How to treat small buccal concavity/deficiency?

Split the ridge and expand the facial osteo-periosteal cortical segment facially to correct the defect and open the crest for the osteotomy.

Split the ridge using several procedures depending on how much buccal movement you need. Your choices are from least to most need of bone: split/development at time of implant placement , split 4 weeks before implant placement, onlay graft, block graft. These techniques work on maxilla and mandible.

All advise that we give you is limited to the CBCT slices provided and I would obviously want to see clinical photographs of occlusion, clearance , ridge location. However if everything is fairly ideal I would simply Expand the ridge ( Osseodensification) using Versah’s Densah drills , you have 9mm of bone width , at area that counts ,....that is a football field of bone! Depending on interarch space and other factors like tissue width I would either sink fixture 2mm and shave bone or if you decide To keep fixture platform at current crestal location and following autocompaction with versah drill , and if a few bucal threads are exposed or if facial crestal bone is thin ( dehiscence issue) then place a buccal graft graft with resorbing collagen membrane . Don’t have to decoricate but RAP phenomenon causing bleeding and stressing bone only helps your graft out come . I like primary closure for resorbing membranes , and if your graft has bulk you may need a little release . But , please look into osseodensification protocols with Versah , however please take their course to know the evidence and protocols . Versah drills can cause failure if you use them without their researched guidelines. I use densah burs routinely all the time , move the bone , even autocompaction to push sinus membrane all the time for straight forward crestal vertical lifts ,....don’t feed it to your suction tip! And waste that bone . Can expand other ways as well w Piezo expansion works well , piezo and Versah combination my fav for narrower sites , expansion screws , bone spreading w/ mallet! , but versah is so easy to use and control . There are far more seasoned clinicians on the site , looking to hear their advice please . Boarding flight in two minutes at airport, so this was a quick response , sorry Thx you

Rarely does it require anything special. I will usually place a bovine particulate (slow resorbing for space maintenance only) since you already stated that there is sufficient bone for implant placement. If the mucossa is thin I will place a small CT graft to augment the soft tissue. Either procedure can be done with a simple pouch. The DynaBlast will work but it tends to turn over pretty fast and may not provide the long term contour you are looking for. It doesn't need to be complicated and I do not charge for the additional procedure as they are very simple and in my practice the "cost of doing business".

Titanium mesh after decorticating bone and grafting with Sticky bone/afg with cgf membrane. Or micro tunneling with bone graft would be least traumatic but sometimes not as esthetically appealing due to movements. Might require trimming to make smooth. But if simply for esthetics and bulking up area, might consider connective tissue graft.

There are actually new flexible allografts, like the Demineralized Cortical Sheet, that may be useful in these situations.

yeah. osseodensification is amazing i would lay a minimal flap, position 5.2x implant slightly lingual (not much even) and place augma (biphasic calcium sulfate) over slight’deficient site, versah will push that out nicely. and suture with a surgifoam over to not leqve graft more than 3mm exposed. i did just buy membrane fixation screws cause im running low but in this case; versah and augma or graft material of choice that can withstand collapse of particulate.

Rather than challenging all the ridge splitting and grafting that in itself carry some risks, you may consider a smaller diameter implant upholding the standard set backs in all directions. Looking at the cross sections, a little recontouring of the ridge in the buck-lingual direction will provide the condition for a successful implant more than the ridge augmentations by various methods suggested by others.

Would be a nice inlay graft hybrid approach. Meaning that you flap, guided pilot, versah drill osteodensification with mineralized particulate graft, densify some more, replace flap, wait 6 months, then guided implant. Basically, i see bone tabecular bone on your photo. So densify the site like an internal sinus lift with versah drills except you are bulking up tabecular space. Just my thought on it. Best of luck doc and have fun with it .

Buccal Plate Preservation: A new technique to improve aesthetic results in single implant placement Speaker: Alfonso Caiazzo Go to botiss website watch this free webinar Ernesto lee SMART technique

Dr Lee is not on Botiss . and his course is pricey

I follow the same protocol , published in 2015 ( See Pubmed ) , minimal flap at 3-4 weeks post extraction , then expand place and graft with EthOss or a good synthetic , no membrane as we want true bone regeneration not GBR , load at 8 to 10 weeks dependant on were the buccal plate fractured on expansion placement . Done thousands over a 17 year period . The less I do the better the host will heal . Will be speaking on this and host driven regeneration at the ICOI in NY . Regards

Is there a need for ridge expansion?

Caiazzo's buccal plate preservation technique is quite simple and results are good

OSSIX Volumax is a volumizing/ossifying scaffold. It is the classic solution for buccal bone loss cases (1st/2nd stage surgery), and replaces the need for bone graft + membrane and a complex procedure. You place it like a "bone bandage" on the defect (with no bone graft). It is 2mm thick but can be folded to provide 4mm (in contact with bone it will ossify. Great tissue healing is expected as it is based on the GLYMATRIX(R) technology with over 18 years of clinical experience and 110 scientific publications. This product can transform and simplify the way these and other indications are treated.