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
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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.
