Alveolar Ridge Splitting Research Articles

Full-mouth dental implant rehabilitation for a patient suffering from PapillonLefevre syndrome

Papillon-Lefevre syndrome (PLS) is an autosomal recessive disorder that affects the primary and permanent dentitions. It is characterized by severe periodontitis. Titanium implants have emerged as a significant therapeutic option in recent years for both tooth replacement and oral rehabilitation in individuals with PLS. Due to the severe bone loss, these patients may require bone grafting procedures, sinus lifts, and the alveolar ridge splitting technique (ARST) in order to properly position the implants. This report aims to demonstrate how a patient with PLS can be successfully managed for full-mouth rehabilitation with dental implants and hybrid prosthesis. Periodontists and prosthodontists should combine their efforts for an optimal customized treatment plan. Dental implants have been successfully used to restore functionally and esthetically the patient’s mouth.

Advancements in dental implantology: The alveolar ridge split technique for enhanced osseointegration.

The alveolar ridge split (ARS) technique is a pivotal advancement in dental implantology, addressing the limitation of insufficient bone width for implant placement. This review traces the historical development of ARS from its initial conceptualization to current practices and future directions. Emphasizing the technique's development, indications, procedural overview, and osteotomy variations, we highlight its minimally invasive nature, which reduces patient morbidity and treatment time. This article reviews various osteotomy methods within ARS, examining their applications, benefits, and limitations. Furthermore, it discusses the technique's role in expanding treatment options for patients with compromised alveolar structures, underpinned by a high implant survival rate and the potential for immediate implant placement. We also cover the necessity of meticulous surgical technique, the importance of patient-specific factors, and the promising future of ARS facilitated by advancements in biomaterials and regenerative medicine. In summary, this review provides a comprehensive overview of ARS, offering valuable insights for dental professionals and informing future clinical practices and research in implantology.

Alveolar Ridge Split and Expansion Utilising a Piezo-surgical Approach for Implant Placement in Narrow Ridges

Abstract In clinical settings, it is common to encounter alveolar ridges that lack sufficient width, posing challenges for implant placement. To ensure a successful implant placement, the bone’s width must be at least 1.5 mm greater than the implant’s diameter on both the buccal and lingual/palatal sides. The alveolar ridge split technique has been developed as a solution for horizontal bone deficiencies, allowing for the expansion of the alveolar ridges. This article discusses a case where an implant was placed in a 35-year-old male patient who had a missing lower left first molar for 5 years. Due to the horizontal deficiency of the alveolar ridge, a ridge split and expansion procedure was executed using piezosurgery. After 6 months, a screw-retained prosthesis was successfully delivered.

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.

Postoperative Outcomes in the Surgical Rehabilitation of Alveolar Bone in Implant-Prosthetic Therapy: A Review

Surgical rehabilitation of the muco-osseous support in edentulous patients with severe alveolar bone resorption is a challenging stage for the specialists in implant-prosthetics and oral surgery. Various biomaterials including autogenic, allogenic, xenografts, and synthetic biomaterials are considered on-the-board options for implant-prosthetic therapy. The selection of the bone graft must consider the systemic status, the osteogenic potential of the recipient site, and the available growth time of the new bone. A large range of alveolar bone reconstruction techniques is available to implantologist or oral surgeon: guided bone regeneration (GBR), vertical/horizontal augmentation by onlay blocks, distraction osteogenesis, alveolar ridge splitting techniques, bone expansion techniques) Various research groups reported the bone gain both in vertical and horizontal augmentation techniques by xenografts. Lateral bone augmentation techniques were recommended in post-extraction areas. The potential of the vertical augmentation procedures was highlighted but the long-term success depends on clinician’ experience level. Various factors that can influence the implant success/failure rate when implants were placed in alveolar bone areas after reconstruction by grafting materials. The main factor responsible for the absence of graft integration, its migration, and the absence of implant integration in the grafted area is represented by the poor execution of the surgical technique and graft migration because of poor vascularization in the grafted area.

Lateral augmentation of the jaw by the split expansion ridge technique. A critical review.

Bone augmentation has become a routine procedure to enhance and/or repair a deficient or resorbed alveolar ridge for predictable and successful implant placement. The split expansion ridge i.e., the alveolar ridge splitting (ARS) procedure, is one of the less invasive procedures, and is characterized by minor morbidity. This would allow to widen narrow ridges in order to allow implant reconstruction in a sufficient bone volume. Its efficacy and long-term stability rely upon clinical opinions and long-term retrospective studies, while prospective comparative studies and randomized controlled trials are rare. This critical review presents the development of this technique, describes the surgical procedure, and provides technical notes and modifications. The learning curve and in-depth knowledge of the oral anatomy, as well as the recognition of incidence and management of complications are of utmost importance in the clinical application of the ARS procedure.

