Ridge Expansion and Immediate Placement With Piezosurgery and Screw Expanders in Atrophic Maxillary Sites: Two Case Reports
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 × 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 × 14 mm implants. The implants were restored to a functional and esthetic outcome.
Figure 1. Preoperative cone beam computerized tomography (CBCT) sagittal image of the edentulous #11 in patient 1, demonstrating a 17.09 mm height and 3.12 mm width. Figure 2. Intraoperative radiographic image of the expansion screw. Figure 3. Radiographic image of the #11 implant in place. Figure 4. CBCT image of site #8, demonstrating a ridge height of 18.97 mm and width of 4.56 mm. Figure 5. Clinical outcome of the #11 implant.
Figure 6. Postoperative cone beam computerized tomography (CBCT) of site #8, demonstrating the facially displaced coronal bone. Note the thinner apical facial bone. A ridge width of 8.19 mm has been attained. Figure 7. Postoperative CBCT of site #9, demonstrating the thickened coronal ridge. A ridge width of 8.20 mm was attained. Figure 8. Postoperative CBCT of site #11, demonstrating the thickened coronal ridge. A ridge width of 8.90 mm was attained. Figure 9. Radiographic image of restored implants. Figure 10. Clinical appearance of implant-supported crowns.
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