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.
Internal allocortical tenting procedure. (a) Axial, panoramic, and cross-sectional views of the vertical defect. Adequate bone width exists at the base of the vertical defect for ridge splitting. (b) Clinical view of an unhealed bone defect approximately 4 weeks postexplant. (c) Use the piezosurgery tip for vertical and midcrestal cuts and the bone expander for ridge splitting. (d) The allograft plate is placed according to the prepared mesiodistal width inside the defect. (e) Trim the cortical plate to match the defect. (f) GBR. (g) Internal horizontal and single interrupted sutures. (h) Clinical view of suture removal 10 days after surgery.
Second-stage procedure. (a) Axial, panoramic, and cross-sectional views after 5 months. (b) Uneventful soft tissue healing. (c) Full-thickness flap inside keratinized tissue. The vertical defect has been reconstructed close to the membrane’s fixation pin. (d) A histological bone core was obtained using a trephine drill for histological evaluation. (e) The correct position of the new implant. (f) Tightening the healing abutment and suturing. (g) Postoperative periapical radiograph.
Immediately after delivery of the restoration
The vertical changes were assessed using the CEJ of the canine tooth (#22). (a) The preoperative linear radiographic evaluation showed that the distance between CEJ and the deepest point of the defect was 13 mm. (b) After 5 months, a postoperative linear radiographic evaluation was conducted, demonstrating that the defect’s depth had reduced by almost 5 mm. This resulted in approximately 8 mm of vertical reconstruction.
Histological images under the bright field light microscopy. (a) Magnification ×40.
Allograft material (*) was visible in the longitudinal section of the compact bone core with Haversian systems (**). The quantity of bone marrow observed was minimal. There are no inflammatory cells or foreign body reactions. (b) Magnification ×100. Lamellar bone with prominent Haversian systems (**) and remaining allograft material (*) on its surface. (c) Magnification ×400.
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