Multidisciplinary Management of a Protrusive Malocclusion in an Adult Patient with Atrophic Ridges by Alveolar Ridge Split Technique - A Case Report

Multidisciplinary Management of a Protrusive Malocclusion in an Adult Patient with Atrophic Ridges by Alveolar Ridge Split Technique - A Case Report

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

<p>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 ± 0.56 mm at baseline; the mean RT1 was 7.61 ± 0.96 mm at least 6-month postoperatively, with the mean HBG of 3.77 ± 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.</p> <p> </p>

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

<p>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 ± 0.56 mm at baseline; the mean RT1 was 7.61 ± 0.96 mm at least 6-month postoperatively, with the mean HBG of 3.77 ± 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.</p> <p> </p>

The effect of modern devices of alveolar ridge split and expansion in the management of horizontally deficient alveolar ridge for dental implant: A systematic review.

The alveolar ridge split and expansion (ARSE) can be performed using conventional devices (osteotome/chisel) or modern devices (ultrasonographic [USG], motorized ridge expansion [MRE], etc.). The aim of this systematic review was to evaluate the effect of modern devices for ARSE. This review has been registered at PROSPERO under the number CRD42020213264. A systematic search was conducted by two reviewers independently in databases PubMed, MEDLINE, Cochrane Central Register of Controlled Trials, Grey Open, Hand search of reference lists of relevant studies, and previously published systematic reviews. The article published until September 2020 were searched for this review. The searches identified 24 eligible studies, twenty-two cohort and two randomized control trial studies. A total of 1287 dental implants were installed in 634 patients with the age range of 17-70 years and a minimum of 3 months of follow-up. Ten articles of USG device and seven of MRE device were finally evaluated for metanalysis. The mean ridge width gain was 3.40 mm (USG device) and 2.83 mm (MRE device). The overall implant survival rate was 98.07%. Mean width gain between USG and MRE devices was significantly different (P < 0.0001, HS). Test of heterogeneity was significant (Q = 88.3877, P < 0.0001, HS) and there was no publication bias (Intercept = 6.6634, P = 0.6142, NS) by Egger's test. The most commonly used devices were USG and MRE. USG is more effective for osteo-mobilization type and MRE device for minimally invasive osteo-condensation.

Alveolar ridge split and expansion with simultaneous implant placement in mandibular posterior sites using motorized ridge expanders - modified treatment protocol.

"The purpose of the study is to evaluate alveolar ridge split and expansion (ARSE) with simultaneous implant placement in mandibular posterior implant sites using motorized ridge expanders." The ARSE is used in the management of horizontally deficient (narrow) alveolar ridge with optimum bone height available. The ARSE procedure in the posterior mandible has limited application as per literature. The successful cases reported are with extensive procedure of the osteo-mobilization with four corticotomies on buccal side. The authors presented the study of mandibular posterior implant sites using motorized ridge expanders. The ARSE performed here was by only crestal osteotomy simple osteo-condensation and immediate implant insertion. The study was prospective type. The sample size was 15 patients and 31 implant sites. The study population included partially edentulous patients between 18 years and 60 years indicated for implant-supported prosthesis. The outcome variables studied included gain in ridge width, cervical bone loss, success of implant, and survival rate. Successful surgical outcome was evaluated by Buser's criteria. The data collected was evaluated by differential statistics. The minimally invasive technique of one-stage ARSE performed with motorized ridge expander and insertion of implant in the same operative procedure decreases the morbidity, treatment time, number of surgical procedures, and the risk of complications, thereby, increasing patient acceptance. In this study, the authors have used this technique in the posterior mandible for narrow ridges (minimum 3 mm) and obtained promising results. The survival rate of the implants was 100% and the gain in ridge width was 3.2 mm. The author has also recommended the protocol according to bone density of mandible.

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.

Carving the Niche for Implant Placement in Narrow Alveolar Ridges: A Case Report

Insufficient width of the alveolar ridge often prevents ideal implant placement. Guided bone regeneration, bone grafting, alveolar ridge splitting and combinations of these techniques are used for the lateral augmentation of the alveolar ridge. Ridge splitting is a minimally invasive technique&#x0D; indicated for alveolar ridges with adequate height, which enables immediate implant placement and eliminates morbidity and overall treatment time. The classical approach of the technique involves splitting the alveolar ridge into two parts with use of ostetomes and chisels. Modifications of this technique include the use of rotating instrument, screw spreaders, horizontal spreaders and ultrasonic device. The purpose of this article is to thoroughly describe all the different approaches in ridge splitting technique. Procedures in Dental implantology have witnessed significant advancement in the recent times. A plethora of options have opened these days owing to improved surgical techniques and wider criteria for patient selection. Ridge-expansion technique has gained immense popularity in patients with limited crestal bone width yielding improved outcomes. The procedure entails implant placement in narrow alveolar ridges following splitting and expanding the existing bone. This article illustrates this approach with a fascinating clinical case of insufficient mandibular alveolar ridge.

