Journal of Oral Implantology October 2013 - (Page 615)

CASE REPORT Two-Stage Bone Expansion Technique Using SpearShaped Implants Associated With Overlapped Flap: A Case Report Luiz Carlos Magno Filho, DDS1* Fernando Hayashi1 Alexandre Conte1 Hsu Shao Feng1 ´ Marcio Zaffalon Casati1,2 Fabiano Ribeiro Cirano1 The conventional method of ridge expansion uses a mucoperiosteal flap elevation to allow bone corticotomy, which is followed by bone expansion performed with chisels and bone expanders. To facilitate corticotomy and avoid flap elevation, bone expansion can be performed in 2 stages. This case report presents a modified 2-stage bone expansion technique to achieve better implant stabilization and wound closure. This modified approach may be an efficient procedure for minimizing complications. Key Words: ridge expansion, two stages surgical procedure, narrow pointed implants INTRODUCTION A fter the loss of a tooth, the alveolar resorption process begins, which reduces bone volume and could make it difficult to place implants.1,2 Several procedures have been developed for increasing bone volume to overcome these anatomic obstacles. Among these procedures, the use of block bone grafts, guided bone regeneration, osteogenic distraction, and bone expansion with corticotomy (BEC) can be performed.3 In BEC, a complete flap is raised so that horizontal and vertical osteotomies can be performed. Horizontal osteotomy is performed in the center of the ridge in the mesiodistal direction and vertical osteotomies via the vestibular approach, mesially and distally to the areas where the implants 1 ˜ Department of Implant Dentistry, Paulista University, Sao Paulo, Brazil. 2 Department of Implant Dentistry, State University of Campinas, ˜ Sao Paulo, Brazil. * Corresponding author, e-mail: lulamagno@ig.com.br DOI: 10.1563/AAID-JOI-D-11-00038 will be placed. After the osteotomies, the bone is expanded by means of greenstick fracture, which is accomplished by introducing chisels and expanders in the osteotomy performed in the center of the ridge. After expansion, a gap forms between the vestibular and lingual bone plates in which one or more implants are immediately placed. The space between the plates is filled with a blood coagulum, presenting a repair process very similar to that which occurs in immediate implants.4 The BEC presents very drastic technical problems that may make the procedure difficult or even unfeasible. The first and most severe is that at the moment of expansion or implant placement, instead of a greenstick fracture occurring, the bone plates and their bone bases could rupture completely. This loosening prevents implants from being placed and can cause a more severe bone defect due to resorption, infection, or sequestration of the bone fragment. Another problem is how to achieve primary stability of the implants as anchorage is obtained in the most apical portion of the bone6 and conventional implants have points that Journal of Oral Implantology 615

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

Food and Drug Administration: Reclassification of Blade Form Dental Implants
Optimizing Platelet-Rich Plasma Gel Formation by Varying Time and Gravitational Forces During Centrifugation
Effect of Surface Roughness and Low-Level Laser Therapy on Removal Torque of Implants Placed in Rat Femurs
Impression Techniques for Multiple Implants: A Photoelastic Analysis. Part I: Comparison of Three Direct Methods
Impression Techniques for Multiple Implants: A Photoelastic Analysis. Part II: Comparison of Four Acrylic Resins
A Pig Model for the Histomorphometric Evaluation of Hard Tissue Around Dental Implants
In Situ Tooth Replica Custom Implant: A 3-Dimensional Finite Element Stress and Strain Analysis
Influence of Different Soft Liners on Stress Distribution in Peri-Implant Bone Tissue During Healing Period. A 3D Finite Element Analysis
Influence of Surface Nano-Roughness on Osseointegration of Zirconia Implants in Rabbit Femur Heads Using Selective Infiltration Etching Technique
Modified Titanium Surfaces Alter Osteogenic Differentiation: A Comparative Microarray- Based Analysis of Human Mesenchymal Cell Response to Commercial Titanium Surfaces
Hemorrhage Secondary to Interforaminal Implant Surgery: Anatomical Considerations and Report of a Case
Rehabilitation of a Patient With Mandibular Resection Using Osteointegrated Implants: A Case Report
Two-Stage Bone Expansion Technique Using Spear-Shaped Implants Associated With Overlapped Flap: A Case Report
Implant Esthetic Restoration in Ridge Deficiencies in Cases of Trauma: A Case Report
Rehabilitation of the Atrophic Maxilla With Tilted Implants: Review of the Literature

Journal of Oral Implantology October 2013