic activation"?

@SamerDDS 12 лет назад

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

@ramanangra9768 7 лет назад

how much graft (cc ?????)did u use to augment?????

@panimpas 12 лет назад

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

@UKOR1925 11 лет назад

without membran ??

@AllThingsDentistry 12 лет назад

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

@lslofssi 11 лет назад

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 horizontally?

@bar_jeremaia 11 лет назад

can you show the implant placement stage?

@giuseppemarinaci434 11 лет назад

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

@ulivix 12 лет назад

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?

@AllThingsDentistry 12 лет назад

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

@AllThingsDentistry 12 лет назад

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

@xqg1981 Год назад

Do you still choose to use this technique looking back 10 years after?

@lslofssi 11 лет назад

I would use Cerasorb it forms beautiful bone.

@AllThingsDentistry 12 лет назад

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.

@gregdanielm 4 года назад

Has your opinion on this technique changed since you posted this video? Are you still happy with the techniques and results? How long till implant placement?

@wrightdental 11 лет назад

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

@hopesohee 5 лет назад

What about allograft?

@AllThingsDentistry 5 лет назад

DR. SOHEE Kim hi there. Such a great question. I just looked up a lit article and here it is!! The original paper on this topic used xenograft (if I can remember correctly) and this article talks about using allograft. www.joms.org/article/S0278-2391(16)30131-8/pdf