To Ridge split prior to placement or not?

Based on the anatomy expanding the ridge should work well. I use motorized expanders, not familiar with the splitter but there seems to be enough bone just be gentle with the split. Nice case.

Hi agree with CRS , just a gentle expansion . Two things here if expanding Using the Meisinger kit ( have one ) try to keep the soft tissue attached and use particulate . If you have to raise a flap grafting is critical as once done as there is PDL blood supply , denuding the periosteal blood supply will lead to bone loss . Peter

For the site of tooth # 12, osteotomes or expansion with the Meisinger Kit or Abrahami Kit will work very well. You may have to graft the buccal to maintain the 1.5 to 2 mm of bone. Remember buccal resorption. I have used OsseoTape from Impladent Ltd. for this purpose. Wet said tape in saline and apply with your fingers to the buccal bone and perform undermining release incisions to obtain primary closure. If you do not get primary closure a resorbable membrane is needed.

This will be the first time using the ridge split or expansion kit. Would love any pointers in using these kits with the most success. Thank you guys.

HI Mike , just a few thoughts from years of joy with success and pain from occasional failure . THis case as the others have stated will benefit more from and expansion , as to a full ridge split best try out first on pigs jaw as technoque sensitive and if you get things wrong , may lead to sequestration of the buccal plate , a disater! Simple rules though if you raise a flap for the expansion , a good idea to get things in the right place then you must graft as expansion with the removal of periosteal blood supply can lead to bone loss . If doing a full ridge split , be wary and retain the soft tissue atttachment . Strange world you can buy a ridge splitting kit with what appears to be little teaching , let alone hands on ? Like buying a car without a driving leasson. In Europe Meisinger have great courses with hands on pigs jaws demonstration , as these can be difficult to do even with Implant experience . Regards Peter

hello, your question about splitting seems to concern the sole premolar, on the panoramic view, there is obviously need of sinus grafting before placing the implants, why not graft the sinus first so at a later stage you will help yourself with a crestal bony incision that will permit easy expansion of the crest while reducing risks of buccal fracture? other advantage would be reducing the number of surgeries for the patient by stepping the case. just ideas among others, best regards .

If you expand the ridge you can place 3-3.5 mm implants with little problem and no wait for graft healing before implant placement. Ridge spit will work fine also but is not necessary.

In this case I would expand the ridge in the maxilla and place either a Quantum 6 mm long or a 9 mm long implant. For full disclosure I am the president of Quantum Implants. Then again you can also place a Bicon implant. Raul

Looks like a good case for a ridge split. It's fun going back in and seeing this big ridge you didn't have a few months back. I'm still concerned about one I did a few months back on a smoker. Wasn't going to smoke but did anyway . Instruct the patient to take care if this thing on the front end. I should have been more firm about that commitment. It seems that there is a significant amount of pathology on the pan view just sitting there waiting to deliver some excitement to this case. Any thoughts about handling that before you launch into surgery? Just an idea. Happy splitting. Bill

You guys are the best. Love the suggestions. With the expansion kit would you expand and place the implants at the same time. Also, how slow do you try to expand the ridge. Any specific suggestions from the kit use for the expansion and ridge split kits? Seems like Meisinger talks about placing the implants at the same time as the expansion but you are suggesting to only split those cases and than wait. If someone has some case photos that they could share would be great. Thanks, just trying to avoid a huge learning curve that there seems to be associated with these kits. ' Michael

I agree with a Quantum Implant. On of Quantums advantages over Bicon in the anterior is that the abutments do not come out. I've had this problem with Bicon on numerous occasions. I restrict the Bicon now to the posterior. However, Quantum can be used in the entire arch (maxilla and mandible). There was a recent case in Northern Virginia, where a GP had a patient visit her office with a Bicon in the anterior ((maxillary lateral). The abutment repeatedly came dislodged. So instead of doing the occlusal adjustments etc. she refers to an OMS for removal of the Bicon. The Bicon was removed. Patient grafted and subsequent implant replaced. This is a tragedy. The patient probably needed an occlusal adjustment or cement the abutment into the well with Panavia.

When dealing with the maxilla....remember that the quality of the bone at best may be pressed Balsa Wood , or softer. As mentioned above, try not to disturb the blood supply by opening a full thickness flap .... my suggestion would be to drill the full depth of the proposed implant site with a narrow diameter pilot drill, and gently enlarge the diameter with osteotomes, followed by a narrow platform 3 mm in diameter implant made by Adin Implant Systems.........Adin makes a variety of narrow platform abutments for these 3 mm implant..... so the site is gently expanded by the initial osteotome expansion, and then the final expansion by seating the implant ........... no interference with the circulation, and a compaction of the bone to make it denser . Gerald Rudick dds Montreal Canada

In this case I'll try in a gentle split expansion with osteotome; immediatly position of an adequate fixture; little hole with bur, bone graft and collagen membrane on the buccal aspect... for all your right consideration. About the region of 2.5/2.6, why not a distaly tilted implant, instead of a sinus surgery ? well, in case of sinus elevation, looking the project on the x-rays, it seems that the position of the fixture may be too palatal, leading on a cross bite with the prostetic recostruction. dr Dario Galli

Hi guys, Good discussion. Not so sure what is the final planned restoration as this seriously changes consideration. If it is a single tooth implant 24 region jolly good you can get a good emergence with Bio Horizons 3.0 implant without split or expansion. Reason being if it is D3 bone which may well be the case, you will be in trouble operating in a closed area holding on to blood supply of the split fragment. Worse is if you had a antral perforation- unlikely but possible.You can even use a angulated abutment. Looks like you are planning a sinus graft and implant in 26 region? If so why not have first stage surgery to gain some (24) width by simple decortication-particulate graft and a non resorbable membrane combine with sinus lift. Second stage - remove membrane you can carry on with implant placement and restoration. Works in my hands and am sure there are 1001 ways to do this. Hope it isn't controversial. I would love to do ridge split if necessary.