This a follow up to our original case using the DALI Flex Graft, a 1 mm thick demineralized cortical allograft that when hydrated, becomes flexible and easily adapts to graft sites. For reference, the original case is: DALI Flex Graft for Buccal Augmentation
Following 6 weeks of healing, we see nice healing and an obvious increase in the facial contour (Photo 1). An impression was taken and the implant was restored with a screw-retained crown (Photo 2).
In my opinion, the use of the DALI Flex Graft cortical bone sheet was easier to handle and apply to this type of defect, as compared to the standard particulate graft and a barrier membrane.
Daniel, very nice documentation. Do you have any re-entry pictures? Also, do you think the rigidity of the material would be good enough to use in the Khoury technique for ridge augmentation?
Hi. Thanks for the question. I don’t have re-entry pictures because I used the graft at the time of surgical uncovery- I did not want to open a flap again after that if it wasn’t necessary. I am not familiar enough with Khoury technique to give you an answer regarding that although it is an interesting question.
Thank you for the rapid reply. The Khoury technique involves securing a block graft from the oblique ridge and then splitting it in 2 pieces, approximately 1 mm thick. These are then used to provide the vertical structure for horizontal bone grafting, if there is sufficient lingual portion available. They may also be placed on the buccal and palatal to increase vertical height of the future graft area, but the height can not exceed the peak crest of the bone. Meissinger screws are used to fix the bone plates and autogenous bone scraped from the surgical donor site is used to fill the void between the bone and the plate or plates. Here is a YouTube production from the Spanish surgeons who taught me how to do this. My concern with the flexible plate you showed in your case is that the bone is not autogenous and may undergo more loss during healing, jeopardizing the results. However if autogenous bone is used to fill the space between the plate and the native bone the amount of loss may be mitigated, You can find other videos on YouTube as well.
I may be wrong but I have always been under the impression that autogenous bone turns over more rapidly thus leading us to supplement with allograft or xenograft. If true then the technique of using the Dali Flex would be advantageous…
Having spent time in Europe while I was in the Army I noticed that they are big fans of autogenous grafting. I later discovered that this bias is due in part to the difficulty of obtaining allograft due to regulations. In other words I don’t think we should get too carried away with materials as they all work and we all have our biases for whatever reason.
Thanks. I meant to say that I am familiar with the technique but I don’t perform it. I guess it will come down to how much the autogenous cortical plates are revascularized or if they simply act as a wall to hold the particulate in place. If the latter, perhaps the allograft would be a suitable substitute.
