Bone Expansion by means of Ridge Splitting

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.

Residual spaces are filled with a bone graft.

A clinical case is showed below.

Preoperative x-ray.

Preoperative situation. A fistula is

observed at canine level due to a

root fracture.

Flap raised. A longitudinal fracture of

the canine root is observed.

View of the narrow ridge after the extraction.

Start of the ridge splitting with thin chisels.

Ridge splitting with chisels.

Initial ridge splitting.

Continuation of the procedure by means of

osteotomes to prepare the implants sites and

to get the final expansion.

Continuation of the procedure by means of

osteotomes to prepare the implants sites and

to get the final expansion.

Final expansion.

Comparison between the initial aspect of the

ridge and the situation after the expansion.

Implants placed.

Bone graft filling the residual spaces.

Suture.

Abutments in place.

Definitive crowns.

Pre and post operative comparison.

Post operative x-ray.

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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.

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.

...