Alveolar Ridge Splitting Technique Research Articles

The efficacy of alveolar ridge split on implants: a systematic review and meta-analysis

ObjectivesTo evaluate the effects of the alveolar ridge split (ARS) technique on gained horizontal width of the alveolar ridge and implant survival rate.Materials and methodsElectronic searching was performed in six electronic databases (Pubmed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, and SIGLE) from January 1, 2010, to November 1, 2023. Two authors performed study selection, data extraction, and study qualities (ROBINS-I and RoB 2.0) independently. Meta-analysis was performed by Comprehensive meta-analysis 3.0.Results24 included studies were observational, and 1 study was a randomized controlled trial (RCT). 14 studies investigated the gained width of the horizontal alveolar ridge, and 17 examined the implants’ survival rate. For assessment of risk of bias, nine studies were high risk of bias and 16 studies were moderate risk of bias. Meta-analysis demonstrated that the pooled gained alveolar ridge width was 3.348 mm (95%CI: 4.163 mm, 2.533 mm), and the implant survival rate was 98.1% (95%CI: 98.9%, 96.9%). Seven studies showed seven different complications including exposure, infection, bad split, dehiscence, fracture, paresthesia and soft tissue retraction.ConclusionRecent ARS technique seems to be an effective method of bone augmentation with enough gained width and a high implant survival rate. Further long-term and RCTs research remains needed to enhance the study quality.Clinical relevanceThe ARS technique could generate sufficient bone volume, and implants had a high-level survival rate. Therefore, ARS has been proposed to be a reliable horizontal bone augmentation technique that creates good conditions for the implantation of narrow alveolar crests.

Clinical and radiographic evaluation of transalveolar two-step osteotome-mediated sinus floor elevation versus sinus augmentation with displacement of the palatal wall in lateral direction coupled to alveolar ridge split technique: A 3-year retrospective study

IntroductionThe present study aimed to examine the middle-term effects of transcrestal double-sinus elevation (TSFE) versus alveolar/palatal split expansion technique (APS) and simultaneous implant placement in the augmented sinus. Null hypothesis: there were no differences between groups. Material & methodsMagnetoelectric device was used for bone augmentation and expansion techniques in long-standing edentulous patients with a deficiency in vertical height in the posterior maxilla (3mm to 4mm residual bone height): TSFE group, or two-stage process with a first transcrestal sinus floor augmentation and a second sinus floor elevation with immediate implant placement; APS group, or “dual split and dislocation” of the two cortical bony plates towards the sinus and palatal side. Volumetric and linear analyses were performed on the superimposed preoperative and postoperative 3-year computed tomography scans. The level of significance was set at 0.05. ResultsThirty patients were selected for the present analysis. For both groups significant differences were found in the volume outcomes between baseline and 3-year follow-up, showing a gain of about +0.28±0.06cm3 for the TSFE group, and +0.43±0.12cm3 for the APS group, with p-values < 0.0001. However, an effective increase of the volume of the alveolar crest was registered just in the APS group (+0.22±0.09cm3).A significant increase in bone width was found in the APS group (+1.45±0.56mm with p-value < 0.0001); on the contrary, a slight width reduction of the alveolar crest was observed in the TSFE group (-0.63±0.21mm). DiscussionTSFE procedure seemed to not affect the shape of the alveolar crest. APS procedures led to a higher increase of the volume available for dental implant placement and could be used in horizontal bone defects too.

Alveolar Ridge Splitting with Simultaneous Implant Placement in Narrow Atrophic Ridges: A Case Series

