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Ask UsRidge Splitting Techniques in Implant Dentistry
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Sunday, March 16th, 2008 | in
Piezosurgery, Ridge Augmentation, en, Dental Implant Videos
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Special Video Presentation from DentalXP
Author: Dr. Maurice Salama
Description of Video:The technique of Ridge Splitting and Expansion will be featured utilizing piezo-surgery, ridge split instrumentation and bone expansion drills. The additional role of PRGF and Fibrin in lateral ridge augmentation utilizing membranes and bone tacks will be discussed.
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26 Responses to “ Ridge Splitting Techniques in Implant Dentistry ”
Excellent video
I am impressed that he did not use loops…..clearly much younger eyes then mine.
Would love to see the uncovering and the final restorations.
Does anyone know how deep to make the horizontal cuts in depth and length? Great technique.
About the first procedure, does the crest really need to be expanded? In my opinion, i think there was enough space to allow an implant insertion without any augmentation procedure.
I use the piezo and it is a great ridge splitting tool and more prrecise than a 701 bur. Miesenger makes a ridge expanding kit also which is another great tool. Showing my age, I also use the Tatum D expanders due to the convexity to the buccal. I have expanded to the point of fx. If this happens drill holes in the separated piece(if it is big enough) and fixate it to the site. Do not completely screw it down but once stable fill in betwee with Curasan or autagenous or what ever you like and then tighten down. It is harder than it sounds and this technique is to prevent you from opening another area for a monocortical block and extendint the time and money that you will spend when you go bak to place the implant. Hope this is helpful. Got the idea from a Dr in Germany.
It seems like a nifty device, but there appeared to be enough bone to place an implant or at least using osteotomes. I don’t really see the need for ridge splitting in this case especially since he grafted and placed a membrane. A thinner ridge would have been a better demonstration along with a follow up in 4-6 months.
Also, what happens if the sectioned ridge breaks off during implant placement or during initial separation. Is there a minimum ridge width that you need to have to start with?
ADH
You are perfactly right.
Is there a need for ridge splitting, when a ridge augmentation also needed to save fractured block? He had to augment ridge any way.Why not just augment and wait or place implant in right place and augment if need arise in this wide ridge.
Why should we take extra risk ?
Most of all what’s the point of inserting implants in between healthy prepped teeth? All the patient needs is two good bridges! I would call all that surgery with its name: overtreatment!
Fred,
That is a very valid point.But lets assume patient is determined to have all restorations seperate and you may have to do implants.
Regardless of your valid point,this is a beautiful surgery without any indication.Ridge splitting for more than 4mm ridge is unnecessary unless you have use 6 mm implant, in my opinion.Osteotome would have been lot easier and less complicated and require definitely less skills than Dr. Salama’s.
I dont buy this protocol at all
Nice surgery but thinking and rational is flawed
Very nice video from Dr. Salama, one of the Grand Masters in this field. But in my own cases, I prefer to put the vertical stop cuts within the palatal cortex rather than the buccal one. I bet if Dr. Salama had taken advantage of the palatal cortex, he would have been able to place the implant for the tooth #7 as well.I do not have a piezo machine, instead, I use an oscillating saw.
totally agree with satish .excellent skills but poor clinical judgement.
I am in agreement with all the above posting doctors! Excellent video shooting of an unnecessary surgery and an unnecessary graft!
Excellent unsurpassed surgical skills but where is the clinical judgment? Excess amount of graft was placed below the membrane. Nature is not about to allow over contouring of it’s live breathing tissues. See what happens to over contoured crowns.
The last part shows healing which frankly isn’t impressive.
Good as a demo but unfair to the patient.
