Immediate Implant Placement in Maxillary Molars using Threaded Expanders

Cesar Luchetti, Gregori Kurtzman and Alicia Kitrilakis

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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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Treatment of the agenesis of a lateral incisor

Daniel Ostrowicz - Barcelona, Spain

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.

I hope you it find interesting.

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Dental Implants. Flapless Surgery and Immediate Loading

Cesar Luchetti

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.

Dental Implants. Flapless Surgery and Immediate Loading

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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.

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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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