Wide Implants in a Narrow Maxillary Alveolar Ridge: Best Technique?

Anon You can do ridge expansion using expanders from Microdent in spain, or use an implant that do automatic bone expansion as the Maxi Z from OsteoCare in England, Also osteotomes are an option although they are very alarming to the patient.

Hi Do you know the ridge width now? You can test it with a conebeam CT. Or you can use ridge mapping techniques. The ridge must be at least 3mm thick to do a ridge split safely, and for the first one you should try it on a 4mm wide ridge. Ridges thinner than 3mm are difficult to do for all but the most experianced clinicians. You might require a block or particulate graft with a membrane. I would also be helpful to you to watch a ridge expansion live before attempting this. There is some video available on the blue sky bio web site on ridge expansion in the library section of the web site. Best Sheldon Lerner Blue Sky Bio Dental Implants

If you need major ridge expansion and you are doing first time,do yourself a favour.Do not do it. Ridge augmentaton will be better option for following reasons. 1 Ridge augmentation is more predictable. 2, You can increase even height. 3, You can augment soft tissues with CT graft at the same time. 4, Expansion will be at the expense of labial plate, so there are chances that a,labial plate may fracture or become thin and part may die leaving an aesthetic problem due to metal showing through or periimpltisis. b,During expansion osteotomy may be displaced labially and your implant will be more labial than required. c,More labial placement may requird use of angeled abutment. d,Labial implant will force you to have crown with 'undercontour' on labial and it may cause gingival recession.

If you think it looks thin then it moist likely is even thinner.

I feel it would be best to on an onlay graft using an allograft material to increase the ridge with. Then, place the implant as indicated by the surgical guide made from the wax-up. The ridge split may be used but, there is a risk of loosing the blood supply to part or all of the area that is split. Try both, then use the procedure that works best for you. Don Callan

Unfortunately I have lost occasionally onlay grafts and I must say that I did not like the feeling telling a patient 4 months after a difficult procedure that we got nowhere. That made me look in different directions and I modified a technique that I have learned from Norman Shepherd. In my hands, using a ridge split is a lot more predictable and the width obtained is much greater. I am using a 2 stage (and in very thin ridges or in mandible a 3 stage) approach. 2 stage approach: -crestal incision (no flap) -piezo unit to filet the ridge -widen the ridge with ostotome and place large granules graft (whatever you like but I use Biooss) and cover with surgical plaster membrane - 3-4 months later insert implants 3 stage approach -crestal incision and buccal flap -outline osteotomies with pieze unit including filet cut and horizontal buccal cut just enough not to fracture the segment -close back up -3 weeks later crestal incision and fracture the segment out which is attached to periosteum. Not a green stick fracture but a full fracture where the segment is loose and only attached to the periosteum -pack large granules graft and cover with surgical plaster membrane -3-4 months later place implants Using these techniques I was able to widen ridges 5mm or more without being limited by the with of the onlay graft and in my hands in a much more predictable manner. Patient discomfort is minimal compared to the discomfort of a harvest site and risks are significantly reduced. Best, Albert

Why not use mini dental implants and save yourself the hassle? IMTEC corporation makes 1.8, 2.1 and 2.4 mm implants. Are you planning on dentures in this case?

Dear "Anon" I am not sure you "need" to place wide body implants If a standard 3.5 diameter implant will work place longer and more of them...? Use tuberosity for placement as well Wide body implants are great in molar areas when you have the bone if not then ...well.. you dont Bone expansion in posterior maxilla is pretty much standard protocol today i cant remember the last time I used the full set of drills in the posterior maxilla very common you will find tons of literature on the technique SS

I think talking by number is very important in tratment planning for implant, instead of using the terms wide narrow, thin , short...so on. i also recomend if you do the procedure for the first time it is better to be done with supervesion cos any mistake cost the patient alot(not only mony) important point to remmeber when you increase the ridge width that the imlant should be surrounded by high quality bone & not bone filling material

I like to use the osteotomes in the upper jaw. The bone is much more elastic, but you have to take time. Don't do it in a rush and give the bone so time to relax after to let stay the osteotome in for some time. As stated above You don't have to do the bone-expansion and placing the implantat the same time. You can even build up with some grafting material and some palatal graft if necessary--> it is then the same as after an extraction of a tooth and pocketpreserving procedure. This time you will allreaydy have buccal bone and this makes it easier. If you do a procedure like this, just make a little incission at the top of the ridge. If the buccal bone fractures, it is still stuck to the periosteumand have some blood supplies. If you make a full flap you havea big problem in this situation and advance ridge augementation will be necessary. Good luck

By Narrow implant it is recognised as 3.5mm and less Wide body is 5mm and more Mini Implants are less than 3mm Short is less than 9mm Long is greater than 12mm All implants need to be surrounded by 1mm of bone Not only is surgical technique important in the placement of implants in Narrow ridges the prosthetic design s crucial Biomechanic design is the difference of success and failure,particularly in cases like this DrSS

bone expanders in the posterior maxilla is quite difficult to use to poor access and visibility , however for a very thin ridge, I have found that raising a clean flap high up into the sulcus, creating tiny holes in the bone with rosehead burs while harvesting the bone in a bonetrap, then augmenting the buccal surface with particulate(I use Bio-oss) with the bone mush from the bone trap,and repostioning the flap without tension in blanket sutures has always worked with me. approx 3/4 mm residual bone is created and so regular implants of 4.3 can then be used.I have founf no difference in the success of the graft with or without the use of adjunctine antibiotic paste in the graft, no membrane is usually used but if you do, be careful it does not get exposed. regards FSDaar uk

A nice small gadget for horizontal osteogenesis is maufactured by Osteo-tech. Very easy to use, but you must have neighbouring teeth to anchor the device. It is effective and much faster than to wait for block bone augmentation to take.

DEAR Anon first of all there is a difference between bone expansion & distraction osteogenesis(D.O.), to use bone expanders is less traumatic & easy technique than D.O.,but you must have a minimum width 3mm at least.I advice you to do the following use the 1st. recommended drill then advance the 1st. expander then the 2nd. and so on & finally manually insert the implant which must be wider than the last expander by about 0.9mm. good luck

A peizo can be used to give a crestal incision and 2 vertical incision on the buccal(mesial and distal)from the crestal incision..I use the Mesissenger controlled bone expansion kit for the spreading.Fill the gap with bioss and also in the buccal areaa and cover with guide.Leave for 6 months come back and place implants ...or simultaneously with the packing you can place implants.