• Crest Widening by Distraction - Case Study

    Crest Widening - Performed by Dr.Zvi Laster D.M.D Head of the Department of Oral & Maxillofacial Surgery, Poriya Hospital, Tiberias, Israel Case 1: 67 years old female Medical Doctor was referred to our department for bone augmentation at the upper left narrow maxilla. The patient suffered from resorbed narrow alveolar crest .

    All options were introduced to her and she chose distraction because it was the shorter procedure . Under local anesthesia, 3 mucoperiosteal incisions were performed and bone cuts were done through the cuts using a Piezo machine. (Fig 1C). The periostium is never stripped in this technique, thus preventing bone resorption.

    Osteotome was used to fracture incomplete fracture of the buccal plate.

    The Crest Expander was inserted , soft tissue sutured and the device was secured by ligating it to adjacent tooth.

    After 1 week latency period, the patient was asked to activate the device at home in front of a mirror, 1/4 of a turn 3 times a day. (0.3 mm a day).

    The patient was invited for observation every 3-4 days. After 3 weeks of activation, sufficient width was achieved and activation was stopped.

    After 3 weeks of consolidation, the device was removed under local anesthesia.

    3 implants were inserted flapless transmucosally at the same session with the healing cups sunk in the callus.

    4 months later the implants were examined and were found osseointegrated. Patient was sent for final rehabilitation.

    If you have questions about the Crest widener and you would like a Sales Representative to call you just -> -> -> click and fill out your contact details....

    Look at this procedure showing placement of the widener - by Dr. Zvi laster

    Case 2- Complication and solution:

    A 25 years old women was referred to us for crest widening by distraction by her dentist .The patient was planning her marriage and wanted a short period of treatment. Examination of the CT scans revealed a very narrow crest at the anterior upper incisors area. (Fig 2A).
    Fig 2A
    The same technique was utilized, performing 3 mucoperiosteal incisions and bone cuts without stripping the periostium and splitting the bone with an Osteotome. (Fig 2B),
    Fig 2B

    The base of the crest was too narrow (Fig 2A), the fracture was completed, the buccal fragment was too loose to stabilize the device. (Fig 2C).
    Fig 2C

    Therefore, the flap was sutured back (Fig 2D), and the patient was sent home for 4 weeks for consolidation of the callus.
    Fig 2D

    4 weeks later, a small incision was performed under local anesthesia , the fracture line was exposed minimally,(Fig 2E), and the Crest Expander was tapped gently into the fracture line and secured with titanium wire to adjacent tooth. (Fig 2F).
    Fig 2E

    Fig 2F

    Activation started immediately 1/4 of a turn 3 times a day. The device was activated for 18 days. 2 weeks later the device was removed and the patient was sent for new CT. (Fig 2G).
    Fig 2G

    2 weeks later implants were inserted. (Fig 2H).
    Fig 2H

    4 months later, the implants were exposed and patient was sent back to her dentist for final rehabilitation. (Fig 2I).
    Fig 2I

    If you have questions about the Crest widener and you would like a Sales Representative to call you just -> -> -> click and fill out your contact details....

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