Ridge Splitting Technique for Horizontal Augmentation and Immediate Implant Placement

Open access


Insufficient width of the alveolar ridge often prevents ideal implant placement. Guided bone regeneration, bone grafting, alveolar ridge splitting and combinations of these techniques are used for the lateral augmentation of the alveolar ridge. Ridge splitting is a minimally invasive technique indicated for alveolar ridges with adequate height, which enables immediate implant placement and eliminates morbidity and overall treatment time. The classical approach of the technique involves splitting the alveolar ridge into 2 parts with use of ostetomes and chisels. Modifications of this technique include the use of rotating instrument, screw spreaders, horizontal spreaders and ultrasonic device.

The purpose of this article is to thoroughly describe all the different approaches in ridge splitting technique. 2 interesting clinical cases of narrow alveolar ridges treated with ridge splitting and immediate implant placement are also presented.

1. 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.

2. Buser D, Mericske-Stern R, Bernard JP, Behneke A, Behneke N, Hirt HP, Belser UC, Lang NP. Long-term evaluation of non-submerged ITI implants. Part 1: 8-year life table analysis of a prospective multi-center study with 2359 implants. Clin Oral Implants Res, 1997; 8:161-172.

3. Lekholm U, Gunne J, Henry P, Higuchi K, Lindén U, Bergström C, van Steenberghe D. Survival of the Brånemark implant in partially edentulous jaws: a 10-year prospective multicenter study. Int J Oral Maxillofac Implants, 1999; 14:639-645.

4. Leonhardt A, Gröndahl K, Bergström C, Lekholm U. Longterm follow-up of osseointegrated titanium implants using clinical, radiographic and microbiological parameters. Clin Oral Implants Res, 2002; 13:127-132.

5. Lindquist LW, Carlsson GE, Jemt T. A prospective 15-year follow-up study of mandibular fixed prostheses supported by osseointegrated implants. Clinical results and marginal bone loss. Clin Oral Implants Res, 1996; 7:329-336.

6. van Steenberghe D. A retrospective multicenter evaluation of the survival rate of osseointegrated fixtures supporting fixed partial prostheses in the treatment of partial edentulism. J Prosthet Dent, 1989; 61:217-223.

7. Weber HP, Crohin CC, Fiorellini JP. A 5-year prospective clinical and radiographic study of non-submerged dental implants. Clin Oral Implants Res, 2000; 11:144-153.

8. Buser D, Brägger U, Lang NP, Nyman S. Regeneration and enlargement of jaw bone using guided tissue regeneration. Clin Oral Implants Res, 1990; 1:22-32.

9. Nevins M, Mellonig JT, Clem DS 3rd, Reiser GM, Buser DA. Implants in regenerated bone: long-term survival. Int J Periodontics Restorative Dent, 1998; 18:34-45.

10. Brunel G, Brocard D, Duffort JF, Jacquet E, Justumus P, Simonet T, Benqué E. Bioabsorbable materials for guided bone regeneration prior to implant placement and 7-year follow-up: report of 14 cases. J Periodontol, 2001; 72:257-264.

11. Hämmerle CH, Jung RE. Bone augmentation by means of barrier membranes. Periodontol 2000, 2003; 33:36-53.

12. Jung RE, Lecloux G, Rompen E, Ramel CF, Buser D, Hammerle CH. A feasibility study evaluating an in situ formed synthetic biodegradable membrane for guided bone regeneration in dogs. Clin Oral Implants Res, 2009; 20:151-161.

13. Machtei EE. The effect of membrane exposure on the outcome of regenerative procedures in humans: a metaanalysis. J Periodontol, 2001; 72:512-516.

14. Nyström E, Ahlqvist J, Kahnberg KE, Rosenquist JB. Autogenous onlay bone grafts fixed with screw implants for the treatment of severely resorbed maxillae. Radiographic evaluation of preoperative bone dimensions, postoperative bone loss, and changes in soft-tissue profile. Int J Oral Maxillofac Surg, 1996; 25:351-359.

