A Modified Ridge Splitting Technique Using Autogenous Bone Blocks-A Case Series

Dorottya Pénzes, Fanni Simon, Eitan Mijiritsky, Orsolya Németh, Márton Kivovics, Dorottya Pénzes, Fanni Simon, Eitan Mijiritsky, Orsolya Németh, Márton Kivovics

Abstract

Background: Alveolar atrophy following tooth loss is a common limitation of rehabilitation with dental implant born prostheses. Ridge splitting is a well-documented surgical method to restore the width of the alveolar ridge prior to implant placement. The aim of this case series is to present a novel approach to ridge expansion using only autogenous bone blocks. Methods: Patients with Kennedy Class I. and II. mandibles with insufficient bone width were included in this study. Ridge splitting was carried out with the use of a piezoelectric surgery device by preparing osteotomies and after mobilization of the buccal cortical by placing an autologous bone block harvested from the retromolar region as a spacer between the buccal and lingual cortical plates. Block-grafts were stabilized by osteosynthesis screws. Implant placement was carried out after a 3-month healing period. A total of 13 implants were placed in seven augmented sites of six patients.

Results: Upon re-entry, all sites healed uneventfully. Mean ridge width gain was 2.86 mm, range: 2.0-5.0 mm.

Conclusions: Clinical results of our study show that the modified ridge splitting technique is a safe and predictable method to restore width of the alveolar ridge prior to implant placement.

Keywords: alveolar bone loss; bone transplantation; dental implantation; mandibular ridge augmentation; piezo surgery.

Conflict of interest statement

This review article was supported by the NSK Europe GmbH and Hungarian Dental Association. These two institutes provided the piezoelectronic device (NSK Variosurg3 Ultrasonic Bone Surgery System) used in the study.

Figures

Figure 1
Figure 1
Clinical illustration of the surgical procedure of the modified ridge splitting. (A) Preoperative view of the atrophied alveolar ridge. (B) Full thickness flap preparation. (C) Buccal view of the osteotomies and the corticotomy. (D) The autologous bone block graft placed in the recipient site. (E) The graft was stabilized with osteosynthesis screws. (F) Tension free primary closure.