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 Implant Stability after Conventional Versus Piezoelectric Alveolar Ridge Splitting with Immediate Implantation in Mandibular Posterior Region “A Randomized Controlled Trial”

Aim of the Study: The purpose of this study is to answer a clinical question whether the use of piezoelectric alveolar ridge splitting (ARS) with simultaneous implant placement will enhance implant stability in comparison with conventional motorized surgical disc and bur or not.Materials and Methods: twenty four dental implants were placed in fourteen edentulous ridges and were divided into 2 equal groups (Group I &amp; Group II). Patients in both groups underwent ARS for narrow edentulous posterior mandibular ridge with simultaneous implant placement. In Group I, 12 implants were placed in 8 edentulous ridges after ARS performed using piezoelectric saws. In Group II, 12 implants were placed in 6 edentulous ridges after ARS performed using conventional motor driven surgical disc and bur. Implant stability was measured by means of Osstell TM device, first intraoperatively, then at 6 months and 9 months postoperatively. Moreover, radiographic assessment of marginal bone loss (MBL) was done at 6 months postoperatively. Bone width gain was calculated from pre and post-operative cone beam CT.Results: Regarding implant stability, there was a statistically significant difference between the two groups at all time intervals. Regarding MBL, and width gain, there was no statistically significant difference between both groups.Conclusion: Piezosurgery enhanced implant stability but didn’t mitigate the bone loss associated with ARS or increase amount of ridge width gain.

Implant Placement Using Alveolar Ridge Split in Atrophic Maxillary Alveolar Bone

If the volume of the horizontal alveolar bone is insufficient during the implant procedure, it is difficult to establish a fixture of the required diameter without surgical procedures such as block bone graft, lateral bone graft, and ridge split. Among them, alveolar ridge split is known as an effective technique to increase the volume of the horizontal alveolar bone using maxillary bone elasticity. The theoretical background of this technique is to provide a basis for maintaining the implant with the expectation that new bone will form when the implant and bone graft material are operated, forming a space surrounded by the bone and periosteum. In two cases reported herein, there was no postoperative inflammatory reaction and normal healing was observed. Since then, the follow-up radiograph has shown good outcomes, and ongoing progress is being observed. Alveolar ridge split and bone graft are effective techniques for horizontal alveolar augmentation. In these cases, it was actually possible to form a stable alveolar ridge for implant placement through a successful procedure in the maxillary edentulous region.

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.

Dental implantasyondan önce sert doku hazırlığı: dört yıllık retrospektif bir çalışma

Aim: The purpose of this study is to investigate the requirements of hard tissue preparation prior to dental implant placement.Methods: In this retrospective study, the records of 1086 patients who referred to Mustafa Kemal University, Faculty of Dentistry, for dental implant between 2011 and 2015 were investigated. The received frequency of patients’ onlay grafting, autogenous block grafting, socket preservation, guided bone regeneration, open sinus lifting, ridge split osteotomy, alveolar distraction osteogenesis, inferior alveolar nerve repositioning were evaluated in any process of the dental implant. Findings: 3186 dental implants in 1086 patients were included to the study. Among 295 patients, it was observed that the number of men was 144 (48.8%) and number of implants was totally 309 (47.2%) implants, while the number of grafted implants in women of 151 (51.2%) was 346 (52.8%). The numbers of grafting procedures for augmentation are as follows; 286 (43.7%) onlay grafting, 23 (3.5%) socket preservation, 9 (1.4%) guided bone regeneration, 271 (41.3%) open sinus lifting, 62 (9.5%) alveolar ridge splitting, 2 (0.3%) alveolar nerve repositioning and 2 (0.3%) distraction osteogenesis. Conclusion: With ongoing the increasing of developments in dental implant surgery, it will be inevitable that the different grafting procedures can be carried out before and during the implantation.

Ridge splitting for horizontal bone augmentation with Guided Bone Regeneration (GBR) and simultaneous implant placement

Horizontal lack of residual ridge width can complicate the implant procedures. Therefore, ridge construction prior to implant placement is a biomechanical requirement. Guided bone regeneration, bone grafting, alveolar ridge splitting and combinations of these techniques are used for the lateral augmentation of the alveolar ridge. The ridge splitting technique with simultaneous implant placement seems to be a minimally invasive treatment option for horizontal augmentation of narrow alveolar ridges with adequate vertical height. This paper thoroughly describes a segmental ridge splitting technique with both vertical and horizontal osteotomy cuts followed by the use of chisel and mallet to lateralise the buccal bone which was accompanied by GBR and simultaneous implant placement.

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.