Radiographic Evaluation of Crestal Bone Level in Split-Crest and Immediate Implant Placement: Minimum 5-Year Follow-up

Alveolar ridge bone changes in patients treated with the split-crest technique with simultaneous implant placement: A retrospective longitudinal observational study

OBJECTIVES

To investigate long-term alveolar ridge bone changes in patients treated with the split-crest technique (SCT) with simultaneous implant placement.

MATERIALS AND METHODS

Alveolar ridge width (ARW) was measured with a caliper immediately before (ARW1) and after SCT (ARW2) with a caliper. Existing CBCT scans taken at least 5 years postoperatively were used to assess the healed ARW (ARWF), buccal bone thickness (BBT), and lingual/palatal bone thickness (L/PBT) at 0, 3, and 5 mm apically from implant platform level (IPL). The distance between IPL and buccal bone crest (IPL-BBC) was also measured. Findings were compared with Wilcoxon and Student's t tests (p < .05).

RESULTS

Records of thirty patients with 85 implants were included. Eleven patients (31 implants) presented CBCT scans taken in two separate occasions, resulting in 116 measurements. Tomographic follow-up ranged from 5 to 18 years (11.5 ± 4.18 years). Mean ARW increased from 3.2 ± 0.6 to 6.6 ± 0.48 mm after SCT, but significantly reduced overtime to 4.46 ± 0.83 mm (ARWF) (p < .0001). Mean BBT was 0.5 ± 0.9, 1.3 ± 0.9, and 2.0 ± 1.2 mm, while mean L/PBT was 0.9 ± 0.7, 1.6 ± 0.9, and 2.1 ± 1.0 mm at 0, 3, and 5 mm from IPL, respectively. IPL-BBC distance varied up to 8.7 mm (1.4 ± 2.0 mm), with 56/116 measurements (51/85 implants) showing IPL-BBC = 0 mm.

CONCLUSION

Although SCT with simultaneous implant placement can predictably increase ARW postoperatively, ARW tended to significantly reduce over time, due to reductions in BBT and L/PBT, especially coronally. Nonetheless, 60% of the implants still presented some buccal bone at IPL.

Tomographic assessment of bone changes in atrophic maxilla treated by split-crest technique and dental implants with platelet-rich fibrin and NanoBone® versus platelet-rich fibrin alone: Randomized controlled trial

BACKGROUND

This study evaluated the clinical benefits of adding NanoBone® with split-crest technique and simultaneous implant placement covered with platelet-rich fibrin membrane in horizontally deficient maxillary ridges in terms of crestal and horizontal bone changes and patient morbidity.

METHODS

Forty patients indicated for maxillary ridge splitting and simultaneous implant placement were assigned randomly to the study groups: control group (Platelet Rich Fibrin membrane) and test group (Platelet Rich Fibrin membrane + Nanobone®). The Cone Beam Computed Tomography Fusion technique was utilized to assess crestal and horizontal bone changes after five months of the surgical procedure. Patient morbidity was recorded for one week post-surgical.

RESULTS

Five months post-surgical, buccal crestal bone resorption was 1.26 ± 0.58 mm for the control group and 1.14 ± 0.63 mm for the test group. Lingual crestal bone resorption was 1.40 ± 0.66 mm for the control group and 1.47 ± 0.68 mm for the test group. Horizontal bone width gain was 1.46 ± 0.44 mm for the control group and 1.29 ± 0.73 mm for the test group. There was no significant statistical difference between study groups regarding crestal and horizontal bone changes and patient morbidity.

CONCLUSIONS

The tomographic assessment of NanoBone® addition in this study resulted in no statistically significant difference between study groups regarding crestal and horizontal bone changes and patient morbidity. More randomized controlled clinical trials on gap fill comparing different bone grafting materials versus no grafting should be conducted.

CLINICALTRIALS

GOV REGISTRATION NUMBER

NCT02836678, 13th January 2017.

The efficacy of alveolar ridge split on implants: a systematic review and meta-analysis

OBJECTIVES

To evaluate the effects of the alveolar ridge split (ARS) technique on gained horizontal width of the alveolar ridge and implant survival rate.

MATERIALS AND METHODS

Electronic searching was performed in six electronic databases (Pubmed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, and SIGLE) from January 1, 2010, to November 1, 2023. Two authors performed study selection, data extraction, and study qualities (ROBINS-I and RoB 2.0) independently. Meta-analysis was performed by Comprehensive meta-analysis 3.0.

RESULTS

24 included studies were observational, and 1 study was a randomized controlled trial (RCT). 14 studies investigated the gained width of the horizontal alveolar ridge, and 17 examined the implants' survival rate. For assessment of risk of bias, nine studies were high risk of bias and 16 studies were moderate risk of bias. Meta-analysis demonstrated that the pooled gained alveolar ridge width was 3.348 mm (95%CI: 4.163 mm, 2.533 mm), and the implant survival rate was 98.1% (95%CI: 98.9%, 96.9%). Seven studies showed seven different complications including exposure, infection, bad split, dehiscence, fracture, paresthesia and soft tissue retraction.

