EUROMEDICA  Hanover 3-4  Juni 2010	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover Berliner Medizinischen Gesellschaft, Berlin

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Actuality. Insufficient volume of bone tissue is one of the major factors of poor prognosis in dental implantation. The edentulous alveolar processes are often affected by resorbtion which results in bone loss. Alveolar bone augmentation techniques include different surgical approaches such as guided bone regeneration, onlay grafting, interpositional grafting, distraction osteogenesis, ridge splitting, and socket preservation. Unfortunately, bone-grafting techniques require a longer treatment time, a need for a second surgical appointment, and an additional surgical site if autogenous bone is used. This may add significant cost and complexity to the treatment. Another technique for placement of dental implants in narrow bone ridges is repositioning and remodeling of alveolar bone by condensing and expansion with the help of bone osteotomes. This study presents the efficacy of using lateral bone expansion technique in 32 patients during implant placement.

Materials and Methods. Bone expansion technique is indicated for partially edentulous healthy patients, with insufficient localized jaw bone volume to receive dental implants.

Presurgical radiographic evaluation is used to determine the severity of ridge resorption (CT, panoramic, and periapical radiograms) followed by clinical examination to evaluate the type of gingiva (attached or mobile). The patients should receive a detailed explanation regarding the technique and sign an informed consent prior to the procedure.The site was anesthetized using local anesthetic in the immediate buccal and lingual vestibule. A crestal incision was used, but only minimal tissue reflection was done in order to preserve the periosteum attachment surrounding the buccal and lingual bone. A full-thickness mucoperiosteal flap was raised. The osteotomy was started by using the pilot burs in 1.0-m diameter followed by the 1.8-mm diameter bur. This was followed by condensing of the bone using the 2.3-mm diameter condensing bur. Because the bone quality was subjectively judged to be Type III bone, it was decided to skip the 3.0-mm-diameter condensing bur and progress to the threadformers. Further osteotomy widening was started by the use of the thinnest threadformer (2.7-mm diameter) initially fitted to the threadformer carrier by hand and then by using the disengaging ratchet. Primary stability was tested by torquing the implant to 30 NCm. The soft tissue flap was approximated, and primary closure was achieved. Patients were instructed to wash the mouth with chlorhexidine 0.2% twice daily, continue antibiotic therapy for 7 days.

Results. Six weeks postsurgery showed good soft-tissue healing. After 3-5 months, the implants were uncovered and restored with either a fixed bridge. The mean period of observation after prosthetic loading was 5 years. The bone levels were monitored radiographically. Marginal bone loss around the implants was within established limits. The results indicated that 95.5% of the implants survived.

Conclusions. The results of this paper suggest that this technique can be used as an effective method to widen alveolar ridges during implant placement.

The major benefits of this technique:

Can be used in both the maxilla and mandible with some technique modification

Allows immediate placement of implants in narrow ridges at the time of expansion

Is an alternative to block grafting in select cases to increase ridge width for implant placement Requires less time from first surgery to final restoration as compared to the use of block grafts is minimally invasive, is cost effective. This technique offers a viable alternative to bone grafting in select cases for lateral bone expansion where teeth have been missing for a considerable time with resultant buccal bone concavity.