The Alveolar Ridge Splitting Technique on Maxillae: A Biomechanical Human Cadaveric Investigation.

Fabian Duttenhoefer,Leonard Grünwald,Dominik Jenni,Luisa Thiemann,Boyko Gueorguiev,Peter Varga,Andres Stricker,Paolo Pesce

doi:10.1155/2020/8894471

Fabian Duttenhoefer, Leonard Grünwald + Show 6 more

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https://doi.org/10.1155/2020/8894471

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Abstract

The alveolar ridge splitting technique (ARST) offers an alternative to classic ridge augmentation techniques for successful insertion of dental implants. However, the buccal lamella is at risk of fracturing during ARST distraction. To better understand the fracture mechanisms and displacement limits of the split lamella, this study conducted biomechanical tests on human cadaveric maxilla specimens having extremely atrophied alveolar ridges treated with ARST. A total of 12 standardized alveolar splits were prepared on the maxillae of 3 elderly female donors using an oscillating piezoelectric saw. Mimicking the surgical distraction process of the lamella, each split was tested to failure using a dental osteotome attached to the crosshead of an electromechanical testing system. All specimens were scanned by means of high-resolution peripheral quantitative computed tomography prior to and post testing to evaluate split geometries and failure modes. Split stiffness, failure force, and displacement were 27.4 ± 18.7 N/mm, 12.0 ± 8.4 N, and 0.97 ± 0.31 mm, with no significant differences between anatomical sides and split locations (p ≥ 0.17). Stiffness correlated significantly with failure force (R2 = 0.71, p < 0.01). None of the alveolar split widths correlated significantly with the outcomes from biomechanical testing (p ≥ 0.10). The results suggest that simple geometrical measures do not predict the allowed extent of lamella distraction prior to failure. More sophisticated methods are required for surgical planning to optimize the ARST outcomes. Still, the present study may advocate a clinical protocol for the maxilla where the implant site is prepared directly after osteotomy setting and immediately before full lamella dislocation, when the lamella is still stable, resistant to mechanical stress, and bone loss caused by the abrasion of the burr is minimized.

Highlights

Rehabilitation of strongly atrophied alveolar ridge using dental implants usually requires complex augmentation techniques for their successful insertion
The most common complication of alveolar ridge splitting technique (ARST) is the intraoperative fracture of the buccal lamella [16]
A pilot study by Stricker et al successfully developed a biomechanical setup for relevant replication of lamellar fracturing applying ARST on porcine jaw specimens; a mean critical lamella displacement of 1.27 mm was reported for porcine mandibles osteotomized via piezosurgery and tested in lateral distraction with an osteotome [16]

Summary

Introduction

Rehabilitation of strongly atrophied alveolar ridge using dental implants usually requires complex augmentation techniques for their successful insertion. As an alternative to the classic augmentations through bone grafts or guided bone regeneration, the splitting and expansion of the alveolar ridge, so-called alveolar ridge splitting technique (ARST), offers the possibility of increasing the width of the alveolar ridge. This method is applied when the alveolar ridge exhibits sufficient vertical bone height but has insufficient horizontal width. Comparable success rates to augmentations with bone blocks or guided bone regeneration can be achieved with this technique [4]. Further ARST advantages are that a second operation is avoided and the treatment duration is shortened due to simultaneous implant insertion [5]

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