Ridge Splitting Technique Research Articles

Maxillary and Mandibular Split Crest Technique with Immediate Implant Placement: A 5-Year Cone Beam Retrospective Study.

This study aimed to test the effectiveness and reliability of the alveolar ridge-splitting technique in atrophic posterior arches, investigating the middle-term volumetric and clinical outcomes. Atrophic alveolar ridges in the maxillary and mandibular posterior areas were treated with the alveolar ridge-splitting/expansion technique (ARST), immediate implant placement, collagen sponges covering the defect, and healing by secondary intention. Areas were rehabilitated by fixed dental prostheses supported by dental implants. Changes in volume and width of the alveolar ridge were retrospectively calculated by comparing the x-ray tomography scans obtained before and 5 years after surgery. Report of failure in the case sheets was taken into account. Cross-sectional images were also used to assess the thickness of the labial alveolar plates at the implant shoulder. Nonparametric analyses of variance with post hoc and pair-comparison tests were performed with a level of significance of .05. A total of 38 patients were retrospectively selected (23 women and 15 men). Six patients underwent ARST surgeries in both the maxilla and the mandible and were excluded from statistical analysis. Differences between 16 maxillae and 16 mandibles and between 12 single crowns and 20 fixed partial dentures (FPDs) were searched. Episodes of minor swelling occurred within the first 2 days after surgery. Neither mucositis nor flap dehiscence had been registered. The mean values of buccal cortical thickness were 2.46 ± 0.49 mm and 1.15 ± 0.33 mm, respectively, in the maxillary and mandibular areas. After 5 years of survey, maxillary increases in alveolar ridge width and volume were +4.4 ± 0.4 mm and +295 ± 45 mm3, respectively, whereas the same outcome variables (+3.5 ± 0.7 mm and +217 ± 53 mm3) measured in the mandible appeared to be significantly smaller than those in the maxilla (P < .0001). One maxillary single implant failed. Cumulative survival rates at 5 years were 100% for mandibles and 95.5% (95% CI: 86.8% to 100%) for maxillae. Posterior areas of the maxilla displayed a higher increase in alveolar width and volume than mandibular areas, and even if it would be premature to draw survival conclusions at this stage without any statistical support, a lower cumulative survival rate was reported for the maxillary single implants.

Piezoelectric driven mandibular ridge split technique with immediate implant placement: A case report

Narrow dentoalveolar ridges pose a major challenge for the successful placement of endosseous implants. This case report focuses on a Piezoelectric driven mandibular Ridge Split technique without vertical osteotomy for an immediate implant placement in a narrow alveolar ridge measuring 3.0mm.Following anaesthesia, a mucoperiosteal flap was elevated after giving a mid-crestal incision distal to 35 along the entire edentulous ridge. Then, with the help of a micro-saw and horizontal spreaders, an osteotomy site of required diameter was achieved. Finally twist drills were used and implants were placed in the expanded site.Clinically, healing was uneventful with no step defect in the expanded buccal bone and the final occlusion obtained was satisfactory.The Piezo-electric driven Ridge Split technique promises to be a minimally invasive option for horizontal augmentation of narrow alveolar ridges- predictability within a short interval of time and with minimal risk of fracture.

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.

Maxillary horizontal alveolar ridge augmentation using computer guided ridge splitting with simultaneous implant placement versus conventional technique: A randomized clinical trial.

Ridge splitting technique is considered one of the successful horizontal bone augmentation procedures especially for the maxillary bone, the aim of this study was to compare marginal bone loss using a novel ridge splitting protocol versus the conventional technique. This was a randomized clinical trial including 20 patients who were randomly assigned to ridge splitting with simultaneous implant placement at the anterior maxillary aesthetic zone (10 patients, 29 dental implant) using patient specific guides (PSGs) or conventional technique (10 patients, 29 dental implant). In the control group free hand ridge splitting was done, while in the study group all the splitting and drilling procedures were done through specific slits and sleeves at the patient specific guides. Radiographic Assessment included measurements of linear changes in the vertical dimensions of the labial plate of bone on cross sectional cuts of computed tomography (CBCT) using mimics software. Wound healing was uneventful for all the patients except one patient in the control group that showed bad split and another showed buccal fenestration. The study group showed lower bone loss (1.38 ± 0.61 mm) compared to the control group (2.42 ± 0.63 mm), with statistical significance difference (P value=0.001). The loss percentage also was higher in the study group (10.99 ± 4.76%) compared to the control group (19.12 ± 4.53%), and there was statistical significance difference between the two groups (P value=0.001). Ridge splitting using PSGs appear to be efficient and promising than the free hand technique.

