Ridge expansion and sinus elevation: A minimally invasive approach to maxillary reconstruction

Abstract

Current implant therapy includes a number of techniques that allow for site development, implant placement and esthetic restoration with long-term function. Ridge expansion techniques have been developed to meet the ongoing challenge to improve results and shorten treatment time. Ridge expansion utilizes the biologic healing potential of bone, like an extraction site with simultaneous insertion of appropriate tooth size implant(s) to reproduce the functional proportions of the dentoalveolar complex. Miniflap or split-thickness flaps are used to preserve microvascular supply of the periosteum to the alveolus. With ridge expansion, a vascular “bone flap” is developed for implant placement and as necessary, allows transalveolar access to the sinus floor. Through this intrabony defect, sinus floor elevation can be completed at single or multiple adjacent sites using “osteotome,” “palatal infracture,” or “ridge pole” techniques. Significant sinus elevation of 7 to 9 mm can be obtained with implant placement. Sinus floor access can also be gained through the alveolar crest at an extraction site. Using a staged protocol, incremental sinus elevation can be completed with tooth removal in extraction sites and adjacent areas, and again in 8 weeks at implant placement. We will detail the various approaches including indications, contraindications, flap design, intraoperative decision making, and the management of complications. The role of split thickness flaps, free and pedicle grafts, and adjunctive periodontal “plastic” techniques will be demonstrated. Comparison with traditional techniques for block and particulate grafting, lateral wall sinus elevation, and osteotome sinus elevation will be reviewed. These minimally invasive techniques offer significant advantages, including excellent esthetics, minimal discomfort, faster healing, and eager patient acceptance. Experience in the use of “osteotomes” is helpful to reduce a significant learning curve. A practical approach to the introduction and progressive implementation of the techniques will be discussed.ReferencesBruschi GB, et al: Int J Oral Maxillofac Implants 13:219, 1998Scipioni A, et al: Int J Periodont Rest Dent 14:451, 1994Tatum H: Dent Clin North Am 30:207, 1986 Current implant therapy includes a number of techniques that allow for site development, implant placement and esthetic restoration with long-term function. Ridge expansion techniques have been developed to meet the ongoing challenge to improve results and shorten treatment time. Ridge expansion utilizes the biologic healing potential of bone, like an extraction site with simultaneous insertion of appropriate tooth size implant(s) to reproduce the functional proportions of the dentoalveolar complex. Miniflap or split-thickness flaps are used to preserve microvascular supply of the periosteum to the alveolus. With ridge expansion, a vascular “bone flap” is developed for implant placement and as necessary, allows transalveolar access to the sinus floor. Through this intrabony defect, sinus floor elevation can be completed at single or multiple adjacent sites using “osteotome,” “palatal infracture,” or “ridge pole” techniques. Significant sinus elevation of 7 to 9 mm can be obtained with implant placement. Sinus floor access can also be gained through the alveolar crest at an extraction site. Using a staged protocol, incremental sinus elevation can be completed with tooth removal in extraction sites and adjacent areas, and again in 8 weeks at implant placement. We will detail the various approaches including indications, contraindications, flap design, intraoperative decision making, and the management of complications. The role of split thickness flaps, free and pedicle grafts, and adjunctive periodontal “plastic” techniques will be demonstrated. Comparison with traditional techniques for block and particulate grafting, lateral wall sinus elevation, and osteotome sinus elevation will be reviewed. These minimally invasive techniques offer significant advantages, including excellent esthetics, minimal discomfort, faster healing, and eager patient acceptance. Experience in the use of “osteotomes” is helpful to reduce a significant learning curve. A practical approach to the introduction and progressive implementation of the techniques will be discussed. References Bruschi GB, et al: Int J Oral Maxillofac Implants 13:219, 1998 Scipioni A, et al: Int J Periodont Rest Dent 14:451, 1994 Tatum H: Dent Clin North Am 30:207, 1986