Ridge Reduction with Surgical Handpiece

After incision and flapping, wheel saw is found to be not feasible for ridge reduction, probably due to severe bone loss. Instead, a 45° surgical handpiece with 4 mm diamond rounded bur is used for the ridge reduction (Fig.1 arrowheads).  The flat surface of the reduced ridge is ~ 8x8 mm before osteotomy with a 2 mm pilot drill at the depth of 6 mm, ~ 2 mm from the superior border of the Inferior Alveolar Canal (IAC, red dashed line).  As planned, next drills are 2.8 and 3.6 mm round burs from Sinus Master Kit and 4.8 mm and 6 mm drills from UF Extra Wide Implant Kit.  The bottom of the osteotomy is checked after each drill.  When a 6x6 mm implant is placed, there is 3 mm separation from the IAC (Fig.3).  A 6.5x5(5) mm abutment is placed with autogenous bone placed buccally and allograft lingually (Fig.4).  After cementation of an immediate provisional, periodontal dressing is applied for further wound protection.

Unfortunately, the implant fails in 2 months due to unfavorable crown/implant ratio and the immediate provisional.

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Xin Wei, DDS, PhD, MS 1st edition 05/02/2016, last revision 02/16/2019