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F/g la A crestql ihoision i$ mode. Fig Ib Partiai-thickness buccal and tinguai flaps ate raised.
followed by fwo verileo! incisions defining the ¡urgicai area.
with situations in whioh the with an antibiotic (Ciproxin, grooves were formed by the
ridge is so narrow that implant Bayer), l g per day, and an penetration of the buccal oor-
placement using the traditionai anti-inflammatory agent ticai piate of the bone. The
technique is impossible. The (Naprosyn, Recordati), 1,5 g crestol incision was continued
present investigation wos per day. Two types of implants into the bone (Fig le) so thot
undertaken to assess the effec- were included in this study: an intraosseous groove was
tiveness of the technique AI2O3 impiants (Tübingen and formed with a #64 Beaver
called edentulous ridge expan- Monaco versions,Friatec) and blade. This groove was contin-
sion (ERE) for impiant place- iMZ impiants (Friateo). ued apicaiiy (Figs If and lg)
ment. Using the ERE technique, a and, when sufficient depth was
polotal incision in crestai direc- reoched, the buccai plate was
tion was mode, and portiai- slowiy dislocated in a taoial
Method and materials thickness buccal and linguai direction (Figs Ih and li). Care
fiaps were raised (Figs l a and must be taken to maintain a
In 170 individuáis, 329 implants lb), followed, when necessary, zone of spongiosa beneath the
were piaced in aiveoiar ridges by two verficoi reieasing inci- cortical piate so that there is a
that were tao narrow orofa- sions defining the surgical area. minimum overail thiokness ot
cialiy to permit traditionai After the fiaps were reflected, approximateiy 1.5 mm.' The
implant instailation. The ERE two transperiosteal incisicns biood supply on the facial
technique wos used in all cases. were made into the bone par- aspect of the displaced buc-
Ail patients were premed- aliel to the releasing incisions cal plate must aisa be main-
icated 1 hour before surgery (Figs l c ond Id); two vertioai tained by safeguarding the
Figs le and Id Two transperiosfeat incisions are made in rhe bone poraiiel to the releas.
figs í/) and li The buocal piate is slowiy dislocated m a facial direction.
Fig Ik
Fig II
Fig 2a Edentuious ridge at oreo of Fig 2b Probe moihfoining displace- Fig 2c Two probes placed ih implont
teethBto W. which were lost 20 years ment of labial plate of bone whiie fur- sites.
previously in an automobile occident. ther ridge expansion is effected with
Note tack of dimension to arch form. elevator.
partiai-thickness fiap also aids sented a variety of surgicai Cne fracfure was due to a
in immobilization of the dis- solutions to the probiem of nor- motorcycle accident; the
placed buccal corticai plate. row alveolar ridges and implanf remoining three were attribuf-
When using fhe ERF tech- piacemenf, Sfreckbein ond abie to occiusal overioad.
nique, fhe integrity of the Woifge,"* and Koury'^ used The two toiled liVlZ implanfs
periosfeum must be main- bone graffs fo increase bone are sfiii in funcfion, but are con-
tained so thdt fenestratians, subport. Osborn,'* and Nenfwig sidered foilures because fhey
dehiscences, or necrosis of the and Kniha^' suggesied the use hove iosf subsfanfioi bony sup-
buccal piate are avoided dur- of hydroxyapafife. A recent port: one has losf cresfai bone
ing the placement and heaiing investigation by Nyman et aP^ for 10% to 15% of its iengfh, the
phase of osseointegrafed used guided tissue regenera- other for approximateiy 40% of
impiants. It is thus necessary to tion materiais and techniques ifs iength. it is interesting fo
maintain buccai cartical bone to attempt a soiution. note thaf fhese faiiing impianfs
and spongiosa at a minimum In this study, fhe fwo failures occurred in fhe same patient
thickness of nof iess than 1.5 of AI2O3 impionfs occurred in aged 43 years, who was heav-
mm. The rafes of revascuiariza- fhe same pafienf, an 18-year- iiy medicafed with anticoogu-
tion of cortioai bone (0.D05 mm ianf fherapy for pre-exisfing
oid woman who had losf aii
per day) and meduiiory bone cardiac pathosis.
four maxiiiary incisors in an
(0.500 mm per day) are aufomobiie accidenf. This was The heaiing period for
thereby assured.'°'^"'^ one of the firsf cases treafed impiants inserted with the ERE
In fhis sfudy, the ccnsistent wifh fhe ERE fechnique in 198Ó. technique appears to be the
fotai bone fiii achieved in each The faiiure was due to a fenes- same as for other impionts,
case was remarkable. It should fration of the palafdl bone sur- although it is recommended
be nofed fhat fhis was accom- face, probabiy fhe resuif of an that fhe provisional prcsthetic
plished wifhcuf the use of a erroneous evaiuation of fhe phase be extended for more
membrane and, thus, without bone fhickness. fhan fhe usuoi 2 months.
ifs inherent risk of postoperative Four of the foilures nofed in Figures 2o to 2j are represenfa-
five of a case using fhe ERE
infection. Over the years, other Tabie 1 were the resuif of
fechnique.
invesfigators'''"'^ have pre- impiant fraoture, as indicdfed.