Loss of teeth for a long time leads to local bone resorption. Therefore, when time comes to put dental implants in the jaws, very often you don’t find the right amount: height and width. Finally the residual bone is useless.
Implants should be placed according to the concept of “prosthetic-guided-positioning“. You don’t put implant just where you find the bone! The other way of doing is: think about the final restoration (teeth) and plan implant-surgery in order to accomplish the most useful prosthetic (crowns). So, if you have lack of bone (resorption), you regenerate bone.
Now-a-days we got many “bone regeneration techniques”. One of the less invasive and with the highest rate of success (99%) is the “split-crest” technique.
How it works
Technically it’s a distraction osteo-genesis made through a green wood fracture. The thickness of the jaw-bone has to be cut in the middle (where the spongy bone is) and the two halves only partially fractured: green-wood-fracture. Expansion of bone halves is done with elevator until the right width is gained. Surgical split-crest-expansion is well possible in upper jaw (more spongy bone), less indicated in highly mineralized (hard) jaw bone. You risk to get a real complete fracture of jaw bone. No worry: a skilled surgeon can manage the issue fixing the buccal plate with 1-2 screws.
Once you got the space in-between the two halves, you put in what you want: autologous bone (grafted bone from patient), heterologous (like Bio-Oss) or whatever you prefer. Bone regeneration will speed up and very soon, normally after a couple of months, you’ll get the right thickness of alveolar crest for an easy prosthetic-guided-implant-surgery.
The piezoelectric instrument is an ultrasonic device using a micrometer cutting, allowing you to perform osteotomies of extreme precision, unthinkable with conventional rotary burs.
The limited range of ultrasonic frequencies (24 – 32 KHz) allows the device to be selective being active only on hard tissues such as bone and teeth, but not on the soft tissue (i.e. vessels and nerves).
Patients nerve is safe and surgeon’s peace of mind guaranteed !
The post-operative morbidity of the patient is near to nothing. Poor swelling, little pain, no bleeding.
The stereo-microscope (Zeiss ProErgo) amplifies precision and safety of piezo-surgery procedures.
We use both on a routine basis!
dr. Massimo Mazza & dr. Piero Lazzari
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