Ridge Split Techniques: A Literature Review

Extraction of teeth leads to loss of alveolar bone in several patterns. The bone loss can occur in a horizontalor vertical direction or a combination of both. Horizontal ridge width deficiency possesses a challenge for theclinician to obtain primary stability during loading and there is risk of fracture of bone segment. Thereforedifferent techniques have been described to gain the ridge width. One of the techniques used is ridge splittechnique which was first described by Simion et al in 1992. It is a technique of bone manipulation in sucha way that it becomes a site for implant placement without removing any bone. Various types of techniqueslike 3 staged approach, one staged approach etc are described for various sites and situation that help inobtaining an adequate width for loading. This article specifically deals with the different types of ridge splittechniques and its description in a simplified manner.

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

Ridge Split Technique With Immediate Implant PlacementA Case Report

Bone resorption following tooth loss is one of the main problems faced in the present era. The posterior regions of the jaws show more resorption compared to the anterior regions with the mandible being affected more. Therefore various techniques have been sought upon and incorporated for expanding the lost bucco-lingual width of the alveolar ridge. In the search for better techniques, ridge split technique has emerged as a successful method. We, present a case of a 36-year-old female patient who came to the outpatient department of periodontology with the chief complaint of missing left back lower tooth which was extracted one year back due to caries. After thorough investigations, it was decided to do a ridge split technique. A piezosurgical unit was used for splitting the ridge, following which bone graft material (alloplast) was placed. This was followed by immediate implant placement.

Narrow Ridge Expansion for Implant Placement Using Ultrasonic Bone Surgery and Platelet Rich Fibrin With and Without Silk Fibroin.

ABSTRACT Object: To evaluate the effect of combined split-crest technique using ultrasonic bone surgery with platelet rich fibrin alone and in combination with silk fibroin for dental implant placement in narrow ridge. Subject and Methods: A total of 24 implants inserted in 18 patients with narrow ridge. Patients were assigned into one of the following 2 groups based on the graft material used. For group I, the peri implant gap was filled with silk fibroin mixed with PRF while for group 2 was filled with PRF only. All patients undergone a ridge splitting technique using piezoelectrical device and immediate implant placment. Assessments included measurements of the ridge width, implant stability and bone density. Results: The differences in implant stability measurements were non- significant in both groups at baseline however, at 6 months was statistically significant (P=0.001) in favor of silk fibroin group. Additionally, the differences in mean crest width measurements between both studied groups, were statistically non- significant at base line and immediately after surgery while silk fibroin group exhibited a statistically significant (P=0.010) increase in mean crest width measurements at 6 months. Moreover, silk fibroin group also showed higher and statistically significant (P=0.001) mean bone density measurements, at 6 months compared to PRF group. Conclusions: Compared to PRF alone, adding silk fibroin might provide a better reconstruction of ridge width, implant stability and bone density in the narrow ridge augmented with crest splitting and immediate 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.

Implant placement in narrow alveolar ridge with ridge split technique: A new approach in implant placement

Dr. Hilt Tatum 1970s introduced a method of ridge splitting or bone spreading, which over a period have been used in implant dentistry for esthetic rehabilitation and implant site preparation in cases of deficient alveolar ridges to satisfy the basic ideal need of hard tissue augmentation for functional and esthetic outcome of implant. In this case report, we describe a case of horizontal ridge augmentation using ridge split and simultaneous implant placement in esthetic maxillary premolar zone.

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

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.

