JIACD
The Journal of Implant & Advanced Clinical Dentistry
Block Graft vs Particulate Grafting what is your determinant factor
JIACD
© 2008 Journal of Implant and Advanced Clinical Dentistry. Privacy Policy | Terms & Conditions
Block Grafting eliminated in my practice: Craig Misch lecture
I recently went to a Craig Misch lecture and he says that block grafting and intraoral harvesting is still the best way to go and is low morbidity treatment option. I totally disagree.
I virtually eliminated blocks and autogenous grafts out of my practice. With the advent of putty grafts and growth factors you can more then eliminate the need for autogenous grafts. I get more then enough bone to place the implant with materials like grafton, zimmer putty and so on.
There is high morbidity with block grafting why do it?
Block Graft vs Particulate Grafting: determinant factore
Short answer is size of the defect. If my defect is in need of 4mm or more of regeneration then I will do a ramus or chin block. 4mm or less I will go with a particulate graft.
Blocks have more success in larger defects.
Block Grafting VS Particulate grafting: Go with Particulate
Particulate works great depending on what you’re try to do. For vertical augmentation, you should use a titanium reinforced PTFE membrane with primary closure of the wound. An alternative is to place the fixture and scrape or otherwise harvest some autogenous bone from the same surgical site and place against the nude threads. Then place a xenograft like NuOss, then a titanium reinforced membrane on top of it, again with primary closure.
At the last AO meeting, Craig Misch showed some good stuff using titanium mesh. 4 mm of vertical should predictable. The main downsides to particulate are early exposure of the membrane, and 9 months of healing time. When you place the fixture AND do the augmentation simultaneously, the 9 months is worth it.
Block vs Particulates: patient prospective
I have to agree most of my patients would rather not have a block, however when presented to the patient and lay out the complications are low, they will do a block.
I do a fair number of blocks and doesnt seem to be an issue.
Block vs Particulates: patient prospective
Most of my patients would rather have a particulate graft versus a block graft. Most patients I experienced are miserable after block surgery.
In my hands I rather do a particulate.
Block Graft vs Particulate Grafting what is your determinant
What are your patients prospectives on blocks vs particulate? Based on experience do you find more people have pain with blocks as oppose to particulate grafts? Post op complications?
Particulate vs Block graft
I disagree with mental foramens comments. Block have a definite place. I tend to use blocks if I need 4mm or more of ridge augmentations. If I need less I can use a particulate graft. I usually use puros mixed with calcium sulfate. Works very well.
Blocks have a 98% success in my hands.
Particulate vs. Block Grafting
For me its a non issue. I never use blocks, to much risk. I can build out what I need ridge wise with particulate graft. I use a lot of regeneform these days with some bioss. Works well
Autogenous blocks extinct in my practice
In my practice at least, I have virtually eliminated autogenous block grafts. They work just fine, but the patient just doesn't like it. I am getting great results with ridge splitting, particulate, allograft blocks, tenting screws, etc. I can do 99% of cases that come my way with these techniques.
IMHO, if a case is so bad that it requires hip or calvarial grafts, I am sending it to an Oral Surgeon. I am a Periodontist and I can handle just about any graft that comes my way, but I know when it is best to refer.