Dental implants placed in expanded narrow edentulous ridges with the Extension CrestR device. A 1-3-year multicenter follow-up study

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.

Lateral augmentation of the jaw by the split expansion ridge technique. A critical review

Bone augmentation has become a routine procedure to enhance and/or repair a deficient or resorbed alveolar ridge for predictable and successful implant placement. The split expansion ridge i.e., the alveolar ridge splitting (ARS) procedure, is one of the less invasive procedures, and is characterized by minor morbidity. This would allow to widen narrow ridges in order to allow implant reconstruction in a sufficient bone volume. Its efficacy and long-term stability rely upon clinical opinions and long-term retrospective studies, while prospective comparative studies and randomized controlled trials are rare. This critical review presents the development of this technique, describes the surgical procedure, and provides technical notes and modifications. The learning curve and in-depth knowledge of the oral anatomy, as well as the recognition of incidence and management of complications are of utmost importance in the clinical application of the ARS procedure.

Narrow Alveolar Ridge Management with Modified Ridge Splitting Technique: A Report of 3 Cases

Purpose. In this study, we report the usefulness of implant placement with modified ridge splitting technique from three cases of patients with narrow alveolar ridge. Materials and Methods. Three patients were those who visited the Department of Oral and Maxillofacial Surgery of Ewha Medical Center for consultation regarding implant placement. Through clinical and radiographic evaluation, narrowed alveolar ridge after tooth loss was confirmed in all three patients. For them, it was necessary to use the modified ridge split technique with bone augmentation for the implant to be well placed with enough bone width. Results. In all cases, sufficient bone width was confirmed for implant placement, and bone volume was well maintained after prosthetic restoration without any complications. Initial width of alveolar bone was 4.9 mm on average and was well maintained at an average of 7.6  mm at 1-year follow-up after implant installation. Conclusion. Although the number of subjects in this case report was small and was done by only one surgeon, we suggest that modified ridge splitting technique might be a useful surgical method to enhance narrow edentulous alveolar ridges and enable successful implant placement with shorter healing period compared with single guided bone regeneration.

Short-Term Evaluation of Prosthetic Rehabilitation of Thin Wiry Ridge by Ridge Splitting and Simultaneous Implants Placement: Non-randomized Control Trial

Objective  This article evaluates the success of prosthetic rehabilitation of thin wiry ridge and implants placed simultaneously in splitted ridge both clinically and radiographically.

Materials and Methods  Twenty-one participants were enrolled of which 13 patients (8 females and 5 males) were suffering from maxillary ridge atrophy and 8 patients (5 females and 3 males) had mandibular ridge atrophy; a total of 42 implants were performed using the ridge expansion technique. The expansion was performed using the conventional disk technique, piezoelectric corticotomy, and self-threading expanders. Implants were placed and loaded with fixed partial denture after 4 months for the mandible and 6 months for the maxilla. Implant stability quotient (ISQ) was measured at T0 (implant placement) and TL (loading). Crestal bone levels were measured at different times: T0, TL, and T12 (12 months). Evaluation of prosthetic and surgical complications was carried out. Data were analyzed and compared using analysis of variance and paired t -tests at a significance level of 5%.

Results  All implants met the criteria for success. All implants showed a higher mean bone loss from T0 to TL (1.259 ± 0.3020) than from TL to T12 (0.505 ± 0.163) with a statistically significant difference ( p  < 0.0001). ISQ values sharply increased at the time of loading (72.52 ± 2.734) than at implant insertion (44.5 ± 4.062) with a significant difference ( p  < 0.0001). Minor prosthetic and surgical complications were reported.

Conclusion  The results from this study support the efficacy of prosthetic rehabilitation of thin wiry ridge using split ridge technique and the success of implants placed simultaneously in splitted ridge.