&lt;p&gt;Objectives: Implant placement in atrophic ridges with severe horizontal bone deficiency without adequate bony housing around the defects remains a significant clinical challenge. The aim of this case series is to evaluate the effectiveness of alveolar ridge splitting (ARS) with simultaneous implant placement. Materials and Methods: Four patients with severe horizontal bone deficiency in atrophic ridges received ARS with simultaneous implant placement. The stability of the widened ridges was evaluated by superimposition of initial and postoperative CBCT images. The ridge thickness at baseline (RT0) and at least 6-month postoperation (RT1), as well as horizontal bone gain (HBG), were measured with the reference of implant platform. Results: All 7 implant sites healed uneventfully without complications. The mean RT0 was 3.84 &amp;plusmn; 0.56 mm at baseline; the mean RT1 was 7.61 &amp;plusmn; 0.96 mm at least 6-month postoperatively, with the mean HBG of 3.77 &amp;plusmn; 0.80 mm. The results demonstrated significant HBG and sufficient bone thickness around implants after ARS with simultaneous implant placement in all cases. Conclusion: The ARS technique with simultaneous implant placement is an effective and predictable treatment modality to augment ridge width significantly for narrow atrophic ridges without adequate bony housing.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Radiological Evaluation of Marginal Bone Loss Around Sandblasted and Acid-etched (SLA) and Modified Surface (SLActive) Tissue-level Implants Surfaces: A Retrospective 5-year Follow-up Study

&lt;p&gt;Objectives: Implant placement in atrophic ridges with severe horizontal bone deficiency without adequate bony housing around the defects remains a significant clinical challenge. The aim of this case series is to evaluate the effectiveness of alveolar ridge splitting (ARS) with simultaneous implant placement. Materials and Methods: Four patients with severe horizontal bone deficiency in atrophic ridges received ARS with simultaneous implant placement. The stability of the widened ridges was evaluated by superimposition of initial and postoperative CBCT images. The ridge thickness at baseline (RT0) and at least 6-month postoperation (RT1), as well as horizontal bone gain (HBG), were measured with the reference of implant platform. Results: All 7 implant sites healed uneventfully without complications. The mean RT0 was 3.84 &amp;plusmn; 0.56 mm at baseline; the mean RT1 was 7.61 &amp;plusmn; 0.96 mm at least 6-month postoperatively, with the mean HBG of 3.77 &amp;plusmn; 0.80 mm. The results demonstrated significant HBG and sufficient bone thickness around implants after ARS with simultaneous implant placement in all cases. Conclusion: The ARS technique with simultaneous implant placement is an effective and predictable treatment modality to augment ridge width significantly for narrow atrophic ridges without adequate bony housing.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Alveolar Kret Ayırma Tekniği ile Atrofik Çenelere Konik ve Silindirik İmplantların Yerleştirilmesinin 3B Sonlu Eleman Analizi ile Değerlendirilmesi: Analitik Çalışma

Objective: Alveolar ridge splitting technique (ARST) is a horizontal bone augmentation technique used in atrophic alveolar ridge. The present study aimed to evaluate the insertion of conical and cylindrical implants with the same surface structure in atrophic alveolar ridges augmented by ARST and to analyze the stress distributions on the implant and adjacent bone surfaces using three dimensional (3D) finite element analysis (FEA). Material and Methods: The thickness of the atrophic alveolar ridge was adjusted to 5 mm. The implants were inserted in the atrophic alveolar ridges that were augmented by ARST with a torque of resistance of 35 Newtons. Stress distributions were evaluated by using FEA. Results: The results indicated that the conical implants resulted in lower strain on the implant and adjacent bone surfaces compared to cylindrical implants. It was also revealed that conical implants had a homogeneous stress distribution on the implant surfaces while the stress in cylindrical implants was mostly concentrated on the neck region. As the diameter of the implants increased, the Von Mises stress values on the adjacent bone surfaces decreased. Conclusion: Although no definitive recommendations can be made regarding the design of the implants used in ARST, the results of the present study indicated that conical implants could be more advantageous than cylindrical implants with regard to stress distribution.

