U-shaped Splitting Technique vs Conventional Bone Grafting in Maxillary Facial Undercut for Dental Implants Placement: A Preliminary Randomized Controlled Clinical Trial.

Abstract

This prospective randomized clinical trial was designed to compare the apical U-shape splitting technique (AUST) combined with guided bone regeneration (GBR) vs GBR alone for horizontal bone augmentation in maxillary labial undercut areas. The study included twelve patients with labial undercuts that made their alveolar ridges not able to compass dental implants. They received a total of 14 dental implants in the anterior maxilla where 7 (group I) were placed after AUST with GBR and the other 7 (group II) after the conventional GBR. The clinical and radiographic evaluations were done preoperatively, after surgery, and 6 months later. Facial flap fracture, peri-implant health, ridge width (RW) gain and loss, marginal bone loss (MBL), and implant esthetics were measured. Data were analyzed and compared and for any of the used tests, results were considered statistically significant if p-value ≤ 0.05. For group I, no fracture of the bone flap happened and the gain in RW was significantly higher at 6 months postoperatively. Marginal bone loss was similar for both groups. The total pink esthetic score was significantly higher in group I vs group II (p = 0.024). Within the limitations of this study, it was concluded that AUST combined with GBR was more effective in RW gain than GBR alone and it provided a merit approach for restoring function and esthetics if labial fenestration was unavoidable during implant placement. Apical U-shape splitting technique for horizontal ridge augmentation is a valuable option for the benefit of patients in clinics who need dental implants and have anterior undercut areas that may lead to fenestration and usually requires onlay bone grafting which is less successful in maintaining the RW.