Implants in Narrow Ridge Situations: A Piezo-Surgical Approach For Alveolar Ridge Split
Implants in Narrow Ridge Situations: A Piezo-Surgical Approach For Alveolar Ridge Split
Implants in Narrow Ridge Situations: A Piezo-Surgical Approach For Alveolar Ridge Split
and Modern devices. Chisel and hand mallet, Osteotomes, prosthodontics with the chief complaint of missing tooth in
Surgical burs, micro-saw blade comprise of traditional the lower left jaw region. All the treatment modalities were
devices whereas Modern devices consists of Motorized ridge explained to the patient. She chose the replacement of the
expander, Treaded Bone expanders, Expansion Crest Device, missing tooth with implant followed by crown. Primary
LASER, Ultrasonic/ Piezoelectric Device [14]. diagnostic procedures were conducted and in CBCT report it
The following is a case report on the Alveolar Ridge Split was found that on 4.4 mm of bucco-lingual bone availability.
[ARS] by using Piezoelectric Device. On examination it was found that it belongs to Class III of
Tolstunov’s classification of alveolar ridge width. Hence it
Case Report was planned to augment the alveolar ridge using piezoelectric
A 23 year old female came to the department of device in order to increase the alveolar bone width.
Surgical Procedure situation less than 6mm bone requires transverse bone
Initially asepsis of the surgical field was done. Inferior augmentation [4-8]. Although there are various protocols are
alveolar nerve block was given to incorporate the local available ridge augmentation with ridge split techniques were
anesthesia. Upon successful onset of local anesthesia a crestal proven to be successful.
incision was given using number 15 BP instrument. Relieving In 1970 Dr Hit Tatum used D-shaped osteotomes to split the
incisions were also given. The flap was reflected. The center alveolar bone. In 1985 he expanded the atrophic ridges of
of the ridge is marked. The tip of the piezoelectric device was greater than 3mm [15]. In 1992 Simon et al. used longitudinal
placed on the top of the ridge at the denoted mark and the green stick fracture in order to extend the socket, performed
device was activated. The tip was inserted into the bone and through osteotomies [16]. Later Summers and Schipani in 1994
the ultrasonic vibrations of the tip make it possible to cut revived this procedure and achieved 98% success rate [17, 18].
through the bone. The proposed length of the implant is 9mm. Summers has described the technique with progressively
hence the tip is inserted into the bone till the required depth of increasing osteotomes to create osteotomy that is closely
the drill is achieved. Once the depth is achieved the drills of receptacle to implant dimension. Padmanabhan and Gupta had
the implant surgical kit were used in order to increase the found greater crestal bone loss associated with this technique
[19]
width. An Implant of dimensions 3.1mm* 9mm was placed. .
Cover screw was placed and the flap is sutured back. The In 2000 Vercellotti introduced piezo surgery in the treatment
position of the implant was checked using radiograph. of atrophic jaw. This made the split technique easier, safer,
The post-operation instructions, with special emphasis on the and also reduced the risk of complications [20].
maintenance of oral hygiene, were given and the patient was The indications of the ARS are situations that don’t require
scheduled for a recall after 1 week, 1 month and 3 months. vertical bone augmentation and situations where the bucco-
lingual width of 3mm is available. The advantages of this
Discussion technique are it maintains the integrity of the periosteum and
It is established that the width of the bone should be greater this procedure never allows the loss of patient bone. The
than 6mm for the successful treatment. If the sufficient bone disadvantages of this technique are it cannot achieve vertical
width is not available, implant placement may result in height and also this technique is difficult to perform in single
dehiscence or off axial loading of the force. Hence any tooth replacesment situations rather than long edentulous
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Fig 2: CBCT report showing inadequate bone Fig 6: Measuring the width of the alveolar ridge
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Fig 10: Checking the depth of the drill Fig 13: Radiographic verification of implant placement
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