The Osteoperiosteal Flap: A Simplified Approach to Alveolar Bone Reconstruction by Quintessence Pub; 1 edition (December 15 2009)

Author:Quintessence Pub; 1 edition (December 15, 2009)
Language: eng
Format: epub
ISBN: 9780867155457
Publisher: International Quintessence Publishing Group
Published: 2012-04-06T04:00:00+00:00

Fig 10-5i The preoperative panoramic radiograph reveals why the implants originally were placed so deeply, leading to long clinical crowns. The alveolar plane had migrated 4 mm apically because of horizontal bone loss.

The definitive restorative result is satisfactory (Figs 10-5g and 10-5h), but it still represents an unnecessary retreatment for a patient who experienced significant disappointment and could not tolerate the esthetic compromise. Furthermore, the final result is never as good as that achieved when the sandwich osteotomy is performed prior to implant placement because it is difficult to establish an optimal alveolar plane with implants already in place. To prevent this complication, the surgeon must look critically at the preoperative radiographs (Fig 10-5i) and analyze any deficiency in the alveolar plane.

This concept also applies to single-tooth sites where an implant is placed in a deficient vertical dimension too deeply, well away from the facial alveolar plane. A thin alveolus in the maxillary anterior region is really the result of resorption or loss of the facial plate. Therefore, implants placed in this setting are often dehisced and, as a result, are placed deeper than is esthetically desirable.14

Typically, soft tissue subsequently migrates apically, exposing the neck of the implant.15 This situation can sometimes be corrected by implant repositioning, which essentially moves the marginal bone level closer to the alveolar plane (see chapter 20), but it is much better to restore bone height prior to implant placement, especially in the esthetic zone.

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