Horizontal Augmentation Through the Ridge-Split Procedure: A Predictable Surgical Modality in Implant Reconstruction
Among alveolar ridge augmentation techniques, the ridge-split procedure demonstrates many benefits, including no need for a second (donor) surgical site, rare risk of inferior alveolar nerve injury, and less pain and swelling, and others. Lateral bone augmentation through the ridge-split works best in a localized lateral bony defect intended for 1 or 2 implants and where the ridge is vertically intact. In this article, the authors present a detailed description of the implant-driven technique of alveolar ridge-split procedure in small and large bone deficiencies, in maxilla and mandible, supplemented by multiple photographs. The authors emphasize the need for careful manipulation of the thin ridge based on knowledge of precise surgical principles and stress that a practitioner needs specialized training and experience to perform this type of alveolar bone augmentation.
Cone-beam computerized tomography (CBCT) slices are useful in providing necessary information on alveolar thickness, position of the inferior alveolar canal in the mandible or maxillary sinus in the maxilla, and comparative assessments of postoperative and preoperative bone morphology. CBCT demonstrates enhancement in alveolar width after ridge augmentation with the ridge-split procedure.
Figure 2. An intraoral photograph demonstrating a narrow osteotome that is lightly tapped into the cancellous layer of bone with a surgical mallet separating 2 cortical layers during the ridge-split procedure in the edentulous maxillary ridge. Figure 3. An intraoral photograph demonstrating a cancellous graft that is packed into the created bone gap. Figure 4. An intraoral photograph demonstrating placement of sutures without tension to allow healing by secondary intention; the depth of the vestibule and position of the keratinized tissue are preserved. Figure 5. An intraoperative photograph demonstrating 4 corticotomies (1 crestal, 1 apical, and 2 vertical) at stage 1 of the ridge-split procedure; about 9–10 mm of distance is needed between the apical and crestal corticotomy. Figure 6. Patient 1: Preoperative panoramic radiograph demonstrating a failing bridge connecting the upper right lateral incisor with a non-restorable canine and extending as a cantilever to the premolar region. Figure 7. Patient 1: Intraoperative photograph demonstrating 2 endosseous implants (Biomet 3i) that were placed after the split stage of the ridge-split procedure. Good primary implant stability (20 NCm) was achieved.
Figure 8. Patient 1: Intraoperative photograph showing bone grafting (Bio-Oss) placed between 2 implants into the created gap (split). Figure 9. Patient 1: Final panoramic radiograph of the completed case demonstrating porcelain-fused-to-metal implant-supported bridge. Figure 10. Patient 2: Intraoperative photograph at stage 2 showing a greenstick fracture widened to a 8-mm width (stabilized with two 2.0-mm tru-fix self-drilling mini screws). Figure 11. Patient 2: Intraoral photograph showing the implant surgical stage in which 3 Replace Select 4.0-mm tapered implants were placed in the position of the second and first molars and second premolar 6 months after the ridge-split procedure. Figure 12. Patient 2: Clinical post-completion intraoral photograph demonstrating osseointegrated and restored implants; 3 separate porcelain-fused-to-metal implant-supported crowns were cemented to full function and satisfactory occlusion and esthetic results. The patient was satisfied with the results. Figure 13. Patient 2: Close-up panoramic radiograph demonstrating osseointegrated and restored implants; 3 separate porcelain-fused-to-metal implant-supported crowns were cemented to proper function and occlusion.
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