Ridge Splitting Technique Research Articles

Implant Stability and Marginal Bone Changes Associated with Different Staged Ridge-splitting Techniques Using Piezoelectric Surgery in Atrophic Posterior Mandible:A Comparative Study.

The ridge-splitting technique is considered one of the common solutions for horizontal ridge augmentation. The study evaluated implant stability and marginal bone loss after two vs three staged ridge-splitting technique. Twelve dental implants were inserted into 10 patients through staged ridge-splitting approach. In group I, six dental implants were inserted through a full mucoperiosteal flap reflection and bony incision. After 3 weeks, a closed buccal plate expansion and grafting were done, with sequential implant insertion 3 months later. While in group II, six dental implants were inserted through the same procedure as the first stage. Then bone expansion, grafting, and implant insertion were made at the second stage. All implants were loaded after 3 months and assessed clinically regarding implant stability and radiographically through marginal bone loss. One-way ANOVA test was used. Implant stability quotient (ISQ) values showing highly significant difference (p = 0.003) were recorded at implant placement. In contrast, no statistically significant differences were recorded among the studied groups at the other assessment time intervals (p = 0.219, 0.366, and 0.394, respectively). Meanwhile, group II reported lower marginal bone loss values than group I with a highly significant difference between both groups over all assessment time intervals (p = 0.001, 0.008, and 0.002, respectively). Two staged ridge-splitting technique offered a shorter treatment time with lower marginal bone loss and comparable implant stability. Two-staged ridge-splitting technique provided less patients' recall visits with a less surgical intervention than the three-staged technique. This may be prospectively reflected in further research for its clinical merits. How to cite this article: Elsaieed MT, El-belasy FA, Ibraheim SA, et al. Implant Stability and Marginal Bone Changes Associated with Different Staged Ridge-splitting Techniques Using Piezoelectric Surgery in Atrophic Posterior Mandible: A Comparative Study. J Contemp Dent Pract 2024;25(7):661-668.

Bone augmentation with ridge split technique in implant placement

Bone augmentation with ridge split technique in implant placement

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.

Internal Allo-Cortical Tenting: A Modified Ridge Split Technique in Three-Dimensional Ridge Augmentation.

Three-dimensional (3D) alveolar ridge deficiencies necessitate horizontal and vertical bone reconstruction for optimal implant positioning. Despite several available techniques, achieving desired augmentation outcomes remains challenging. This case study aims to present a modified ridge split technique for bone reconstruction in horizontal and vertical dimensions. The proposed technique was used to reconstruct the horizontal and vertical ridge defect from removing a previously failed implant. This technique includes placing a cortical allograft plate as an internal tent in the split ridge. A portion of the plate was inserted into the ridge, while the other part was placed in the coronal of the vertical defect. Additional guided bone regeneration was performed around the tented plate on both the buccal and lingual sides. After 5 months, cone beam computerized tomography revealed sufficient bone formation in horizontal and vertical dimensions. Within the limitations of the present case study, internal cortical tenting would be a reliable method for 3D bone reconstruction in cases where the ridge split is feasible.

Horizontal ridge augmentation through ridge expansion via osseodensification, guided bone regeneration and ridge‑split: Systematic review and meta‑analysis of clinical trials.

The aim of the present systematic review was to compare three ridge augmentation procedures in order to assist clinicians in finding the ideal surgical method relative to the horizontal bone gain needed and the width of the alveolar ridge available. An electronic and hand literature search was performed in the online databases PubMed-Medline, Cochrane Central Register of Controlled Trials, EMBASE, Cochrane Oral Health Group Trials Register and Web of Science, and various specialized journals, between January 2017 and December 2022. The included studies were evaluated using the Methodological Index for Non-randomized Studies score and Cochrane's RoB tool. The primary variable studied in the meta-analysis was the final bone gain. The implant survival rate and initial ridge width were the secondary variables. Then four studies on ridge expansion via osseodensification (OD), seven on guided bone regeneration (GBR) and seven on the ridge-split technique (RS) were included in the review; 17 out of 18 were selected for meta-analysis. The mean horizontal bone gain for OD was 2.151 mm [1.327-2.975 mm; 95% confidence interval (CI)], for GBR was 4.036 mm (3.351-4.772 mm 95%CI) and for RS was 3.661 mm (2.991-4.399 mm 95%CI). The results were statistically significant (P=0.002). GBR reported the most bone gain horizontally, followed closely by RS and then OD. OD is a recent technique that should be taken into account when discussing the protocols of horizontally atrophied ridge rehabilitation.