Volumetric assessment of changes in the alveolar ridge dimension following GBR using a combination FDBA with collagen membrane or novel resorbable scaffold: A prospective two-center clinical trial

BACKGROUND

The aim of this study was to examine osseous changes following lateral bone augmentation using a novel Ossix Volumax (OV) scaffold alone and compare it to combination therapy using freeze-dried bone allograft (FDBA) and resorbable collagen membrane (FDBA/CM).

METHODS

Thirty patients completed this 9-months prospective two-center cohort clinical trial. Before surgery and 9-months re-entry, linear measurements were performed, and impressions taken. Cone-beam computed tomography (CBCT) were done at baseline and 9 months. DICOM slice data were converted into volumetric images using 3D Slicer. Following 3D volumetric image construction, pre- and post-op Standard Triangle Language files were superimposed and volumetric data were extracted for a 10-mm region of interest. Linear measurements were compared similarly.

RESULTS

Baseline clinical parameters were similar in both groups (4.22 and 4.53 mm for OV and FDBA/CM at -2 mm, respectively). Following treatment, vertical distance from the stent had changed minimally (-0.36 and -0.12 mm, respectively). Similarly, lateral bone gain ranged from 0 to 0.4 mm, for both groups. To the contrary, the CBCT measurements showed a significantly greater increase in horizontal width in the control at -2 mm (0.95 ± 0.2 mm) compared with -0.62 mm for the OV (P = 0.000). Similar changes were observed at -5 mm (0.63 and -0.41 mm, respectively, P = 0.01). Sites volume had increased from 266 ± 149 mm³ to 360 ± 138 mm³ (P = 0.001) for FDBA/CM with negligible changes for OV (from 334 to 335 mm³ , P = 0.952). these between-group changes being statistically significant (P = 0.023).

CONCLUSION

FDBA/CM yielded better albeit moderate increase in the volume of the edentulous ridge, while OV scaffolds failed to produce similar results.

Comparison between immediate vs. delayed lateral expansion technique to augment narrow alveolar ridges for placement of implants - A pilot study

Objective

Narrow alveolar ridges pose a serious challenge for successful placement of endosseous implants and alveolar ridge widening procedure is indicated in cases of crest thickness of ≤4.0 mm. The study evaluated and compared, immediate and delayed techniques of implant placement using split crest technique to augment atrophic narrow alveolar ridges.

Methods

The study was carried out in 10 patients randomly divided into two groups of five each for immediate or delayed placement of implants. Implants were placed simultaneously after split crest procedure in immediate technique and after 3-4 weeks of healing in delayed technique. Data collected was statistically analyzed by SPSS version 22 using unpaired t-test, ANOVA and Pearson's correlation with p value = 0.05.

Results

Statistically significant (p = 0.000) difference was observed for implant stability at intra-op, 4 months and 6 months post-op between the two groups, however there was no statistically significant difference in amount of augmentation achieved between the two groups.

Conclusion

We observed that both the techniques were comparable on the basis of augmentation achieved, implant success and survival rates, whereas implant stability was significantly higher in delayed technique group.

Implantes extracortos en mandíbulas con extrema reabsorción vertical: serie de casos

Introducción: el uso de los implantes extracortos permite la rehabilitación de extremas reabsorciones. Esto obliga en ocasiones a la utilización de prótesis sobre los mismos con una proporción corona-implante desfavorable llegando a ratios de 2:1 o de 3:1 en los casos más extremos. Materiales y métodos: se realizó un análisis de casos clínicos donde se insertaron implantes extracortos con un reborde residual (menor o igual a 5,5mm) y tiempo de carga mínimo de seis meses. Se realizó una prueba de chi-cuadrado para las variables categóricas y una t de Student para las variables continuas. Posteriormente, se realizaron modelos de regresión lineal ajustados. Resultados: fueron reclutados seis casos a los que se les insertaron implantes extracortos. El 21,2% de los pacientes incluidos en el estudio fueron hombres y el 78,8% mujeres, con una edad media de 57 años. La proporción corona-implante medio fue de 3,19 (+/- 0,24). La media de la pérdida ósea mesial de los implantes estudiados fue de 0,86mm (+/- 0,33) y la media de la pérdida ósea prodistal fue de 0,83mm (+/- 0,47). Cuando se analizó la pérdida ósea mesial y distal en función proporción no se encontraron diferencias estadísticamente significativas (p=0,224). Conclusiones: el uso de implantes extracortos no es un factor de riesgo para la pérdida ósea crestal o para el fracaso de la prótesis o del implante según los datos aportados por este estudio aun cuando la proporción corona-implante sea superior a tres.

