Treatment of a Narrow Ridge with Versah Osseodensification Burs
This is a 50 year old female who had previous extractions of teeth numbers 28 and 29 along with simultaneous placement of mineralized allograft and PTFE membranes approximately 4 months prior. She now presents for implant placement in each of the bicuspid sites along with the first molar region. (Figure 1) The bone grafts in both extraction sites incorporated quite well (Figure 2).
Full flap reflection revealed Division A bone present in both bicuspid sites but Division C-W bone in the number 30 site. (Figure 3). Versah osseodensifying burs were used as per conventional protocol for osteotomy preparation (Figure 3). Note the well circumscribed osteotomies so characteristic of utilizing these precision burs in the osseodensification mode. Subsequently 3 BioHorizon tapered internal Laser Lok Implants 3.8 mm diameter x 10.5 mm length were placed 1 each in numbers 28, 29 and 30 sites. Insertion torques averaged approximately 70 Ncm per implant site (Figure 4).
Site preparation was then done via intramarrow penetrations in anticipation of adjunctive bone grafting for increased horizontal dimension (Figure 5). A porcine membrane (Memlok Pliable) was then fixated apical to the 29-30 site on the buccal aspect (Figure 6) with subsequent grafting that was done with a combination of autogenous scrapings and xenograft (BioOss) (Figure 7). Finally, cover screws were utilized for membrane fixation at the crestal aspect and primary closure was obtained (Figures 7, 8).
Patient was seen at 2 week post op for suture removal (Figure 9).
This case is a good example of how to handle a relatively thin alveolar ridge by utilizing the osseodensification burs. In essence, there is a controlled expansion of the ridge and most importantly preservation of the trabeculae vs. conventional ridge splitting with rotary burs that would actually injure the trabeculae and the osteoblasts. I have been using these burs now for approximately 6 months and have been very pleased with the precision osteotomies that are possible, the densification of the osteotomy site in the outer wall and finally as importantly, increased insertion torque values that allow for immediate placement and provisionalization. I utilize these burs now exclusively for all implant work that I perform. This includes placing of implants in thin ridges, using a crestal approach for sinus grafting as well as for application in immediate load cases.
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