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ePaper created 2016-06-01, 09:58:05 | version 1.38.0
implants 1_2016 I C.E. article_ bone-expansion technique 06 I the cortical bone is very thin. The lamina dura, which enables the attachment of collagen and Sharpey’s fibres, presents a high potential for contamination. Consequently, a light manual curettage of the socket wascarriedout,followedbyasuperficialdebridement (vaporisation) of the entire “lamina dura” with an Erbiumlaser(2,870nm)followedbydecontamination with a diode laser (940 nm). This was a flapless surgery. The expansion oste- otomy was performed through the inter-radicular septum. It was initiated with a very thin manual bone tap (pointed), and then an automatic mechanical os- teotome(Figs.4-5)(OsteoSafe®–Anthogyr)wasused. The use of convex inserts in the beginning enables lateral expansion of the native or healed bone, and then concave inserts during the breaking of the last sub-sinus millimeter enables lateral bone recovery of this bone socket while projecting it apically. During sinus progression, PRF membranes (or na- tivecollagenmembranes)areplacedintheosteotomy opening to fill the intra-sinus space that is thereby gained (they also provide protection of the sinus membrane). The Erbium laser is again passed through the osteotomy socket to vaporize the bone debris and sludge along the walls of this osteotomy. The implant isplacedaccordingtothemanufacturer’srecommen- dations but with an even slightly higher torque if the titanium grade so allows. A healing screw that fits the diameterandheightoftheresidualgaptobeclosedis carefully chosen (Fig. 6). If the healing screw does not enable primary clo- sure of soft tissue, PRF membranes are used to fill the gap. If this gap is too big, a mucoperiosteal detach- ment of 6-10 mm and then a horizontal incision of the periostium of 6-8 mm are made. This technique serves to pull the gum around the healing screw by maintaining it with two sutures. The control X-rays clearly showed good osseointegration of the implant, significant filling and regeneration in only three months,andthenperfectfillingandregenerationfour months after surgery. The bone remodeling around and above the im- plant neck also seemed to be well executed. The cone- beam 3-D imaging in the first place showed a healthy sinus without inflammation or infection as well as bone remodelling at the apex and around the implant (Figs. 7, 8). In the case of a trans-alveolar sinus lift combined with the placement of an implant by bone expansion, convex-tipped inserts should be used first to enable lateral expansion, and then concave inserts enable scraping of the bones of the lateral walls of the oste- otomy to enable apical projection after breaking the Fig. 7 Fig. 7_Panoramic views: (7a) Pre-op, (7b) Post-op, (7c) three months, (7d) follow-up at one year. Fig. 8_Control at six months. Fig. 9_Pre-operative view of fistula on #24. Fig.10_Panoramic view with gutta-percha cone inserted in the fistula that reaches the apex. Fig. 8 7a 7b 7c 7d Fig. 9 Fig. 10