CONCLUSION

Recent ARS technique seems to be an effective method of bone augmentation with enough gained width and a high implant survival rate. Further long-term and RCTs research remains needed to enhance the study quality.

CLINICAL RELEVANCE

The ARS technique could generate sufficient bone volume, and implants had a high-level survival rate. Therefore, ARS has been proposed to be a reliable horizontal bone augmentation technique that creates good conditions for the implantation of narrow alveolar crests.

Lateral augmentation of the jaw by the split expansion ridge technique. A critical review

Bone augmentation has become a routine procedure to enhance and/or repair a deficient or resorbed alveolar ridge for predictable and successful implant placement. The split expansion ridge i.e., the alveolar ridge splitting (ARS) procedure, is one of the less invasive procedures, and is characterized by minor morbidity. This would allow to widen narrow ridges in order to allow implant reconstruction in a sufficient bone volume. Its efficacy and long-term stability rely upon clinical opinions and long-term retrospective studies, while prospective comparative studies and randomized controlled trials are rare. This critical review presents the development of this technique, describes the surgical procedure, and provides technical notes and modifications. The learning curve and in-depth knowledge of the oral anatomy, as well as the recognition of incidence and management of complications are of utmost importance in the clinical application of the ARS procedure.

Alveolar ridge split and expansion with simultaneous implant placement in mandibular posterior sites using motorized ridge expanders - modified treatment protocol

Purpose

"The purpose of the study is to evaluate alveolar ridge split and expansion (ARSE) with simultaneous implant placement in mandibular posterior implant sites using motorized ridge expanders."

Background

The ARSE is used in the management of horizontally deficient (narrow) alveolar ridge with optimum bone height available. The ARSE procedure in the posterior mandible has limited application as per literature. The successful cases reported are with extensive procedure of the osteo-mobilization with four corticotomies on buccal side. The authors presented the study of mandibular posterior implant sites using motorized ridge expanders. The ARSE performed here was by only crestal osteotomy simple osteo-condensation and immediate implant insertion.

Materials and Methods

The study was prospective type. The sample size was 15 patients and 31 implant sites. The study population included partially edentulous patients between 18 years and 60 years indicated for implant-supported prosthesis. The outcome variables studied included gain in ridge width, cervical bone loss, success of implant, and survival rate. Successful surgical outcome was evaluated by Buser's criteria. The data collected was evaluated by differential statistics.

Conclusion

The minimally invasive technique of one-stage ARSE performed with motorized ridge expander and insertion of implant in the same operative procedure decreases the morbidity, treatment time, number of surgical procedures, and the risk of complications, thereby, increasing patient acceptance. In this study, the authors have used this technique in the posterior mandible for narrow ridges (minimum 3 mm) and obtained promising results. The survival rate of the implants was 100% and the gain in ridge width was 3.2 mm. The author has also recommended the protocol according to bone density of mandible.

Bone remodeling around implants placed after socket preservation: a 10-year retrospective radiological study

BACKGROUND

To evaluate and compare the long-term clinical and radiological outcomes of post-extraction sockets after ridge preservation either with porcine xenograft or collagen alone. Patients underwent single-tooth extraction in the posterior mandible. Fresh extraction sockets were filled with pre-hydrated cortico-cancellous porcine bone or collagen sponge. Two or 3 months later, a ridge expansion technique with immediate implant positioning placement was performed. Primary (alveolar width changes) and secondary outcomes (adverse events and long-term maintenance of buccal plate covering the implant) were evaluated.

RESULTS

Thirty-four women and 20 men were selected: 30 implants (group A) placed into healed post-extraction sockets grafted with porcine bone and 24 (group B) into sockets filled with a collagen sponge. There was a significant loss in width in both groups from the first and second surgery (ranging between 2.7 mm and 4.5 mm). The ridge splitting with bone expansion resulted in significant long-term increases in width for both procedures and implant sites. Non-significant differences in alveolar width were registered between the groups at 10-year follow-up even if the analysis of the implant buccal bone coverage suggested that group A had significantly worst results.

CONCLUSIONS

Porcine bone group had significantly better short-term outcomes with lower long-term maintenance of the buccal plate.

