Journal of Oral Implantology February 2013 - (Page 85)

CASE REPORT Ridge Expansion and Immediate Placement With Piezosurgery and Screw Expanders in Atrophic Maxillary Sites: Two Case Reports Andrew Kelly, DDS1 Dennis Flanagan, DDS2* Endosseous dental implants may require bone augmentation before implant placement. Herein is described an approach to edentulous ridge expansion with the use of piezosurgery and immediate placement of implants. This may allow for a shortened treatment time and the elimination of donor-site morbidity. Two cases are reported. This technique uses a piezoelectric device to cut the crestal and proximal facial cortices. Space is then created with motorized osteotomes to widen the split ridge. This technique allows for expansion of narrow, anatomically limiting, atrophic ridges, creating space for immediate implant placement. The facial and lingual cortices provide support with vital osteocytes for osteogenesis. The 2 patients presented had adequate bone height for implant placement but narrow edentulous ridges. In patient 1 at site #11, the ridge crest was 3.12 mm thick and was expanded to accept a 4.3 mm 3 13 mm implant. The resulting ridge width was 8.88 mm, which was verified using cone beam computerized tomography (CBCT). In patient 2 at site #8 and site #9, the narrow ridge was expanded using the same technique to accept 2 adjacent 3.5 mm 3 14 mm implants. The implants were restored to a functional and esthetic outcome. Key Words: dental implant, immediate implant placement, immediate placement, minimally invasive, piezosurgery, split-crest, ultrasonic bone surgery INTRODUCTION F or dental implant treatment to be successful, an adequate amount of bone and soft tissue must be present.1 Several methods have been used over the years to achieve these results.2 When the alveolar ridge is not optimal in width, some authors have advocated the use of onlay block or particulate grafts.3,4 The challenge of many of these techniques is that they require secondary surgical sites with increased morbidity and discomfort so that in many cases patient sedation is necessary. All of these factors combine to increase the time and cost of treatment delivery.5 Edentulous ridges can 1 Private practice, Clemmons, NC. Private practice, Willimantic, Conn. * Corresponding author, email: dffdds@comcast.net DOI: 10.1563/AAID-JOI-D-11-00124 2 be cut and expanded to widen a narrow ridge to accept a standard-sized implant. Osseous ridge expansion with a piezoelectric-driven saw and subsequent expansion of the bone cut with motor-driven expansion screws can create space for immediate implant placement. Piezoelectric bone surgery was introduced to the dental profession to perform precise, minimally traumatic bone surgery.6 Traditional approaches to treating narrow alveolar ridges require careful effort and care. Earlier techniques for ridge expansion were performed with chisels, air-driven rotary handpieces, or oscillating saws.7 Ridge expansion can be difficult when the cortex is dense, as in the mandible. Rotating and oscillating instruments are effective but may damage nerves and arteries. Piezoelectric saws will not significantly damage these structures. Journal of Oral Implantology 85

Table of Contents for the Digital Edition of Journal of Oral Implantology February 2013

Could the Fountain of Youth Be All in Your Bones?
Vertical Bone Augmentation With Simultaneous Implant Placement Using Particulate
Evaluation of the Bone Healing Process Utilizing Platelet-Rich Plasma Activated by Thrombin
Effect of Model Parameters on Finite Element Analysis of Micromotions in Implant Dentistry
Peri-Implant Defect Augmentation With Autogenous Bone: A Study in Beagle Dogs
Would Nitric Oxide be an Effective Marker for Earlier Stages of Peri-Implant Disease? An
The Effect of Different Surface Treatments on Cement-Retained Implant-Supported
Effect of Rotating Osteotomes on Primary Implant Stability—An In Vitro Investigation
Horizontal Augmentation Through the Ridge-Split Procedure: A Predictable Surgical
The Bis-Acryl Stent
Clinical, Histological, and Histomorphometrical Analysis of Maxillary Sinus Augmentation
A Technique to Salvage a Single Implant-Supported Fixed Dental Prosthesis Having a
Ridge Expansion and Immediate Placement With Piezosurgery and Screw Expanders in
Pterygoid Implants for Maxillofacial Rehabilitation of a Patient With a Bilateral Maxillectomy
Technology in Maxillary Premolar Region: A New Strategy for Soft Tissue Management
Fracture of Anterior Iliac Crest Following Bone Graft Harvest in an Anorexic Patient: Case
A Technique for Constructing a New Maxillary Overdenture to a Nonretrievable Implant
Edentulous Maxillary Arch Fixed Implant Rehabilitation Using a Hybrid Prosthesis Made of

Journal of Oral Implantology February 2013