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.

Ridge split technique and implant placement- A case report

: One of the key obstacles to successful implant placement is insufficient alveolar ridge width. To create a functional restoration that blends well with the surrounding natural dentition, augmenting inadequate alveolar ridges is a crucial component of dental implant therapy. Ridge-splitting techniques are used for the narrow edentulous ridge for implant placement with predictable outcomes in the maxilla than in the mandible.This case report describes a young female patient who underwent horizontal ridge augmentation using the ridge split technique in the esthetic maxillary central incisor area. This technique was used along with demineralized freeze-dried bone allograft with membrane for the implant placement.: While this surgical method can be used for either jaw, it is most appropriate for the maxilla. Augmenting inadequate alveolar ridges is therefore a crucial part of dental implant therapy to meet the ideal goals of implant dentistry, with the ultimate goal being the provision of a functional restoration that blends in harmoniously with the surrounding natural teeth.

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.

Effect of Ridge Splitting of Mandibular Knife Edge Ridges with Two-implant Retained Overdenture with Locator Attachments on Peri-implant Bone Level and Posterior Ridge Resorption: A One-year Preliminary Study.

This study was conducted to evaluate peri-implant bone height changes and posterior ridge resorption by using two-implant retained polyetheretherketone (PEEK) overdentures with locator attachments following expansion of mandibular knife edge ridges by ridge splitting. Eighteen patients were selected for ridge splitting followed by expansion, implant placement, and bone graft application. Six months later, the fabrication of PEEK overdentures retained by locator attachments was accomplished. Friedman test, Wilcoxon signed-rank test, and Spearman correlation were used to evaluate the changes over time. Peri-implant bone height loss increased significantly with the advance of time between 6 and 12 months following denture insertion. Posterior area index changes were significant over time when measured at the time of denture insertion and twelve months following denture insertion. The effect of using PEEK as overdenture base material retained with two locator attachments allowed sharing the load between the peri-implant bone anteriorly and residual ridge posteriorly in cases with ridge splitting technique. Using PEEK as an overdenture base material is a successful means of bone preservation. How to cite this article: Helmy MA, El-Shaheed NH, El Waseef FA, et al. Effect of Ridge Splitting of Mandibular Knife Edge Ridges with Two-implant Retained Overdenture with Locator Attachments on Peri-implant Bone Level and Posterior Ridge Resorption: A One-year Preliminary Study. J Contemp Dent Pract 2023;24(11):834-839.

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.

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

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.

Maxillary Ridge Split with Simultaneous Implant Placement – A Case Report

Inadequate alveolar ridge width often poses difficulty in implant placement. Such ridges require a combination of techniques in placing implants. One such technique is the ridge split technique which helps the expansion of the ridge with or without greenstick fracture of cortical plates. Before placing implants the width of the alveolar ridge can be effectively restored utilising the modified ridge splitting approach employing autologous bone grafts. This case report describes the ridge splitting and placement of a dental implant in the left maxillary central region followed by guided bone regeneration. Ridge expansion was done in relation to 21 and osteotomy was prepared to the desired depth. After proper treatment planning implant measuring 3.5 mm in diameter and 11.5 mm in length was placed. Four months later final cementation was done with PFM crown. The ridge split technique with the immediate implant placement resulted in minimal resorption of alveolar bone along with maximum expansion of the bone. The sequential surgical and restorative techniques were combined into one successful protocol whose steps are well elaborated in this case report.

