In a recent session of "Let’s Talk," esteemed professionals Dr. Federico Hernandez-Alfaro from Spain and Dr. Istvan Urban from Hungary delved into the evolution of bone regenerative protocols. This discussion, moderated by Kenneth Haikoup, was part of the online EAO Congress, providing valuable insights into advanced techniques for bone regeneration.
The Importance of Bone Regeneration Bone regeneration is crucial in implant dentistry, ensuring adequate bone support for reliable implant placement. Dr. Gary Roccobar, a fellow expert, emphasized that without sufficient bone, implant procedures can fail, leading to complications such as peri-implantitis, which often requires the removal of the implant. Both Hernandez-Alfaro and Urban presented techniques that address these challenges effectively.
Techniques for Bone Regeneration Dr. Hernandez-Alfaro and Dr. Urban shared their approaches to bone regeneration, focusing on the use of autogenous bone and bone substitutes covered with membranes. This method has shown significant promise in achieving stable and predictable outcomes. Dr. Hernandez-Alfaro detailed his technique of using small bone blocks combined with biomaterials, which are then covered with a membrane. This approach helps maintain the stability and volume of the graft, ensuring successful implant placement.
Membranes in Bone Regeneration A key point of discussion was the use of membranes in bone regeneration. Dr. Hernandez-Alfaro stressed the importance of using membranes, citing his research which showed that covering bone grafts with membranes significantly improves outcomes. He highlighted that in his experience, both iliac crest bone and bone from membranous origin benefited from membrane coverage, resulting in better preservation of the graft.
Dr. Urban agreed, noting that membranes provide crucial protection and stability to the graft. He mentioned that while some studies suggest that perforations in the cortical bone are necessary to improve blood clot formation and communication with progenitor cells, his experience showed that ensuring a well-vascularized flap and using a stable membrane are sufficient for successful bone regeneration.
Suturing Techniques Effective suturing is vital for the success of bone regenerative procedures. Dr. Urban uses a Teflon suture for its strength and resistance to bacterial contamination. He emphasizes the importance of using a strong suture to hold the flap securely in place. Dr. Hernandez-Alfaro added that ensuring no tension in the flap is crucial, as even the best suturing technique cannot compensate for poor flap management. Both experts use a combination of mattress sutures and continuous running sutures to achieve optimal results.
The Role of PRF Platelet-rich fibrin (PRF) was another topic of interest. While some clinicians advocate for the use of PRF to enhance healing, Dr. Urban and Dr. Hernandez-Alfaro remain cautious. Dr. Urban pointed out that while PRF can potentially aid in wound healing, it should not be relied upon to compensate for poor surgical technique. Dr. Hernandez-Alfaro shared this sentiment, emphasizing that mastering flap management and ensuring a stable graft are far more critical to the success of the procedure.
Managing Complications Smoking is a significant risk factor in bone regenerative procedures. Both experts agree that patients who smoke must quit for at least three months before undergoing surgery. Dr. Hernandez-Alfaro shared his strategy of convincing patients by highlighting the direct impact of smoking on their treatment outcomes. Dr. Urban echoed this approach, emphasizing the importance of patient compliance in achieving successful results.
Antibiotic Protocols Antibiotics are commonly used to prevent infections following bone regenerative procedures. Dr. Urban uses a standard protocol of 2 grams of amoxicillin an hour before surgery, followed by 500 milligrams three times a day for a week. He avoids using augmentin due to its gastrointestinal side effects. Dr. Hernandez-Alfaro follows a similar protocol, ensuring adequate prophylaxis while minimizing patient discomfort.
Conclusion The session concluded with a consensus on the importance of advanced bone regenerative techniques in implant dentistry. Both Dr. Hernandez-Alfaro and Dr. Urban emphasized the need for meticulous surgical technique, proper use of membranes, and effective patient management to achieve optimal outcomes. Their insights provide valuable guidance for clinicians seeking to improve their bone regenerative practices and ensure successful implant placements.