Cortical Perforations in Guided Bone Regeneration

This video discusses the importance of cortical perforations in guided bone regeneration procedures. Specifically, it reviews the concept of blood supply to the graft, why it is important to ensuring the success of the graft, and how cortical perforations help ensure vasculature in growth. Clinical photos, including a case in the posterior mandible, show what you want and do not want to see at your graft site. The video closes with a short tip clinical tip about perforating to the cortical plate to get into the marrow spaces. For an interesting study regarding Cortical Perforations, please see The influence of cortical bone perforation on guided bone regeneration in humans

This study found that cortical bone perforation favourably affects the amount of new bone formation in the grafted sites after 7 months of healing. Cortical bone perforation significantly increase number of new vessels (angiogenesis) of the regenerated bone. (Int J Oral Maxillofac Surg, 2017 Feb;46(2):261-266. doi: 10.1016/j.ijom.2016.10.017. Epub 2016 Nov 16.,Tarnow et al.))

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Cortical Perforations in Guided Bone Regeneration 1

Cortical Perforations in Guided Bone Regeneration 2

Cortical Perforations in Guided Bone Regeneration 3

bromike comments:

do you use high speed handpiece or surgical handpiece for this procedure? Does using high speed handpiece tend to burn the bone?

timcarter comments:

I can only speak for myself but I use a high speed with a #4 round bur and have done so for over 15 years...

timcarter comments:

I was trained to perform cortical perforations and I still do them today utilizing a #4 high speed round bur. I have been amazed though at the number of techniques, some of which are proposed by reputable clinicians (Dr. Michael Block- sausage technique) which ignore this seemingly necessary step... I can't recall the author or journal but I recently read a study that claims no statistically significant difference with or without cortical perforations... but I will continue to utilize them for my cases.

I use a high speed for this procedure as well. I think that burning the bone is an issue if the bur is dull making contact with the cortical bone for too long.