Alveolar Ridge Splitting Versus Autogenous Onlay Bone Grafting: Complications and Implant Survival Rates

PURPOSE

To compare the complications and implant survival rates of localized alveolar ridge deficiencies in the horizontal dimension reconstructed by alveolar ridge splitting (ARS) or autogenous onlay bone grafting (OBG).

MATERIALS AND METHODS

Twenty-eight ARS and 28 OBG were performed. The survival rate of the all included implants was evaluated using the clinical and radiographical evaluation criteria of Misch et al. Temporary exposure of graft, mild infection, temporary paresthesia, and bad split were defined as minor complications; permanent exposure of graft, loss of graft, and permanent paresthesia were defined as major complications. Major and minor complications of ARS and OBG groups were statistically compared.

RESULTS

When the minor and major complication rates are considered, there was not any statistically significant difference between OBG (P = 0.099) and ARS (P = 0.241) groups. The satisfactory survival rate of OBG group was 92% and was 100% in the ARS group, and the difference was not statistically significant (P = 0.116).

CONCLUSION

When reconstructing vertically sufficient but horizontally insufficient alveolar ridges, ridge splitting technique could shorten the treatment period, decrease postoperative swelling and pain, eliminate the need for a second surgical site, reduce the treatment cost, and ease the patient cooperation to the surgery.

Delayed expansion of atrophic mandible (deam): a case report

Purpose

The present case report presents the clinical results of delayed expansion of mandibles by ultrasonic surgery in case of mono edentulous.

Materials and methods

The patients with a residual alveolar ridge thickness between 2,3 and 4,1 mm in the coronal area of posterior mandible was threated. In the first stage, four linear corticotomies were carried out by ultrasonic surgical device; bone expansion was not performed. After 4 weeks, in the second stage, adequate bone expansion, without compromising cortical vascularisation, by utilising a combination of scalpel, thin chisels and threaded osteotomes was achieved and one implant was placement, after filling the gaps with a cortico bovine biomaterial.

Results

The postoperative course was uneventful and final width ridge was 6,17±0,26mm.

Conclusions

The present case report showed that mandibular ridge expansion using a delayed split-crest technique by means of ultrasonic surgery and association with biomaterial clinically lead to a good horizontal bone gain with no fractures of the buccal plate and high implant success rate.

Types of devices used in ridge split procedure for alveolar bone expansion: A systematic review

The aim of this systematic review was to evaluate instrumentation procedures of the alveolar ridge expansion technique (ARST) with or without Guided Bone Regeneration (GBR) and to identify the most used instruments for successful outcome. An electronic as well as manual literature search was conducted in several databases including Medline, Embase, and Cochrane Central Register of Controlled Trials, for articles written in English up to September 2016. The question in focus was to identify the type of device for ridge expansion that is most frequently used and provides adequate bone expansion and implant success rate. To meet the inclusion criteria, the studies were analysed for the following parameters: prospective or retrospective studies, cohort or case studies/series, cases with 5 or more human subjects, type of device used for surgery, location of defect, and minimum follow up period. The frequency of osteotome usage in this study was approximately 65%, and on average, the implant success was 97%. The motorized expanders and ultrasonic surgery system are easier to use and cause less trauma to the bone compared to the traditional/conventional instruments like mallets and osteotomes. However, their cost is a limiting factor; hence, osteotomes remain a popular mode of instrumentation.

