Vertical ridge augmentation is challenging and unpredictable while horizontal is quite predictable… IMHO. I know Istvan personally and have sit through a number of his presentations and he is capable. While he is capable of demonstrating success on the podium with vertical augmentation I have yet to see many people repeat his success. Thank you though for showing a case as an example of his technique… Could you perhaps show something similar-in the maxilla-with follow up…
I honestly don’t mean to throw shade on your case that you attached but it appears that this “sausage technique” was only successful in filling the “voids” left from the previous extractions. The pre-op shows what appears to be healing extraction sockets and the extent of you vertical augmentation is only to the extent of the native bone peaks. This is essentially a glorified socket preservation and does nothing to justify complex vertical augmentation. While your technique and attention to protocol is impressive this is not vertical augmentation and should not be touted as such. Otherwise nice job though!!
I suppose that your plan is to go back and augment the soft tissue at a later date? Or do you plan to keep all of this work safely guarded under the protection of thin unattached mucosa? While “implant” related courses do a great job of promoting and selling bone grafting materials there is rarely a mention of the soft tissue which is tasked to protect this stuff.
not at all scotty. It’s your duty to be skeptical, scrutinize and question dental treatments of others and you own. i have a thick skin. no problem. vertical GBR just seem impossible if it’s not Urban doing it. I understand. by your definition then all GBR are glorified ridge preservation bc there was a tooth at the edentulous site once upon a time. but your incorrect, ridge preservation is D7953 in extraction socket and GBR D7950 in edentulous site. different codes different techniques different price. pt had severe bone loss horizontally and vertically due to severe periodontal disease, ie attachment loss. first I had to remove teeth #18,19,20 and waited a month to gain enough soft tissue to cover the site. I had to sacrifice #20 because the distal interproximal bone was too low. a successful vertical ridge augmentation. i found out, the interproximal bone on the either side of edentulous ridge have to be as high as possible. Urban mention this but not strongly enough. #21 distal inteproximal bone is higher. Ive outlined (RED) original alveolar ridge. so i did gain some vertical perhaps 2-3mm. IF you just did a normal ridge preservation (D7953) with collagen membrane and primary closure, the result will be flat or a shallow concavity at the extraction sites. not only no vertical gain. perhaps a little vertical loss (outlined GREEN). Since i don’t have a CT at this office, i really can’t show you the gain in vertical and horizontal accurately. If i had CT to show you actual numbers when I’m sure you would be even more impressed. CT is the only way to show objective measurement of bone loss or gain.
As for keratinized tissue, i don’t know yet. im still couple months away from placing implant. im in no hurry to finish this case. If there’s enough keratinized tissue, then i wont have to do anything. if there’s not enough. then yes. i’ll have to do FGG. I do understand the principle of keratinized tissue needed around implants. but your correct some drs do not know not becauase they are ignorant but most likely they just haven’t learned about it yet and are getting there slowly.
Implantology is just a huge topic which involves materials, hard tissue, soft tissue, occlusion. implant company CE courses do offer GBR and soft tissue grafting separately. But rarely dr is told by sales rep of said implant company to take both courses (dr would think sale rep trying to make more money for the implant company) and most drs wait to take separate courses to fulfill CE requirements every other year. I am sure you don’t complete 100 CE credits every 2 years when all you need is 50 CE.
GBR is a huge umbrella. which covers socket preservation. horizontal GBR, vertical GBR, lateral/vertical sinus lift. and with BMP even GBR at sites w/o any bone. which i can’t wait to try on a cleft palate patient. Each topic is its own CE course.
i would love to discuss teeth w/ you over coffee. i think we would have very enlightening conversation. I can talk about teeth for hours.
Your work is well done and you appear to have excellent skill. Given the fact that this is a site of recent extractions and residual socket walls still present it is not the same as vertical augmentation of an edentulous ridge like the case that initiated this conversation. You present a beautiful case that was well handled though it is not in the same category of the original post. Perhaps you are one of the few that is actually capable of duplicating Urban’s work but this is not a proof of principal case because there was too much preexisting favorable architecture to compare to the original post. I would like to reiterate that I think your work is excellent but I think it is comparing apples to oranges in relation to what started this thread.
Please be sure you check your images before you upload them to make sure the patient’s name is not on the images. We had to edit your images and delete the name and replace them. We will delete any images with patient names.
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