15. Nevins M, Mellonig JT. Enhancement of the damaged edentulous ridge to receive dental implants: a combination of allograft and the GORE-TEX membrane. Int J Periodontics Restorative Dent, 1992; 12:96-111.

16. Chiapasco M, Abati S, Romeo E, Vogel G. Clinical outcome of autogenous bone blocks or guided bone regeneration with e-PTFE membranes for the reconstruction of narrow edentulous ridges. Clin Oral Implants Res, 1999; 10:278-288.

17. Blus C, Szmukler-Moncler S. Split-crest and immediate implant placement with ultra-sonic bone surgery: a 3-year life-table analysis with 230 treated sites. Clin Oral Implants Res, 2006; 17:700-707.

18. Lekholm U, Wannfors K, Isaksson S, Adielsson B. Oral implants in combination with bone grafts. A 3-year retrospective multicenter study using the Brånemark implant system. Int J Oral Maxillofac Surg, 1999; 28:181-187.

19. Chiapasco M, Romeo E, Vogel G. Tridimensional reconstruction of knife-edge edentulous maxillae by sinus elevation, onlay grafts, and sagittal osteotomy of the anterior maxilla: preliminary surgical and prosthetic results. Int J Oral Maxillofac Implants, 1998; 13:394-399.

20. Bahat O, Fontanessi RV. Efficacy of implant placement after bone grafting for three-dimensional reconstruction of the posterior jaw. Int J Periodontics Restorative Dent, 2001; 21:220-231.

21. Felice P, Pistilli R, Lizio G, Pellegrino G, Nisii A, Marchetti C. Inlay versus onlay iliac bone grafting in atrophic posterior mandible: a prospective controlled clinical trial for the comparison of two techniques. Clin Implant Dent Relat Res, 2009; 11:e69-82.

22. Schwartz-Arad D, Levin L, Sigal L. Surgical success of intraoral autogenous block onlay bone grafting for alveolar ridge augmentation. Implant Dent, 2005; 14:131-138.

23. Hodges NE, Perry M, Mohamed W, Hallmon WW, Rees T, Opperman LA. Distraction osteogenesis versus autogenous onlay grafting. Part II: biology of regenerate and onlay bone. Int J Oral Maxillofac Implants, 2006; 21:237-244.

24. Tatum H Jr. Maxillary and sinus implant reconstructions. Dent Clin North Am, 1986; 30:207-229.

25. Sethi A, Kaus T. Maxillary ridge expansion with simultaneous implant placement: 5-year results of an ongoing clinical study. Int J Oral Maxillofac Implants, 2000; 15:491-499.

26. Suh JJ, Shelemay A, Choi SH, Chai JK. Alveolar ridge splitting: a new microsaw technique. Int J Periodontics Restorative Dent, 2005; 25:165-171.

27. Blus C, Szmukler-Moncler S, Vozza I, Rispoli L, Polastri C. Split-crest and immediate implant placement with ultrasonic bone surgery (piezosurgery): 3-year follow-up of 180 treated implant sites. Quintessence Int, 2010; 41:463-469.

28. Bravi F, Bruschi GB, Ferrini F. A 10-year multicenter retrospective clinical study of 1715 implants placed with the edentulous ridge expansion technique. Int J Periodontics Restorative Dent, 2007; 27:557-565.

29. Koo S, Dibart S, Weber HP. Ridge-splitting technique with simultaneous implant placement. Compend Contin Educ Dent, 2008; 29:106-110.

30. Elian N, Jalbout Z, Ehrlich B, Classi A, Cho SC, Al-Kahtani F, Froum S, Tarnow DP. A two-stage full-arch ridge expansion technique: review of the literature and clinical guidelines. Implant Dent, 2008; 17:16-23.