Management of Limited Vertical Bone Height in the Posterior Mandible: Short Dental Implants Versus Nerve Lateralization With Standard Length Implants

Inferior alveolar nerve lateralization (IANL) and short dental implants (SDI) are 2 viable implant-based treatment approaches in the presence of atrophied posterior mandible. Despite the risks of dysfunction, infection, and pathologic fractures in IANL, it becomes possible to place standard implants. The purpose of this study was to compare SDI and IANL approaches from clinical and radiographic aspects. Fifteen subjects having unilateral atrophic mandibles were allocated to SDI and IANL treatment groups. Following surgical procedures, early postoperative complications, implant survival, and periimplant clinical and radiographic parameters including probing pocket depth, attachment level, keratinized tissue amount, vertical tissue recession, and marginal bone loss were recorded at baseline and 1-year after prosthetic rehabilitation. In both groups, no implant was lost. Except usual postoperative complications, 2 patients had transient paraesthesia after IANL. According to time-dependent evaluation, both groups showed significant increase in probing pocket depth and attachment level at 1-year follow-up compared with baseline (P < 0.05). Except a slight but significant increase in mesial surface of SDI group (P < 0.05), no remarkable time-dependent change was identified in vertical tissue recession. Keratinized tissue amount did not exhibit any inter- or intragroup difference during whole study period. Marginal bone loss did not show any difference between IANL and SDI groups at follow-up. SDI placement or standard length implant placement with IANL can be considered promising alternatives in the treatment of atrophic mandibular posterior regions. However, SDI may be preferred in terms of lower complication risk.

Effectiveness of Lateral Bone Augmentation on the Alveolar Crest Dimension

Lateral ridge augmentation procedures are aimed to reconstruct deficient alveolar ridges or to build up peri-implant dehiscence and fenestrations. The objective of this systematic review was to assess the efficacy of these interventions by analyzing data from 40 clinical studies evaluating bone augmentation through either the staged or the simultaneous approach. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline for systematic reviews was used. The primary outcomes were the changes at reentry, in the ridge width, and in the vertical and horizontal dimensions of the peri-implant defect, measured in millimeters, in the staged and simultaneous approaches, respectively. The results of the meta-analysis showed, for the simultaneous approach, a statistically significant defect height reduction when all treatments were analyzed together (weighted mean difference [WMD] = −4.28 mm; 95% confidence interval: [CI] –4.88, –3.69; P < 0.01). The intervention combining bone replacement grafts with barrier membranes was associated with superior outcomes The most frequently used intervention was the combination of xenograft and bioabsorbable membrane. Similarly, for the staged approach, there was a statistically significant horizontal gain when all treatment groups were combined (WMD = 3.90 mm; 95% CI: 3.52, 4.28; P < 0.001). The most frequently used intervention was the use of autogenous bone blocks. Both treatment strategies led to high survival and success rates (>95%) for the implants placed on the regenerated sites. Nonexposed sites gained significantly more in the simultaneous and staged approaches (WMD = 1.1 and 3.1 mm).

The alveolar ridge splitting/expansion technique: a systematic review

PURPOSE

The aim of this systematic review was to evaluate clinical, radiological and histological outcomes of the alveolar ridge splitting/expansion technique (ARST) with or without GBR.

MATERIALS AND METHODS

A screening of two databases MEDLINE (PubMed) and EMBASE (OVID) and hand search of articles were performed. Human and animal studies reporting on dental implants placed with simultaneous ARST up to May 31st 2014 were considered. Quality assessment of selected full-text articles was performed according to the ARRIVE guidelines and the Cochrane collaboration's tool to assess risk of bias.

RESULTS

Overall, 18 human and six animal studies (risk of bias: high/unclear) were included in this review. No randomized controlled trials were found. Due to the heterogeneity of study designs, definitions of success criteria, outcome variables, observation times and surgical procedures, no meta-analysis was performed. Reported survival (18 studies) and success (nine studies) rates ranged from 91.7 to 100% and 88.2 to 100%, respectively, with a mean follow-up of 1-10 years. Crestal bone level changes (∆CBL) in some studies indicate slightly higher bone loss before and after loading. Histologic and histomorphometric data from six animal studies confirm the crestal bone loss, particularly at buccal sites.

