Horizontal Alveolar Ridge Distraction in an Edentulous Patient

Comparison of the success rate and marginal bone loss of implants placed simultaneously with either bone expansion or ridge splitting in maxillary sites: a prospective non-randomized study

This study was performed to compare the amount of marginal bone loss (MBL) and the success rate of implants placed following maxillary ridge expansion with two surgical techniques. A non-randomized prospective study was designed. The patients underwent either bone expansion or ridge splitting, and simultaneous implant placement. The implants were loaded according to the delayed loading protocol with single crowns. Each study group included 35 implants placed in 31 patients. One year after loading, the implant success rate was 100 % in both groups. The median MBL was 1.00 mm in both groups (interquartile range 0.10 mm in the bone expansion group and 0.30 mm in the ridge splitting group) (no significant difference, P = 0.749). The median MBL around implants placed in sites with D2, D3, and D4 density bone was 1.40 mm, 1.00 mm, and 0.80 mm in the expansion group and 1.50 mm, 1.00 mm, and 0.85 mm in the splitting group, respectively. There was a significant difference in MBL between the different bone density types within both groups (P < 0.001). In conclusion, no significant difference in the amount of MBL or the success rate was observed between implants placed simultaneously with ridge splitting and those placed simultaneously with bone expansion, in the maxilla.

Outcomes of Bifocal Transport Distraction Osteogenesis for Repairing Complicated Unilateral Alveolar Cleft

OBJECTIVES

This study aimed to assess the outcomes of bifocal transport distraction osteogenesis (BTDO) for closure of a wide or previously failed unilateral alveolar cleft.

METHODS

Patient in this study had a large alveolar cleft that had not healed with bone grafts. Bone-borne distraction was used under general anesthesia. Intraoperative complications as bleeding and trauma to neighboring teeth were documented. Postoperative complications as wound dehiscence, paresthesia, infection, and bleeding were recorded. Complications including changes in bone segment movement, activation force loss, and occlusal interferences were observed during the activation phase. During the consolidation phase, problems including gingival recession, pulpal vitality, and cosmetic concerns were evaluated. Postoperative, periapical, occlusal, and orthopantomograms were used to evaluate bone gain and bone generation in the distracted area.

RESULTS

Ten patients (6 males and 4 females) with unilateral alveolar cleft were included, with mean age of 9.5 ± 2.5 years. Average cleft width was 12.25 ± 2.54 mm. There was no intraoperative or postoperative bleeding. Only 1 patient had a wound dehiscence (10%). All patients had mild postoperative pain and edema in upper lip. Only 1 patient complained of numbness in infraorbital nerve's innervated region. Radiographs revealed bone formation in cleft area and bone healing in distracted chamber.

CONCLUSIONS

Bifocal transport distraction osteogenesis improves success rate of an alveolar cleft treatment especially a wide or previously failed one. This technique associated with minimal complications when careful planning and cooperation from a patient are combined. It can be recommended when other modalities for alveolar cleft are failed. Patients also tolerate the device well.

Two-Stage Ridge Split at Narrow Alveolar Mandibular Bone Ridges

PURPOSE

When the bone ridge is corticalized, the displacement of the buccal plate may result in an unintentional malfracture. The aim of this study was to report the results of a 2-stage atrophic alveolar ridge expansion performed with a sonic-air surgical instrument.

MATERIALS AND METHODS

In this retrospective cohort study, the atrophic distal segments of the mandible were treated by a split-thickness flap approach and application of an alveolar ridge expansion performed in 2 surgical phases. A sonic-air surgical instrument was used. In the first surgical procedure, only basal corticotomies on the buccal plate were performed. In the second stage, sagittal and vertical osteotomies were added, aiming to facilitate the displacement of the buccal bone plate. Subsequently, implants were installed into the created space between the buccal and lingual plates. No bone substitutes were used. The width of the displaced buccal bone wall and the gaps that occurred mesially and distally to the implant were measured at the time of implant installation. Cone beam computed tomography scans were taken before the first and after the second surgical procedures, and the width of the alveolar crest at both observations and the width of the residual mesial and distal gaps after implant installation were measured.

RESULTS

We included 10 patients (6 women and 4 men; aged 37 to 69 years) in the study, and 15 implants were installed in expanded narrow ridges. Clinically, the mean width of the buccal bone wall was 1.2 ± 0.2 mm and the gaps ranged between 2.8 and 3.2 mm. On the radiographic assessments, the mean initial width of the alveolar bone crest measured 4.1 ± 0.5 mm, reaching 6.8 ± 0.9 mm after ridge expansion (P < .01).

CONCLUSIONS

The use of a modified edentulous ridge expansion in 2 stages allowed the installation of implants in narrow and corticalized alveolar ridges. We suggest that this technique is especially applicable in the distal segments of the mandible because of the low invasiveness, low risk of buccal plate fractures, reduced morbidity, and reduced costs.

Classification of the alveolar ridge width: implant-driven treatment considerations for the horizontally deficient alveolar ridges

Among many techniques advocated for the horizontally deficient alveolar ridges, ridge-split has many advantages. Here, treatment management strategies of the horizontally collapsed ridges, especially the ridge-split approach, are discussed and a clinically relevant implant-driven classification of the alveolar ridge width is proposed, with the goal to assist an operator in choosing the proper bone augmentation technique. Comparison and advantages of two commonly used techniques, ridge-split and block bone graft, are presented.

Horizontal alveolar distraction osteogenesis for dental implant: long-term results

OBJECTIVES

The aim of the present study was to present the results of patients followed for at least 3 years who underwent horizontal distraction osteogenesis DO and a final implant prosthesis.

MATERIAL AND METHODS

A total of 13 sites in 12 patients (three men, nine women; mean age 45.4 years, range 21-63 years) who presented with severe horizontal atrophy of a partially edentulous maxilla or mandible were treated using horizontal DO. The horizontal distraction device was set on the transport bone which was osteotomized as bone splitting method and fixed to the segment using microscrews.

RESULTS

The median of latency period was 9 days (range: 7-17); the median of amount of device activation was 5.6 mm (range: 4.4-9.6); the median of distraction period was 14 days (range: 8-24); and the median of consolidation period, from the end of activation until implant placement, was 13 weeks (range: 11-20). The median of actual gain in bone width at the end of the consolidation period was 3.6 mm (range: 1.1-5.6). A total of 35 implants were inserted in the augmented area with primary implant stability. The median of follow-up from the start of prosthetic loading was 5.4 years. Consequently, the implant survival and success rates were 100% and 94.2%, respectively.

CONCLUSION

This article reports the long-term results of horizontal alveolar DO using a mesh device for patients with an atrophic alveolar region. Our results confirm that this technique is a predictable and effective regenerative procedure for implant preprosthetic treatment in patients with severe horizontal atrophy of the alveolar ridge.