Once more I see myself agreeing with Dr Knecht.
i would prefer doing a splitthickness flap leaving the periosteum intact and lifting a bigger block labially ,filling the gap with autogenous bone +bio-oss as spacemaintainer……primclosure …and implants 3mnths later in expanded ridge
I agree with some of the comments above. I think it is great that someone let us have a look in his kitchen and maybe we do things sometimes in another way, but there are more ways to do omething right. It is the end result that counts. On a video it is difficult to see if the ridge is that big as we think and maybe we can contour this ridge just by using osteotomes. At the comments of grafting. I have always understand that the best thing to do is to put an implant in autologes bone. So if you place an implant and you miss some extra bone you have to harvest it somewhere else ( an second operation site) or you use the slury ( None f us now if this is as good as harvest bone in the other ways and free of stuff). So in this way of few it isn’t a bad idea the way it was performed and to use some bio-oss to preserve the buccal plate for resorption because of the full thickness flap. At least it was a planned surgery and not seeing what we come up with during surgery
Boy, you guys are rough on Dr. Salama. I think he picked this case because it was easy to film. Ridge splitting is much easier on the maxilla. The film gives you the idea how easy the bone cuts with the instrument. It is a great bone cutter without loosing bone with a saw cut. The Piezo is much easier than using a saw and can get into areas you could not get to otherwise.
Woh.
A little kindness and respect, gents. EXCELLENT work Dr. Salama.
Remember the concavity.
I would want a fatty, if he were placing an implant to be restored with a cantilever on me.
Bridges are not just passe, they are expensive. If one abut/pontic fractures, the patient has no bone and is looking at 2 surgeries.
michaelp
I believe that one thing that is missed in previous comments is how ideal your goal of 3D implant placement is. While crestally the ridge appears wide enough to place a narrow diameter implant, the labial plate is way palatal compared to the adjacent teeth. Any implant placed would have had to be placed more apically to allow for running room to get the proper labial profile. By expanding the ridge to the buccal Dr. Salama will be able to place an implant in an optimal 3-dimensional and periodontal relationship to the adjacent teeth. I think it comes down to how much a perfectionist you want to be.
Why Bio-Oss, it is only a filler? Totally agree with Satish
Great surgery from one of the greats. I have done the ridge splitting procedure many times and many different ways. I completely agree with Dr. Salama’s rationale and technique. I Personally prefer split tickness flap, but that is my own preferance. The overgrafting is to compensate for resorption. His goal is to maintain 2mm of bone buccal to the implant. BEAUTIFUL CASE. He is a very talented surgeon and lecturer who has contributed significantly to the literature.
For my own mouth I would prefer implants on #7 and 10 rather than a bridge… therefore that is what I would do for my own patients in this similar case. NOT overtreatment at all.
No membrane and fillers over the splinted space but needed on the empty concave space? What is the indication for osteotomes vs splinting? Pleasel anybody correct my confusing implant philosophy
I have used ridge splitting in both the maxilla and mandible for eight years and have added the piezo to this technique a year ago. Piezo simplifies a biologically sophisticated technique making it much more elegant. I split much more frequently than graft and sometimes stage, splitting twice (with no graft) placing the implants at the second visit. Excellent presentation. Why are’nt we all using these techniques?
Dr Munns how do you do mandibular ridge splits can you show us a video of the same? I have seen slides of a two stage mandibular ridge split by the “Bicon” doctors. Is it something similar?
Maurice has presented excellent technique and explanation for what was done. I agree with his full thickness flap, as visualization is so important. The Piezzo unit offers so many advantages with respect to precision over alternatives. Thanks for making available a video that shows our fellow practitioners the details and nuances of a complicated procedure.
Michael Tischler, DDS
Woodstock, NY
Very nicely done case.
I think he validates really well his rationale in the video. The main point of splitting versus expanding with osteotomes is that he avoids any drilling of the facial cortical plate which he expects to give him tissue stability on the coronal part overtime.
Such a beatiful video but i would like to see him demonstrating as well the handling of the temp bridge and its cementation after suturing.
does this technique work at very thin ridges?
THANK YOU FOR THE EXCELLENT SURGERY.
DO YOU KNOW IF ARE STUDYS ABOUT PARTIAL VS FULL TICKNESS FLAP?
WHAT DO YOU THINK ABOUT THE TWO TECHNIQUES?
BEST REGARDS.
Carmine Rapani
Chieti
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