Marginal Bone Loss Clinical Trial
Official title:
Evaluation of Marginal Bone Loss Using Computer Guided Ridge Splitting With Simultaneous Implant Placement Versus Conventional Technique (a Randomized Clinical Trial)
This clinical report describes a technique for ridge splitting, and gradual expansion in the maxilla with simultaneous implant placement with in the split ridge, with the preservation of the thin buccal plate of bone for proper blood supply.
All the procedures will perform under local anesthesia (mepivacain with levonordefrin).
Horizontal Atrophic maxillary sectors will use for the development of the treatment sequence.
All the patients will prepare initially with study models that permitted surgical and
prosthetic planning as well as the non-strict surgical guide for intraoperative use. After
application of conventional local anesthesia techniques, a full thickness incision 3 line
pyramidal flap will be expose the defect ridge. The incision will extend to the next tooth or
at least 5 mm more posterior from the end of the osteotomy indicated, securing direct
observation of the alveolar crest.
With a direct view of the alveolar crest, if the ridge presented a width close to 1.5 mm, the
ARST was performed immediately; if it presented less than 1.5 mm, then it was worn down with
a diamond bur (low speed motor at 1800 rpm) to reduce the height, obtaining an improved
alveolar crest width up to approximately 1.5 mm.
With this condition the bone splitting technique could be performed using the piezoelectric
system (Piezotome2¨, Satelec Action, France), calibrating the device on the D1 setting and
using profuse saline irrigation. The preparation sequence was begun with the CS3 insert until
a total depth of 10 mm was achieved across the entire extension of the ridge. The procedure
continued with the CS1 insert and finally the CS2 insert. The CS% insert was used in two
patients with the possibility of widening the osteotomy segment; this sequence always
achieved a complete extension in depth of application.
In the study group the vertical bone cuts through the cortical layer.
- At the distal end of the horizontal split: a vertical cut was made with the high-speed
bur within the vicinity of the buccal plate of bone; for the start of the separation.
With a full vertical depth of 13 mm. Final design of the splitting cut was (L-SHAPE)
SPLIT The control group the vertical bone cuts through the cortical layer.
- At the distal and mesial end of the horizontal split: a vertical cut was made with the
high-speed bur within the vicinity of the buccal plate of bone; for the start of the
separation. With a full vertical depth of 13 mm corresponding and joining the previous
vertical cut.
Using the expander to do the implants bed.-Preparation of the implant bed in the mesial end
of the horizontal split using the spreading kit.-The final size spreader in the first implant
osteotomy site with the first spreader in the second implant bed 3 mm apart. Dental implant
placement. Placing the first implant in place while the separation kept preserved .placing
the last spreader in the second implant osteotomy site. Bone deficiency is addressed by
filling with osteoplastic material; a bio resorbing barrier membrane is arranged.
CBCT assessment For the calculation of marginal bone loss(MBL), the implant will use as a
reference by adjusting the cross-sectional long axis in the center of the implant and
bisecting it (showing the buccolingual and mesiodistal dimensions). On the cross-sectional
view, a line will draw just parallel to the implant, starting at the crest of the labial
plate of bone and ending at the apical level of the implant; height will recorded in
millimeters. The same process was repeated from the palatal direction. The panoramic view
(longitudinal cut) will utilized to calculate the mesial and distal bone heights in
millimeters.
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