Tenting Screws in Implant Dentistry
Tenting screws are specialized devices used in implant dentistry to facilitate guided bone regeneration (GBR) procedures. Their primary role is to maintain space for bone graft materials and soft tissue, enabling adequate bone regeneration in areas with significant vertical or horizontal deficiencies. By preventing the collapse of the overlying soft tissue into the grafted area, tenting screws create a stable environment conducive to new bone formation.
Applications of Tenting Screws
⦁ Alveolar Ridge Augmentation
Tenting screws are often used in cases where the alveolar ridge has undergone resorption due to tooth loss, trauma, or pathology. They help rebuild the ridge to provide sufficient bone volume for implant placement.
⦁ Vertical Bone &Horizontal Bone AugmentationAugmentation
In cases of vertical bone deficiencies, tenting screws are used to help rebuilding the height of the ridge serving as “tent poles” in case graft material is used and ensure that the regenerated bone matches the required implant dimensions.
Mechanism of Action
Tenting screws act as scaffolds that prevent the periost from compressing the graft material. Once inserted into the residual bone, the screws provide vertical or horizontal support. This space maintenance is critical for osteoconduction, allowing osteogenic cells to migrate and new bone to form without interference from the overlying tissues.
Procedure Overview
⦁ Planning and Placement
The surgical site is prepared with careful attention to the defect dimensions. Tenting screws are strategically placed into the remaining bone to ensure they support the grafted material in the desired position.
⦁ Graft Application
Bone graft material—autogenous, allograft, xenograft, or synthetic—is packed around the screws. The screws hold the graft in place and maintain the desired shape of the augmented area.
⦁ Membrane Coverage
A barrier membrane is typically used to cover the grafted area and screws, preventing soft tissue infiltration and supporting guided bone regeneration. Long standing membranes such as cross-linked collagen membranes are used.
⦁ Wound Closure
The surgical site is closed with tension-free sutures to ensure proper healing.
Advantages of Tenting Screws
⦁ Space Maintenance: Ensures adequate room for bone regeneration.
⦁ Stability: Provides mechanical support for the graft material.
⦁ Cost-Effective: Compared to other advanced bone augmentation techniques, tenting screws are relatively economical. The price for tenting screws is low, as well they can be reused after been autcolaved.
⦁ Versatility: Useful in a wide range of defect types, including complex cases.
Challenges and Considerations
⦁ Surgical Skill: Proper placement of tenting screws requires experience to avoid damaging vital structures or compromising primary stability.
⦁ Soft Tissue Management: Ensuring tension-free closure is critical to prevent wound dehiscence and exposure of the graft or screws.
⦁ Post-Operative Care: Careful monitoring and maintenance are essential to avoid complications such as exposure of screw heads.
⦁ Screw Removal: Once bone regeneration is completed, screws may need to be removed either after opening a flap or directly in case the heads are visible throuhout the periost and soft tissue.
Conclusion
Tenting screws are a valuable tool in implant dentistry for addressing challenging bone deficiencies. By creating a stable environment for bone regeneration, they enhance the predictability and success of augmentation procedures. Advances in surgical techniques, biomaterials, and patient-specific planning continue to optimize outcomes, making tenting screws an integral component of modern bone augmentation strategies.