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

Posted on 06.01.2019 02:29 AM 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.



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