Use of the OsteoHarvester™ for Bone Harvesting, Collection, and Placement

Cortical and cancellous bone often is used to augment sites with less than adequate bone height and width for implant placement. Many methods have been used to harvest bone from the recipient site and place bone into the receptor site. "The OsteoHarvester [OsteoMed, Dallas, TX] can be used to harvest, morselize, and collect cortical and cancellous bone from different sites throughout the oral cavity and deliver the harvested bone to the recipient site," says Arun K. Garg, DMD, associate professor of surgery, University of Miami School of Medicine.

Indications

When harvesting autogenous bone, clinicians would have to cut the cortical block graft, collect it, and then divide it into particles. Using the OsteoHarvester, autogenous bone is harvested in a particulate form that can be immediately delivered to the recipient site. "No additional steps or instruments need to be used between harvesting and delivery of the bone," Garg elaborates. Recommended bone harvesting sites include the symphysis and the ascending ramus of the mandible.

The OsteoHarvester is used with a surgical handpiece. This device can be used with any contra-angle surgical handpiece that has a minimum gear reduction ratio of 18:1 and a speed range of 500 to 700 rpm at the drill tip.

During harvesting procedures, the OsteoHarvester creates holes 4.5 mm in diameter and 7 mm deep. There is a built-in safety mechanism that will not allow the drill to go more than 7 mm deep into the donor site.

The number of holes created depends on the amount of bone necessary for the procedure. The holes will regenerate within a few months, Garg explains. When used with the proper external irrigation, the cutting method used with the OsteoHarvester minimizes cellular damage from heat or compression.

Minimal handling of the bone is required, ensuring preservation of the graft's vitality. In addition, there is a reduced possibility for bacterial contamination from the oral cavity using this device.

Assembly of the Bone Collector

The Bone Collector accessory components include the Collector Cap, Collector Filter, and Collector Wand. When used as a bone collector, the OsteoHarvester is assembled in four steps:

1. The collector wand is inserted into the distal end of the Reservoir.
2. The collector filter is placed on top of the Reservoir.
3. The collector cap is screwed onto the Reservoir.
4. The operatory suction tubing is attached to the collector cap.
   

The suction is then activated to use the OsteoHarvester as a bone collector.
The following steps are followed when the OsteoHarvester is used to harvest bone:

• The suction is turned on first.
• The tip of the harvest drill is placed onto the harvest site. The reservoir cannula tip should be flush with the bony surface."It may be helpful to hold the reservoir with one hand while the handpiece module is held with the other hand," Garg says. "This ensures that the device is properly positioned, which should be flush with the bone throughout the procedure."
• While maintaining contact pressure on the bone, the drilling is begun under irrigation of the site with sterile saline.

The use of proper irrigation is necessary to avoid bone necrosis. As many holes as are needed to obtain the necessary amount of bone can be drilled at this time. When harvesting bone, care should be taken to avoid tooth roots, soft-tissue structures, and underlying nerves, Garg cautions.

After harvesting is completed, a plug is inserted into the reservoir. The plug will keep the bony content inside the reservoir, Garg explains. The harvest drill is detached from the handpiece module. The harvest cap should be carefully unscrewed from the reservoir.

If there is bone accumulation on the filter, it can be scraped using a curet or elevator. The final bony mixture that will be delivered to the receptor site can be prepared or mixed in the reservoir or the OsteoHarvester dish, depending on how full the reservoir is. To deliver the bony mixture to the site, the reservoir and the plunge can be useed together in a syringe-like fashion. With the mixture in the reservoir, the plug is removed and the plunger is used to release the bony mixture into the recipient site.

When used as a bone collector, the bone is delivered to the bone site in a slightly different way. After bone collection is complete, the Collector Wand is removed, and the plug is inserted into the reservoir. The Collector Cap is unscrewed from the reservoir. A curet or elevator can be used to remove any bone accumulation on the filter.

Again, the final bony mixture that will be delivered to the receptor site can be prepared or mixed in the reservoir or the OsteoHarvester Dish, depending on how full the reservoir is. As with harvested bone, the reservoir and plunger can be used together in a syringe-like fashion to deliver the bone mixture to the recipient site.

The OsteoHarvester is an easy way to harvest and deliver bone to the recipient site because all stages of the procedure can be accomplished with the use of this device, Garg concludes.

Contact: Arun K. Garg, DMD, 6633 Roxbury Lane, Miami Beach, FL 33141. Telephone: (305) 865-1148.

Related Readings

Marx R, Garg A. "Bone Graft Physiology with Use of Platelet-Rich Plasma and Hyperbaric Oxygen." In: The Sinus Bone Graft. Jensen O, ed. Chicago: Quintessence Publishing; 1998, pp. 183-189.
Peleg M, Mazor, Z, Chaushu G, Garg A. Floor augmentation with simultaneous implant placement in the severely atrophic maxilla. J Periodontal 1998; 69:1,397-1,403.
Marx R, Garg A. Bone structure, metabolism, and physiology: Its impact on dental implantology. Implant Dentistry 1998; 7:267-276

EDITOR

Arun K. Garg, DMD
Associate Professor of Surgery
Director, Center for Dental Implants
Division of Oral/Maxillofacial Surgery
University of Miami School of Medicine

EDITORIAL ADVISORS

Editor Emeritus: Morton L. Perel, DDS, MScD

Charles A. Babbush, DDS, MScD
Head, Section of Dental Implant Reconstructive Surgery
Mt. Sinai Medical Center
Cleveland

Thomas J. Balshi, DDS, FACP
Private Practice, Implant Prosthodontics
Prosthodontics Intermedica
Institute for Facial Esthetics
Fort Washington, PA

Charles E. English, DDS
Staff Prosthodontist
Veterans Affairs Medical Center
Augusta, GA

Jack A. Hahn, DDS
Private Practice
Cincinnati

Kenneth W.M. Judy, DDS
Clinical Professor
Department of Prosthodontics
University of Pittsburgh School of Dental Medicine

Jack T. Krauser, DMD
Private Practice, Periodontics and Implantology
Boca Raton, FL
Department of Periodontics
Nova Southeastern College of Dental Medicine
Davie, FL

Richard J. Lazzarra, DMD, MScD
Associate Clinical Professor
Periodontal and Implant Regenerative Center
University of Maryland
Private Practice
West Palm Beach, FL

Robert E. Marx, DDS
Professor and Chief
Division of Oral/Maxillofacial Surgery
University of Miami School of Medicine

Carl E. Misch, DDS, MDS
Co-Director, Oral Implantology
University of Pittsburgh School of Dental Medicine

Daniel Y. Sullivan, DDS
Private Practice, Implant Prosthodontics
Mclean, VA; Washington, DC

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