Journal of Dental Implants
   About JDI | Editorial | Search | Ahead of print | Current Issue | Archives | Instructions | Subscribe | Login 
Users Online: 548  Wide layoutNarrow layoutFull screen layout Home Print this page  Email this page Small font size Default font size Increase font size


 
 
Table of Contents
CASE REPORT
Year : 2011  |  Volume : 1  |  Issue : 2  |  Page : 97-100

Narrow ridge augmentation technique for improved immediate oral implant placement


1 Department of Periodontia, KSR Institute of Dental Sciences and Research, KSR Kalvinagar, Tiruchengode, India
2 PG Student, Department of Periodontia, JKK Nataraja Dental College, Komarapalayam, Tamil Nadu, India

Date of Web Publication30-Dec-2011

Correspondence Address:
S Elanchezhiyan
65-A, IYANKADU, Devasthanampudur, Namagiripet, Namakkal, Tamil Nadu - 637 406
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-6781.91290

Rights and Permissions
   Abstract 

Resorption ridges often pose hindrance in oral implant placement. Inadequate width of ridge requires some more innovative techniques in placing implants. One of such techniques is ridge splitting technique, which helps expansion of narrow ridge with or without fracture of cortical plates. This technique has the advantage of immediate implant loading, in comparison with other ridge widening techniques. This article deals a case study using the ridge splitting technique with the conclusion of, it could be consider as novel technique for implant placement in narrow ridges.

Keywords: Immediate loading, implant placement, narrow ridge, ridge splitting


How to cite this article:
Elanchezhiyan S, Vennila K. Narrow ridge augmentation technique for improved immediate oral implant placement. J Dent Implant 2011;1:97-100

How to cite this URL:
Elanchezhiyan S, Vennila K. Narrow ridge augmentation technique for improved immediate oral implant placement. J Dent Implant [serial online] 2011 [cited 2020 Sep 22];1:97-100. Available from: http://www.jdionline.org/text.asp?2011/1/2/97/91290


   Introduction Top


Sufficient bone quantity will be an essential pre-requisite for implant placement in oral implant therapy. [1] Many etiologies as extraction, trauma, periodontal disease resulting in decreasing the bone quantity, ended with both vertical and horizontal bone loss. Inadequate horizontal bone volume often results in an implant surface exposure and consequent decrease bone-implant interface and potential implant failure.

To enhance the bone volume in implant therapy, several techniques are used. They are like bone grafting, guided bone regeneration (GBR), distraction osteogenesis. Residual ridge widening is another novel method to prepare atrophic jaw bones for implant placing.

The ridge splitting technique also called as widening technique first done by Hilt Tatum and further developed by Summers [2] followed by greenstick fracture technique with membrane closure for root form ceramic implants by Bruschi and Scipioni. This technique is useful in widening the narrow ridge for implant placement. Suitable for only increasing the width of the ridge, 3-5 mm width will be ideal corresponding to the implant diameter with available adequate bone height.

The ridge splitting technique having the advantage over ridge augmentation techniques as bone grafting may be the simultaneous implant placement. The simultaneous implant placement shortens the treatment period in comparison with other techniques. [3]

Technique

The patient evaluation and preparation for implant placement is similar to preparing for other implant procedures. Started with the bone height calculation by conventional radiograph, advanced CT scanning may also be advocated. [4] Starting the procedure with crestal incision along the ridge crest and minimum mucoperiosteal flap reflection is performed to expose only the crest ridge. The lateral cortices periosteum should remain intact to ensure blood supply to the underlying bone. A round-handed scalpel with a #15 or round tip Beaver blade is used to begin the osteotomy. The osteotomy should bisect the ridge crest and separate the cortical plates. A mallet may be used to advance the scalpel blade through the bone. The handle of the scalpel blade through the bone should be parallel to the cortex. The length of the osteotomy along the edentulous span should extend well beyond the planned implant sites. After crestal osteotomy is completed, thin chisels, osteotomes, tapered fissure burs, or saws may be used to separate the cortices and begin the ridge expansion. If possible, the depth of the osteotomy should be extended beyond the planned length of the implant, which will allow a hinging of bony plates at the base of the ridge split osteotomy. Gradual expanding of the ridge will be done by wider chisels or osteotomes. Bone grafts included may be with platelet rich plasma in implant placement. The graft is covered with bio-resorbable membrane followed by flap approximation. [5] For primary wound closure, the split thickness is flap dissected from facial part. Adequate implant healing time (minimum 3 months) is needed to allow regeneration of the bone between the separate plates.


   Case Report Top


A 41-year-old woman was referred for prosthetic treatment associated with implant placement in the anterior edentulous maxilla in relation to upper central incisors [Figure 1] Clinical examination revealed an edentulous margin with obvious labial and palatal bone resorption. Clinical and radiographic examination showed that the ideal vertical bone height and inter arch space both favor implant placement. The ridge width of 5 mm was not adequate for implant placement; it was decided to augment the alveolar crest horizontally.
Figure 1: Preoperative