References

    1. Tallgren A. The continuing reduction of the residual alveolar ridges in complete denture wearers: A mixed-longitudinal study covering 25 years. J. Prosthet. Dent. 1972;27:120–132. doi: 10.1016/0022-3913(72)90188-6.
    1. Ulm C., Tepper G., Blahout R., Rausch-Fan X., Hienz S., Matejka M. Characteristic features of trabecular bone in edentulous mandibles. Clin. Oral Implants Res. 2009;20:594–600. doi: 10.1111/j.1600-0501.2008.01701.x.
    1. Reich K.M., Huber C.D., Lippnig W.R., Ulm C., Watzek G., Tangl S. Atrophy of the residual alveolar ridge following tooth loss in an historical population. Oral Dis. 2011;17:33–44. doi: 10.1111/j.1601-0825.2010.01699.x.
    1. Yoda N., Zheng K., Chen J., Li W., Swain M., Sasaki K., Li Q. Bone morphological effects on post-implantation remodeling of maxillary anterior buccal bone: A clinical and biomechanical study. J. Prosthodont. Res. 2017;61:393–402. doi: 10.1016/j.jpor.2016.12.010.
    1. Dottore A.M., Kawakami P.Y., Bechara K., Rodrigues J.A., Cassoni A., Figueiredo L.C., Piattelli A., Shibli J.A. Stability of implants placed in augmented posterior mandible after alveolar osteotomy using resorbable nonceramic hydroxyapatite or intraoral autogenous bone: 12-month follow-up. Clin. Implant Dent. Relat. Res. 2014;16:330–336. doi: 10.1111/cid.12010.
    1. Santagata M., Guariniello L., D’Andrea A., Tartaro G. A modified crestal ridge expansion technique for immediate placement of implants: A report of three cases. J. Oral Implantol. 2008;34:319–324. doi: 10.1563/1548-1336-34.6.319.
    1. Sheikh Z., Sima C., Glogauer M. Bone replacement materials and techniques used for achieving vertical alveolar bone augmentation. Materials. 2015;8:2953–2993. doi: 10.3390/ma8062953.
    1. Zakrzewski W., Dobrzynski M., Rybak Z., Szymonowicz M., Wiglusz R.J. Selected Nanomaterials’ Application enhanced with the use of stem cells in acceleration of alveolar bone regeneration during augmentation process. Nanomaterials. 2020;10:1216. doi: 10.3390/nano10061216.
    1. Tatum O. The omni implant system. Clarke’s Clin. Dent. 1984;5:126–127.
    1. Simion M., Baldoni M., Zaffe D. Jawbone enlargement using immediate implant placement associated with a split-crest technique and guided tissue regeneration. Int. J. Periodontics Restor Dent. 1992;12:462–473.
    1. Scipioni A., Bruschi G.B., Calesini G. The edentulous ridge expansion technique: A five-year study. Int. J. Periodontics Restor Dent. 1994;14:451–459. doi: 10.1097/00008505-199509000-00022.
    1. Basa S., Varol A., Turker N. Alternative bone expansion technique for immediate placement of implants in the edentulous posterior mandibular ridge: A clinical report. Int. J. Oral Maxillofac. Implant. 2004;19:554–558.
    1. Coatoam G.W., Mariotti A. The segmental ridge-split procedure. J. Periodontol. 2003;74:757–770. doi: 10.1902/jop.2003.74.5.757.
    1. Curie J., Curie P. Contractions et dilatations produites par des tensions dans les cristaux hémièdres à faces inclinées. C. R. Acad. Sci. Gen. 1880;93:1137–1140.
    1. Lynn J.G., Zwemer R.L., Chick A.J. The biological application of focused ultrasonic waves. Science. 1942;96:119–120. doi: 10.1126/science.96.2483.119.
    1. Vercellotti T., De Paoli S., Nevins M. The piezoelectric bony window osteotomy and sinus membrane elevation: Introduction of a new technique for simplification of the sinus augmentation procedure. Int. J. Periodontics Restor Dent. 2001;21:561–567.
    1. Peñarrocha-Diago M., Peñarrocha-Diago M., Sanchez-Recio C., Peñarrocha-Oltra D., Romero-Millán J. Osteotomy in direct sinus lift. A comparative study of the rotary technique and ultrasound. Med. Oral Patol. Oral Cir. Bucal. 2012;17:457–461. doi: 10.4317/medoral.17599.
    1. Gonzalez-Garcia A., Diniz-Freitas M., Somoza-Martin M., Garcia-Garcia A. Ultrasonic osteotomy in oral surgery and implantology. Oral Surg. Oral Med. Oral Pathol. Oral Radiol Endod. 2009;108:360–367. doi: 10.1016/j.tripleo.2009.04.018.
    1. Leclercq P., Zenati C., Dohan D.M. Ultrasonic bone cut part 2: State-of-the-art specific clinical applications. J. Oral Maxillofac. Surg. 2008;66:183–188. doi: 10.1016/j.joms.2005.12.050.
    1. Ella B., Laurentjoye M., Sedarat C., Coutant J., Masson E., Rouas A. Mandibular ridge expansion using a horizontal bone-splitting technique and synthetic bone substitute: An alternative to bone block grafting. Int. J. Oral Maxillofac. Implant. 2014;29:135–140. doi: 10.11607/jomi.2201.
    1. 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;20:251–258. doi: 10.4317/medoral.20194.
    1. Chappuis V., Cavusoglu Y., Buser D., von Arx T. Lateral Ridge Augmentation Using Autogenous Block Grafts and Guided Bone Regeneration: A 10-Year Prospective Case Series Study. Clin. Implant. Dent. Relat. Res. 2017;19:85–96. doi: 10.1111/cid.12438.
    1. Wang R.E., Lang N.P. Ridge preservation after tooth extraction. Clin. Oral Implants Res. 2012;23:147–156. doi: 10.1111/j.1600-0501.2012.02560.x.
    1. Roccuzzo M., Ramieri G., Bunino M., Berrone S. Autogenous bone graft alone or associated with titanium mesh for vertical alveolar ridge augmentation: A controlled clinical trial. Clin. Oral Implants Res. 2007;18:286–294. doi: 10.1111/j.1600-0501.2006.01301.x.
    1. Antoun H., Sitbon J.M., Martinez H., Missika P. A prospective randomized study comparing two techniques of bone augmentation: Onlay graft alone or associated with a membrane. Clin. Oral Implant. Res. 2001;12:632–639. doi: 10.1034/j.1600-0501.2001.120612.x.
    1. Moro A., Gasparini G., Foresta E., Saponaro G., Falchi M., Cardarelli L., De Angelis P., Forcione M., Garagiola U., D’Amato G., et al. Alveolar ridge split technique using piezosurgery with specially designed tips. Biomed. Res. Int. 2017;2017:4530378. doi: 10.1155/2017/4530378.
