The bony lid approach in pre-implant and implant surgery: a prospective study

Purpose: The aim of this prospective study is to evaluate the outcome of the bony lid approach in pre-implant and implant surgery. Materials and methods: A total of 200 consecutive patients were treated between 2003 and 2008 with the bony lid technique in a prospective study and followed up for at least 4 years. The bony lid approach consisted in cutting and luxating a bony lid using a microsaw, which was then repositioned at the end of the surgery to avoid large bone defects in the case of osteotomies. In 146 cases the bony lid approach was used for implant explantation, in 29 cases for removal of fractured roots or foreign bodies from the implant site, in 14 cases for removal of impacted teeth from the implant site, in 4 patients in combination with nerve decompression/nerve lateralisation, and in 7 cases for removal of implants from the sinus. In 76 patients, the bony lid technique was performed simultaneously with the implant insertion or bone grafting procedure. In the remaining 124 cases, the bone grafting procedure/implant insertion was performed 3 months postoperatively. Outcome measures were success of the procedure, complications and stability of the bone volume of the alveolar crest. Results: All of the bony lid procedures obtained the desired aim and healed without any complication. The re-entry showed, in most cases (98.5%), a well integrated vestibular bone wall with volume stability. The average width of the alveolar crest after the reimplantation of the bony lid was 7.6 ± 0.8 mm in 124 patients, where the bony lid was reimplanted without simultaneous implantation/augmentation. At the re-entry 3 months later, an average width of 7.1 ± 1.2 mm was observed. In the 76 patients where the bony lid was reimplanted simultaneously with the implant insertion or with the bone grafting procedure, normal healing without any infection was observed. Only 3 cases demonstrated important volume changes, all in the 2-stage group. In all patients, it was possible to continue the treatment as planned. Conclusion: The results of the present study showed good outcomes for the bony lid approach. Parole chiave: bone graft, bone reimplantation, bony lid, diamond disc, microsaw Conflict-of-interest statement: This study was completely self-supported and no contribution from any commercial party was received, even in the form of free materials.