engleski

Bone expansion and bone condensation – Alternative techniques for maxillary implant bed preparation

Background Maxillary alveolar ridge resorption with a consequential width reduction and limitation of drilling into an atrophic ridge present a frequent problem in implantology. In such cases bone expansion and bone condensation, prior to dental implant placement, make additional surgical augmentation unnecessary especially in patients who refuse augmentation. D‐shaped bone expanders, with an increasing diameter, push the alveolar cortical bone laterally by separating the labial and palatal lamellae. Aim/Hypothesis To show advantages and disadvantages of bone expansion and condensation in gaining the horizontal dimension of the maxillary alveolar ridge on four patients. The purpose was to show how the bone condensers, due to the rounded profile, after bone expansion, adjust the bed for implant placement. Material and Methods Dental implant bed was prepared in all patients using bone expanders and bone condensers. Case 1‐ a year after tooth 24 was extracted, alveolar width and height was 3 and 17 mm. Case 2‐ teeth 24 and 25 were extracted after several apicoectomies. The gap between implants and between implants and bone was filled with a particulated xenograft. Case 3‐ socket preservation was performed after the extraction of a fausse‐routed tooth 22. During the healing period, a temporary Maryland bridge was provided. Case 4‐ the bilateral sinus‐lift was performed and bone‐grafts placed due to insufficient alveolar width. Six months later, bone showed low resistance during pilot drilling. During the implant bed preparation the graft had detached. Nevertheless, six implants were inserted and bone graft was fixed by screws. In all patients Ankylos implants (Dentsply Sirona, Germany) were inserted, and resorbable membranes and particulated xenograft were used (Bio‐Gide® and Bio‐Oss®, Geistlich, Switzerland Results In all patients a poorly structured bone showed low resistance during pilot drilling. All the implants were inserted six months after teeth extractions and implant beds were prepared using bone expanders and bone condensers. All implants were loaded six months after insertion. After a five‐ year follow‐up period, satisfactory functionality and esthetics were observed in all four cases. Conclusion and Clinical Implications Bone expansion and condensation are valuable alternative techniques for implant insertion into maxillary alveolar ridge with compromised width. Poorly structured bone shows low resistance during pilot drilling. Thereby, instead of drilling, bone expanders can provide adequate bone width allowing that the implant bed is created by condensation. Both procedures can ensure bone dimensions to the adequate diameter of the planned implant. The healing phase should last up to six months (after these procedures).

dental implantology ; alveolar ridge ; expansion ; condensation

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