Alveolar Ridge Splitting Research Articles

Effect of Nano-hydroxyapatite and platelet-rich fibrin covered by the amniotic membrane on osseointegration after mandibular piezoelectric ridge splitting

ObjectiveThis study aimed to assess the clinical and radiographic findings obtained by using amniotic membrane (AM) to cover nano-hydroxyapatite (nHA) bone grafts coated with platelet-rich fibrin (PRF) and thereby evaluate the osseointegration of posterior mandibular implants inserted simultaneously during alveolar piezoelectric ridge splitting technique (RST). MethodsA prospective cohort study was implemented with thirty patients who had a narrow posterior mandibular alveolar ridge and required implant restoration. Patients were distributed randomly into three groups (group I treated by piezoelectric RST and immediate implant insertion, augmented by the nHA bone graft only; group II treated by piezoelectric RST augmented by nHA bone graft and covered by AM; while group III was treated by piezoelectric RST augmented with PRF and nHA graft and covered by AM). Patients were evaluated clinically to assess the implant stability quotient (ISQ) and radiographically to assess horizontal ridge dimension, crestal bone level (CBL), and bone densitometric (BD) parameters. ResultsISQ results showed a non-significant clinical difference between groups while CBL values showed a high statistically significant difference over the 12-month interval when comparing groups III and II with group I. BD outcomes showed statistically significant differences at all intervals in comparisons of group III with groups I and II. ConclusionsThe results of this study suggest that concomitant use of PRF with nHA graft covered with AM for augmentation around the dental implant in a narrow posterior mandible after piezoelectric alveolar ridge splitting accelerate osseointegration and significantly increase bone density around the osseointegrated implant and decrease bone resorption in comparison to that achieved with the graft alone.

Interantral alveolar ridge splitting for maxillary horizontal expansion and simultaneous dental implant insertion: A case report.

IntroductionDental implants present an advanced technique for the rehabilitation of partial or edentulous patients. Tooth loss caused by caries, periodontal disease or systemic factors often results in a decline of the bucco-lingual alveolar ridge dimension. Within one year the initial bone width can be resorbed up to 50%. As a consequence dental implants may be limited for rehabilitation and cannot be performed in a conventional manner because of the risk of dehiscence and fenestrations. Bone blocks, guided bone regeneration (GBR), horizontal osteogenic distraction and bone grafts may be used for augmentation procedures. In case of sufficient vertical bone dimension, an alveolar ridge splitting and augmentation technique (ARST) can be conducted. This case has been reported in line with PROCESS criteria [1].Case presentationWe present a 51-year old female patient, who has had a full denture for about 30 years. The reason for consultation was the demand for a fixed prosthesis. Dental implants in combination of the ARST with GBR allowed us to correct horizontal deformities of the alveolar ridge.DiscussionWe discuss the possibility of using the ARST in the interantral region for a full arch rehabilitation of the maxilla with simultaneous dental implant placement in a narrow alveolar ridge.ConclusionThe ARST in addition to simultaneous implant placement with a GBR can be successfully used for a full arch rehabilitation of the maxilla in a narrow alveolar ridge.

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.

Piezoelectric-Alveolar Ridge Splitting: A Successful Modality Reducing Crestal Bone Loss around Dental Implants and Enhancing Implant Secondary Stability

Aim: This study was performed to compare two different modalities of alveolar ridge splitting performed simultaneously with dental implant placement regarding the alveolar crestal bone changes and implant stability Subjects and methods: 12 patients were included in this study. Group 1 (6 patients, 12 implant) while Group 2 (6 patients, 10 implants). Single surgery was performed to each patient involving alveolar ridge splitting, expansion and simultaneous implant (or implants) placement. Ridge splitting in group 1 was performed using the piezoelectric surgery and in group 2 using the traditional surgical disc, while the alveolar ridge expansion and implant placement were performed using the same procedures for both groups. Marginal bone loss on the buccal and lingual aspects of the implant was evaluated 4 months after implant insertion using the CBCT. The implant stability ISQ values were measured immediately after implant insertion and 4 months after the surgery during the prosthetic steps by the Ostell. Results: Post treatment, a higher mean percent resorption in marginal bone was recorded in traditional surgical disc group with an extremely significant difference between groups. Also, a higher mean percent increase in ISQ2 was recorded in piezo- electric surgery group with an extremely significant difference between groups. Conclusion: Piezoelectric ridge splitting is accompanied with decreased postoperative marginal bone loss and enhanced secondary ISQ compared to traditional surgical disc splitting.

