: Perfect for exceptionally difficult cases
The BonEx Kit was developed to include all instruments necessary to do a ridge split technique and is the ideal choice for bone expansion techniques. It consists of a series of expanders made of surgical grade stainless steel which have 5 diameters and can be used sequentially to expand the ridge.
A full thickness flap incision is made mid-crestal and a saw is used to cut the bone to the desired depth for implant placement.
A pilot drill (lance) is used to select the implant site followed by a 2mm drill to open the crest followed by the bone expander to widen the site to accommodate an implant.
The expanders are used at slow speed with 50ncm torque. After placement of implant, you can either do a 1 or 2 stage approach depending on the case.
Ridge Split Technique
Step 1. Indications
Ridge Splitting techniques may be used in many cases presenting a narrow ridge. Single implant or limited space cases, however, offer less room for expansion. If the narrow ridge consists solely of cortical bone with no intervening cancellous bone, it will be difficult to achieve a good ridge split. Caution is also advised in the maxillary anterior as ridge splitting may cause the labial cortical bone to move too labially resulting in severe angulation of the implant.
Step 2. Incision
Incision line is recommended to be at the centre of the remaining keratinized tissue. A longer horizontal incision is better to permit adequate sawing for ridge splitting. One tooth size more, mesially and distally.
Step 3. Flap Reflection
Full thickness or full-to-partial thickness flap is recommended. If the ridge crest is less than 2mm, it is advisable to reduce the crestal bone until the width is at least 2mm.
Step 4. Sawing or Ultrasonic
Sawing starts from the centre of ridge. The ridge should be cut at a slightly buccal angulation because resorption occurs on buccal bone. If the lingual bone is too thin after sawing, splitting may occur to the lingual side making implant position too far lingual. Thin ridged bone should be cut to the depth of implant length. For example, if the intended implant length is 8.5mm, the incision should be cut to 8.5mm. In most cases, vertical bone cutting is not necessary when you place the AnyRidge implant. Only small offsets at the ends of horizontal bone cutting are enough to guide the direction of ridge expansion if needed.
Try to maintain lingual bone thicker than buccal to expand thin ridge buccally.
Slightly angulated cutting is recommended.
If the crest is less than 2 mm expand with a chisel first. To avoid bone defects which can be made by drilling on thin ridge, lightly tap with a mallet.
Step 5. Drilling
Drill at the desired position and axis of implant.
In ridge expansion technique, lance and 2mm drilling is enough in most cases. It’s only to guide the implant path. If a flat-bottomed implant was planned, drilling should be extended to the diameter recommended by the manufacturer.
Expanding with BonEx kit (Optional)
When wider, slow expansion with BonEx kit is recommended.
The Expanders can be engaged easily with bone by a handpiece (50 Ncm). If it stops before the depth of osteotomy, use a hand wrench and a ratchet extension. Same procedure can be repeated with wider diameter of BonEx Expander.
Step 6. Implant Placement
When the ridge is expanded adequately or has enough flexibility, place the implants.
If you use BonEx Expanders, it’s better to leave an Expander during placement of the first implant to keep the ridge expanded. Torque force up to 60-70 Ncm will be fine to place an implant.
Step 7. Bone Graft & Membrane
The remaining bone defects can be filled with any kind of bone graft material.
Resorbable membrane is recommendable for better bone fill.
Step 8. Closing flap
One stage or two-stage approach can be chosen according to the conditions, but it is recommended to finish several cases with the successful result before trying one stage surgical approach.
Adequate periosteal releasing incision is needed if a primary closure is planned.