Agabiti Ivo, Botticelli Daniele
Private Practice, Pesaro, Italy, and Visiting Professor, Post Graduate Program in Advanced Implantology, School of Dentistry, University of Modena and Reggio Emilia, Italy.
ARDEC Academy, Rimini, Italy.
J Oral Maxillofac Surg. 2017 Oct;75(10):2115.e1-2115.e12. doi: 10.1016/j.joms.2017.05.015. Epub 2017 May 24.
When the bone ridge is corticalized, the displacement of the buccal plate may result in an unintentional malfracture. The aim of this study was to report the results of a 2-stage atrophic alveolar ridge expansion performed with a sonic-air surgical instrument.
In this retrospective cohort study, the atrophic distal segments of the mandible were treated by a split-thickness flap approach and application of an alveolar ridge expansion performed in 2 surgical phases. A sonic-air surgical instrument was used. In the first surgical procedure, only basal corticotomies on the buccal plate were performed. In the second stage, sagittal and vertical osteotomies were added, aiming to facilitate the displacement of the buccal bone plate. Subsequently, implants were installed into the created space between the buccal and lingual plates. No bone substitutes were used. The width of the displaced buccal bone wall and the gaps that occurred mesially and distally to the implant were measured at the time of implant installation. Cone beam computed tomography scans were taken before the first and after the second surgical procedures, and the width of the alveolar crest at both observations and the width of the residual mesial and distal gaps after implant installation were measured.
We included 10 patients (6 women and 4 men; aged 37 to 69 years) in the study, and 15 implants were installed in expanded narrow ridges. Clinically, the mean width of the buccal bone wall was 1.2 ± 0.2 mm and the gaps ranged between 2.8 and 3.2 mm. On the radiographic assessments, the mean initial width of the alveolar bone crest measured 4.1 ± 0.5 mm, reaching 6.8 ± 0.9 mm after ridge expansion (P < .01).
The use of a modified edentulous ridge expansion in 2 stages allowed the installation of implants in narrow and corticalized alveolar ridges. We suggest that this technique is especially applicable in the distal segments of the mandible because of the low invasiveness, low risk of buccal plate fractures, reduced morbidity, and reduced costs.
当骨嵴皮质化时，颊侧骨板移位可能导致意外骨折。本研究的目的是报告使用声波空气手术器械进行两阶段萎缩性牙槽嵴扩展的结果。
在这项回顾性队列研究中，下颌骨萎缩远端节段采用分层皮瓣法治疗，并分两个手术阶段进行牙槽嵴扩展。使用了声波空气手术器械。在第一次手术中，仅在颊侧骨板上进行基底皮质切开术。在第二阶段，增加矢状和垂直截骨术，旨在促进颊侧骨板移位。随后，将种植体植入颊侧和舌侧骨板之间形成的间隙中。未使用骨替代物。在种植体植入时测量移位颊侧骨壁的宽度以及种植体近中和远中出现的间隙。在第一次手术前和第二次手术后进行锥形束计算机断层扫描，并测量两次观察时牙槽嵴的宽度以及种植体植入后剩余近中和远中间隙的宽度。
本研究纳入了10例患者（6例女性和4例男性；年龄37至69岁），在扩展的狭窄牙槽嵴中植入了15枚种植体。临床上，颊侧骨壁的平均宽度为1.2±0.2mm，间隙在2.8至3.2mm之间。在影像学评估中，牙槽嵴的平均初始宽度为4.1±0.5mm，牙槽嵴扩展后达到6.8±0.9mm（P<.．01）。
两阶段使用改良的无牙颌牙槽嵴扩展术可在狭窄和皮质化的牙槽嵴中植入种植体。我们认为，由于该技术侵入性低、颊侧骨板骨折风险低、发病率降低且成本降低，特别适用于下颌骨远端节段。
