Apical U-shape splitting technique for undercut areas of the anterior alveolar ridge: a prospective non-randomized controlled study

Digital Guides for Precise U-Shaped Splitting and Simultaneous Implant Placement With Minimal Surgical Trauma

OBJECTIVE

The aim of this report is to present the workflow of a surgical procedure involving U-shaped splitting in an envelope flap with simultaneous implant placement using two digital guides for patients with insufficient bone width and labial concavity.

CLINICAL CONSIDERATION

Two digital guides and an envelope flap are proposed in this report. An implant drilling guide and an osteotomy guide guarantee the precise execution of surgical procedures. Using an envelope flap enhances the integrity of the labial mucoperiosteum, minimizing surgical trauma and improving the effect of bone augmentation.

CONCLUSION

With the assistance of two digital guides, precise U-shaped splitting in an envelope flap can minimize surgical trauma and have a significant effect on horizontal bone augmentation.

CLINICAL SIGNIFICANCE

This workflow considers the implant positions, the scope of osteotomy, and the kind of flap. It ensures minimal surgical trauma and excellent bone augmentation effect, which means predictable esthetic outcomes and stability in oral implantology, and provides a considerable solution for patients with insufficient bone width and labial concavity.

Advancements in dental implantology: The alveolar ridge split technique for enhanced osseointegration

The alveolar ridge split (ARS) technique is a pivotal advancement in dental implantology, addressing the limitation of insufficient bone width for implant placement. This review traces the historical development of ARS from its initial conceptualization to current practices and future directions. Emphasizing the technique's development, indications, procedural overview, and osteotomy variations, we highlight its minimally invasive nature, which reduces patient morbidity and treatment time. This article reviews various osteotomy methods within ARS, examining their applications, benefits, and limitations. Furthermore, it discusses the technique's role in expanding treatment options for patients with compromised alveolar structures, underpinned by a high implant survival rate and the potential for immediate implant placement. We also cover the necessity of meticulous surgical technique, the importance of patient-specific factors, and the promising future of ARS facilitated by advancements in biomaterials and regenerative medicine. In summary, this review provides a comprehensive overview of ARS, offering valuable insights for dental professionals and informing future clinical practices and research in implantology.

The efficacy of alveolar ridge split on implants: a systematic review and meta-analysis

OBJECTIVES

To evaluate the effects of the alveolar ridge split (ARS) technique on gained horizontal width of the alveolar ridge and implant survival rate.

MATERIALS AND METHODS

Electronic searching was performed in six electronic databases (Pubmed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, and SIGLE) from January 1, 2010, to November 1, 2023. Two authors performed study selection, data extraction, and study qualities (ROBINS-I and RoB 2.0) independently. Meta-analysis was performed by Comprehensive meta-analysis 3.0.

RESULTS

24 included studies were observational, and 1 study was a randomized controlled trial (RCT). 14 studies investigated the gained width of the horizontal alveolar ridge, and 17 examined the implants' survival rate. For assessment of risk of bias, nine studies were high risk of bias and 16 studies were moderate risk of bias. Meta-analysis demonstrated that the pooled gained alveolar ridge width was 3.348 mm (95%CI: 4.163 mm, 2.533 mm), and the implant survival rate was 98.1% (95%CI: 98.9%, 96.9%). Seven studies showed seven different complications including exposure, infection, bad split, dehiscence, fracture, paresthesia and soft tissue retraction.

CONCLUSION

Recent ARS technique seems to be an effective method of bone augmentation with enough gained width and a high implant survival rate. Further long-term and RCTs research remains needed to enhance the study quality.

CLINICAL RELEVANCE

The ARS technique could generate sufficient bone volume, and implants had a high-level survival rate. Therefore, ARS has been proposed to be a reliable horizontal bone augmentation technique that creates good conditions for the implantation of narrow alveolar crests.

U-shaped Splitting Technique vs Conventional Bone Grafting in Maxillary Facial Undercut for Dental Implants Placement: A Preliminary Randomized Controlled Clinical Trial

AIM

This prospective randomized clinical trial was designed to compare the apical U-shape splitting technique (AUST) combined with guided bone regeneration (GBR) vs GBR alone for horizontal bone augmentation in maxillary labial undercut areas.

MATERIALS AND METHODS

The study included twelve patients with labial undercuts that made their alveolar ridges not able to compass dental implants. They received a total of 14 dental implants in the anterior maxilla where 7 (group I) were placed after AUST with GBR and the other 7 (group II) after the conventional GBR. The clinical and radiographic evaluations were done preoperatively, after surgery, and 6 months later. Facial flap fracture, peri-implant health, ridge width (RW) gain and loss, marginal bone loss (MBL), and implant esthetics were measured. Data were analyzed and compared and for any of the used tests, results were considered statistically significant if p-value ≤ 0.05.

RESULTS

For group I, no fracture of the bone flap happened and the gain in RW was significantly higher at 6 months postoperatively. Marginal bone loss was similar for both groups. The total pink esthetic score was significantly higher in group I vs group II (p = 0.024).

CONCLUSION

Within the limitations of this study, it was concluded that AUST combined with GBR was more effective in RW gain than GBR alone and it provided a merit approach for restoring function and esthetics if labial fenestration was unavoidable during implant placement.

CLINICAL SIGNIFICANCE

Apical U-shape splitting technique for horizontal ridge augmentation is a valuable option for the benefit of patients in clinics who need dental implants and have anterior undercut areas that may lead to fenestration and usually requires onlay bone grafting which is less successful in maintaining the RW.