There are different techniques these days to manipulate the bone. Usually a hole with the diameter of the implant is drilled. If, however, there is not sufficient bone available, it is possible to prepare the bone with special techniques, so that an implantation is possible. Amongst those techniques are bone spreading, bone condensing and distraction osteogenesis.
Bone spreading can be used, if the patient has a narrow alveolar ridge. After drilling a hole with a pilot drill, the thin bone is split and then stretched with either a small bone chisel with a special screw device, or with ultrasonic surgery.
The implant is placed into the gap that was created. Possible spaces are filled with bone replacement materials.
Bone condensing is used, when the bone is extremely soft, as is often the case in the upper jaw. After the initial hole is drilled with a thin pilot drill, the rest of the implant bed is prepared with hand instruments. The hand instruments are used to condense the bone sideways, so that the former soft bone is formed to compact bone mass. This way the screwed in implant can be better fixed firmly.
The aim of distraction osteogenesis is to get the body to produce new bone. Two sections of bone are connected to each other with an extension screw and then are divided at the centre to this anchorage. The space gets larger by turning the screw. During the first 14 days of the wound healing phase the space will be opened up as far as the new formation of bone is desired. After the two sections have been fixated for 6 months, the distractor can be removed and the bone has become resident and solid.