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ePaper created 2017-12-04, 09:17:08 | version 1.38.0
I C.E. article_ bone-expansion technique 7a 7c Fig. 7 7b 7d Fig. 8 Fig. 9 Fig. 10 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_Case No. 2. Pre-operative view of fistula on #24. Fig.10_Panoramic view with gutta-percha cone inserted in the fistula that reaches the apex. 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 was carried out, followed by a superficial debridement (vaporisation) of the entire “lamina dura” with an Erbium laser (2,870 nm) followed by decontamination 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 oste- otome (Figs. 4, 5) (Osteo Safe® Anthogyr) was used. The use of convex inserts in the beginning enables lateral expansion of the native or healed bone, and then con- cave 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- tive collagen membranes) are placed in the osteotomy 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 is placed according to the manufacturer’s recommen- dations but with an even slightly higher torque if the titanium grade so allows. A healing screw that fits the diameter and height of the residual gap to be closed is 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, and then perfect filling and regeneration four 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 06 I implants 2_2017