July 19, 2017

View from the Dentists Chair – Keep it Simple! A Philosophy for Bone Grafting

I’ve been placing implants and performing bone graft procedures for over 25 years now. The entire dentistry world has changed massively in that time, but recent developments in bone grafting are some of the most exciting and important changes I have ever seen.

After starting to place grafts, it took me a long time to realise what we are actually working towards is simple.  We want 3 things from any grafting procedure:

The patient’s own bone

The patient doesn’t want bone from a foreign host, whether human or animal, and neither does their dentist.  We want to restore their body to the position it was in before bone loss occurred, with healthy, true host bone being grown back.

The key to this is “upregulated host healing”.  The human body is incredibly versatile and given the right environment will quickly heal itself.  As a dentist it is my job to use the materials which create this optimal environment for bone regrowth.

We want the bone to grow quickly and reliably, reducing treatment timescales

Having decided that we want to work with the patient’s own bone, the next job is to encourage it to grow quickly and reliably.  Shortening the overall treatment timetable benefits everybody, and being able to deliver predictable results in 12 weeks is fantastic for the patient.

Reduced pain for the patient

Throughout the procedure we want to use materials and techniques which actively reduce the pain of the patient.  We can do this through a combination of advanced biomaterials and minimally invasive surgical techniques (I have published a Multicenter Clinical Study discussing the treatment protocol which I developed with my colleague Dr Minas Leventis – this is available here).

This might look like a fairly simple list of demands, but it has taken me many years to find a grafting material that ticks all of the boxes.  It is slightly ironic that it has taken the latest developments in advanced biomaterials to give us a material which lets us pull back the layers of complexity and give our patients a reliable solution with their own bone.

One of the key advances has been removing the need for a collagen membrane.  I haven’t used a collagen membrane in any of my procedures for years – I’ve done almost 4,000 grafts without touching one!  Removing the collagen membrane gives the periosteum, and the related blood supply, direct access to the graft site.  This seems to speed up both soft tissue healing and new bone generation significantly.  It also seems to reduce pain levels significantly – 90% of my patients of my patients now require no pain medication the day after treatment, even in Sinus Augmentation procedures.

I do this by using a grafting material that contains a built-in barrier already.  This prevents soft tissue ingress and stabilises the material, keeping it in the graft site until it is absorbed and replaced by new host bone.

ethoss®

Many of you will know the story of ethoss® already.  I felt it was time to develop a material myself, informed by clinical experience.  All the other materials on the market seem to have been developed by scientists, I wanted something that was actually developed from a clinician’s standpoint.  In the development process we created a material which meets all of the demands above, has a built in membrane, and works very quickly and reliably.

The results which we are seeing with the material are remarkable.  It feels like a really exciting time to be working in implant dentistry, and it’s an honour to be working with talented and dedicated dentists all over the world who are seeing the benefits that Upregulated Host Healing is having, ultimately and most importantly, for their patients.

 

Dr Peter Fairbairn is Visiting Professor at the University of Detroit Mercy School of Dentistry, MI, USA, President of the London Dental Fellowship and Principal Dental Surgeon at the Scarsdale Dental Aesthetic and Implant Clinic in West London, UK. He has written chapters in 2 published books (Quintessence) and many journal articles as well as new published protocol in the use of synthetic graft materials.

Peter is current Director of Education for the ADI (UK) and President Elect of the LDF.