Introduction One of the most important factors in a successful implant will be, first of all, securing sufficient available bone. In order to have enough available bone for implant placement, dentists use a variety of bone augmentations such as GBR, Ridge split and Block bone graft, etc. Among them, the ridge split technique is an excellent technique in terms of extending the alveolar bone of the patient and completing the bone wall surrounding the implant with the patient’s own cortical bone. In this regard, we will look into the clinical case using Neobiotech’s Ridge Wider Kit, which makes the ridge split procedure more convenient and safe.
Pre-operative procedure
The patient in this case who was a female in her 40s came to the clinic to remove the old bridge on #34-#38 and replace it with implant on #36 and 37. #38 was extracted and crown was planned to place on #34, 35 natural teeth then implant placement was planned on #36 and 37.
After the incision and flap reflection, narrow alveolar ridge on buccal area is visible. In this state, the horizontal bone augmentation is required because buccal dehiscence is predicted in implant placement. In this case, the horizontal bone augmentation will be obtained by ridge splitting.
To level the alveolar ridge, use the bone trimmer in Ridge Wider Kit to make the area flat, then use safe disk to cut the width of buccal and lingual area. The protective covers in a semi-circular form are fitted to prevent any injury caused by sharp disc, so if only the handpiece is ensured, the alveolar bone can be cut safely.
Osteotomy for implant placement is performed by 1.5mm initial drilling. Then continue to use the safe disk to make a cut little by little. The horizontal osteotomy as well as the vertical osteotomy need to be performed to achieve sufficient bone expansion for implant placement, because unlike the maxilla, the mandible has less cancellous bone and lacks the elasticity of the bone. In this case, two vertical osteotomy were done on mesial and distal side.
After cutting with a disc, use a chisel to perform slight bone expansion initially.Then increase the bone expander sequentially by diameter, and perform the expansion gradually.The implant is placed after the bone expansion and is performed very slowly using a bone expander at 25~35rpm similar to that of implant placement.
After greenstick separation of buccal plate, screw was used for fixation of buccal bone wall. At this time, the sharp cortical plate that protrudes into buccal area due to vertical osteotomy must be gently trimmed to avoid soft tissue perforation even after suturing. Then allografts were placed between the space of bone.
After bone graft, resorbable collagen membrane was used then suture the soft tissue.
About 4 to 5 months after the 1st surgery, flap reflection was done for 2nd surgery and very successful bone augmentation can be seen.
The fixing screws that had been fixed to the buccal area were removed and healing abutment was placed. The greatest advantage of ridge splitting is that the buccal wall surrounding the implant is pristine cortical bone. It is difficult to obtain a cortical bone of buccal wall in a short period of time in GBR with alloplastic bone or xenograft.
Horizontal bone augmentation was achieved by ridge splitting. However, the keratinized gingiva around the implant was so insufficient, so free gingival graft was done after. Although keratinized gingiva is not essential to the success of implant, it helps to stabilize the implant for a long-term period, so it is better to secure it if possible.
Final restoration
This is the cement-type final prosthesis after final abutment. Longterm stability can be expected due to sufficient bone augmentation and keratinized gingiva of #36 and 37.
Conclusion Currently, a variety of bone augmentation are being performed in implant cases and there are pros and cons in each procedures. GBR is the most widely used technique, but ridge splitting is also very useful one if only the proper instruments are equipped in situations where horizontal bone augmentation is required.In particular, the advantage of ridge splitting is that, bone augmentation can be achieved by preserving the condition of cortical bone of the patient, whereas in GBR, bone grafting that may causes decreasing of bone quality is needed.In Neobiotech’s Ridge Wider Kit, it is composed of bone trimmer, safe disk, chisel, bone expander. So it is very convenient and safe instrument to execute the ridge split.Ridge splitting is a very good horizontal bone augmentation in a horizontal bone deficiency case, if applied to appropriate indications.