Bone Expansion Using Threaded Expanders

Cesar Luchetti
 
Department of Implant Dentistry. National University of La Plata. Argentina

In the previous post, a group of instruments for bone expansion was analyzed.

Bone atrophies must be treated adequately to allow the implant placement in optimal position, according to the biomechanical requirements, and also to achieve better esthetics of the future crowns.

Here we are presenting a case, where there is bone atrophy and a low insertion of the frenulum. 

The therapeutic approach was to make a bone expansion together with a frenectomy.

Bone atrophy and a low insertion of the frenulum.

After raising the flap, the bone atrophy is

observed, which is more important in the

anterior part.

Expander number 3 in position.

Expander number 4 in position. With this one

is enough to place a 4 mm diameter implant.

Bone expansion achieved.

Implants in place.

Implants in place from another view.

Suture of the flap.

In the buccal aspect the suture associated

with the frenectomy is observed.

Pre and post operatory comparison.

...

Instruments for Bone Expansion: Threaded Expanders

Cesar Luchetti
Department of Implant Dentistry. National University of La Plata. Argentina

Threaded expanders are another group of instruments for bone expansion. They work by rotation, which differentiate them from the osteotomes, which work by impactation. 

Threaded expanders have an aggressive conical shape and penetrate the bone easily. The principal advantage is that they are less traumatic to the patient and that they can be used in the lower jaw. The rotation movement can be done with a wheel inserted in the back part of the expander, or if more resistance is present, with a racket wrench.

The principal disadvantage is that is easier to loose the direction of the preparation compared to the osteotomes. Anyway, in both cases an adequate training is important.

In most usual cases, where the expansion needed is not so important, the expanders can be work well. In more extreme cases, is usually necessary to split the ridge first and the make the expansion.

...

Instruments for Bone Expansion: Osteotomes

Cesar Luchetti

Department of Implant Dentistry. National University of La Plata. Argentina

In this post we will make a short review of one kind of instruments to expand bone: The osteotomes.

Osteotomes have an active part, slightly conical, which could finish in, basically, two different shapes: Sharpened and concave. Also, they have a handle and a posterior part to apply the mallet. These instruments are used only in the maxilla.

There are different options in the market, however their designs are similar.

Osteotomes with sharpened end are used to perform bone expansion and for ridge splitting. The principal advantage is that we can make the implant site preparation and to expand the bone at the same time. If we use drills for this purpose, we will loose bone instead of expand it. People must have in mind that expansion usually happens towards the buccal plate, because it normally has less resistance. That is why in most cases, it is important to initiate the preparation slightly to the palatal.

Osteotomes with concave end, are used to achieve bone compactation and to make sinus lift via alveolar approach.

In both cases, if the osteotome has too much resistance to go deeper, this technique should be combined with the use of drills.

There is another kind of instrument, the threaded expansors, which are used for the same objective. I will talk about them in a next post.

Osteotomes with sharpened end and a mallet.

Osteotomes with sharpened end in a closer view.

Osteotomes with concave end.

The first one has sharpened end to facilitate

the initial mark of the site.

Osteotomes with concave end in a closer view.

Differences between the two kind

of osteotomes.

Osteotomes use for bone expansion.
The complete case, from which these photos were taken, 
can be seen here.

Immediate Implant Placement in Upper Incisor Area

Cesar Luchetti

Department of Implant Dentistry. National University of La Plata. Argentina

We are presenting a case of immediate implant placement in an upper incisor. Twenty years old patient came to us presenting mobility of the upper right central incisor with compromised esthetics. He has an antecedent of exfoliation and re-implantation during his childhood due to a bike accident. X-rays showed root resorption. We decide the extraction followed by an immediate implant placement.

Pre-operatory situation.

The tooth is extracted and the root

resorption is visualized.

The bone presents loss of the buccal wall.

An osteotome preparation is performed in

order to expand the bone and then

the implant is placed.

 

A small autogenous bone graft is placed in

the buccal side.

 

Suture. Coronal repositioned flap is used to

compensate the soft tissue deficiency present

at pre-operative stage

 

After two months, 2^nd stage surgery is

performed together with a micro-polishing of

the gum’s surface to improve the future esthetics.

After seven days the tissue is healed

and the abutment is placed.

Definitive porcelain crown, together with a

small angle reconstruction with composite of

the adjacent central incisor.

 

Pre and post comparison.
The management and improvement of the

tissues contour, both hard and soft, played a

major role in the esthetic obtained.

...