Click here to view


Procedure

With 2% lidocaine local anesthesia, a full thickness flap was raised to expose the defect, and surface of the bone was freed from the remaining muscle and periosteal fibers. The initial osteotomy was performed on mid-crestal bone using a #15 blade [Figure 2]. Chisels of increasing width and a mallet were used to further enlarge the osteotomy to a point 3 mm shorter than the final length of the implants placed [Figure 3]. Approximately 2-3 mm of expansion was achieved without performing vertical incisions in the bone [Figure 4]. Sequential surgical burs according to standard implant placement protocol were used to prepare the osteotomy site for implant placement up to the final length of the implants. The implants were placed [Figure 5] and presented with initial primary stability, the cover screws were placed and implants were submerged for a healing period of 4 months. The widened space between cortical plates were densely filled with a mix of bone filler (Bio-OSS) and surfaced with bioresorbable collagen membrane [Figure 6]. The flaps were approximated and patient was instructed not to give any pressure on the healing site.
Figure 2: Crestal splitting

Click here to view
Figure 3: Midcrestal osteotomy

Click here to view
Figure 4: Osteotomy

Click here to view
Figure 5: Implant placement

Click here to view
Figure 6: Bone grafting around implants

Click here to view


Second surgery was performed 4 months later, healing abutments were placed and the soft tissue was allowed to heal for an additional 5 weeks. Splinted porcelain fused-to-metal crowns then were delivered [Figure 7]. Post operative X-ray was taken for recheck the implant condition before placing prosthetic components [Figure 8].
Figure 7: Final prosthetic restoration

Click here to view
Figure 8: 6 months post-operative X-ray

Click here to view



   Discussion Top


The ridge splitting technique allows single procedure implant placement in a narrow crestal ridge. The surgical success and implant survival rate are high, with the advantage of shorter treatment period. [6] Though partial thickness flaps also advocated by many authors, full thickness flaps were used to avoid excessive bleeding, resulting in better visualization of the operating sites and better handling of the surgical steps. The partial thickness flap procedure becomes difficult, if there is thin connective tissue, and remaining tissue over the alveolar bone is too thin to protect the bone adequately. [7] The unexpected cortical plate factures may be retained with bone fixation screws. [8] If the primary stability of the implants is compromised, placement of implants should be done only after the healing of the augmented site.

The dense mandibular bone requires different approach in ridge splitting in comparison with the maxilla. [9] Maxillary crestal osteotomy may be done with chisels and without the assistance of the surgical burs. Plate expansion may be done with a mallet without vertical osteotomy. In mandible, however, surgical burs are used in initial osteotomy along with two vertical osteotomies.

The possibility of treating only horizontal defects and necessity of spongy bone are the limitations of the technique. The following are the benefits of ridge splitting technique in comparison to other techniques. [10]

  1. It allows less invasive manner implant placement and avoids donor-site morbidity caused by bone grafting and
  2. It allows primary implant placement and short treatment time.


It allows treatment of narrow ridge location within the context of a routine dental office procedure.


   Conclusion Top


This article gives a brief view on implant placement in narrow ridge crests using the ridge-splitting technique. The correct indication associated with careful clinical maneuvers of the ridge-splitting technique allows predictable placement of implants even in narrow alveolar ridges.

 
   References Top

1.Lekholm V, Zarb GA. Patient selection and preparation, Tissue-integrated prostheses: Ossteo integration in Clinical Dentistry. Chicago: Quintessence; 1985. p. 199-204.  Back to cited text no. 1
    
2.Summers RB. A new concept in maxillary implants surgery: An osteotome technique. Contin Educ Dent 1994;15:152-60.  Back to cited text no. 2
    
3.Scipioni A, Brusch GB, Giargia M, Bergulunth T, Lindhe J. Healing at implants with or without primary bone contact. An experimental study in dogs. Clin Oral Impl Res 1997;8:39-47.  Back to cited text no. 3
    
4.Rosenfeld AL, Mecall RA. The use of interactive computed tomography to predict the esthetic and functional elements of implant-supported prostheses. Compend Cont Educ Dent 1996;17:1125-44.  Back to cited text no. 4
    
5.Misch CM. Ridge augmentation using mandibular ramous bone grafts for the placement of dental implants: Presentation of a technique. Prac Periodontics Aesthet Dent 1996;8:127-35, quiz 138.  Back to cited text no. 5
    
6.Chiapasco M, Zaniboai M, Boisco M. Augmentation procedures for the rehabilitation of deficient edentulous ridges with oral implants. Clin Oral Implants Res 2006;17 (Suppl 2):136-59.  Back to cited text no. 6
    
7.Wood DL, Hoag PM, Donnenfeld OW, Rosenfeld LD. Alveolar crest reduction following full and partial thickness flaps. J Periodontol 1972;43:141-4.  Back to cited text no. 7
[PUBMED]    
8.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 Implants 2004;19:554-8.  Back to cited text no. 8
[PUBMED]    
9.Chiapasco M, Ferrini F, Casentini P, Accardi S, Zaniboni M. Dental implants placed in expanded narrow edentulous ridges with the extension crest devise. A 1-3 year multicenter follow up study. Clin Oral Implants Res 2006;17:265-72.  Back to cited text no. 9
[PUBMED]  [FULLTEXT]  
10.Rominger JW, Triplett RG. The use of guided bone regeneration to improve implant ossteointegration. J Oral Maxillofac Surg 1994;52:106-13.  Back to cited text no. 10
[PUBMED]  [FULLTEXT]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Case Report
   Discussion
   Conclusion
    References
    Article Figures

 Article Access Statistics
    Viewed4514    
    Printed144    
    Emailed0    
    PDF Downloaded763    
    Comments [Add]    

Recommend this journal