DALI Flex Graft for Buccal Augmentation

Following a GBR at the time of implant placement (Pictures 1,2,3), a buccal ridge deficiency persisted (Picture 4). Surgical uncovery of the implant to expose the cover screw revealed successful bone regeneration around the implant, but a residual lack of ridge contour (Picture 5). Instead of using a traditional particulate graft covered with a resorbable membrane, a “flexible bone graft” sheet, DALI Flex Graft, was placed over the buccal plate to augment the buccal contour (Pictures 6 & 7). Because the graft comes hydrated, it is easy to handle and adapt to the defect location. The flap was then pulled over the graft and adapted around the healing abutment (Picture 8).

Pictures 1-3

Picture 4

Picture 5

Pictures 6,7

Picture 8

Hi Dr. Gober,
a couple of questions regarding Dali Flex graft,

  1. Did you/Do you, have to decorticate bone before placing this graft, like you normally would to get osteocytes in there?
  1. How long do you expect the turnover to native bone?

Thanks for all your contribution on this site, I enjoy learning from these cases .

Thanks for your questions.
In this case I did not decorticate bc the bone surface appeared well vascularized so I did not think it was necessary. In terms of graft turnover rate, I am not completely sure although I would expect it to behave like any other demineralized allograft.

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As someone who was trained to decorticate I also sometimes opt to proceed without performing this step in similar situations. I recall reading an article from a legitimate source recently, either International Journal of Perio and Restorative Dentistry or the Journal of Periodontology I believe, in which the authors concluded that there was no clinically significant difference in the outcome of GBR procedures with or without recipient bed decortication. I still opt to decorticate most of the time but will opt to do exactly as Dr. Gober has in this case and perhaps this will help justify…

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Based on the outcome of this particular study it could be concluded that the process of decortication prior to osseous grafting could just be another one of those feel good things we tend to do because it makes sense and seems to work. I would tend to consider the use of a membrane when doing a socket graft to be very similar in that most folks tend to utilize membranes despite the fact that the extraction socket is at least 3 walled and well contained. Bottom line is that decortication works but is likely not necessary just like membranes for socket grafts are fine but also likely not necessary…

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