Straumann roxolid dental implants or Horizontal ridge augmentation?

I think ridge augumentation is a high risk procedure for this mandíbule region. The lack of blood nutrition can lead to absortion and you may loose even the poor amount of bone the patient has. I'm all for the prosthetic driven planning, but we should low the riscs we put our patients on. Maybe the solution would be the ridge split with imediat implant placement and a bone graft. What do you think?

I've done ridge split but in the maxilla. The bone has some give to it and you can flex it to allow for implant placement. The mandible does not have the same luxury. Look at the CT. The buccal bone has a huge cortical plate. The will more likely break off then bend enough to facilitate implant placement. Have you heard of a technique called SonicWeld. I've never tried it but the oral surgeon I that introduced me to this technique swears by it to such a degree that he prefers this over a ramus or symphysis block graft.

Hi John, How has this technique worked for you? I hadn't been introduced to it before. Thank you. Omid

Omid, you can see detailed video of this procedure on the Bicon.com site under "Webcast Replays". While it appears complicated, it is really the easiest, most predictable, fast and low stress of the bone augmentation procedures. On the first appointment, after careful measurement, you simply flap the buccal and cut a rectangular window thru the buccal cortical plate, and gently replace the tissue with common sutures. Three weeks later, you flap the tissue again, just at the crest, a bit over the lingual edge to ensure some attached tissue coverage. Gentle vertical chiseling on the crestal bone slit will separate the callous there and the flexible callous healing area around the other three sides of the window slits will allow the window to pop out buccally much like the old rumble seats. I usually size the window to put two or three implants, one each against the Mesial and Distal edge, and perhaps a third centered. While complete closure is generally advised, especially for a beginner, one using implants submerged below the crest 3 mm can put a thin lengthwise slice of a Collaplug cylinder atop the slit filled with native bone and allow some secondary healing to obtain a nice wide ridge crest of attached gingiva. The big cautions in these window cut procedures are to 1- Avoid Mental Nerve area, 2- plan a short enough implant to fit above the lingual shelf, and 3- Locate and avoid the Inferior Alveolar nerve. One nice thing about Bicon is that you can use a hand reamer on a 40 rpm hand piece for the depth while being able to feel any contact with the cortical plate at the lingual shelf area. We usually use 4.0 x 5.0 or 4.5 x 6.0 implants for our mandibular buccal ridge splits in sets of two or three. What makes them easy is that, if well planned, there is very little stress on the patient nor operator. e.g. The first task is to cut a lengthwise slit atop the boney ridge, starting at where you want the front implant to abut and back to the length you want the back implant to abut. So maybe you cut a 14 mm, 16 mm, 18 mm or 20 mm slit on the crest. The Mesial vertical window slit, for me, is almost always 6-7 mm down the buccal cortical plate. The Distal vertical cut will usually be shorter, especially on three implant placement, since you are going down only to the external oblique ridge. So it is not usually a truly rectangular window. Lastly, you connect the two vertical cuts horizontally at the depth cut. You are only cutting thru the cortical plate, not medullary bone, not near a nerve. The fap is gently replaced and the patient waits three weeks for the second appointment. At the second appointment, you have already established the Mesial edge of the front implant and the Distal edge of the back implant, and the Bicon reamers will automatically back away from the uncut cortical plate, leaving you with perfect front to back locations. You need to see the webcasts and get some training, but, to me, they are very predictable and not stressful to perform. Patients will have more discomfort from the first appointment due to the flap surface area. The second appointment does not bother them apmusch at all. Another caution is that I am using the 4.0x5.0 implants in this mandibular area much like two molar roots. I would not advise them singly for a molar, nor widely space as two molars. They may wor that way, but I'm mainly using them for patients with thin roots and narrow ridges as replacement roots at this time.

Why double membranes and a split periosteum in the posterior mandible? The periosteum is very thin back there. The double layer closure is usually reserved for the anterior mandible and your membranes provide the extra layers. This is just harder on your flap to split. You need width, use allograft the autologous alone will just resorbable faster.. I 'd have the patient use nicotine patches or no go! Very interesting case perhaps after the grafting heals you can repeat the ct with a radiographic barium stent so that the implant placement can be determined. Good luck nice post!