Alveolar ridge split and expansion with simultaneous implant placement in mandibular posterior sites using motorized ridge expanders - modified treatment protocol

Abstract

Purpose: "The purpose of the study is to evaluate alveolar ridge split and expansion (ARSE) with simultaneous implant placement in mandibular posterior implant sites using motorized ridge expanders."

Background: The ARSE is used in the management of horizontally deficient (narrow) alveolar ridge with optimum bone height available. The ARSE procedure in the posterior mandible has limited application as per literature. The successful cases reported are with extensive procedure of the osteo-mobilization with four corticotomies on buccal side. The authors presented the study of mandibular posterior implant sites using motorized ridge expanders. The ARSE performed here was by only crestal osteotomy simple osteo-condensation and immediate implant insertion.

Materials and methods: The study was prospective type. The sample size was 15 patients and 31 implant sites. The study population included partially edentulous patients between 18 years and 60 years indicated for implant-supported prosthesis. The outcome variables studied included gain in ridge width, cervical bone loss, success of implant, and survival rate. Successful surgical outcome was evaluated by Buser's criteria. The data collected was evaluated by differential statistics.

Conclusion: The minimally invasive technique of one-stage ARSE performed with motorized ridge expander and insertion of implant in the same operative procedure decreases the morbidity, treatment time, number of surgical procedures, and the risk of complications, thereby, increasing patient acceptance. In this study, the authors have used this technique in the posterior mandible for narrow ridges (minimum 3 mm) and obtained promising results. The survival rate of the implants was 100% and the gain in ridge width was 3.2 mm. The author has also recommended the protocol according to bone density of mandible.

Keywords: Alveolar ridge split and expansion; bone density; horizontal ridge deficiency; immediate implant; mandible; motorized ridge expanders; narrow ridge; one stage ridge split; ridge width.

Figure 1

The motorized ridge split kit consisting of rotating saw and set of sequential drills

Figure 2

Clinical presentation of Case no 3 showing missing 35, 36, 37

Figure 3

Cone beam computed tomography cross section of Case no 3 at dental implant site 35

Figure 4

Cone beam computed tomography cross section of Case no 3 implant site 36

Figure 5

Implant site marking with pilot drill and crestal osteotomy in an intraoperative illustration of Case no 3

Figure 6

Intra-operative illustration after use of sequential expanders showing widened crestal osteotomy and implant site osteotomy of Case no 3

Figure 7

Intra-operative illustration showing the cover screw of implants inserted in implant osteotomy of Case no 3

Figure 8

Illustration of Case no 5 showing intraoral missing 45, 46 and intra operative crestal split and implant with cover screw

Figure 9

The digital intra-oral periapical image of Case no 5 taken after implant insertion showing two implants in 45, 46 sites

Figure 10

The digital intra-oral periapical image of Case no 5, 6-month postimplant insertion at the time of prosthetic loading showing good osseointegration and maintained cervical bone level

Figure 11

The digital intraoral periapical image of Case no 5, 6 months after prosthesis that is 1-year postimplant insertion showing good osseointegration and maintained cervical bone level

Figure 12

Orthopantomogram of Case no 1 showing missing teeth no 43 to 47

Figure 13

Orthopantomogram 3-year postprosthesis of Case no 1 showing implant with prosthesis in 43, 44, and 46 sites with maintained cervical bone level and good osseointegration