Ridge Splitting and Internal Sinus Graft Part 1

566 Rating(s).


Posted on By Maurice Salama In Bone Grafting

Patient presents with horizontal deficiency and limited bone below sinus in Maxillary Right Quadrant. Ridge Split and internal Sinus Lift performed rather than GBR and Lateral Window approach. Comments, suggestions or thoughts. Dr. Salama

Ridge Split Piezo
PA Preop

Ridge Split chisels
BTI Motorized Ridge Expanders


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17 Comments

Always curious....how would you have treated this same case?
1. Narrow implants
2. GBR or Ti-Mesh
3 Ridge Split
4. Lateral Approach to Sinus
5. Crestal Approach to Sinus

Dr. Salama


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Beutiful case.. I will always do a same job in this same case as you did. Piezoelectric ridge split and crestal approach is minimally invasive tech for this patient.
Even if bone width is much narrower than thse case ( 2 mm or less), implant can be placed in bony envelop..Thank you for sharing..DS


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Maurice, Very impressive skill and case management. I have yet to fully develop the "feel" for this technique. I like this solution, but in my hands, when 3mm of bone is available in the maxilla, I prefer ridge expansion/ osteotome approach using the implant to displace the bone. In addition, I usually augment soft tissue as well. In the mandible, I prefer a staged approach. First softening the bone by inducing inflammation with small perforations and placing dfdba. Then perform ridge expansion at 12-16 weeks. Depending on the amount of KT present, I usually augment the soft tissue before or after implant placement.
Thank you for sharing another beautiful case. Truly a pleasure to view your solutions and admire your surgical abilities. Keep it coming. Best regards. Chuck.


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Chuck, can you post a link on a technique you describe please? Gregory


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Thanks DS and Chuck. I appreciate and admire your posts. Chuck when you use the technique you suggested how do you perform the Osteotome expansion? Osteotome only? Hand or motorized like the BTI motorized expanders I highlight here?
thanks again Maurice


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Maurice, I condense bone apically by hand in an underprepared site. Then I expand and "work the bone" as I place the implant with a torque wrench by hand.


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I'ts a good job,but in my opinion,the
Implants could be insert without damaging the periostic membram,using bone expanders.althoug you have a good cortical bone,crestal one can be injuried.


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Pedro; Thanks for the comment. Scippioni et al. in the 1990's showed this technique years ago without raising a full thickness flap and performing the split with intact periosteum, placing implants and leaving the split gap to fill with bone at the crest of ridge. Unfortunately in my hands, I found post-op crestal resorption over time.
thanks Dr. Salama


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very good job,since i saw you u Maurice in Paris in the Zimmer Journée,i fell in love of your good job.My dream is to be in Atlanta Team with u,Henry,David and Ronald as Teachers.You are Great Dentists


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Thanks Tarek.


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As always... excellent... Not only did you keep it less invasive you save the patient significant time and surgeries.. You would have had to do lateral window, then ridge graft... No having said that i have to agree with chuck... in my hands my experience with sinus grafting with osteotome in 3mm of bone is meh at best.. and to end a bridge on an 8mm implant?? good thing you have total control of the occlusion!!


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top case doc . what was the implant D. & L. ? how long did u wait to load ?


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As always cases with very perfect solution. How long waits for one second surgical time '. Congratulations.

Sandro Valente


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Dear Friends; Thanks for the comments. Please click on top right of screen where it says "related posts" and you will see Part 2 of this series with the 6 year follow up. Brad great point about distal implant length of 8mm but width is 4.7mm. But, by splitting the ridge we do have easier access to crestal approach sinus graft. The mesial implant is 3.7mm by 16mm in length. Ehab, we waited 6 months to load case. thanks Dr. Salama


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As always a great case and a greater way to learn . In these kind of cases, should the crestal split be at the midline or slightly palatal?
Thanks.


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Rita; Welcome to the Forum. Yes. always slightly palatal and angled towards the palate. This allows for a favorable split and leaves a thicker labial portion. regards Dr. Salama


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Very impressive! Gregory


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