Splitting for good: A case report

: The bone split procedure is a unique technique used to increase the width of narrow ridge for possible simultaneous implant placement. : We would present a case of horizontal ridge augmentation in this article, using an alveolar ridge expansion approach and simultaneous implant placement. : In this report, we have described a ridge split technique and immediate implant placement for a 40-year-old male patient with missing teeth in maxillary anterior tooth region who reported to us for implant treatment: A successful prosthetic rehabilitation was obtained following the healing phase. This approach leads to restoration of aesthetics, function and speech with a predictable outcome.

Assessment of narrow alveolar ridge expansion by ossiodensification vs. ridge splitting technique for dental implant placement

Objectives: Comparing osseodensification vs. ridge splitting techniques in dental implant placement regarding implant stability, insertion torque, bone width and density. Patients and Method: Twenty individuals with a narrow ridge width of 3-6 mm at crestal bone level were included in this study. They were divided into two groups: Group I Osseodensification technique, Group II Ridge splitting technique with bone expanders and sticky bone augmentation. Implant stability, insertion torque, surgical procedure duration, bone width, and density were all evaluated by CBCT. Results: Group (I) had showed higher statistically significant Insertion torque than group (II). While group (II) had showed statistically significant increase in mean ISQ reading after 6 months (p&lt;0.001). Group (II) showed statistically significant higher surgical time than group (I). Group (II) showed a higher increase in bone gain than group (I). Group (I) had showed statistically significant increase in mean bone density postoperatively, after 3 and 6 months (p&lt;0.001*). While group (II) had showed statistically significant increase in mean bone density postoperatively, after 3 and 6 months (p&lt;0.001). Conclusion: Osseodensification technique had been shown to increase ridge width while maintaining primary implant stability and bone density around dental implants without sacrificing bone.

Horizontal ridge augmentation by ridge split technique using piezosurgery- exploring the techniques beyond prosthetic replacements for resorbed ridges

Extraction of teeth leads to hasty ridge resorption. Alveolar ridge resorption occurs rapidly in horizontal direction than in vertical direction, thusdemanding ridge augmentation for implant placement.Conventional techniques such as block grafting shows increased post-operative morbidity and requires second surgical site. Horizontal ridge augmentation (HRA) by ridge split technique (RST) is a minimally invasive procedure that aids in ridge expansion, at the same time preventing the need for second surgical site. The case presented here had adequate ridge height but reduced ridge width in mandibular right quadrant. RST was accomplished using piezosurgery in combination with bioactive glass and platelet-rich fibrin (PRF), followed by implant placement. The patient was evaluated periodically at ten days, three months and six months before implant placement.RST provides promising results in terms of gain in ridge width. The use of piezosurgery, bone graft, PRF had added advantage in preservation of the alveolar ridge and post-operative healing. Key words:Ridge augmentation, Ridge split technique, Piezosurgery, Bioactive glass, Platelet-rich fibrin.

Clinical Assessment of the Bone Width Following Lateral Ridge Expansion in Augmentation of Narrow Alveolar Ridges for Placing Immediate Dental Implants.

Background:Less residual alveolar bone at extraction site at esthetic and functional tooth position is the main limitation in placing a dental implant, especially at long-span edentulous ridges. This needs ridge augmentation.Aims:To assess bone width gain and implant stability following narrow ridge augmentation using the vertical ridge split technique.Materials and Methods:In 22 subjects within the age group of 20–60 years and the mean age of 38.46 years. The vertical ridge split technique was done in all subjects for horizontal ridge augmentation. Paraesthesia, pain/discomfort, mobility, and radiographic crestal bone width were assessed 6 months postoperatively. The data were described as mean and standard deviation along with number and percentage. Paired t-test was also used keeping the level of significance at P < 0.05.Results:Implant stability was seen in 86.36% (n = 19) study subjects and were not stable in 13.63% (n = 3) subjects. Bone width preoperatively was in the range of 3.1–4.4 mm with the mean value of 3.64 ± 0.41. Postoperatively, the bone width increased and was in the range of 5.2–6.3 mm with the mean value of 5.62 ± 0.45 mm. This increase postoperatively was statistically significant with a P value of <0.001Conclusion:The present study concludes that acceptable success results are seen using the ridge split technique with simultaneous dental implants placement in both atrophic maxilla and 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.