Splitting expansion and palatal approach technique for implant placement in severely resorpted maxilla

The treatment of patients with atrophic maxillary alveolar ridge who need oral rehabilitation is a common problem in Implant Dentistry. One of the techniques used is the alveolar ridge splitting technique to expand alveolar ridges with a horizontal bone decrease. The palatal approach technique is also recommended in cases with an insufficient thickness of the alveolar ridge for the placement of implants in the bone envelope. The aim of this work is to describe the splitting expansion and palatal approach technique for the treatment of atrophic maxillary ridges with a horizontal bone deficit and rehabilitation with implant placement. This technique combines the alveolar ridge splitting/expansion technique and the palatal approach technique. It allows alveolar ridge expansion using piezosurgery and immediate placement of implants without thread exposure in the palatal aspect. With one surgical time, this technique avoids the fracture of the buccal bone plate due to the expansion, eliminates the need for bone graft and donor-site morbidity, is simple and effective, and shows great esthetic results and implant success.

EVALUATION OF INTERCHANGEABLE GUIDE IN MINIMALLY INVASIVE RIDGE SPLITTING WITH SIMULTANEOUS IMPLANT PLACEMENT (A PROSPECTIVE CLINICAL STUDY)

Background: The conventional ridge splitting technique offers a feasible and more consistent approach for the challenging narrow alveolar ridge. However, this entails raising of a complete flap to allow an adequate visibility of the osseous defect resulting in disturbance of vascular supply and risk of bone resorption. Stereolithography helps the manufacture of surgical guides using 3D generated models for an accurate placement of implants with minimal invasiveness thus preserving the periosteum. Objectives: To assess the precision of dental implant placement in narrow ridges after ridge splitting minimally invasive technique using an interchangeable guide. Materials and Methods: A prospective study was including 5 patients with anterior maxillary narrow ridge. All patients were selected to suit the proposed inclusion and exclusion criteria. Ridge split procedure was performed for all selected subjects assisted with the surgical guide with simultaneous placement of implants. Patients were evaluated by clinical and radiographical assessments with an average of 6 months follow up. Results: 8 implants were placed. Angular deviations with an average of 2.61 ± 1.46 degrees. The mean values of the horizontal deviation at the coronal and apex sides of the implant were 0.70 ± 0.46 mm and 0.98 ± 0.35 mm. While the Vertical deviations (V) with an average of 0.39 ± 0.29 mm. There were statistically significant differences between preoperative, immediate postoperative and 6 months postoperative values of bone width and density. Conclusions: Alveolar ridge split technique assisted with an interchangeable surgical guide is a feasible and reliable method for placement of dental implants

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

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.

Alveolar ridge split technique and immediate implant placement in atrophic maxilla. Case series

Background: Alveolar ridge split technique (ARST) is a surgical procedure performed for horizontal ridge augmentation in cases of narrow crestal ridges. It is a biologically oriented technique, taking advantage of the osteogenic and osteoconductive dynamic of the native bone. Recently, the utilization of devices such as thin diamond disks or piezoelectric cutting devices has enhanced ARST success rate, reduced surgical time and patient's morbidity, regardless of bone quality. Aim/Hypothesis: The purpose of this poster is to present and discuss our experience in a series of clinical cases where ARST was performed for horizontal bone augmentation with simultaneous implant placement, using classical or piezoelectric-assisted surgical procedures. Materials and Methods: ARST was performed in 6 patients with 10 sites of horizontal defects. Under local anesthesia, a crestal incision was performed and a full thickness mucoperiosteal flap was reflected. Initial osteotomy was done using the classical technique in 6 cases (diamond disk, rotary burs), while a piezoelectric device was used to the remaining 4 cases. Osteotomes and chisels with gradually increasing dimensions were used to expand the alveolar ridge to facilitate the immediate placement of 18 implants, approximately 2 mm subcrestally in order to prevent marginal bone loss. The remaining space between bony plates was filled with allograft or xenograft and covered with collagen membrane in 9 cases, while in one case no bone graft or membrane were used. Primary closure without tension was achieved with periosteum releasing incisions of the buccal flap. Post-operative instructions included administration of antibiotic and analgesic, chlorhexidine solution, smoke cessation and thorough oral hygiene. Results: Sutures were removed 10 days postoperatively. Follow up was uneventful for 5 out of 6 patients. One patient did not comply with the postoperative instructions, applying poor oral hygiene and continuing smoking as before which resulted in exposure of the collagen-membrane the second week, leading to secondary wound closure compromising the augmentation. A new CBCT was performed 4 months following the split which revealed successful bone augmentation and implant osseointegration without any significant bone loss around the implants. Oral rehabilitation with either fixed or removable prosthetics was accomplished and the patients remain under systematic review. Conclusions and Clinical Implications: ARST is a predictable and reliable procedure characterized by its low invasiveness and morbidity. The major advantage is the simultaneous bone augmentation- implant placement, which provides reduced treatment time and cost. Piezoelectric devices make the split technique easier and safer, decreasing the risk of complications in the treatment of extremely atrophic crests. ARST's success and efficacy depends greatly on patient selection in order for the basic anatomical criteria to be fulfilled. Keywords: ridge splitting, horizontal bone augmentation, piezoelectric device

