Ridge Splitting, Nasal Cavity Lift and Simultaneous Dental Implants Placement

Cesar Luchetti

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

the splitting.

Making the cut using the disk.

Initial ridge split.

Ridge split after using the chisels.

Final expansion using threaded expanders.

Surgical sockets.

Implants placed.

Graft placed in the nasal cavity. (Black arrows)

Graft placed between the expanded plates.

Suture.

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Nasal Cavity Lift

Cesar Luchetti and Alicia Kitrilakis

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

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 describe the technique to do the nasal lift. The surgery was performed by Dr. Luchetti and crowns were made by Dr. Kitrilakis.

The nasal cavity lift is some times easier than maxillary sinus lift. The pituitary mucosa is often more resistant than Schneider membrane and there is not need to make an access window.

The technique is simple. Once the incisions were made, the flap must be raised to reach the nasal cavity. Then, the mucosa is detached using the same curettes we use to use for sinus lift procedures and a bone graft is placed below the pituitary. Implant placement can be done simultaneously or in a two stage approach. The main difference with sinus lift is that is not recommendable to make a lift bigger than 3-4 millimeters.

Preoperative situation.

Flap raised. An old failing implant is present

and must be extracted.

Curette doing the pituitary lift before the final

placement of the implants.

Implants in position. Due to limitations in the

ridge anatomy, there were placed in the areas

where we achieved the best initial fixation.

The blue arrows point the nasal cavity.

Graft in nasal cavity placed.

In this case we use a bovine hidroxyapatite.

Graft placed in the ridge irregularities.

Polilactic Acid polimerizable membrane is

placed to protect the graft.

Suture.

Seven days postoperative.

Abutments in place.  

Metal substructure try in.  

Final ceramic crowns.

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