Evaluation of the Outcome of Implant Placement Concerted with the Ridge Split and Expansion Technique

Abstract

Introduction: The alveolar ridge resorption is inevitable and progressive if the teeth are lost after tooth extraction. Bone remodelling results in the reduction of the bucco-lingual width of the alveolar ridge in its horizontal dimension and compromises the placement of dental implants.³ Various literature states that the alveolar ridge loss six months after extraction is approximately five mm in width and one mm in height¹ . Hence the primary limiting factor to place a typical standard diameter implant is inadequate ridge width. Various methods like onlay bone grafting, alveolar distraction osteogenesis, osteotomy, Guided bone regeneration, ridge split techniques.are endorsed in splitting and expanding the ridge to receive a normal standard diameter implant.  Dr. Hilt Tatum introduced the split ridge technique in early 1970s.⁶ This technique involves longitudinal osteotomy with the use of hand instruments, rotating burs or ultrasonic devices and create a green stick fracture. The ridge expansion can be done by using osteotomes, chisels or screw spreaders. Ridge Split and Expansion technique with micro saw and expansion drills is a noninvasive procedure which provides least trauma to the patients, and this procedure demands less time.⁷

Objectives: To investigate the volume of bone gain buccolingually at the crest after the Ridge Split Procedure

Methods: A total of 20 sites (10 in anterior maxilla and 10 in posterior mandible) was choosen to evaluate the                    efficacy of ridge split technique among 15 patients of both gender, aged between 20-40 years, who reported to the Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Vijayawada with partially edentulous site in anterior maxilla and posterior mandible were selected for the study. Implant placement was done using ridge split technique. Radiographic evaluation was performed after 3^rd and 9^th month to measure the Bucco-lingual crestal bone width at the center of the implants by CBCT. The results were compared with the pre-operative baseline measurements. 

Results: The difference in bone volume measured using CBCT in the maxillary arch among pre-op & 3 month post-op, pre-op & 9 months post-op and 3 month post-op & 9 months post-op appears to be statistically significant with a p value of 0.000, 0.000 and 0.003 respectively (p<0.05). The difference in bone volume measured using CBCT in the mandibular arch among pre-op & 3 month post-op, pre-op & 9 months post-op and 3 month post-op & 9 months post-op appears to be statistically significant with a p value of 0.000, 0.000 and 0.037 respectively (p<0.05).

  Conclusions:We could achieve a mean increase in buccolingual width from 4.2 mm and 3.9 mm pre operatively to 7.98 mm and 7.29 mm in maxilla and mandible respectively. There is significant increase in the bone volume in immediate Post-op,3rd month and 9th month post-op compared to pre-op measurements made using both CBCT & Surgical caliper. Based on this study, it can be concluded that, Micro saw and expansion drills are safe, less sensitive, less expensive and an efficient bonecutting and expanding device without risk which can be used for ridge splitting and implant site preparation