Bone Expansion and Condensation

The fearful patient is satisfied with implant placement at #29 and will return to have #5 implant placed.  Fig.1 is coronal section of the site of #5 (B: buccal).  It shows the narrow crest and low bone density (40-200 Hounsfield unit).   Start bone expansion with #15 blade slightly palatal (Fig.2 green line), followed by bone scalpels and bone blades.  The latter leads to differential expansion of the buccal and palatal plates (Fig.3 arrows).  Once the crestal bone is expanded, use drills or osteotomes (RTs) for deeper portion of osteotomy (Fig.4 red arrow).  Finally an appropriately-sized implant is placed (Fig.5).  Also prepare bone expanders.   Upper Arch Reconstruction, Upper Premolar Immediate Implant Xin Wei, DDS, PhD, MS 1st edition 04/08/2016, last revision 06/12/2019