Dr. N. asks:
Are ridge expansion instruments safe for D-1 or D-2 bone of the lower posterior arch? I have used these for D-3 and D-4 type bone in the maxilla but have been reluctant to do so in the mandible due to concerns of fracturing of the buccal plate on the harder and more dense bone bone. Any comments?
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Also look into Meissinger of Germany , some progressive ideas
Actually it is easier in softer bone. The question will always be, even with expansion and condensation, implants in type IV bone, how well will they integrate, how will they respond under load and what is the osteogenic potential of the patient.
To properly expand the lower ridge, you must split the ridge at the crest with a Piezo, bone Saw, or a 701 surgical bur to the medulary boneYou also may nee to make vertical releasing cuts at the proximal edges of teh crestal cut. I wil use Tatums D expanders and the Mesenger kit. The boen can fx and if it does you can use fixation screw to hold it(this is very difficult so don’t think that it is an option). It is not easy to expand and you need to have a large area to get good expantion. Hope this helps
You can start your inital bone cut with a saclpel blade, using a mallet, then follow with osteotomes and proer osteotomy bur between osteotomes.
Ck this site. I like this technique.
http://www.bicon.co.uk/casestudy.jsp?ref=10
expantion of d1 and d2 bone is a bit riskey by using con ventional expanders and oesteo tomes how ever pieso tips are best in such situations missinger expanders are riskey as base expantion is more chanceto fracture is too hi in d1 d2 may be stoma is better
Rajesh, The bone in the mandible is just as plastic as that of the maxilla. You can expand the bone with the osteotomes from Tatum Surgical. You have to implant for rxery other tooth on the first surgery, they returm aprox 8 weeks later and implant the sites that were avoided on the first go. This is because if you expanded and placed an implant for adjacient teeth, you WILL break the buccal plate. So you have to give the bone a chance to recover. If you are serious, check with Tatum Surgical at 1-888-360-5550.