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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.

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Dental implant course soft tissue grafting for implant restoration.

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

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

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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.

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Executing the Hockey Stick Incision

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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.

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Preparing the Graft Site

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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.

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Healing Progress: 8-Month Follow-Up

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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

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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
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Final Steps and Tissue Graft Completion

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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.

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