Staged ridge-split evaluated using cone beam computed tomography and peri-implant plastic surgery in the mandibular arch

Nikhil Vasant Jain; Purva H. Shinde; Gaurav R. Poplai; Affaf A. Gharatkar

doi:10.4103/2278-9626.163339

European Journal of General Dentistry, Table of Contents

CC BY-NC-ND 4.0 · European Journal of General Dentistry 2015; 4(03): 140-144
DOI: 10.4103/2278-9626.163339

Case Report

Staged ridge-split evaluated using cone beam computed tomography and peri-implant plastic surgery in the mandibular arch

Nikhil Vasant Jain

Department of Maxillofacial Prosthodontics and Oral Implantology, M. A. Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India

,

Purva H. Shinde

Department of Maxillofacial Prosthodontics and Oral Implantology, M. A. Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India

,

Gaurav R. Poplai

²Department of Conservative Dentistry and Endodontics, Terna Dental College, Navi Mumbai, Maharashtra, India

,

Affaf A. Gharatkar

¹Department of Conservative Dentistry and Endodontics, M. A. Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India

› Author Affiliations

Abstract

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Abstract

Lack of sufficient bone to place an implant at a functionally and an esthetically appropriate position is a common problem, especially in the mandibular posterior region. Narrow edentulous alveolar ridges <5 mm wide require bone augmentation before implant placement to establish a bony wall of at least 1 mm around the endosseous implant. Various surgical widening techniques are available, including lateral augmentation with or without guided bone regeneration, ridge-split technique and horizontal distraction osteogenesis. The ridge-split technique aims at creating a new implant bed by longitudinal osteotomy of the alveolar bone. The buccal cortex is repositioned laterally by greenstick fracture, and the space between the buccal and lingual cortices is filled with a graft material. Peri-implant plastic surgery focuses on harmonizing peri-implant structures by means of hard- and soft-tissue engineering and includes bone structure enhancement, soft-tissue enhancement, precision in implant placement and improves quality of the prosthetic restoration. The rationale for the peri-implant plastic surgery approach goes well beyond pure esthetics as it creates peri-implant keratinized mucosa and interimplant soft-tissue height in order to avoid food impaction, interimplant airflow, and speech problems. This case report demonstrates a staged ridge-split technique evaluated with cone beam computed tomography using a piezosurgical unit and a surgical technique to restore a papilla-like tissue at the time of the second-stage implant surgery.

Keywords

Alveolar ridge - cone beam computed tomography - grafting - peri-implant plastic surgery - piezosurgery - ridge-split

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References

References
1 Buser D, Martin W, Belser UC. Optimizing esthetics for implant restorations in the anterior maxilla: Anatomic and surgical considerations. Int J Oral Maxillofac Implants 2004;19 Suppl: 43-61.
2 Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: A review and proposed criteria of success. Int J Oral Maxillofac Implants 1986;1:11-25.
3 Shulman LB. Surgical considerations in implant dentistry. J Dent Educ 1988;52:712-20.
4 Andersson B, Odman P, Widmark G, Waas A. Anterior tooth replacement with implants in patients with a narrow alveolar ridge form. A clinical study using guided tissue regeneration. Clin Oral Implants Res 1993;4:90-8.
5 De Boever AL, De Boever JA. A one-stage approach for nonsubmerged implants using a xenograft in narrow ridges: Report on seven cases. Int J Periodontics Restorative Dent 2003;23:169-75.
6 Bedrossian E, Tawfilis A, Alijanian A. Veneer grafting: A technique for augmentation of the resorbed alveolus prior to implant placement. A clinical report. Int J Oral Maxillofac Implants 2000;15:853-8.
7 Cordaro L, Amadé DS, Cordaro M. Clinical results of alveolar ridge augmentation with mandibular block bone grafts in partially edentulous patients prior to implant placement. Clin Oral Implants Res 2002;13:103-11.
8 Simion M, Baldoni M, Zaffe D. Jawbone enlargement using immediate implant placement associated with a split-crest technique and guided tissue regeneration. Int J Periodontics Restorative Dent 1992;12:462-73.
9 Takahashi T, Funaki K, Shintani H, Haruoka T. Use of horizontal alveolar distraction osteogenesis for implant placement in a narrow alveolar ridge: A case report. Int J Oral Maxillofac Implants 2004;19:291-4.
10 Engelke WG, Diederichs CG, Jacobs HG, Deckwer I. Alveolar reconstruction with splitting osteotomy and microfixation of implants. Int J Oral Maxillofac Implants 1997;12:310-8.
11 Duncan JM, Westwood RM. Ridge widening for the thin maxilla: A clinical report. Int J Oral Maxillofac Implants 1997;12:224-7.
12 Palacci P, Nowzari H. Soft tissue enhancement around dental implants. Periodontol 2000 2008;47:113-32.
13 Summers RB. A new concept in maxillary implant surgery: The osteotome technique. Compendium 1994;15:152.
14 Scipioni A, Bruschi GB, Calesini G. The edentulous ridge expansion technique: A five-year study. Int J Periodontics Restorative Dent 1994;14:451-9.
15 Summers RB. The osteotome technique: Part 2 - The ridge expansion osteotomy (REO) procedure. Compendium 1994;15:422-6.
16 Summers RB. The osteotome technique: Part 3 - Less invasive methods of elevating the sinus floor. Compendium 1994;15:698-704.
17 Holtzclaw DJ, Toscano NJ, Rosen PS. Reconstruction of posterior mandibular alveolar ridge deficiencies with the piezoelectric hinge-assisted ridge split technique: A retrospective observational report. J Periodontol 2010;81:1580-6.
18 Vercellotti T. Technological characteristics and clinical indications of piezoelectric bone surgery. Minerva Stomatol 2004;53:207-14.
19 Schlee M, Steigmann M, Bratu E, Garg AK. Piezosurgery: Basics and possibilities. Implant Dent 2006;15:334-40.
20 Hertel RC, Blijdorp PA, Baker DL. A preventive mucosal flap technique for use in implantology. Int J Oral Maxillofac Implants 1993;8:452-8.