56
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CERECDOCTORS.COM
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QUARTER 2
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2016
in this recurring section of the magazine
, we share a sample of conversations occurring online:
An experienced CEREC surgeon seeks advice on bone grafting technique.
D I S C U S S I O N F O R U M
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CHARLES LOGIUDICE
I would like some feedback on how this patient
should be treatment planned. How “do-oable”
is grafting this ridge to make it wider? I would hate to grind
that much bone down to create a wide enough flat area for an
implant. The virtual placement right now is a Straumann BL
4.8 x 8, which can be changed to a 4.1. What are your thoughts?
GREGORY MARK
You can do a ridge
split, Khoury tech-
nique and others.
MARK STOCKWELL
I would think this would be a very predictable
particulate graft to augment the width. I know
many would do it at time of surgery. If I were doing it, I’d do
it before implant placement. I would not prepare the crest
deeper to accommodate the crest module of the fixture, and
I’d rather have that 4.8 over the 4.1 for the molar.
Compiled from
I Wish the Ridge Was Wider
Bone Support Is an Important Factor in Implant Placement.
When Deficient, What Do You Do?
Maybe the 4.1 might allow a single step. I’d graft first, but
I’m not sure of the predictability in my hands to do simulta-
neous grafting. You may also have more length available with
a decent zone of safety if you went with a narrower fixture.
But, as I said, I’d do the grafting first for the larger BL. Just
my two cents.
KURTIS DAVIS
I would place im-
plant, particulate
graft with membrane, then bury
that sucker.
DANIEL NGUYEN
Agree with Kurtis.
If you are a risk
taker — like with your beautiful
molar root canal treatments
and subgingival margins in the cases you have posted — you
can definitely make bleeding points, place this implant, put
cortical mineralized FDBA plus maybe bio-OSS, use a long
resorbing collagenmembrane with or without tacks, and bury
the implant with cover screw. Make sure you get passive full
primary closure.
Or you can always do graft first, then implant.
JOHN DAW
Emil Verban has posted some great cases with
Densah burs used in this situation. I knew
you would be thrilled to have to buy more drills, and there
isn’t a guided solution, but it’s another, somewhat simpler,
solution.