PC343: Guided bone regeneration vs. alveolar ridge splitting as means to horizontally augment the alveolar bone ridge. A review of the literature and case report

PC343: Guided bone regeneration vs. alveolar ridge splitting as means to horizontally augment the alveolar bone ridge. A review of the literature and case report

Does Graft Particle Type and Size Affect Ridge Dimensional Changes After Alveolar Ridge Split Procedure?

The absence of an adequate volume of bone at implant sites requires augmentation procedures before the placement of implants. The aim of the present study was to assess the ridge width gain with the use of allografts and biphasic β-tricalcium phosphate with hydroxyapatite (alloplast) in ridge split procedures, when each were used in small (0.25 to 1mm) and large (1 to 2mm) particle sizes. A randomized controlled trial of 23 subjects with severe atrophy of the mandible in the horizontal dimension was conducted in a private institute. The patients underwent placement of 49 dental implants after a staged ridge split procedure. The patients were randomly allocated to alloplast and allograft groups (predictor variable). In each group, the patients were randomly assigned to either small graft particle or large graft particle size (predictor variable). The gain in ridge width (outcome variable) was assessed before implant placement. A 2-way analysis of variance test and the Student unpaired t test were used for evaluation of the ridge width gain between the allograft and alloplast groups (predictor variable). Differences were considered significant if P values were < .05. The sample included 23 patients (14 men and 9 women). The patients were randomly allocated to the alloplast (n=11) or allograft (n=12) group before the ridge split procedure. In each group, they were assigned to a small graft particle or large graft particle size (alloplast group, small particle in 5 and large particle size in 6 patients; allograft group, small particle in 6 and large particle size in 6). A statistically significant difference was observed between the 2 graft types. The average ridge width gain was significantly greater in the alloplast group (large, 4.40±0.24mm; small, 3.52±0.59mm) than in the allograft group (large, 3.82±0.19mm; small, 2.57±0.16mm). For both graft types (alloplast and allograft), the large particle size graft resulted in a greater ridge width gain compared with the small particle size graft (P<.05). Within the limitations of the present study, we suggest the use of large particle alloplast as the graft material of choice for staged ridge split procedures in the posterior mandible.

EVALUATION OF PIEZOTOMED ALVEOLAR RIDGE SPLITTING WITH STEREOLITHOGRAPHIC SURGICAL GUIDE FOR IMPLANT PLACEMENT

INTRODUCTION: Narrow dentoalveolar ridges remain a serious challenge for the successful placement of endosseous implants. Several techniques for this procedure may be considered, such as guided bone regeneration, bone block grafting, and ridge splitting for bone expansion. The ridge split procedure provides a quicker and a more reliable method. Advances in technology, Stereolithography allow fabrication of surgical guide from 3D generated models for precise implant placement. OBJECTIVES: Evaluation of minimally invasive ridge splitting procedure aided with surgical guide. MATERIALS AND METHODS: A clinical study was performed on a total of 7 patients with mandibular free end saddle. The sample was selected conveniently to fulfill a list of inclusion and exclusion criteria. Then the selected participants performed ridge splitting with the aid of surgical guide. After ridge splitting, all patients had simultaneous implant placement followed by clinical and radiographical evaluation over a period of 6 months. RESULTS: Merging the preoperative, immediate and 6 months postoperative CBCT images showed statistically significant values of accuracy and increase in bone width. CONCLUSIONS: Alveoalar ridge splitting with the aid of stereolithographic surgical stent is a well acceptable technique for implant placement.

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.

Assessment of Temperature Rise and Time of Alveolar Ridge Splitting by Means of Er:YAG Laser, Piezosurgery, and Surgical Saw: An Ex Vivo Study.

The most common adverse effect after bone cutting is a thermal damage. The aim of our study was to evaluate the bone temperature rise during an alveolar ridge splitting, rating the time needed to perform this procedure and the time to raise the temperature of a bone by 10°C, as well as to evaluate the bone carbonization occurrence. The research included 60 mandibles (n = 60) of adult pigs, divided into 4 groups (n = 15). Two vertical and one horizontal cut have been done in an alveolar ridge using Er:YAG laser with set power of 200 mJ (G1), 400 mJ (G2), piezosurgery unit (G3), and a saw (G4). The temperature was measured by K-type thermocouple. The highest temperature gradient was noted for piezosurgery on the buccal and lingual side of mandible. The temperature rises on the bone surface along with the increase of laser power. The lower time needed to perform ridge splitting was measured for a saw, piezosurgery, and Er:YAG laser with power of 400 mJ and 200 mJ, respectively. The temperature rise measured on the bone over 10°C and bone carbonization occurrence was not reported in all study groups. Piezosurgery, Er:YAG laser (200 mJ and 400 mJ), and surgical saw are useful and safe tools in ridge splitting surgery.

