Immediate Implant Placement in Maxillary Molars using Threaded Expanders

Cesar Luchetti, Gregori Kurtzman and Alicia Kitrilakis

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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.

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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.