CONCLUSIONS

Within the limitations of this review, ARST seems to be a well-functioning one-stage alternative to extended two-stage horizontal grafting procedures. Data indicate that during healing and first year of loading, increased ∆CBL particularly at buccal sites must be anticipated. Additional horizontal GBR can help to preserve buccal bone height and width.

Horizontal ridge expansion and implant placement using screws: a report of two cases

Implants are typically placed after performing ridge expansion by inserting screws of gradually increasing thickness and good clinical outcomes are often obtained. We placed 11 implants in 6 patients, and one implant failed during osseointegration but it was replaced immediately after removal and successful prosthetic treatments were completed. During these surgeries, buccal cortical plate complete fractures do not occur. Inserting screws for ridge expansion is a successful and predictable technique for implant placement in narrow alveolar bone.

The platform switching approach to optimize split crest technique

The split crest technique is a reliable procedure used simultaneously in the implant positioning. In the literature some authors describe a secondary bone resorption as postoperative complication. The authors show how platform switching can be able to avoid secondary resorption as complication of split crest technique.

Are there specific indications for the different alveolar bone augmentation procedures for implant placement? A systematic review

Bone resorption following tooth loss often interferes with dental implant placement in a desired position, and requires additional bone augmentation procedures. Many techniques have been described to augment and reconstruct alveolar ridge width and height. The aim of this study was to systemically review whether there is evidence to provide indications for the various bone augmentation procedures based on defect dimension and type. An electronic search of the Medline database and Cochrane library, complemented by a manual search, was performed. Inclusion criteria for partial edentulism were: clinical trials on bone augmentation procedures in preparation or at the time of implant placement, reporting preoperative and postoperative dimensions of the ridge. For edentulous patients, studies were included when providing the data on ridge and defect description, or the amount of augmentation achieved. The search yielded 53 publications for partially edentulous patients and 15 publications for edentulous patients. The literature provides evidence that dehiscence and fenestrations can be treated successfully with guided bone regeneration (GBR) at the time of implant placement (mean implant survival rate (MISR) 92.2%, mean complication rate (MCR) 4.99%). In partially edentulous ridges, when a horizontal defect is present, procedures such as staged GBR (MISR 100%, MCR 11.9%), bone block grafts (MISR 98.4%, MCR 6.3%), and ridge expansion/splitting (MISR 97.4%, MCR 6.8%) have proved to be effective. Vertical defects can be treated with simultaneous and staged GBR (MISR 98.9%, MCR 13.1% and MISR 100%, MCR 6.95%, respectively), bone block grafts (MISR 96.3%, MCR 8.1%), and distraction osteogenesis (MISR 98.2%, MCR 22.4%). In edentulous patients, there is evidence that bone block grafts can be used (MISR 87.75%), and that Le Fort I osteotomies can be applied (MISR 87.9%), but associated with a high complication rate. The objective of extracting specific indications for each procedure could not be fully achieved due to the heterogeneity of the studies available. Further studies on bone augmentation procedures should report precise preoperative and postoperative measurements to enable a more exact analysis of the augmentation procedure, as well as to provide the clinician with the rationale for choosing the most indicated surgical approach.

Ridge expansion alone or in combination with guided bone regeneration to facilitate implant placement in narrow alveolar ridges: a retrospective study

OBJECTIVE

To evaluate the long-term outcomes of ridge expansion technique in dealing with horizontal bony insufficiency of alveolar ridges for implant placement.

MATERIALS AND METHODS

During the period 2004-2009, 168 patients with width insufficiency of alveolar ridges were treated using the ridge expansion technique to obtain an improved bony base for implant placement. Depending on the severity of width insufficiency, the surgical procedures were classified into two groups: ridge expansion alone (Group 1) and ridge expansion in combination with guided bone regeneration (Group 2). After 4-6 months of unloaded healing, the implants were restored. The patients were followed up until 2013 with clinical and radiographic examinations.

