Bone Manipulation Technique for Implant Placement in Horizontal Bone Deficiency

Objectives: Tooth loss negatively affects the quality of life and daily activities. Dental implants are considered the standard of care for replacing missing teeth. The amount and quality of bone is a critical aspect in the long-term success of dental implants. Since bone resorption is commonly observed in patients needing dental implants, multiple bone enhancement techniques have been described. The purpose of this study was to evaluate a minimally invasive bone manipulation (BM) technique, which consists of bone expansion, bone compaction, and preservation of the periosteum for precise implant placement and initial stability.
Methods: A Cone Beam CT scan was taken by a calibrated examiner pre- and post-operatively to assess bone quality in 11 patients at 19 implant sites. Implant stability (ISQ) was measured using the Penguin device, which measures micro-mobility. BM technique was performed in maxilla and mandible. We used signed rank sum test to evaluate change in bone width.
Results: The initial width ranged from 2.39mm to 13.52 mm (mean±SD: 5.08mm ± 2.80). The final width ranged from 4.98mm to 15.01mm (mean±SD: 7.41mm ± 2.29). There was a statistically and clinically significant increase in bone width that averaged 2.33mm ± 1.36, (p .0001). Implant stability ranged from 57 to 85; posterior > anterior, p=.06.
Conclusions: Bone manipulation enhanced narrow alveolar ridges allowing adequate bone architecture for stable implant placement. BM is a novel minimally invasive, technique-sensitive procedure that allowed expansion and compaction of bone in 19 cases; 73.68% had moderate or high ISQ values.