Radiographic Evaluation of the Alveolar Ridge Splitting Technique Combined with Guided Bone Regeneration vs Guided Bone Regeneration Alone in the Anterior Maxilla: A Retrospective Controlled Study.

This study aimed to estimate the radiographic outcomes of the alveolar ridge splitting (ARS) technique combined with guided bone regeneration (GBR) and compare its efficacy with GBR alone in maxillary anterior narrow ridges. Forty patients with 51 implants in the ARS group and 40 patients with 49 implants in the GBR group were included. The buccal bone thickness (BBT) at 0 to 4 mm from the implant shoulder immediately and 6 months postoperative were analyzed using cone beam computed tomography. The BBT at both time points had no statistical disparities between the two groups (P > .05). However, BBT changes indicated significant disparities, with more BBT preservation in the ARS group (P < .05). Compared with GBR alone, the ARS technique combined with GBR, despite obvious buccal bone diminution, could be a reliable modality for treating ridge width deficiency in the anterior maxilla.

A Two-step Method for the Preparation of Implant Recipient Site in Severe Atrophic Maxilla: A Case Report of the Alveolar Ridge Split Technique Followed by Bone Expansion

Augmentation of deficient and atrophic alveolar ridges is an important aspect of dental implant therapy with the goal of providing a functional restoration in harmony with adjacent natural dentition. Bone splitting technique is considered a distinguished augmentation method for treatment of deficient alveolar ridges. According to this procedure, the compromised alveolar ridge is opened from the crest of the ridge and subsequently split with special chisel instruments. In this report, we described a case of horizontal ridge augmentation of an atrophic anterior maxillary ridge using ridge split in the first step and ridge expansion concomitant with implant placement in the second stage after 6 months. A two-step method of alveolar ridge split using piezosurgery followed by bone expansion is a reliable and successful treatment plan for implant recipient site rehabilitation in severe atrophic maxilla (less than 3 mm).

Alveolar Ridge Split Technique with Immediate Implant Placement: a Case Report

Alveolar Ridge Split Technique with Immediate Implant Placement: a Case Report

Finite Element Analysis and Biomechanical Testing to Analyze Fracture Displacement of Alveolar Ridge Splitting

The alveolar ridge splitting technique enables reconstruction of atrophied alveolar ridges prior implantation. However, in cases of severe atrophy, there is an unpredictable risk of fracturing the buccal lamella during the expansion. Currently, there is no preoperative assessment to predict the maximum distraction of the lamella. The aim of this study was to develop a biomechanical model to mimic the alveolar ridge splitting and a finite element (FE) model to predict the experimental results. The biomechanical testing was conducted on porcine mandibles. To build the FE model high resolution peripheral quantitative computer tomography scans of one specimen was performed after the osteotomy outline, but before the lamella displacement. A servo-electric testing machine was used for the axial tension test to split the lamellae. Results showed, in line with clinical observations, that the lamellae broke primarily at the base of the splits with a median displacement of 1.27 mm. The FE model could predict fracture force and fracture displacement. Fracture force showed a nonlinear correlation with the height of the bone lamella. In conclusion, good correspondence between mechanical testing and virtual FE analysis showed a clinically relevant approach that may help to predict maximum lamella displacement to prevent fractures in the future.

