One Stage Ridge Splitting Using 2 Different Techniques in Maxilla

Evaluation of Endosseous Implants in One Stage Ridge Splitting Using the Conventional Technique Versus the Use of Piezo Surgery in the Maxilla

• The selected patients will be informed of the nature of the research work and informed consent will be obtained.
• Patients of both groups will be subjected to CBCT.
• Intra operative procedures (for both groups) followed by CBCT will be taken for every patient after 4 months.
• Infiltration local anesthesia will be given to the patient (Articaine 4% 1:100 000 epinephrine)

Both the study and control group will receive:

• In Recipient site, full thickness mucoperiosteal flap pyramidal flap, reflection using mucoperiosteal elevator.
• The defective site is reevaluated.
• Flap advancement inorder to allow tension free flap closure.
• In the Study group: Piezo surgery bone inserts is used to cut crestal osteotomies.
• In the Control group: Bone discs diameter is used.
• Followed by, the use of bone chisels.
• The point and pilot implant drills are used followed by bone expanders. Based on the preexisting bone, the defect morphology and bone quality. The implant is submerged below the alveolar crest to compensate for crestal bone resorption.
• Following partial immobilization of the buccal bone segment either book or island pattern. The fixture is inserted submerged below the alveolar bone crest.

Followed by bone smoothening and roundation under external saline irrigation at recommended speed of 38000rpm and gear ratio 1:1 calibrated on fesiodespenser.

• Xenogenic bone particle size of 0.5 mm to 1mm is going to be condensed into the dead space.
• Recheck adequate flap advancement to allow tension free closure.
• Double line closure using horizontal mattress followed by interrupted sutures to allow contact area and wound edge eversion.

Study Overview

• Status: Recruiting
• Conditions: Bone Augmentation; Ridge Augmentation
• Intervention / Treatment: Device: Piezo Surgery.; Procedure: Bone Discs.

Detailed Description

• The selected patients will be informed of the nature of the research work and informed consent will be obtained then randomized in equal proportions between control group conventional ridge splitting and study ridge splitting using piezo surgery.
• Patients of both groups will be subjected to CBCT (diagnostic for upper arch), diagnostic wax-up and stent fabrication.
• Intra operative procedures (for both groups) followed by CBCT will be taken for every patient after 4 months.
• Scrubbing and draping of the patient will be carried out in a standard fashion for intra oral procedures.
• Infiltration local anesthesia will be given to the patient (Articaine 4% 1:100 000 epinephrine)

Both the study and control group will receive:

• In Recipient site, using 15C blade on Bard Parker handle incision of full thickness mucoperiosteal flap inorder to obtain, three-line pyramidal flap, reflection using mucoperiosteal elevator molt 9.
• The defective site is reevaluated after its primary evaluation on CBCT using UNC periodontal probe.
• Flap advancement using periosteal releasing incision inorder to allow later tension free flap closure.
• In the Study group: Piezo surgery bone inserts is used to cut crestal osteotomy in the center of the alveolar bone ridge bucco-lingual traversing the compact bone into the spongiosa Followed by two semi vertical osteotomies at least 1.5mm away from the adjacent teeth.
• In the Control group: Bone discs diameter 7mm mounted on contra angled 1:1 is used to cut crestal osteotomy in the center of the alveolar bone ridge bucco-lingual traversing the compact bone into the spongiosa Followed by two semi vertical osteotomies at least 1.5mm away from the adjacent teeth using bone discs diameter 6.5mm mounted on external irrigation straight hand piece.
• First, the spatula bone chisels are used to make sure of extension of osteotomies into the spongy bone in addition to, adequate free of the cut corners, followed by sequential use of tapered bi-angled bone chisels and hammering with bone mallet 3mm shorter than the length of the proposed implant to gain adequate 1ry stability with concurrent support of the buccal plate of bone.
• The point and pilot implant drills are used followed by the sequential use of bone expanders diameters 2.6, 3, 3.4, 3.8 to place an implant of diameter 3.7 or 4.1mm. Based on the preexisting bone, the defect morphology and bone quality. The implant is submerged about 2mm to 3mm below the alveolar crest to compensate for crestal bone resorption.
• Following partial immobilization of the buccal bone segment either book or island pattern. The fixture is inserted submerged below the alveolar bone crest by 2mm to 3mm. Followed by bone smoothening and roundation using large round diamond stone mounted on straight hand piece with external saline irrigation at recommended speed of 38000rpm and gear ratio 1:1 calibrated on fesiodespenser. To avoid soft tissue irritation.
• Xenogenic bone particle size of 0.5 mm to 1mm is going to be condensed into the dead space. To act as a scaffold for the formation of autogenous bone.
• Recheck adequate flap advancement by visualizing passive flap approximation, to allow tension free closure.
• Double line closure using horizontal mattress placed 5mm away from flap margins followed by interrupted sutures on top to allow contact area which is preferred to point contact and wound edge eversion.

• Study Type: Interventional
• Enrollment (Estimated): 20
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Mohannad A. Ismail, MSc.; Phone Number: +20 01222968444; Email: mohannadahmed@hotmail.com
• Study Contact Backup: Name: Ahmed M Youssef, PhD; Phone Number: +20 01067941236; Email: Ahmed.Youssef@dentistry.cu.edu.eg

Study Locations

• Egypt
  • Cairo, Egypt, 11553
    • Recruiting
    • Faculty of Dentistry Cairo university
    • Contact: Ahmed M. Youssef, Lecturer; Phone Number: +20 +201067941236; Email: ahmed.youssef@dentistry.cu.edu.eg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients with maxilla residual alveolar bone height not less than 8 mm.
• Alveolar bone width from 5mm to 3mm.
• Both genders.
• At least single missing tooth.
• Previous failed implants.
• Tapered or cylinder cross sectioned alveolar bone defect pattern.

