Department of Implant Dentistry. National University of La Plata. Argentina
Ridge splitting is a procedure used to expand the bone by separating the buccal and palatal plates.
Nasal cavity lift associated with implant placement is not a common procedure. However, is useful in some cases with ridge atrophy and a low nasal floor.
In this case, we use both approaches together, in order to have the possibility to place the implants.
Preoperatory situation.
Flap raised. An extremely atrophied ridge is observed. Also, the nasal cavity is shown. (Black arrows)
Doing the pituitary membrane lift using a curette.
Doing the pituitary membrane lift using a curette.
Diamond disk used to perform the cut of the ridge to initiate
Department of Implant Dentistry. National University of La Plata. Argentina
Maxillary sinus usually presents partition wall inside, but normally they are incomplete. When a complete partition wall is present, the sinus lift procedure could be more difficult. In such cases, the lateral wall must be taken out (because it is impossible to move it medially inside the sinus) and create two different access at both sides of the partition wall.
In the following case the technique to do this is showed.
In multiple situations, the possibility to place implants must face some challenges.
A frequent situation is the limited space between adjacent teeth, which can be due to extractions made long time ago without the proper repositioning or without the use of space maintainers, or in case of a tooth agenesis.
In this article, Dr. Ostrowicz presents a good clinical report on how to manage a case of a lateral incisor agenesis with limited mesio-distal space and with some atrophie of the buccal plate.
Although the article is in Spanish, it has a lot of photos that are self explanatory.
Below, you can access the article.
Click in the image above and a new page will open. Then scroll down and click in “download file”.
I want to thank Daniel for share this article with us.
Department of Implant Dentistry. National University of La Plata. Argentina
Implant dentistry is pushing their limits towards less invasive procedures and with results in a day.
Although this is a valid approach, an adequate diagnosis is necessary to perform these cases in a secure way.
Flapless surgery is usually faster and gives more postoperative comfort to the patient. However, the adequate tridimensional position of the implants must not be sacrificed just to avoid a flap, especially in cases when bone reconstruction is needed.
Long term prognosis is influenced by a good tridimensional positioning of the implants which is determined by the biomechanical requirements of the teeth being replaced.
Immediate loading is useful because the patient retrieves the function instantaneously, but it must be done just in cases with a good initial fixation.
The following video shows a case with a flapless approach.
Implant site development was made with threaded expander in order to increase bone density allowing a better initial fixation.
The implant used, B&W CIH (Argentina), has an implant carrier who can be adapted as an abutment. A provisory crown was made over it a few moments after surgery.
To see the video in full screen, please click in the link below (opens in a new window). Then, click in the lower right square of the screen.
Cesar Luchetti and Alicia Kitrilakis
Department of Implant Dentistry. National University of La Plata. Argentina Ridge splitting is a procedure used to expand the bone by separating the buccal and palatal plates.
It is normally performed in the maxilla using chisels, osteotomes and a mallet.
It could be done also in the mandible, but is a little bit more complicated due to the denser bone. In this case, is recommended to use a cutting disk or piezoelectric devices and threaded expanders, because these are less traumatic.
It is indicated when:
-The bone is less than 3 mm wide. (If we have more we normally can expand it just by means of osteotomes or expanders)
-The bone is enough to place an implant but we want to expand it for esthetics reasons.
Typically, the procedure is initiated by thin chisels, followed by wider ones and then osteotomes.
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.
Department of Implant Dentistry. National University of La Plata. Argentina
One of the most challenged situations we must face regarding esthetics results is when we must do a crown over a natural tooth adjacent to a crown over a dental implant.
The differences between natural tooth and implant anatomy make difficult to harmonize the two emergency profiles.
Over the last years, slopped implants have proposed to be the solution to this problem. Although this could be true regarding the anatomy, there were some difficulties of some clinicians for the correctly implementation of its use.
We are presenting a case where we must restore a natural upper lateral incisor adjacent to an implant in upper central incisor area.
