LARGE BONE DEFECTS WITH LOSS OF BUCCAL AND PALATAL PLATES POST-EXTRACTIVE WITH MAGNETIC DYNAMIC DEVICE PLACEMENT. 2yr FW-UP

105 Rating(s).


Posted on By roberto crespi In Implants

Fig 1 Preoperative Cone beam computed tomography showed large bone defects with loss of buccal and palatal plates.

Fig 2 The following surgical procedure was performed:
1. The teeth were gently detached from the intrasocket
reactive soft tissue and bony wall in the
mandibular and maxillary bones.
2. The periosteum was not separated, avoiding flap
raising.
3. Reactive soft tissue was left in the defect1. A periodontal
probe was employed to make an assessment of the defect wall.
4. Collagen sheets that were attached by sutures (Condress,
Abiogen Pharma) filled the bone defects2,3.
5. The gingival edges of the wound were not sutured
together; the wound was left “open,” leaving it to
gradually close and heal on its own. The sutures
were not tight and were only used to obtain soft
tissue adaptation without obtaining primary closure
of the wound margins3.

Fig 3 four months later, CBCT examinations were performed,
and dental implants were placed in previous
large defects. The bone crest was exposed by using a modified
partial thickness flap with No. 64 Beaver blade tip. The edentulous bone crest was covered by the preserved suprabony connective
tissue and the underlying periosteum.
In order to create the implant site, it was
necessary to expand bone tissue both laterally against
the preexisting lateral walls and apically by moving
up and compressing with a progressive series of bone
expanders4. Osteotomy
was gradually expanded in 0.5-mm increases
by using osteotomes inserted to the working depth.
The final diameter of the osteotomy was 1.2 mm less
than the expected implant diameter, depending on local
bone density. Osteotomes were directly attached
and pushed by an electrical mallet. The electrical mallet
(Magnetic Mallet, Meta-Ergonomica, Turbigo) is a
magnetodynamic instrument, which assembles into a
handpiece, and is energized by a power control device,
delivering forces by timing of application5-7.
The osteotomes are attached to the handpiece that pushes a shockwave to their tip. The magnetic wave
and the subsequent shockwave are calibrated regarding
the timing of application of the force, and induce
axial and radial movements applied to the tip of the
osteotome, with a fast force of 260 daN/120 microseconds.
The mallet imparted a longitudinal movement to osteotomes
along the central axis, moving up and down
toward the pilot bone hole, providing a driving mechanism
of longitudinal movements. Such a mechanical
sequence of osteotomes progressively condensed the
internal bone wall of the initial hole radially outward
with respect to the central axis, in order to create highdensity
bone tissue along a substantial portion of implant
site preparation duration. The implant platform
was inserted at the alveolar crest level. A minimum
insertion torque of 30 Ncm was considered. Subsequently,
the soft tissues were sutured.

Fig 4. Clinical photograph 4 months after implant placement.

Fig 5,6 Cone beam computed tomography scan obtained after 2 years of implant placement.
A vertical bone gain and maintenance around dental implant were observed.



REFERENCES

1. Crespi R, Capparé P, Gastaldi G, Gherlone EF. Reactive soft tissue
preservation in large bone defects after tooth extractions. A cone
beam study. Int J Oral Maxillofac Implants 2016;31:179–185.
2. Crespi R, Capparè P, Gherlone EF. Bone recontouring in fresh sockets
with buccal bone loss: A cone beam computed tomography
study. Int J Oral Maxillofac Implants 2014;29:863–868.
3. Crespi R, Capparè P, Polizzi EM, Gherlone EF. Tissue remodeling
after bone expansion in grafted and ungrafted sockets. Int J Oral
Maxillofac Implants 2014;29:699–704.
4. Saadoun AP, Le Gall MG. Implant site preparation with osteotomes:
Principles and clinical application. Pract Periodont Aesthetic Dent
1996;8:453–483.

5. Crespi R, Capparè P, Gherlone E. Electrical mallet provides essential
advantages in maxillary bone condensing. A prospective clinical
study. Clin Implant Dent Relat Res 2013;15:874–882.
6. Crespi R, Capparè P, Gherlone E. Sinus floor elevation by osteotome:
Hand mallet versus electrical mallet. A prospective clinical study. Int
J Oral Maxillofac Implants 2012;27:1144–1150.
7. Crespi R, Capparè P, Gherlone E. A comparison of manual and
electrical mallet in maxillary bone condensing for immediately
loaded implants: A randomized study. Clin Implant Dent Relat Res
2014;16:374–382.

pre-op cone beam
post - extraction

implants placed
4 months after placement


Add to Favorites
Add a comment to the discussion on LARGE BONE DEFECTS WITH LOSS OF BUCCAL AND PALATAL PLATES POST-EXTRACTIVE WITH MAGNETIC DYNAMIC DEVICE PLACEMENT. 2yr FW-UP


Upload photos
1.  Photo Title:

2.  Photo Title:

Would you like to follow this post?
Case has been added to your favorites.
Case has been removed from your favorites.
Thank you for your input. Your comment has been posted.
You are now following this member. You will get notified on any new topics posted by this member.
You are no longer following this member. You will not get notified on any new topics posted by this member.
Edit Comment
1.  Photo Title:
Current Image:   Delete Image
2.  Photo Title:
Current Image:   Delete Image
Comment has been updated.

2 Comments

Nice work here from what I can see but significant ridge constriction and what appears to be Thin KT on buccal aspect. Would you consider some form of KT augmentation here? Thanks for sharing Dr. Salama


Reply

Thank you for your feedback. I had to focus on the bone augmentation in order to be able to immediately place the implants, as the bone defect was really important. When i agreed the treatment plan with the patient she declined the soft tissues augmentation, although it was definitely a viable option


Reply


Omnia
PET Kit