Reconstruction of Posterior Mandibular Alveolar Ridge Deficiencies With the Piezoelectric Hinge–Assisted Ridge Split Technique: A Retrospective Observational Report

Abstract

Reconstruction of alveolar defects in the posterior edentulous mandible can be a difficult task. In addition to complicating anatomic features, such as the inferior alveolar nerve, mental foramen, oblique ridge, and lingual undercut of the mylohyoid ridge, edentulous ridges in the posterior mandible have thicker cortices and decreased volumes of vascular trabecular bone than their maxillary counterparts. Traditionally, these areas have been treated with autogenous block grafts. Significant resorption of these grafts, in combination with patient morbidity at secondary donor sites, has led clinicians to seek alternatives for augmenting the edentulous posterior mandible. The aim of this retrospective consecutive case series is to report on both the technique of the piezoelectric hinge-assisted ridge split procedure for augmenting these sites and the results that were achieved. Thirteen patients with 17 horizontal alveolar ridge deficiencies of the posterior mandible were treated with the piezoelectric hinge-assisted ridge split procedure. After an average healing period of 14 weeks, dental implants were placed into the augmented sites. Intrasurgical alveolar ridge measurements taken at the initial surgery and subsequently at the time of implant placement documented the horizontal gains achieved by this procedure. Overall mean gain in horizontal width was 4.03 mm (± 0.67). For single implant-site augmentations, the mean gain was 3.38 mm (± 0.25). For multiple adjacent implant-site augmentations, mean gain was 4.25 mm (± 0.62). A total of 31 dental implants were successfully placed in all sites and none required additional augmentation procedures. There were no instances of adverse outcomes, such as neurosensory deficits or sequestration of mobilized buccal plates. After a minimum of 6 months of loading, all dental implants have been successful. This retrospective observational report demonstrates that the piezoelectric hinge-assisted ridge split procedure can achieve substantial gains in horizontal ridge width of the edentulous posterior mandible without associated morbidity. Further prospective and larger observational studies are warranted to see if this is true over a larger patient population and to compare this technique to other more traditionally used approaches.