Application of two-stage ridge splitting technique in atrophic mandibular alveolar ridge

Adequate bone volume is the primary condition for successful dental implants. However, sufficient bone volume is often encountered in the vertical direction, but the bone volume in the buccolingual direction is insufficient, making it less suitable to be implanted. If the traditional spitting technique is used in the mandible, fracture and necrosis can easily occur in the labial (buccal) bone plate due to the absence of elasticity, thick cortical bone, poor blood supply, and anastomotic branch. The two-stage ridge splitting technique can be used in patients with narrow alveolar ridge in the mandible. This study summarizes the principles and conditions of application, operational points, clinical efficacy, and analysis of the causes of buccal bone plate absorption.

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.

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.

Bone augmentation in atrophic maxillary ridge by ridge split technique and guided bone regeneration: A case report

Bone loss after tooth extraction is inevitable, it can be horizontal, vertical bone loss or combination. Now a days, dental implants are emerging as a better treatment option for oral rehabilitation and become an integral part of dentistry ,thus availability of adequate bone volume in all 3-dimensions to stabilize implant is foremost requirement for successful treatment. Various methods have been used to augment the ridge bone volume which includes bone grafting along with guided bone regeneration, ridge split technique, sinus lift procedure and distraction osteogenesis. This case report presents aesthetic rehabilitation by implant retained prosthesis in upper anterior region with large defect by combining bone augmentation with ridge split technique to enable implant placement. Keywords: Dental implants, Ridge split technique, Bone augmentation, Bone grafting, and Implant retained prosthesis.

A Novel Approach for Horizontal Augmentation of Posterior Maxilla Using Ridge Split Technique.

Over the years, there have been a series of innovative approaches to the alveolar bone augmentation techniques. These have led to the modifications of the existing methods and the establishment of more efficient ways to obtain sufficient bone mass that is necessary for the implant procedure. The aim of this paper is to propose a novel augmentation technique, and to investigate its efficacy, particularly during the healing process of the maxillary alveolar bone prior to the implant treatment. During the application of the proposed methodology, first, the ridge-split technique was applied to the posterior maxilla. Then, a horizontal augmentation procedure was performed with an autogenous bone graft. Implants were placed at the second month of the surgery. Prosthetic rehabilitation was completed after the osseointegration of the implants. The technique was compared with the ridge-split method with simultaneous implant placement in 14 patients. The groups were divided into 2, the control group and the experimental group, each containing 7 patients. The aimed success criteria for the status of the endosteal implants were fulfilled and there were not any complications observed in the second year of follow-up.The basic practical innovation offered by the proposed surgical technique is to achieve the required horizontal dimension and to change the quality of the bone conveniently. The press-fit insertion leads to multipoint contact healing of the transported bone and the use of cortical block bone in posterior maxilla, led to a significantly advantageous higher stability level for both the placement and the survival of the implants.

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).

Implant placement in conjunction with ridge split and expansion technique

AbstractAimThe aim of this study was to evaluate the efficacy of ridge split technique and expansion technique to analyse peri‐implant hard tissue changes following implant placement.Materials and methodsA prospective study was conducted at Swami Devi Dyal Hospital &amp;Dental College, Panchkula, India, from 2015‐2017 on 10 patients, having at least 1–3 teeth missing, with a crestal width of at least 3 mm and an 8 mm apico‐coronal height (3 × 8 mm) from major anatomical structures.ResultsOut of the 10 patients in whom the inclusion criteria met, six were male and four were female. Out of a total of 20 implants inserted, (13 implants in mandible and 7 in maxilla), healing was uneventful in all cases with no major complication. The mean bone width bucco‐lingually preoperatively was found to be 3.79 ± 0.36 mm and bucco‐lingual width recorded immediately after RST was found to be and 6.38 ± 0.51 mm. This difference in bone width was found to be significant (P = 0.000). Also, a significant correlation was seen (P = 0.003), further strengthening the results obtained.ConclusionsWithin the limits of our study, placing implants with simultaneous ridge splitting can reduce the period of edentulism and reduces the duration of treatment with excellent results. Though it is an operator‐dependant technique and it cannot increase the vertical height of the ridge, still ridge split and expansion technique is the best method for augmentation and simultaneous implant insertion in case of narrow ridges with minimum morbidity and less treatment duration.