RESULTS

Among the 168 patients, 11 patients underwent a fracture of labial/buccal bony plate during surgery, which was corrected by changing the procedure into bone grafting, yielding a surgical failure rate of 6.5%. In the remaining 157 patients successfully treated by ridge expansion alone or in combination with GBR, 226 implants were simultaneously placed as planned. No implant failed over 2.8 years (6 months to 8 years) of follow-up, yielding a cumulative implant survival rate of 100% in each group. Six implants in Group 1 and 4 implants in Group 2, although osseointegrated and in function, did not fulfill success criteria: Cumulative implants' success rates were 93.2% in Group 1 and 95.6% in Group 2. The mean marginal bone losses during the first year in Group 1 and Group 2 were 0.69 and 0.43 mm, respectively, followed by an annual loss of ~ 0.06 and 0.07 mm, respectively, in the following years. No clinical parameter was abnormal. Twenty-two (10.4%) implants were exposed to peri-implant mucositis, whereas 19 (11.0%) implant-supported restorations were involved in prosthetic complications.

CONCLUSIONS

The preliminary results of this retrospective study indicate that ridge expansion alone or in combination with GBR can be considered an effective and safe procedure for treatment of width insufficiency of alveolar ridges on the purpose of implant application.

Alveolar ridge augmentation for implant fixation: status review

This literature review was performed to illustrate and compare different alveolar ridge augmentation procedures before dental implant placement. The review was based on clinical and research studies listed in Pubmed. There is not enough evidence to support any single method as gold standard for any given condition, and choice seemed to be based on personal preferences. There is a lack of long-term survival data or success rates of grafting materials regarding donor and recipient sites. Although ridge splitting and distraction osteogenesis techniques eliminate donor site morbidity, circumvent the use of grafting materials, and reduce the operation time, some disadvantages and limitations should be considered. More studies are needed to compare the fate and characteristics of new bone obtained by these different procedures, as well as subsequent implant survival rates.

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.

Expansion of the Alveolar Bone Crest with Ultrasonic Surgery Device: Clinical Study in Mandible

The purpose of this paper was to document the application to the split-crest mandibular procedure in two stage in order to avoid cortical resorption due to periosteal detachment in buccal cortical bone of the alveolar crest. Twenty-two healthy patients with non-contributory past medical history (14 women and 8 men, all non-smokers, mean age 59 years, range 54–65 years) were included in this study. After buccal mucoperiosteal flap was followed by a sagittal corticotomy in the coronal area of the alveolar crest and a second sagittal corticotomy, but in a lower (basal) position and two vertical corticotomies in the buccal wall, using a ultrasonic surgery device (Surgysonic, Esacrom, Imola Italy). Adequate crest expansion was achieved without compromising cortical vascularisation by utilising a combination of scalpel, thin chisels and threaded osteotomes (Bone System, Milano, Italy). Postoperative results were assessed by panoramic and periapical radiographs. Ossification of the osteotomy lines was evident and could be observed as sites with increasing radiopacity on panoramic and periapical radiographs 3 months after implants insertion. No dehiscence of the mucosa was observed. No patient suffered from hypoaesthesia. The mean horizontal bone increase in coronal area was 5±3 mm. Mandibular ridge expansion using a split-crest technique that included grafting the implant sites with a ultrasonic surgery device is a viable therapeutic alternative for implant placement in this patient population.

Clinical evaluation of split-crest technique with ultrasonic bone surgery for narrow ridge expansion: status of soft and hard tissues and implant success

PURPOSE

The aim of this study was to evaluate the split-crest technique with ultrasonic bone surgery for implant placement in patients with narrow ridges, focusing on the status of soft and hard tissues and on implant success rate, at least 6 months after implant loading.

