Ridge Split Technique

Hello and welcome to today’s webcast from Bicon. We’re coming to you from the Bicon Institute and the implant dentistry center in Boston. The procedure will start on the right side with the corticotomy which will be performed using piezoelectric surgery and or drills as the need arises. The most important aspect of this is the turning from the crestal cut to the buccal cut, and that has to be continuous. So in this case, I’m just gonna thin out the buccal here so that we can see it, and then we will drag this out. Okay. Okay. When you’re using a drill, this cut is very easy to drag through. That’s making too much noise, but it’s not hurting. Right? Good. But it is extremely crucial to have the these cuts complete. Making a lot of noise. Apologize for that. Okay. And then we do the posterior cut. And as I said, that junction, a transition from the vertical cut to the horizontal crestal cut, and to the horizontal inferior cut, is very important. It has to be complete. Otherwise, keep suctioning. Although it seems that the the, bony window is very thin here, you cannot make it too low because it will get to a point where it is counterproductive. The bone is just too wide to be split properly. That hurting at all? This cut is extremely important, obviously, because once we have completed it, we will seal this bone to allow for the reestablishment of the blood supply to this part of the bone so that we can mobilize it buccally at the second phase. We wanna be sure that this cut is completely through and through and that it is connected to the vertical cut properly. The anterior inferior corner that has to be kind of completed. Just bear with me. Access is kind of difficult, so we may just switch to a drill. That’s it. So I just curved this because we’re I think we’re close to the root, so we’re okay this way. K. We’re just gonna wash out the area, And we suture it. So what this will allow is the reestablishment of the periosteal circulation to this bone flap that we just scored. So when it comes time to placing the implant, we will be able to just split that bone knowing that it will be alive and perfused and everything, place the implants with stability provided by the unsplit part that’s apical to the lower cut. For this, we’ll just use a quick running suture. In all of our implant placement procedures, we have the patient started on an antibiotic surgical prophylaxis, one gram of amoxicillin, zero to thirty minutes prior to incision. Good. Good. It has to be through the cortical bone. As you saw in the second part, if the cuts were not completely through the cortical bone, I have no way of telling which cut is snagging because I don’t see them. All I see is the very crestal cut and barely so. So you have to trust that you’ve done your your work initially. So when you’re splitting it, all you’re splitting is what you can control, and that is the cancellous bone. I would be very hesitant to do any implant procedure on a heavy smoker, but yes, we’ve done it on a heavy smoker. In the heavy smokers, I would on the side of longer healing time. So instead of making the split and then three weeks making the cut or even twenty days or seventeen days or something, I would go toward the four week because it is not the issue of the bone healing per se, but it’s the soft tissue healing that, can be problematic for us. So, although hesitant, I would do the procedure and I would ask them if they would stop smoking for a week prior and a few weeks after the procedure to improve the circulation in the area? That’s a good question. However, we’re finding, and especially our colleagues in Europe and outside of the States, where smoking is still very prevalent, that if you drop all the smokers out of your patient roster, you would end up with a very small patient population, right? That’s very important. The preoperative medication regimen that we have in our practice. First of all, the patients are given the surgical prophylactic antibiotic regimen, which is a double treatment dose, zero to thirty minutes before incision. So in this case, the patient is not penicillin allergic, she gets one gram of amoxicillin as she’s sitting down before anesthesia and before incision. That prophylactic, dose is carried through for another additional minimum of two doses, so it’s, one day, and it can be as much as a week. It depends if the patient feels better doing it, or tolerates the antibiotic, but the most important doses are the first three, one pre op, two post op. As for the remainder, we don’t pre medicate our patients with steroids unless we know that we are going to be within a millimeter or two of the radiographic imprint of the mandibular canal. In this case, if we have the opportunity, we would give the patient steroids in the form of Solu-Medrol Dosepak, and that they would start the day before. If we have not done that, and for any reason we got closer than we had anticipated, or, closer than we had hoped to the nerve, we would start the patient immediately post operatively on that, regimen, and have them start it immediately after the surgery and take all of the total first dose completely as one dose and continue it on for six days. Pain management is usually with a mild non steroidal anti inflammatory, like six hundred of Motrin, or with a mild narcotic, like Tylenol with codeine, number three. But usually, most of our patients will complain a little bit more of the swelling with the mandibular ridge split than anything else. Because of the length of surgery and the flap development, there is a slight amount of swelling. We have not otherwise have had any other issues and concerns with it. From Boston, thank you again and until tomorrow, four o’clock. See you. Bye bye.