Wonderful article this month. Love the Bioderm tech, great technique for pontic site development. Wondering if it would work with other types of materials.
IMHO it depends on what the long term plan is for the site. If it will get a pontic and will not be implanted then use of a nonresorbable osseous graft (ie HTR, HA) will remain the most stable over time. Soft tissue grafts have the potential to shrink over time and what looks great now and adapts well to the underside of the pontic may after 2-3 years develop a space under the pontic and have the pt complaining of food trapping. But this is more of a factor when the pontic is being placed over an extraction site and thought may be given to socket grafting with a material that doesnt resorb that quickly. I think its less of a factor when its an old extraction site as what resorption was going to happen has already occured. My concern is in the pts age as relates to "who knows what they may decide in 10 or more years" so if the pt is over 70 i am less concerned then if they are under that age. Pt may decide down the road if/when one of the bridge abutments fails that they dont want a new bridge but want independant units and as part of that an implant at the edentulous site. In those cases use an osseous graft material like Bioss that will last longer but will eventually convert to native bone. Connective tissue grafts work well when needing to fill as buccal resorptive defect so that the ridge looks like it is the same as the adjacent sites. In those cases you can use host tissue from palate, or packaged material such as Alloderm or Puros Dermis.
Very nice article with great results. A question I have is do start the development of the papilla right away or should one wait for the tissue to heal some post surgery
Nice Technique. Well documented results and looks easy to do.
To answer your question; in the cases I have done with connective tissue, I start developing and molding the tissue ASAP. I usually use ovate pontics to push and mold the tissue.
First off most techniques work, CTG, Ortho, alloderm in the right situations. You have to know when to use the right tool.
I have done the bioderm technique for pontic site development, it works well, dont need a second surgical site. I think it has some limitations. But I do like it and use it.
What is the best way to develop the pontic and gain papilla?
What is the best way to develop the pontic and gain papilla?
I see surgically it can be handled by CTG, HA, Bioderm, VIP and with pink porcelain. What surgically is most predicyable?
What is the proper design for the pontic itself to achieve that?
Dr. Pratt
Predictability of the pontic developlment
IMHO it depends on what the long term plan is for the site. If it will get a pontic and will not be implanted then use of a nonresorbable osseous graft (ie HTR, HA) will remain the most stable over time. Soft tissue grafts have the potential to shrink over time and what looks great now and adapts well to the underside of the pontic may after 2-3 years develop a space under the pontic and have the pt complaining of food trapping. But this is more of a factor when the pontic is being placed over an extraction site and thought may be given to socket grafting with a material that doesnt resorb that quickly. I think its less of a factor when its an old extraction site as what resorption was going to happen has already occured. My concern is in the pts age as relates to "who knows what they may decide in 10 or more years" so if the pt is over 70 i am less concerned then if they are under that age. Pt may decide down the road if/when one of the bridge abutments fails that they dont want a new bridge but want independant units and as part of that an implant at the edentulous site. In those cases use an osseous graft material like Bioss that will last longer but will eventually convert to native bone. Connective tissue grafts work well when needing to fill as buccal resorptive defect so that the ridge looks like it is the same as the adjacent sites. In those cases you can use host tissue from palate, or packaged material such as Alloderm or Puros Dermis.
BioDerm Technique: Very neat but have some questions
I read the article on the bio derm technique
http://www.nxtbook.com/nxtbooks/specops/jiacd_200910/#/32
Very nice article with great results. A question I have is do start the development of the papilla right away or should one wait for the tissue to heal some post surgery
Bioderm Article- nice pontic papilla development.
Nice Technique. Well documented results and looks easy to do.
To answer your question; in the cases I have done with connective tissue, I start developing and molding the tissue ASAP. I usually use ovate pontics to push and mold the tissue.
Bioderm Technique for pontic site development works.
First off most techniques work, CTG, Ortho, alloderm in the right situations. You have to know when to use the right tool.
I have done the bioderm technique for pontic site development, it works well, dont need a second surgical site. I think it has some limitations. But I do like it and use it.
Pontic Site development: Connective tissue graft
I usually do it with connective tissue. I get some shrinkage early on but works well. Read Garbers article.
BioDerm Technique for Ridge plumping.
I read the article and did a case and it works well and is easy to do. I dont think this is the only way to handle the pontic site.
CTG have been the back bone of my practice and you can get great results. I believe in what the article says in that you do get shrinkage.
Pontic site development article- Great JIACD Issue this Month
Overall nice issue this month.