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Osteotomes can offer several significant advantages over the traditional graded series of drills. Osteotomes take advantage of the fact that bone is visco-elastic and can be compressed and manipulated. Compression creates a denser area for implant placement. Heat is a major detriment to osseointegration, but the osteotome technique does not generate heat. This technique also allows for greater tactile sensitivity. Three procedures are used: compaction, cortical floor elevation, and ridge expansion; these can be combined to facilitate implantation. If the practitioner recognized the properties of bone and understands how bone responds to manipulation, the techniques described here can aid in the preparation for the placement of dental implants with greater success.

With appropriate patient selection, single-stage surgery, immediate loading, and flapless site preparation are dependable treatment approaches that offer significant benefits to implant patients. This paper briefly reviews the history of these approaches and describes the conditions necessary to achieve long-term success. Case studies also are included.

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An adequate bone base is usually a prerequisite for functionally and aesthetically optimal reconstruction of the soft tissue architecture around a dental implant. In patients with sufficient bone height but insufficient bone width as a result of tooth loss, a jaw enlargement technique with osteotomes combined with soft tissue manipulation may be utilized to facilitate proper implant placement while concomitantly optimizing the aesthetics of the final implant prosthesis. The learning objective of this article is to familiarize the reader with the principles of ridge expansion with tapered osteotomes combined with periodontal plastic soft tissue surgery to aid in proper implant placement and enhance the aesthetic result of the final prosthesis.