Title: Augmentation techniques, long-term results and their alternatives
Abstract:
The iliac crest is the Golden Standard for grafting. However, due to potential complications and operative expertise alternatives if possible should be considered.
A discussion will be presented on different ways to augment and enhance bone:
Microvascular re-anastomosed TX, Distraction Osteogenesis, Interposition and
Augmentation. Due to the different degrees of vascularisation of the trans-planted materials there are different resorption rates which will be discussed and shown on clinical cases and follow-ups of more than 30 years. We will explain our classification of new bone:
Class I: revascularised bone
Class II: distracted bone (vascularised)
Class III: pedicled Inlay bone (non vascularised)
Class IV: BMP induction Onlay graft (non vascularised)
Class V: Onlay with autogenous bone or allograft (non vascularised)
We will demonstrate Interposition and Augmentation procedures and show our clinical experiences. Furthermore, there will be time allotted for the new frontiers of Guided Bone Regeneration and Bioengineered Bone Production in so called cell chambers as natural porous resorbable scaffolds combined with Proteins, PRP, Fibrin glue, BMP`s. Experimental and clinical results will be shown and discussed.
Following clinical cases will be presented: 243 revascularised Bone TX, 151 Distraction Osteogenesis cases, 23 Immediate Expansion Osteogenesis (Pedicled Sandwich Plasties [PSP]) cases, 36 Horseshoe Le Fort I Osteotomies in severely atrophied maxillas with less than 2 mm remnant bone and 554 Sinusgrafts with 1-5 mm remnant maxillary bone, grafted with different graft materials with and without PRP. The follow-ups will be up to 28 years.
For all these groups of clinical cases we will show our prosthetic solutions.
Last but not least we will report about our studies with 4.0 x 5.0 mm ultra-short implants and diameter reduced 3.0 x 8.0 mm implants on tumour patients after micro-anastomosed fibula transplantation as well as on patients with extreme atrophy of the maxilla with less than 6 mm bone and extreme atrophy of the mandible with less than 7 mm bone.
Until now we applied on 47 patients either in the maxilla in the interantral and/or in the mandible in the interforaminal region four 4.0 x 5.0 mm or 3.0 x 8.0 mm implants.
In our over six years follow up experience we can report about extremely good result with less than 3 % implant losses due to missing osseointegration.
Osseointegrated implants we have lost one until now.
Similar good results we also observe in patients with complicated re-implantations or in compromised bone.
Listening to this lecture there will be following knowledge:
1: Differential diagnosis which problem can be solved and which is unable to be treated.
2: Which procedure will lead to a good satisfactory result and which material may be used to enhance or produce bone.
3: Which prosthetic solution is best for which bone enhancement method.
4: How to prevent complications and how to handle complications if they will occur in such difficult cases.
5: Demonstrating alternatives to augmentation methods by using short implants with their advantages to standard length implants reducing operative complexity, morbidity and costs.
