The alveolar ridge split and expansion (ARSE) technique is a predictable approach for horizontal ridge augmentation in atrophic edentulous sites. The objectives of the present study were to assess the impact of piezoelectric surgery and screw expanders on tissue and implant health, and also to comparatively evaluate the efficacy of piezoelectric surgery and screw expanders in edentulous ridge expansion compared to the conventional drilling technique. Thirty-six single or multiple edentulous sites were recruited into three groups based on ridge width measurements, i.e., 12 sites/group. In group 1 (control), implants were placed with a conventional drilling technique. In contrast, in groups 2 and 3 (test groups), ARSE was performed with implants placed simultaneously, and follow-up was conducted at the 1st week, 2nd week, 4th week, 3rd month, and 6th month postoperatively. Ridge width was measured before and after ridge expansion at 2mm and 6mm from the crest. Implant stability quotient (ISQ), insertion torque (IT), TNF-α inflammatory marker, pain, and soft tissue parameters, including redness and swelling, were also recorded. Wilcoxon signed rank test, Mann-Whitney U test, repeated measure ANOVA test, one-way ANOVA test, Kruskal-Wallis Test, and independent t-test were used. P value was set at ≤0.05.

Results show that intra-group comparison of ridge width before and after expansion at 2mm and 6mm from the crest was statistically significant (p<0.05) in both group 2 and group 3. The change in ridge width was non-significant (p>0.05) between group 2 and group 3 after intergroup comparison. Intragroup comparisons of ISQ were statistically significant (p < 0.05) in all three groups. Intergroup comparisons of ISQ and insertion torque values show no significant differences (p>0.05). The observations of the present study demonstrate that the ARSE technique, using PES and screw expanders, may be an efficient approach for providing predictable ridge augmentation along with simultaneous implant placement in moderate to severe ridge deficiency sites. However, proper case selection, along with the use of appropriate techniques, achieves predictable results even in moderate to severe ridge width deficiency sites. Further studies are needed to determine the long-term success of this technique.