Jawbone Augmentation: Mechanical Ridge Splitting

Bone graft surgery is commonly used in implant dentistry for the purpose of either fortifying a particular implant site (extractions sometimes cause tiny amounts of bone loss) or for larger scale jawbone rehabilitation when loss is more significant.

Difficult extractions, gum disease, resorption, congenital defects (missing incisors) and untreated tooth extractions commonly signal the need for bone augmentation when dental implants are desired for replacing a tooth or creating a fixed bridge.

No Bone for Implants?

Bone Loss - Narrow Width
Implant Not Possible

The most popular form of bone grafting used by dentists, implantologists and Periodontists consists of a pulverized bone matrix product that can be manually packed into an implant site or can be injected directly into an extraction site (known as a socket graft).

When the width of the jawbone is too narrow, as shown in our first two adjacent photos, manual packing of bone graft material on both sides of the exposed jawbone may heal well and provide a "perceived" healthier width of bone. Being able to withstand the physical forces of biting and chewing, however, may remain in question.

Perio Flap Exposes Bone
Thin Ridge Detail

Candidate or Not a Candidate?

Patients who have this condition, whether it affects one tooth or several, are often told they are not a candidate for implants.

Unfortunately, the number of dentists and specialists who have the access to advanced technologies that are designed to overcome unique bone health problems such as this are relatively few.

Using a standard set of dental implant drills cannot be used in this instance. The remaining bone surrounding a standard implant for this patient would be nearly paper thin, practically inviting an implant failure.

Creating Candidacy for Dental Implants

The task of creating a rock solid environment wherein an implant is fully surrounded by dense natural bone is to physically separate the two walls of the boney ridge and insert the implant with solid packing of hybrid pulverized bone graft material.

Technology Demonstration
Splitting - Separating the Ridge

A specialized tool, Osteotome, is used to fit into a prepared hole or extraction site. Several sizes and types of osteotomes are used to control the amount of modification to the boney ridge.

The adjacent picture of Dr. Nazarian using a model represents the basic procedure of tapping on the ridge splitter.

The walls of the boney ridge are separated to a precise width that accommodates a specific type and size of implant.

Osteotome Physics

Video: Ridge Splitting for Upper Central Incisor Implants
Video: Ridge Splitting for Lower Jaw

The next picture in this treatment series shows how Dr. Nazarian has completed the successful seating of the osteotome. The large collar is preset to create an implant depth and width that is calibrated with the diagnostic data and the type of implant used.

Mechanical Boney Ridge Modification
Seating the Osteotome

This degree of precision eliminates the error of creating conditions (wrong depth, width) that can cause an implant failure.

As with the special drill bits used in common implant dentistry, the osteotome has different "bit sizes" that start from small diameter and progress to the larger, specific diameter that matches the specifications of the implant device.

The graduated sizing of bits assures the least invasive movement of bone. Rather, the size needed is created slowly to promote maintenance of overall hard and soft tissue health.

Successful Ridge Splitting
Implant Candidate

The next photo shows the final outcome of the osteotome procedure. Using the graduated osteotome sizes, Dr. Nazarian has completed the modifications necessary to accomodate the desired size of dental implant.

Depth and width are measured a last time to assure a precision match.

Bone Graft Procedure

Implant Placed + Pulverized Bone Graft

Once the implant device is seated, pulverized bone matrix product is manually packed into the surgery site by Dr. Nazarian to create a tight fit for the implant and to add density to the bone, matching dimensions of the ridge along the entire maxilla.

The adjacent photo shows the implant placed, with the healing cap already attached. A special healing membrane (promotes directional tissue growth) is placed immediately prior to final suturing.

New Jaw Bone Width

The entire implant and attached healing cap is sutured in, under the repositioned Perio Flap that was created when first exposing the jawbone.

After adequate healing, the gum tissue sutures are removed to expose the healing cap. The implant abutment is placed and gums are resutured to create a snug fit around the implant abutment.

Here it can be seen that the width of the bony ridge has been increased significantly, matching the dimensions along the entire jaw.

Final Implant Restoration

Final Crown Restoration

After a short time of using a temporary crown as a try-in for making final adjustments in cosmetics and proper bite, the final porcelain crown is placed.

Ara Nazarian, D.D.S.
Michigan Reconstructive Implant Dentistry
1857 East Big Beaver Road
Troy, MI 48083
(248) 457-0500

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