Horizontal augmentation: split crest technique

  • cover image
  • 1. Occlusal view of the width deficient ridge in the edentulous site of the upper right central incisor. The crest is shown with the osteotomy cuts made prior to the crest split.
  • 2. Labial view of osteotomy cuts prior to performing the crest split.
  • 3. Labial view of a 2mm wide Titanium screw used to hold the split crest apart.
  • 4. Occlusal view of the split crest revealing the extent of the volume to be grafted. The threads of the screw engage the flexed out labial plate and the palatal bone to provide secure rigid fixation of the labial plate.
  • 5. OsteoBiol Putty is spooned out with a curette.
  • 6. The OsteoBiol Putty is then packed into the created space.
  • 7.OsteoBiol Putty is also packed over the screw to smooth over the screw head to minimise the chance of the screw head perforating the overlying mucosa.
  • 8. This shows the left over amount of OsteoBiol Putty which gives and indication of the amount of Putty used.
  • 9. At the completion of the OsteoBiol Putty application.
  • 10. Final placement of OsteoBiol Evolution membrane over the OsteoBiol Putty augmented crest split. The membrane is soaked in blood prior to application.
  • 11. This shows a rotation pedicled connective tissue graft from the palatal submucosa rotated around and secured of the anterior nasal spine. This povides extra bulk of soft tissue in the ridge deficient area and is placed over the OsteoBiol Evolution membrane.
  • 12. Primary tension free closure of the site is achieved by incision of the periosteum at the base of the labial flap. Vicryl resorbable sutures are used for closure
  • 13. The site is uncovered 4 months later. This reveals replacement of the OsteoBiol Putty in the split to have be replaced with natural bone.
  • 14. The titanium screw is removed and a drill guidance system used to help position the implant osteotomy site in the correct position.
  • 15. The placement of the 2mm twist drill in the grafted crest. The bone is soft but of normal bone texture.
  • 16. This shows the final placement of a 4mm wide regular platform Branemark implant, prior to cover screw seating. Note the generous width of bone, the labial bulk of bone is beyond the labial bone of the adjacent teeth. This will ensure excellent aesthetics. Healing abutment placement is planned for 4 months following implant placement.
  • Clinical indication: horizontal augmentation
  • Products : Evolution, Putty
  • Authors : Dr. John Bridgman
  • Information about patient: Male 32
  • Credits : Documentation provided by Dr. John Bridgman
    Private practitioner in Tauranga, New Zealand
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