Soft Tissue Grafting -Five Steps to Grafting the Nasopalatine Canal

This soft tissue grafting video shows a case that involves a pedical connected soft tissue graft with implant placement at one month.

‍

Dental implant course soft tissue grafting for implant restoration.

Video Transcript From DR. Michael A Pikos - Pikos Implant Institute:

‍

Advanced Techniques in Grafting the Nasopalatine Canal By Dr. Michael Pikos Pikos Institute

‍

Soft tissue grafting addressing a compromised socket.

When dealing with a compromised socket, the goal is to create the best possible soft tissue pocket despite the absence of periosteum. By going deep enough to establish a stable plane, we can set the foundation for successful grafting.

‍

Executing the Hockey Stick Incision

‍

One key technique involves the hockey stick incision, extending across the socket to ensure proper coverage. While a pedicle approach is preferred, sometimes it becomes necessary to work with a free flap when the soft tissue is too thin.

‍

Preparing the Graft Site

‍

Once the incision is established, the next steps include:

Freeing up the tissue for tunneling
Soaking minerals in GEM 21 for optimal integration
Trimming the graft for precise placement

With the FS2 needle and nylon 5-0 sutures, the connective tissue graft (CTG) is positioned within the pouch using a horizontal mattress suture technique.

‍

Healing Progress: 8-Month Follow-Up

‍

At eight months post-op, the results are clear:

The graft has integrated beautifully
D1-quality bone has formed with mineral and PDGA
The patient now has optimal structural support for implant placement
‍

Managing the Nasopalatine Canal

‍

During pedicle grafting, addressing the nasopalatine canal is crucial. If left unaddressed, it can interfere with the stability of the site. The process involves:

Clearing out the canal to determine depth and structural integrity
Using ball cautery and an 8-round burr to remove residual tissue
Achieving optimal bleeding for graft support

Handling Nerve Considerations

Some practitioners express concern about lateralizing the nerve to preserve blood supply. However, Dr. Pikos’ approach differs:

Rather than lateralizing the nerve, he removes it to clear the graft site
Research supports obliterating the canal without affecting sensation
‍

Final Steps and Tissue Graft Completion

‍

With the area fully prepped:

Residual tissue is cleaned and burnished
Scanning dictates safe depth limits
If needed, a collagen plug is used to reinforce the membrane before grafting

With this meticulous approach, sinus grafting becomes a predictable and effective solution for implant reconstruction.

‍