Alternative Bone Expansion Technique for Implant Placement in Atrophic Edentulous Maxilla and Mandible

This clinical review is an evaluation of the effectiveness of the split ridge bone augmentation technique performed in the atrophic maxilla and mandible with buccolingual bony defects. The osseointegration success of implant placement in the area of split ridge bone augmentation is assessed and compared to implant success rates indicated in the literature. This evaluation includes 15 patients who were treated with alveolar split ridge bone augmentation at Tufts University School of Dental Medicine. During initial consultation, all patients were diagnosed with a buccolingual bone dimension of 3-5 mm on the edentulous alveolar crest. This bony buccolingual dimension was inadequate for placement of implants of desirable width and correct angulation as dictated by the prosthetic requirements. Crestal split augmentation technique involved a surgical osteotomy that was followed by alveolar crest split and augmentation after buccolingual bony plate expansion, prior to implantation. Implants were placed either immediately or 3 weeks after the initial augmentation. No fixation was used to stabilize the buccal bony cortex after the completion of the augmentation. All patients were placed on periodic follow-ups for a 24-month period postoperatively. Implant success was determined with the use of Buser's Criteria. In total, 33 implants were placed in 15 patients. The overall success rate of osseointegration of the endosseous implants placed in the area of split ridge bone augmentation was found to be 97%. One patient presented with facial bone resorption and implant mobility 4 months after the surgery. The implant was removed and the area was reconstructed with autogenous bone graft and later implanted with an endosseous implant. Our results indicate that the split crest bone augmentation technique is a valid reconstructive procedure that can be used to augment the buccolingual alveolar defect prior to implant placement providing good bone foundation for placement of implants with desirable width in favorable angulation. In comparison to traditional bone grafts techniques, crestal split ridge bone augmentation enables placement of dental implants immediately or 3 weeks after augmentation and eradicates the possible morbidity of the donor sites.