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Split crest maxilar and implant placement with Magnetic Mallet
Posted on 03.17.2022 07:04 AM By Fernando Gómez-Ferrer In Implants
The patient, after the loss of the posterior abutment of a bridge that lasted since 1987, even though is in good health, doesn't want to undergo long and complex surgeries.
Following the cutting of the bridge, the anterior abutment component was fixed by endodontics and post reconstruction. Some alginate models are taken and cast in plaster to design them using a wax-up. In this space formed by dense bone, a hole is made in the center of occlusion of the tooth in order to place the implant fixation point.
After opening the flap, the most appropriate angle and position of the implant is followed with FIRST, the instrument of the Magnetic Mallet. FIRST is capable of finding an easy angle in the positioning of implants, providing the right direction from the first impulse without removing bone tissue. In this case the implants are inserted at low speed, maintaining the best possible angle.
With subsequent inserts, the desired depth is achieved using low power to maintain the angle and distance between the implants. The expansion of the ridge in the desired positions is controlled and verified. Implants are inserted at low speed and maintaining the best possible angle.
Any thoughts on this case?
Lotta Carmelo860 says on 03.20.2022 07:09 AM
I will not speak "split crest" but compaction-expansion.
I don't like a similar approach. After the flap, identified the position and the right direction, I prefer a real split crest with a bone cut with piezo, and after you can use the magnetic mallet o screw espander to move the vestibular bone wall.
If you want to use your technique, I prefer to make e GBR to preserve and increasing the bone volume around the implant.
Fernando Gómez-Ferrer says on 03.24.2022 10:59 AM
I think the main problem is that not all the photographs specifically documenting the case with the sequence of steps and inserts have been shown since there's a maximum of 6 photos allowed.
Of course the split crest technique commonly used with Piezo Surgery could have been used in this case.
And what we have done could better been named as a “compaction/expansion” on the hole placement of the implant.
In addition, a GBR technique could also have been carried out, as you very well indicate.
There are different ways of treating our patients that gives us the art of Oral Surgery.
As I explained at the beginning of the text, this is a 77-year-old patient who has had the bridge I made for her since 1987 and who has now lost the posterior pillar (abutment).
With her trust in me all these years, she only asked me not to have a complex surgery.
That is why I chose this technique, which is quick and easy without postoperative discomfort.
Many thanks for your comments.
Maurice Salama says on 03.21.2022 08:45 AM
Nicely documented but I agree with making split crest cuts prior to Magnetic Mallet to maximize bone movement with the MM. warm regards Dr. Salama
Dr. Avijit says on 04.04.2022 02:05 AM
After identifying the correct position and orientation with the flap, I prefer a real split crest with a bone cut with piezo, and then you can use the magnetic mallet or screw espander to move the vestibular bone wall.
If you intend to use your approach, I recommend performing a GBR to preserve and increase the bone volume around the implant.