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. 2009 Jan;2(1):27-36.
Epub 2009 Dec 10.

Clinical indications, advantages and limits of the expansion-condensing osteotomes technique for the creation of implant bed

G DE Vico  1 , M Bonino, D Spinelli, A Pozzi, A Barlattani
Affiliations

Clinical indications, advantages and limits of the expansion-condensing osteotomes technique for the creation of implant bed

G DE Vico et al. Oral Implantol (Rome). 2009 Jan.

Abstract
in English, Italian

The "screw shaped" expansion-condenser are hand instruments that were introduced for the first time at the end of the 70' in order to improve bone density before the positioning of a dental implant. Thanks to these hand instruments it is possibile to compact the bone apically and along the walls of the implant bed (Fig. 3) improving a lot the bone density and the primary stability of the implant even in situations where the starting bone quality is low (es. D3-D4 as in the classification y Lekholm and Zarb 1985) or in cases of severe bone atrophy. Allowing a manageable raising of the shnaiderian membrane through trans-alveolar way, this technique avoids in many cases the necessity to have recourse to the realisation of bone vestibular "gates" when it comes to the techniques of the big sinus lift. The knoledge of the bone visco-elastic and hystologic properties together with the maximum respect of the surgical protocol allows us to obtein % of success superior than traditional surgical protocol in D3-D4 bone class.

Gli espanso-compattatori sono strumenti manuali introdotti per la prima volta alla fine degli anni ‘70 al fine di migliorare la densità ossea in vista del posizionamento di un impianto dentale. Grazie alla loro azione progressiva e costante all’interno delle compagini mascellari, sono in grado di compattare ed espandere le trabecole ossee migliorando la stabilità implantare primaria sia in situazioni iniziali di osso di scarsa qualità (es: D3-D4), sia in casi di atrofie severe. Permettono inoltre un maggior controllo durante la preparazione del letto implantare nei protocolli di piccolo e grande rialzo del seno mascellare. Di contro, questi strumenti, determinando un insulto alla micro-circolazione vasale per compressione trabecolare necessitano dello scrupoloso rispetto del protocollo operativo e della profonda conoscenza delle caratteristiche visco-elastiche dell’osso.

Keywords: bone condensing; oral implantology; ridge expansion.

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Figures

Figure 1
Figure 1
Osteotomes BTLock.
Figure 2
Figure 2
Tatum’s osteotomes.
Figure 3
Figure 3
Bone condensing plan.
Figure 4
Figure 4
Pilot drill.
Figure 5
Figure 5
Surgical steps in cases with bone ≥3mm wide (protocol A).
Figure 6
Figure 6
Fractures can appear during final preparation with osteotomes.
Figure 7
Figure 7
Provided they don’t compromise primary implant stability, these fractures consolidate during the osteointegration phase.
Figure 8
Figure 8
Denta-scan shows a serious mandibolar atrophy.
Figure 9
Figure 9
The initial osteotomies.
Figure 10
Figure 10
After osteotomies the pilot drill giudes the depth preparation.
Figure 11
Figure 11
The osteotomes guarantee a greater control of the bone expansion.
Figure 12
Figure 12
In this way we can put implants of correct dimensions also in cases of serious atrophy.
Figure 13
Figure 13
The post-extraction atrophy and the sinus pneumatization prevent in much cases implant placement.
Figure 14
Figure 14
The osteotomes guarantee a greater control during bone preparation with big control of the sinus membrane.
Figure 15
Figure 15
The osteotomes technique in the big sinus lift.
Figure 16
Figure 16
Post-extracive bone crest. The protocol foresees the implant preparation in the inter-dental and inter-radicolar bone set.
Figure 17
Figure 17
Thanks to the osteotome technique all the implants have been correctly positioned also in this critical situation.
Figure 18
Figure 18
Simulated implant preparation on the left it’s easy to verify the very good bone preservation with the osteotomes protocol.
Figure 19
Figure 19
Every osteotome is mounted during bone preparation on an esagonal screwdriver.
Figure 20
Figure 20
The osteotomes allow also in difficolt cases a greater control of the axes and the depth of the implant preparation.
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