What complications are people seeing with block grafts?

Mon, 02/08/2010 - 17:43 — Dr Chace Heatly

There has been much talk about complications with block grafting. I dont see these as much. What types of complications are people having and what are they doing to avoid them?

Block Grafting

Sat, 06/05/2010 - 16:29 — Mike Hollister DMD

block graft complications: usually rare but happen

I been doing blocks for years. I have had my share of complications.

In general:

1) Pain and swelling is most common
2) Altered feeling in lower incisors
3) Nerve injury
4) Chin ptosis

Follow good surgical principles and these can be avoided.

A cone beam ct also helps reduce these issues.

Ramus less then chin

Mike

Fri, 02/19/2010 - 05:44 — Logan MD DMD

Block Grafting Complications....Less with Ramus

If at all possible I will try and do a Ramus over a chin graft......Less complications.

I think if you follow proper surgical guidelines the complications in general are low.

As Sammy said, closure in a chine graft is critical in reducing complications.

Sun, 02/14/2010 - 10:49 — Dean Spivey

Sammy and Dr. Shu a question on block grafts complications

Sammy and Dr. Shu I agree with both your comments. Are you doing more ramus then chin grafts in your practice?

How do your feel 3d imaging has enhanced your practice?

I myself dont do a block without a scan. I been fooled before and I think this is why I see less complications.

Sun, 02/14/2010 - 20:29 — Sammy Noumbissi...

For Dean: Ramus vs Chin and 3D imaging use

Thank you for your comments and questions. I do very few chin or rami lately unless a patient insists on autogenous which has become pretty rare in my practice. When it happens I go for the chin and yes 3D imaging is a constant in my diagnosis and Tx planning protocol of block grafts. 3D imaging definitely helps you prepare and minimize complications and once you are in surgery you no longer have to go through an exploratory phase during your surgical procedure.

Sun, 02/14/2010 - 10:45 — Dean Spivey

Dr Wentkel a question on blocks complications

Are the complication you seeing yours personal or from other providers? I do many blocks and dont see the complications.

Tue, 02/16/2010 - 05:30 — Dr. Wentkel

Answer for Dean on block complications

I would say I am seeing more from other providers. Mostly managing pain and some failures. Not to say I havent had my fair share complications. Definitely more issues with chin then ramus.

I would say most often I am treating a failed case from another provider. Not to say that anything was mistreated, just didnt work for whatever reason.

Wed, 02/10/2010 - 06:50 — N Shumaker DDS MS

Block Graft Complications

I've done quite a bit of block grafting symphysis/ramus harvests with good results. I think knowing your boundries and selecting the patients carefully is critical. Where people get into trouble is trying to do block grafts on everyone....not every patient's anatomy is amenable to block harvest without morbidity....proper site selection is critical. Overall ramus grafts for me have near zero morbidity when only done on patients with 1-1.5cm of bone between the anterior ramus/external oblique and the IAN. Symphysis grafts do have some morbidity...mostly devitalization of lower anterior teeth and a small area of paresthesia. According to Misch's article comparing ramus and symphysis, ramus has about zero morbidity, but symphysis shows 10% incision dehissence, 10% paresthesia, and 30% incisor devitalization. This mirrors what I have seen in my practice.

Honestly these days I have perfeted my allograft/xenograft GBR, allograft block, and ridge split techniques so much that I have little need for autogenous blocks or autogenous bone at all anymore.

Dr Shu.

Wed, 02/10/2010 - 05:31 — Dr. Wentkel

Complications from block grafting

I have seen nerve injury, infection, wound break down, and damage to adjacent teeth from cases that I had to manage from other providers.

Blocks are a nice alternative if you know what you are doing.

Wed, 02/10/2010 - 13:13 — Sammy Noumbissi...

Block Graft Problems

I agree with Dr.Shumaker, block grafts are not a panacea for all large defects in all patients. Harvest sites should also be selected carefully and 3D imaging is of invaluable assistance in such cases.
The wound issues people are having especially when harvesting from the symphysis mostly in my experince come from poor wound closure and poor postOp handling of the symphysis area. You have to remember when you open that horizontal flap, depending how low in the vestibule you are, you will go through muscle (Mentalis). You also have to make sure you harvest far enough below the apices of the incisors. When closing after harvesting, a two layer suturing should be done, first the muscle with resorbale sutures and then the vestibular tissue; Prior to releasing the patient, they should be provided by your office with a chin strap or some type of a facial compression garnment that will help minimize swelling, the movement of the chin area, and muscles for the first few days.