CLINICAL FINDINGS
  • Knife-edge alveolar ridges
  • Severe buccal-lingual ridge deficiencies
  • Vertical and horizontal ridge collapse
  • Missing anterior and posterior teeth
  • Thin residual alveolar bone
  • Buccal undercuts and contour deformities
  • Deficient soft tissue architecture in esthetic zones
  • Severe localized alveolar ridge resorption
  • Insufficient vertical and horizontal ridge dimensions
  • Buccal-lingual bone deficiencies
  • Residual ridge width commonly 1–4 mm
  • Significant osseous defects precluding implant placement
  • Postoperative radiographs demonstrated successful graft incorporation and implant stability
PP
Dr. Paul Petrungaro
Moderator · IML CaseRounds™

Bone Grafting Challenges

  • Autogenous grafts require second surgical donor sites
  • Morbidity from iliac crest, ramus, symphysis, or tibial harvesting
  • Bone graft resorption rates of 16–20%
  • Technique sensitivity of ridge augmentation procedures

Advantages of Allogenic Block Grafts

  • Avoid donor-site morbidity
  • Reduced surgical invasiveness
  • Predictable ridge width and height reconstruction
  • Histologic evidence of active bone replacement and remodeling
  • High graft survival rates (93%)
  • Implant survival rate approximately 99%

Transitional Implant Concepts

  • Fixed temporization stabilizes grafted sites
  • Prevents pressure on healing grafts
  • Improves patient comfort and function during osseointegration
  • Allows uninterrupted healing and soft tissue maintenance

Stem Cell Block Grafting

  • Stem-cell infused allogenic blocks stimulate osseous regeneration
  • Over 140,000 stem cells placed in grafted regions
  • Improved buccal-lingual ridge reconstruction
  • Reduced need for autogenous harvesting procedures

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Surgical

TOPIC F - STEM CELL RIDGE AUGMENTATION

Missing teeth with inadequate bone volume for implant placement Severe ridge resorption and esthetic defects Difficulty restoring function and esthetics due to deficient alveolar contours Need for implant-supported rehabilitation
PATIENT SUMMARY
AGE / SEX
41-55
CHIEF COMPLAINT
Missing teeth with inadequate bone volume for implant placement Severe ridge resorption and esthetic defects Difficulty restoring function and esthetics due to deficient alveolar contours Need for implant-supported rehabilitation
ASA CLASS
SMOKING
Non-smoker
KEY MEDICATIONS
Augmentin® 875 mg pre- and postoperatively Chlorhexidine rinses Local anesthetic with epinephrine Sedation medications (Versed) Platelet-rich plasma (PRP) adjuncts Antibiotic therapy during healing phases
WORKING DIAGNOSIS
DR. PAUL'S TREATMENT PLAN

Surgical Ridge Augmentation

  1. Full-thickness mucoperiosteal flap reflection
  2. Recipient site decortication to stimulate marrow bleeding
  3. Contouring and adaptation of corticocancellous allogenic block graft
  4. Hydration of graft with platelet-rich plasma
  5. Fixation using titanium miniscrews
  6. Additional particulate grafting around margins
  7. Placement of barrier membrane (BioMend®, e-PTFE, or Pericardium membrane)
  8. Primary tension-free wound closure
  9. Healing period (3–6 months)

Implant Placement Phase

  1. Re-entry surgery and removal of fixation screws
  2. Histologic biopsy sampling where indicated
  3. Osteotomy preparation
  4. Implant placement into regenerated ridge
  5. Provisionalization with transitional implants where indicated
  6. Final implant-supported restoration after osseointegration

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