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.

Assessment of marginal bone loss using full thickness versus partial thickness flaps for alveolar ridge splitting and immediate implant placement in the anterior maxilla

The aim of this study was to evaluate the effectiveness of maintaining the periosteal attachment of the facial and palatal cortical plates on crestal bone loss that occurs at the margin of dental implants placed immediately in split anterior maxillary alveolar ridges. This was a prospective randomized comparative clinical trial. The study population included 22 patients with edentulous anterior maxillary alveolar ridges who presented for treatment during the period March 2012 to September 2013. The selected patients were divided randomly into two equal groups. All patients underwent a maxillary ridge splitting technique; a total of 43 implants were placed immediately. A full thickness mucoperiosteal flap was performed in the control group patients, while a split thickness mucosal flap was done in the study group patients. Assessments included measurements of the linear changes in the marginal bone surrounding the implants immediately postoperative and after 6 months. Measurements were taken from cross-sectional and longitudinal cone beam computed tomography images using special software. The partial thickness flap used in the study group decreased the percentage of bone loss by 9.5% for the labial bone plate, 7.9% for the palatal bone plate, and 3.5% for the mesiodistal bone plate.

Ridge splitting technique for horizontal augmentation and immediate implant placement

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 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 2 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. 2 interesting clinical cases of narrow alveolar ridges treated with ridge splitting and immediate implant placement are also presented.

Minimally Invasive Subnasal Elevation and Antral Membrane Balloon Elevation Along With Bone Augmentation and Implants Placement

Atrophic edentulous anterior maxilla is a challenging site for implant placement and has been successfully treated surgically by anterior maxillary osteoplasty. This procedure is associated with considerable discomfort, morbidity, and cost-and consequently reduced patient acceptance. The efficacy and safety of minimally invasive bone augmentation of the posterior maxilla has not been extended thus far to the anterior subnasal maxilla. We present 2 representative cases in which minimally invasive subnasal floor elevation was performed along with minimally invasive antral membrane balloon elevation. Both segments underwent bone grafting and implant placement during the same sitting. Minimally invasive anterior maxilla bone augmentation appears to be feasible. Designated instruments for alveolar ridge splitting and nasal mucosa elevation are likely to further enhance this initial favorable experience.

Ultraschallbasiertes Knochenschneiden in der Oralchirurgie: eine Übersicht anhand von 60 Patientenfällen

Surgical reconstruction of bony defects in the oral cavity can often be challenging since thin and fragile bony structures are especially prone to fracture cased by bulky cutting tips or the application of significant pressure by conventional mechanical instruments. The risk of accidental damage to adjacent soft tissue structures, such as nerves, by a dental drill or saw is also extremely high. The use of modulated ultrasound (piezosurgery) makes it possible to overcome such complications as a result of the precise and minimally invasive surgery technique which is limited to mineralized hard tissue. In 60 patients (38 male, 22 female) a piezosurgery device was used for different bone augmentation procedures before dental implant placement. The instrument uses modulated ultrasound (25 - 30 kHz) and the amplitude of the working tip ranges from 60 mum to 200 mum. The device was employed for sinus floor elevation (25), alveolar ridge augmentation using an autogenous block graft (25), alveolar ridge splitting (5) or lateralization of the alveolar nerve (5). Physiological sodium chloride was used as a cooling solution. For all osteotomies mode boosted burst c and pump 5 were used. Piezoelectric osteotomy permitted micrometric selective cutting and a clear surgical site due to the cavitation effect created by the cooling solution and the oscillating tip. No excessive bleeding was encountered. The risk of accidental soft tissue harm, such as perforating the sinus membrane or damaging adjacent nerves, was definitely lower than in the case of a conventional bur. No serious complications were encountered in the postoperative wound healing process after 2, 14, 30 and 90 days. However, the surgical procedures were time-consuming. Piezosurgery is an advantageous osteotomy technique for delicate structures in the oral and maxillofacial region. With respect to osteotomies of thin and fragile bones, the application of ultrasound is superior to other mechanical instruments because of the extremely precise and virtually arbitrary cut geometries, easy handling, efficient bone ablation and minimal accidental damage to adjacent soft tissue structures.

Interpositional bone grafting technique to widen narrow maxillary ridge

A narrow edentulous alveolar ridge, less than 6 mm in the buccopalatal aspect, can prevent restoration by means of endosseous implants. A widening technique using alveolar ridge splitting and interpositional autogenous bone grafting is described. Accurate imaging of the alveolar bone shape and size was assessed with computerized tomography in a 1:1 scale. Following 6 months of healing, osseointegrated Brånemark implants were placed in the grafted sites.