Reconstruction of the Narrow Ridge Using Combined Ridge Split and Guided Bone Regeneration with rhPDGF-BB Growth Factor–Enhanced Allograft

Abstract

In clinical situations where the presence of severe horizontal ridge deficiencies precludes simultaneous implant placement and bone augmentation, a staged approach may be desirable to allow optimal implant placement. Numerous therapeutic options are available for the treatment of the horizontally deficient ridge. With advances in tissue engineering, the use of growth factors can significantly improve wound healing with more rapid bone formation and maturation. These case reports demonstrate a technique that enhances the predictability of horizontal bone gain with reduced surgical trauma and postoperative complications. Recombinant human platelet-derived growth factor BB (rhPDGF-BB) in combination with particulate allograft is used to stimulate the proliferation and migration of osteogenic cells. A ridge split technique with vertical bone incisions allows expansion and mobilization of the buccal plate, creating a space that will contain the particulate graft material. Decortication of the mobilized buccal plate will create pathways to allow cellular and vascular access for enhanced maturation. Additional graft material is placed lateral to the mobilized buccal plate to increase apical ridge width. The use of piezoelectric surgery enables a precise crestal bony incision in severely deficient ridge widths and aids in faster wound healing. This study discusses the technique and the recommended therapeutic considerations to ensure predictable regeneration of adequate bone for optimal implant placement in horizontally deficient ridges.