Alveolar distraction before insertion of dental implants in the posterior mandible
Section snippets
INTRODUCTION
One of the most common problems in oral implantology is insufficient bone height between the alveolar ridge and the dental canal, as a result of mandibular atrophy from edentulism. The edentulous mandible atrophies progressively, losing up to 50% of its original volume,1 and in severe cases this atrophy affects both the alveolar ridge and the mandibular basal bone.2 Ulm et al.3 reported that the mandible loses 60% of its bone volume during progressive atrophy, and that most is lost in the early
PATIENTS AND METHODS
Seven patients (5 men and 2 women; mean age (SD) 43 (7) years) were studied. All patients had unilateral (n=4) or bilateral (n=3) partial edentulism in the posterior mandible, with varying degrees of alveolar atrophy. None of the patients had teeth missing from the anterior mandible, or teeth remaining posterior to the edentulous sites. A total of 10 alveolar distractions were done, and 20 implants inserted (16 International Team for Implantology Straumann, Switzerland, and 4 Frialoc, Friadent,
RESULTS
The mean predicted height of crown required (as estimated before distraction) was 12.8 (2.1) mm. The mean available height of bone was 7.8 (1.5) mm. After distraction and implantation, the mean height of the crown was 8.1 (1.9) mm, while the length of the implant was 11.3 (1.9) mm. The mean ratio of predicted crown height to bone available before distraction was 1.7 (0.3) (Index A), and the mean ratio of crown height to length of implant after distraction was 0.7 (0.1) (Index B). These two
DISCUSSION
We used two measurements of available bone. Before distraction we used CT to measure the height available between the alveolar ridge and the dental canal. This measurement is obtained routinely in all patients who are being considered for dental implants. After distraction, however, we used panoramic radiography to calculate implant length (total bone height minus 1 mm), because of the high cost of a second CT and the higher dose of radiation it would entail. We consider that the two
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