MATERIALS AND METHODS

During September 2007 and November 2008, 15 patients received 37 implants (BTI implants) with split-crest surgical procedure using ultrasonic bone surgery. Plasma rich in growth factors (PRGF®) was applied during split crest procedure to promote tissue regeneration. Implant surfaces were humidified with PRGF to accelerate osseointegration. Patients were recalled for a final clinical evaluation at least 6 months after implant loading. Clinical assessment included the status of soft and hard tissues around implants, and implants' success rate.

RESULTS

Thirty-seven implants in 15 patients were evaluated between July 2009 and January 2010. The status of soft tissues was very good, showing adequate plaque index, bleeding index, and probing depth values. Success rate of implants at the end of follow-up (between 11 and 28 months after insertion) was 100%. Bone ridge was measured and compared at final examination showing a mean ridge expansion of 3.35 mm (SD: 0.34).

CONCLUSIONS

Split-crest with ultrasonic bone surgery can be considered an effective and safe procedure for narrow ridge expansion.

Long-term outcome of dental implants placed in revascularized fibula free flaps used for the reconstruction of maxillo-mandibular defects due to extreme atrophy

PURPOSE

the objectives of this study were to evaluate (a) the clinical outcome of revascularized fibula flaps used for the reconstruction of extremely atrophic jaws and (b) the survival rates of dental implants placed in the reconstructed areas.

MATERIALS AND METHODS

between 1999 and 2004, 12 patients presenting with extreme atrophy of the edentulous jaws were reconstructed with fibula free flaps. Five to 12 months after the reconstructive procedure, 75 titanium dental implants were placed in the reconstructed areas, while prosthetic rehabilitation was started 4-6 months afterward. The mean follow-up of patients after the start of prosthetic loading was 77 months (range: 48-116).

RESULTS

an uneventful healing of the bone transplants occurred in all patients. One out of the 75 dental implants placed was not loaded due to prosthetic reasons. No dental implants failed to integrate before prosthetic loading, while three were removed during the follow-up period. Despite the high survival rate of dental implants (95.8%), a relevant number of them presented relevant peri-implant bone-level loss, ranging from 1 to 7 mm for maxillary dental implants and from 1 to 4.5 mm for mandibular dental implants.

CONCLUSION

although no failures of the bone transplants occurred and a high long-term survival rate of dental implants were observed, this study showed that fibula free flaps do not guarantee dimensional stability of peri-implant bone, despite the immediate blood supply delivered by the vascular pedicle. The peri-implant bone resorption was higher when compared with the one related to dental implants placed in native bone.

Augmentation procedures for the rehabilitation of deficient edentulous ridges with oral implants

OBJECTIVES

To analyze publications related to augmentation procedures and to evaluate the success of different surgical techniques for ridge reconstruction and the survival/success rates of implants placed in the augmented areas.

MATERIAL AND METHODS

Clinical investigations published in English involving at least 5 patients and with a minimum follow-up of 6 months were included. The following procedures were considered: a) Guided bone regeneration (GBR); 2) Onlay bone grafts; 3) Inlay grafts; 4) Bone splitting for ridge expansion (RE); 5) Distraction osteogenesis (DO); and 6) Revascularized flaps. Success rates of augmentation procedures and related morbidity, as well as survival and success rates of implants placed in the augmented sites were analyzed.

RESULTS

Success rates of surgical procedures ranged from 60% to 100% for GBR, from 92% to 100% for onlay bone grafts, from 98% to 100% for ridge expansion techniques, from 96,7% to 100% for DO, and was 87.5% for revascularized flaps, whereas survival rates of implants ranged from 92% to 100% for GBR, from 60% to 100% for onlay bone grafts, from 91% to 97.3% for RE, from 90.4% to 100% for DO, and, finally, was 88.2% for revascularized flaps.

CONCLUSION

On the basis of available data it was shown that it was difficult to demonstrate that a particular surgical procedure offered better outcome as compared to another. The main limit encountered in this review has been the overall poor methodological quality of the published articles. Therefore larger well-designed long term trials are needed.