Exclusion Criteria:

• Heavy smokers more than 20 cigarettes per day.
• Patients with bone disease that may affect normal healing, example; hyperparathyroidism.
• Patients had radiotherapy and chemotherapy in head and neck.
• Patients had neoplasms in sites to be grafted.
• Patients with Metabolic diseases uncontrolled diabetic patients, Glycated hemoglobin (Hb A1c) more than 7 mg\dl.
• Pregnant females.
• Patients with Para functional habits, apprehensive and non-cooperative.
• Bone pathology related to the site to be grafted.
• Psychological problems, stress situation (socially or professionally), emotional instability, and unrealistic patients' expectations.
• Intraoral soft and hard tissue pathology.
• Systemic condition that contraindicates implant placement.
• Under the age of 18 years.
• Hourglass defects or defects with bone concavities and or undercuts.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Study Group A: Piezo Surgery.; Straight and angled bone inserts were utilized.	Device: Piezo Surgery.; Piezotome woodpecker®: Surgic touch.
Active Comparator: Control Group B: Conventional Technique.; using bone discs of 7mm diameter mounted on contra angled 1:1 and 6.5mm diameter bone discs mounted on 1:1 external irrigation straight hand piece.	Procedure: Bone Discs.; bone discs mounted on staight hand piece and contra angled 1:1 gear ratio.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Bone Quality of bone gain.	Measured using linear measurements from CBCT in millimeters.	At 4 months from ridge augmentation.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Soft Tissue Dehiscence.	Exposure of the augmented site. Written Binary Numerical.	Baseline 1st Week.

Collaborators and Investigators

• Sponsor: Cairo University

Publications and helpful links

General Publications

• Spin-Neto R, Landazuri Del Barrio RA, Pereira LA, Marcantonio RA, Marcantonio E, Marcantonio E Jr. Clinical similarities and histological diversity comparing fresh frozen onlay bone blocks allografts and autografts in human maxillary reconstruction. Clin Implant Dent Relat Res. 2013 Aug;15(4):490-7. doi: 10.1111/j.1708-8208.2011.00382.x. Epub 2011 Aug 11.
• Acocella A, Bertolai R, Ellis E 3rd, Nissan J, Sacco R. Maxillary alveolar ridge reconstruction with monocortical fresh-frozen bone blocks: a clinical, histological and histomorphometric study. J Craniomaxillofac Surg. 2012 Sep;40(6):525-33. doi: 10.1016/j.jcms.2011.09.004. Epub 2011 Nov 9.
• Dasmah A, Thor A, Ekestubbe A, Sennerby L, Rasmusson L. Particulate vs. block bone grafts: three-dimensional changes in graft volume after reconstruction of the atrophic maxilla, a 2-year radiographic follow-up. J Craniomaxillofac Surg. 2012 Dec;40(8):654-9. doi: 10.1016/j.jcms.2011.10.032. Epub 2011 Dec 3.
• AlGhamdi AS. Post-surgical complications of symphyseal block graft with and without soft tissue grafting. Saudi Med J. 2013 Jun;34(6):609-15.
• Monje A, Monje F, Chan HL, Suarez F, Villanueva-Alcojol L, Garcia-Nogales A, Wang HL. Comparison of microstructures between block grafts from the mandibular ramus and calvarium for horizontal bone augmentation of the maxilla: a case series study. Int J Periodontics Restorative Dent. 2013 Nov-Dec;33(6):e153-61. doi: 10.11607/prd.1664.
• Aloy-Prosper A, Penarrocha-Oltra D, Penarrocha-Diago M, Penarrocha-Diago M. The outcome of intraoral onlay block bone grafts on alveolar ridge augmentations: a systematic review. Med Oral Patol Oral Cir Bucal. 2015 Mar 1;20(2):e251-8. doi: 10.4317/medoral.20194.
• Reininger D, Cobo-Vazquez C, Monteserin-Matesanz M, Lopez-Quiles J. Complications in the use of the mandibular body, ramus and symphysis as donor sites in bone graft surgery. A systematic review. Med Oral Patol Oral Cir Bucal. 2016 Mar 1;21(2):e241-9. doi: 10.4317/medoral.20938.
• Khoury F: Augmentation of severe bony defects with intraoral bone grafts: biological approach and long-term results J Oral Maxillo Fac Surg 2017Volume 46, Supplement 1, Pages 26-27.
• Claudino M, Julio C L, Luis E M, Bernardo M, Fernando G, tomographic evaluation of atrophic maxilla rehabilitated with autogenous and xenogeneic block grafts. Journal of Research in Dentistry 2017, 4(4):112-117.

Study record dates

Study Major Dates

• Study Start (Actual): February 26, 2025
• Primary Completion (Estimated): July 30, 2025
• Study Completion (Estimated): October 31, 2025

Study Registration Dates

• First Submitted: February 16, 2025
• First Submitted That Met QC Criteria: March 17, 2025
• First Posted (Actual): March 24, 2025

Study Record Updates

• Last Update Posted (Actual): July 16, 2025
• Last Update Submitted That Met QC Criteria: July 12, 2025
• Last Verified: July 1, 2025

More Information

Terms related to this study

• Keywords: ridge augmentation; Piezo Surgery; One stage ridge splitting in maxilla.
• Other Study ID Numbers: 00-0001-6142-0568

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No