Daniel James Fortino

Dental implants have transformed restorative dentistry, providing durable and aesthetically pleasing solutions for missing teeth. However, successful implant placement relies on sufficient bone volume and density for stable integration. After tooth extraction, inevitable bone loss occurs, making bone grafting essential for patients with insufficient bone quantity and improper implant positioning. Various techniques, such as particulate bone grafting with resorbable or non-resorbable membranes, have been developed to address this issue. Yet, challenges and unpredictable outcomes associated with large 3D augmentation volumes have led to the exploration of alternative approaches. Autogenous block grafts, particularly the Khoury plate technique, have gained popularity for augmentation. Larger volumes often use the patient’s ilium as the donor site, while smaller volumes come from the chin or oblique ridge. However, these techniques have drawbacks, including morbidity, scarring, and increased operating time. Custom milled block allografts have emerged as a promising solution. Utilizing cone-beam computed tomography (CBCT), these allografts are precisely fabricated to mimic the patient’s anatomical structure. The process involves generating a 3D digital model of the implant site from the CBCT scan, designing the graft using computer-aided design (CAD) software, and then manufacturing the physical block allograft through computer numerical control (CNC) milling. Custom block allografts offer several advantages over other techniques, reducing morbidity, eliminating the need for additional donor sites, and avoiding extraoral scarring. Their personalized design ensures an ideal fit, minimizing the need for extensive graft modifications during surgery. Clinical studies have shown promising outcomes with dental custom block allografts, achieving high success rates in implant stability and enhancing predictability in challenging anatomical conditions. In conclusion, custom block allografts have become a valuable tool in implant dentistry. Leveraging advanced imaging and CAD/CAM technologies, these allografts offer an effective and efficient solution for bone augmentation in patients requiring dental implants.

Dr. Daniel Fortino is a Periodontist dually licensed in the United States and Canada. Dr. Fortino grew up in Hamilton, Ontario and completed his undergraduate education at McMaster University, graduating with a Bachelor of Health Sciences (Honours) Degree with distinction. He graduated from the University of Western – Schulich School of Medicine & Dentistry in London, Ontario. He then went on to pursue Specialty and Master’s degrees in Periodontics from the Centre for Advanced Dental Education in St Louis, Missouri. He successfully achieved Diplomate status from the American Board of Periodontology after his residency. To further his expertise, he undertook a fellowship in Advanced Oral Surgery and Implantology at the School of Dental Medicine at the State University of New York at Buffalo (SUNY-Buffalo). After completing his fellowship, he was invited to join the faculty at the Graduate Periodontics and Implant Center at SUNY-Buffalo, where he remained for a period of time. Over the past decade, he has had the opportunity to perform extensive oral surgery and periodontal treatment across Ontario and the United States which has given him a well-rounded perspective in dentistry. Dr. Fortino is the founder of the DOC+ specialized and focused dental centre which is a multi-specialty practice based out of Collingwood, Ontario. His focus is on periodontics, dental implant and oral surgery procedures. His expertise and interest extends to remote anchorage sites for implant placement (zygomatic, pterygoid and transnasal implants), advanced ridge augmentation and implant surgery, management of periodontal disease, full mouth implant rehabilitation (all-on-x treatment), and soft tissue grafting. Dr. Fortino has been published in the oral and maxillofacial pathology and the oral health preventive dentistry journals. Dr. Fortino is particularly passionate about promoting and encouraging a healthy lifestyle. He finds fulfillment in learning about the world and discovering new things.