31. Engelke WG, Diederichs CG, Jacobs HG, Deckwer I. Alveolar reconstruction with splitting osteotomy and microfixation of implants. Int J Oral Maxillofac Implants, 1997; 12:310-318.

32. Enislidis G, Wittwer G, Ewers R. Preliminary report on a staged ridge splitting technique for implant placement in the mandible: a technical note. Int J Oral Maxillofac Implants, 2006; 21:445-449.

33. 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; 12:462-473.

34. Han JY, Shin SI, Herr Y, Kwon YH, Chung JH. The effects of bone grafting material and a collagen membrane in the ridge splitting technique: an experimental study in dogs. Clin Oral Implants Res, 2011; 22:1391-1398.

35. Piccinini M. Mandibular bone expansion technique in conjunction with root form implants: a case report. J Oral Maxillofac Surg, 2009; 67(9):1931-1936.

36. Demarosi F, Leghissa GC, Sardella A, Lodi G, Carrassi A. Localised maxillary ridge expansion with simultaneous implant placement: a case series. Br J Oral Maxillofac Surg, 2009; 47:535-540.

37. Dene L, Condos S. Ridge expansion and immediate implant placement in the esthetic zone. N Y State Dent J, 2010; 76:28-31.

38. Chan HL, Fu JH, Koticha T, Benavides E, Wang HL. Ridge width gain with screw spreaders: a cadaver study. Implant Dent, 2013; 22:552-558.

39. Scipioni A, Calesini G, Micarelli C, Coppè S, Scipioni L. Morphogenic bone splitting: description of an original technique and its application in esthetically significant areas. Int J Prosthodont, 2008; 21:389-397.

40. Strietzel FP, Nowak M, Küchler I, Friedmann A. Periimplant alveolar bone loss with respect to bone quality after use of the osteotome technique: results of a retrospective study. Clin Oral Implants Res, 2002; 13:508-513.

41. Sohn DS, Lee HJ, Heo JU, Moon JW, Park IS, Romanos GE. Immediate and delayed lateral ridge expansion technique in the atrophic posterior mandibular ridge. J Oral Maxillofac Surg, 2010; 68:2283-2290.

42. Chiapasco M, Ferrini F, Casentini P, Accardi S, Zaniboni M. Dental implants placed in expanded narrow edentulous ridges with the Extension Crest device. A 1-3-year multicenter follow-up study. Clin Oral Implants Res, 2006; 17(3):265-272.

43. Siddiqui AA, Sosovicka M. Lateral bone condensing and expansion for placement of endosseous dental implants: a new technique. J Oral Implantol, 2006; 32(2):87-94.

44. Nishioka RS, Souza FA. Bone spreader technique: a preliminary 3-year study. J Oral Implantol, 2009; 35:289-294.

45. Anitua E, Begoña L, Orive G. Clinical evaluation of splitcrest technique with ultrasonic bone surgery for narrow ridge expansion: status of soft and hard tissues and implant success. Clin Implant Dent Relat Res, 2013; 15:176-187.

46. Anitua E, Begoña L, Orive G. Controlled ridge expansion using a two-stage split-crest technique with ultrasonic bone surgery. Implant Dent, 2012; 21:163-170.

47. Peñarrocha M, Pérez H, Garciá A, Guarinos J. Benign paroxysmal positional vertigo as a complication of osteotome expansion of the maxillary alveolar ridge. J Oral Maxillofac Surg, 2001; 59:106-107.

48. Scipioni A, Bruschi GB, Calesini G. The edentulous ridge expansion technique: a five-year study. Int J Periodontics Restorative Dent, 1994; 14:451-459.

49. Chiapasco M, Zaniboni M, Boisco M. Augmentation procedures for the rehabilitation of deficient edentulous ridges with oral implants. Clin Oral Implants Res, 2006; 17:136-159.

Balkan Journal of Dental Medicine

Successor of the Balkan Journal of Stomatology

Journal Information


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 580 580 37
PDF Downloads 166 166 14