    1. Cortellini P., Pini Prato G., Tonetti M.S. Periodontal regeneration of human infrabony defects. II. Re-entry procedures and bone measures. J. Periodontol. 1993;64:261–268. doi: 10.1902/jop.1993.64.4.261.
    1. Holtzclaw D.J., Toscano N.J., Rosen P.S. Reconstruction of posterior mandibular alveolar ridge deficiencies with the piezoelectric hinge-assisted ridge split technique: A retrospective observational report. J. Periodontol. 2010;81:1580–1586. doi: 10.1902/jop.2010.100093.
    1. Gonzalez-Garcia R., Monje F., Moreno C. Alveolar split osteotomy for the treatment of the severe narrow ridge maxillary atrophy: A modified technique. Int. J. Oral Maxillofac. Surg. 2011;40:57–64. doi: 10.1016/j.ijom.2010.03.030.
    1. Ali Ramal M.E.M., Mohammed S., Nahed A. Modified staged ridge splitting technique versus conventional technique for horizontal expansion of narrow posterior mandible (randomized controlled clinical trial) Acta Sci. Dent. Sci. 2018;2:101–109.
    1. Tang Y.L., Yuan J., Song Y.L., Ma W., Chao X., Li D.H. Ridge expansion alone or in combination with guided bone regeneration to facilitate implant placement in narrow alveolar ridges: A retrospective study. Clin. Oral Implants Res. 2015;26:204–211. doi: 10.1111/clr.12317.
    1. Langer B., Langer L., Sullivan R.M. Planned labial plate advancement with simultaneous single implant placement for narrow anterior ridges followed by reentry confirmation. Int. J. Periodontics Restor. Dent. 2012;32:509–519.
    1. Montero J., Lopez-Valverde A., de Diego R.G. A retrospective study of the risk factors for ridge expansion with self-tapping osteotomes in dental implant surgery. Int. J.Oral Maxillofac. Implant. 2012;27:203–210.
    1. Blus C., Szmukler-Moncler S. Split-crest and immediate implant placement with ultra-sonic bone surgery: A 3-year life-table analysis with 230 treated sites. Clin. Oral Implants Res. 2006;17:700–707. doi: 10.1111/j.1600-0501.2006.01206.x.
    1. Scipioni A., Bruschi G.B., Calesini G., Bruschi E., De Martino C. Bone regeneration in the edentulous ridge expansion technique: Histologic and ultrastructural study of 20 clinical cases. Int. J. Periodontics Restor Dent. 1999;19:269–277.
    1. Mahmoud Z.T., Wainwright M., Troedhan A. Flapless piezotome crest split achieves comparable outcomes to autologous onlay grafts with significant less patient morbidity and complications—A randomized clinical study. J. Oral Maxillofac. Surg. 2020;S0278–2391:30582–30586. doi: 10.1016/j.joms.2020.06.008.
    1. Moghaddas H., Stahl S.S. Alveolar bone remodeling following osseous surgery. A clinical study. J. Periodontol. 1980;51:376–381. doi: 10.1902/jop.1980.51.7.376.
    1. Wood D.L., Hoag P.M., Donnenfeld O.W., Rosenfeld L.D. Alveolar crest reduction following full and partial thickness flaps. J. Periodontol. 1972;43:141–144. doi: 10.1902/jop.1972.43.3.141.
    1. Nickenig H.J., Safi A.F., Matta R.E., Zöller J.E., Kreppel M. 3D-based full-guided ridge expansion osteotomy—A case report about a new method with successive use of different surgical guides, transfer of splitting vector and simultaneous implant insertion. J. Craniomaxillofac Sug. 2019;47:1787–1792. doi: 10.1016/j.jcms.2019.07.025.
    1. Albanese M., Ricciardi G., Luciano U., Donadello D., Lucchese A., Gelpi F., Zangani A., De Santis D., Rizzini A., Rossetto A., et al. Alveolar splitting with Piezosurgery®, bone bank grafts and NobelActive implants as an alternative to major bone grafting for maxillary reconstruction. Minerva Stomatol. 2019;68:3–10. doi: 10.23736/S0026-4970.17.04006-7.
    1. Rocchietta I., Simion M., Hoffmann M., Trisciuoglio D., Benigni M., Dahlin C. Vertical bone augmentation with an autogenous block or particles in combination with guided bone regeneration: A clinical and histological preliminary study in humans. Clin. Implant. Dent. Relat. Res. 2016;18:19–29. doi: 10.1111/cid.12267.
    1. Demetriades N., Park J.I., Laskarides C. Alternative bone expansion technique for implant placement in atrophic edentulous maxilla and mandible. J. Oral Implantol. 2011;37:463–471. doi: 10.1563/AAID-JOI-D-10-00028.
    1. Williams B., Indresano A.T., O’Ryan F. Venous thromboembolism in oral and maxillofacial surgery: A review of the literature. J. Oral Maxillofac. Surg. 2011;69:840–844. doi: 10.1016/j.joms.2010.11.025.
    1. Nicolaides A., Hull R.D., Fareed J. General, vascular, bariatric, and plastic surgical patients. Clin. Appl. Thromb. Hemost. 2013;19:122–133. doi: 10.1177/1076029612474840c.
    1. Geerts W.H., Bergqvist D., Pineo G.F., Heit J.A., Samama C.M., Lassen M.R., Colwell C.W. Prevention of venous thromboembolism: American college of chest physicians evidence-based clinical practice guidelines (8th Edition) Chest. 2008;133:381s–453s. doi: 10.1378/chest.08-0656.
    1. Simurda T., Dobrotova M., Skornova I., Sokol J., Kubisz P., Stasko J. Successful use of a highly purified plasma von willebrand factor concentrate containing little FVIII for the long-term prophylaxis of severe (type 3) von willebrand’s disease. Semin. Thromb. Hemost. 2017;43:639–641.
    1. Simurda T., Kubisz P., Dobrotova M., Necas L., Stasko J. Perioperative coagulation management in a patient with congenital afibrinogenemia during revision total hip arthroplasty. Semin. Thromb. Hemost. 2016;42:689–692.
    1. Khoury F., Happe A. Soft tissue management in oral implantology: A review of surgical techniques for shaping an esthetic and functional peri-implant soft tissue structure. Quintessence Int. 2000;31:483–499.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi