Bone Expanders Without Wheel Saw

The maxillary ridge appears to be wide (Fig.1).  After incision, the bony ridge is narrow at #5 and 6 (Fig.2 <) and 8 and 9 (data not shown).  The patient cannot tolerate vibration associated with wheel saw and osteotomes.  The osteotomy is finished with 1.2 mm initial drill and bone expanders.  The buccal plate undergoes greenstick microfracture at #6, 8 and 9 when larger expanders are being used and implants are being placed.  Implants at 5, 6, 8 and 9 are 4.1x8, 3.8x14, 3.8x10 and 3.8x14 mm, respectively, without sinus lift.  In fact sinus lift was done in the previous surgery at #3 and 11-13 (Fig.3 *).

The patient complains of loose ball abutments approximately 3 months after #21,22,27,28 implant placement, 2.5 month for #3,1-13, 2 months for #20,25,30, 1.5 months for #5,6,8,9.  In fact the ball abutment at #9 is loose. 

The patient returns 7 months after last surgery (Fig.4-6).  The ball abutments change to cemented abutments for fixed provisional bridges.  The upper lip looks collapsed (Fig.7,9).  After upper labial flange build up, the patient is pleased (Fig.8,10).  The flange may need to extend apically and labially a little more in the lab.

When the patient returns for final impression, take photos of the upper anterior bridges before and after addition together.  Confirm and determine the upper incisor edge relative to the upper lip.  Remove the right posterior bridges (which spread more posteriorly) and take the first bite registration.  For more precise bite registration, use models (fabricated a few days earlier) to make base plate and occlusal rim.  Then remove either left posterior or anterior bridges for the 2nd bite registration and so on.  Use upper and lower full arch trays for impression.

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Xin Wei, DDS, PhD, MS 1st edition 07/22/2016, last revision 03/05/2017