Ridge Splitting Techniques: Thoughts?

There are many different variations of ridge splitting techniques. A recent paper 1 described a new technique that represents a staged approach to horizontal alveolar ridge expansion with delayed implant placement. Briefly, (please read the full article for a complete description), the procedure described is for horizontally expanding the alveolar ridge by displacing a trapezoidal shaped segment of bone to the buccal. This has several advantages over a traditional sagittal split. Implants are inserted later after initial stabilization of the bone segment. This new approach seems to hold great promise. Any thoughts on this delayed expansion technique? What ridge splitting technique do you utilize in your practice?

The aim of this study was to evaluate the application of delayed expansion of the alveolar ridge in dental implantation. This method avoids the need to harvest autogenous bone and the requirement to fix a block with screws, and could help prevent the uncontrolled fracture and avascular necrosis that may result from the traditional alveolar split. Eighteen patients and 43 implants were included in this retrospective study. The width of the alveolar ridge was measured before implantation, immediately after implantation, and after the final restoration. The width increased significantly after the insertion of implants and decreased slightly after bone remodelling. Overall, the width of the alveolar ridge increased by 2.37±1.44mm on average, ranging from -0.20mm to 5.75mm. The results suggest the use of delayed expansion for horizontal alveolar bone augmentation; however, the maxillary premolar area may not be a suitable site.1

Another technique, that maybe of interest, for ridge splitting, can be found in this study from 2011, Alternative bone expansion technique for implant placement in atrophic edentulous maxilla and mandible. In that study, the “Crestal split augmentation technique involved a surgical osteotomy that was followed by alveolar crest split and augmentation after buccolingual bony plate expansion, prior to implantation.” The authors concluded that:

In comparison to traditional bone grafts techniques, crestal split ridge bone augmentation enables placement of dental implants immediately or 3 weeks after augmentation and eradicates the possible morbidity of the donor sites.2

1.The application of a delayed expansion technique for horizontal alveolar ridge augmentation in dental implantation. Li X, et al. Int J Oral Maxillofac Surg. 2017 Nov;46(11):1451-1457

2.Alternative bone expansion technique for implant placement in atrophic edentulous maxilla and mandible. Demetriades N et al. J Oral Implantol. 2011 Aug;37(4):463-71.

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