Ridge Expansion

Ridge Expansion

In the pontic area, alveolar ridge atrophy leads to problems as the resulting space between the ridge and the bottom of pontic causing food impaction, tissue ulceration, bleeding, and inflammation. Esthetically, the ridge atrophy buccolingually causing the pontic to cast a dark shadow on the gingival contour and the restoration being unable to integrate into the surrounding environment. Finally, the poor oral hygiene due to more difficulty cleaning in the abutments area leads to localized periodontally disease and ultimately tooth loss. Due to these reasons, more and more bridge restoration is converted to imlant restoration especially when one of the problem discussed above exist. Alveolar ridge expansion is used very frequently to augment the resorbed under the pontic in preparation for implant placement.

Another situation where alveolar ridge expansion is indicated is in the area of tooth loss for a long time. Alveolar ridge resorbs, compromises the bone width for proper implant placement.

Another situation for the alveolar ridge expansion is when buccal bone plate was fracture during the extraction procedure of an anterior maxillary tooth and the site is anticipated for implant placement. The expansion will done at the implant surgery, using the osteotomes.

Finally, alveolar ridge expansion is also a common procedure in the patient who undergoes orthodontic treatment to regain the space for the congenital missing teeth. Before implant can be placed, the alveolar ridge needs to be expand simultaneously at the implant surgery appointment because the bone width usually is inadequate and also to achieve esthetic in the facial contour of the ridge. In these situation, implant placement may be delayed due to the severe deficiency in bone width in the implant site. Usually when the bone width is less than 5mm in the porous compact bone, implant surgery should be delayed.

In these situations, implant placement and simultaneous ridge expansion with osteotome (if possible based on bone density) is definitely a treatment of choice.

There are two ways to perform alveolar ridge augmentation. When the available bone width is five millimeter or less, the ridge can be expanded or augmented using the conventional guided bone regeneration technique.

The second and more preferred way to expand the alvolar ridge is to use the surgical tools called osteotomes. Osteotomes is set of cynlindrical stainless steel cylinder (similar to a smaller version of ring sizer) of various size. They are used in periodontal surgery to laterally compact the bone and expand the ridge and the opening for implant placement. The denser the bone the harder for the expansion to be performed with osteotomes. Also the bone width must be at least four millimeters (preferrably five millimeters) or more for the use of osteotomes.