Alveolar Ridge Split Technique Using Piezosurgery with Specially Designed Tips.

The treatment of patients with atrophic ridge who need prosthetic rehabilitation is a common problem in oral and maxillofacial surgery. Among the various techniques introduced for the expansion of alveolar ridges with a horizontal bone deficit is the alveolar ridge split technique. The aim of this article is to give a description of some new tips that have been specifically designed for the treatment of atrophic ridges with transversal bone deficit. A two-step piezosurgical split technique is also described, based on specific osteotomies of the vestibular cortex and the use of a mandibular ramus graft as interpositional graft. A total of 15 patients were treated with the proposed new tips by our department. All the expanded areas were successful in providing an adequate width and height to insert implants according to the prosthetic plan and the proposed tips allowed obtaining the most from the alveolar ridge split technique and piezosurgery. These tips have made alveolar ridge split technique simple, safe, and effective for the treatment of horizontal and vertical bone defects. Furthermore the proposed piezosurgical split technique allows obtaining horizontal and vertical bone augmentation.

Is Alveolar Ridge Split a Risk Factor for Implant Survival?

There is a paucity of studies that have assessed the long-term outcomes of the alveolar ridge split (ARS). This study evaluated the intraoperative and postoperative complications and assessed the placed dental implant and prosthesis. A retrospective study of the ARS was conducted in a single private dental clinic. The predictor variable was the ARS technique (1 stage vs 2 stages). The primary outcome was the dental implant survival rate. Secondary outcomes were intraoperative complications, marginal bone loss, prosthetic complications, and prosthesis success rate. Descriptive analysis was performed for patients' demographic data, implant details, and prosthetic complications. The Kaplan-Meier method was used to assess implant survival rate and prosthesis success rate. Twenty patients (mean age, 55 ± 6yr) had a mean follow-up time of 5years. Delayed implant placement was performed when the residual alveolar bone width was narrower than 3mm. No intraoperative or postoperative complications were reported. The survival rate of the 31 implants was 100% and the prosthesis success rate was 96.8%. The ARS is an effective technique for horizontal bone augmentation in the mandible. Delayed dental implant placement when the alveolar bone width is narrower than 3mm could minimize the risk of buccal wall fracture.

Alveolar ridge split on horizontal bone augmentation: a systematic review.

Many techniques have been proposed to overcome the limitations displayed by maxillary atrophy. The aim of this systematic review was to assess the predictability, dimensional changes, and associated factors to successfully perform the alveolar ridge split (ARS) technique of augmentation. An electronic and manual literature searches was conducted by two independent reviewers in several databases, including Medline, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register, for articles written in English up to February 2014. A manual search was also performed to ensure a thorough screening process. Based on the PICO (problem, intervention, comparison, outcome) model, the chief question of this study was: Can patients with horizontal ridge deficiency be successfully treated with the ARS technique and implant therapy? Overall, 17 articles met the inclusion criteria, and a subsequent meta-analysis was performed. A Cohen kappa interagreement rate of 0.82 was reached. The implant survival rate of the included studies was 97.0% (range, 94.4% to 100%) with the full-thickness flap (FTF) approach and 95.7% (range, 86.6% to 100%) with the partial-thickness flap (PTF) approach. The weighted mean (WM) of horizontal bone width gain was calculated for included studies using FTF for the ARS technique. Four studies that had data were included in the meta-analysis. The WM ± standard deviation of bone width gain was 3.19 ± 1.19 mm (range, 2.00 to 4.03 mm). For studies using PTF for ARS, only one study provided mean and standard deviation of horizontal bone width gain (4.13 ± 3.13 mm); hence, meta-analysis could not be performed. Buccal wall fracture represented the most frequent postoperative complication, followed by postoperative ridge resorption. In selected scenarios, the ARS technique might represent a predictable approach as demonstrated by a high implant survival rate, adequate horizontal bone gain, and minimal intra- and postoperative complications. Further research is needed to determine the influence of the grafting materials inserted and flap tissue biotype, as well as the anatomical characteristics on final bone augmentation outcomes.