Decision-Making in Implantology-A Cross-Sectional Vignette-Based Study to Determine Clinical Treatment Routines for the Edentulous Atrophic Mandible

This cross-sectional study aimed to investigate the influence of possible factors in the patient history on decision making in the therapy for a severely atrophied edentulous mandible. A vignette-based survey among 250 maxillofacial and oral surgeons was conducted. Determinants that could influence the therapy decision were patient age, smoking, fear of surgery, and radiotherapy in the head and neck area (the implant region is not in the direct radiation area). To achieve a suitable implant site, the options offered to the surgeons were bone split, bone block, augmentation with bone substitute material, and bone resection. There also was the option of rejecting any therapy. The response rate was 47%. Patient age, radiotherapy, and fear of surgery did not influence the approval of a therapy. Smoking was associated with a significantly lower endorsement of a treatment. Resection was preferred by a large majority to all other forms of therapy, regardless of the four determinants. Surgeons tend to refrain from bone block transplants in older patients. In summary, it can be said that, of the four determinants, only smoking influenced treatment refusal. Bone resection is the preferred therapy independent of all determinants.

Wedge-Shaped Implants for Minimally Invasive Treatment of Narrow Ridges: A Multicenter Prospective Cohort Study

The present study aims to investigate clinical and patient-centered outcomes after the implant-supported rehabilitation of narrow ridges using a novel wedge-shaped implant. Forty-four patients were treated with the insertion of 59 tissue-level wedge implants (1.8 mm bucco-lingual width) in horizontally atrophic ridges (mean bone width 3.8 ± 0.4 mm). The main outcome measures were: implant stability quotient (ISQ), marginal bone loss (MBL) and patient morbidity. Fifty-eight implants were functioning satisfactorily after one year of loading (98.3% survival rate). ISQ values measured in the mesio-distal direction resulted significantly higher than those in the bucco-lingual direction at all time points (p < 0.001). Both mesio-distal and bucco-lingual ISQ values at 6-month follow-up resulted significantly higher than at 4-month follow-up (p < 0.001 for both). Mean MBL was 0.38 ± 0.48 mm at prosthesis delivery (6 months after implant insertion) and 0.60 ± 0.52 mm after one year of functional loading. The majority of patients reported slight discomfort related to the surgical procedure. Postoperative pain score was classified as mild pain on the day of surgery and the first postoperative day and no pain over the following five days. Within the limitations of the present study, the device investigated showed low morbidity and positive short-term clinical results in narrow ridges treatment.

Developing evidence-based clinical imaging guidelines of justification for radiographic examination after dental implant installation

Background

This study aimed to develop evidence-based clinical imaging guidelines to assess the proper implant location following implant surgery and identify potential complications during follow-up.

Methods

The guideline development process employed an adaptation methodology in accordance with the Korean clinical imaging guidelines (K-CIG). Core (Ovid-Medline, Ovid-Embase, National Guideline Clearinghouse, and Guideline International Network) and domestic databases (KoreaMed, KMbase, and KoMGI) were searched used to retrieve guidelines, and two reviewers analyzed the retrieved articles. The articles were included in this review using well-established inclusion criteria.

Results

Our online search identified 66 articles, of which 3 were selected for the development of the guidelines. Consequently, based on these three guidelines, we formulated distinct recommendations regarding the appropriate imaging modalities that should be used following implant placement.

Conclusions

Conventional imaging (e.g., periapical or panoramic radiography) should be the first choice for assessing the implant following its placement and osseointegration. The metal artifacts in Cone Beam Computed Tomography (CBCT) should be considered. However, CBCT is recommended for patients with sensory abnormalities following dental implant surgery to evaluate and identify the underlying cause of implant complications and to determine the appropriate treatment.

Split Crest Technique with Immediate Implant to Treat Horizontal Defects of the Alveolar Ridge: Analysis of Increased Thickness and Implant Survival

Objective

To assess bone thickness augmentation and implant survival in ridges with horizontal atrophy managed through split crest technique with concomitant installation of dental implants.

Materials and Methods

Thirteen patients with maxillary bone atrophy underwent surgery and had their bone thickness assessed through cone beam computed tomography 6 months pre- and postoperatively. Comparative measurements of initial and final bone height and thickness were taken using Dolphin Imaging^® 11.5 software. The distance between the nasal fossa floor or the maxillary sinus and the alveolar crest determined the bone height, while the measurement of bone thickness took into account the distance between the vestibular cortical bone and the palatal cortical bone at the crest level, and at 5 mm and 10 mm from it.

Results

The bone height loss of 0.68 mm was statistically significant (p = 0.01). The average horizontal bone gain was 3.45 mm at ridge level, 3.03 mm at 5 mm from it and 2.42 mm at 10 mm from it. The mean horizontal gain for the three regions was 2.97 mm, and the values were statistically significant for all three regions assessed (p < 0.01). No complications were associated with the surgical procedures, and 23 implants were installed following the surgical expansion. No implants were lost (100% survival).

Conclusion

The split crest technique proved to be viable and predictable, enabling a significant increase in ridge thickness and a high percentage of implant survival.

Maxillary Alveolar Ridge Expansion with Split-Crest Technique Compared with Lateral Ridge Augmentation with Autogenous Bone Block Graft: a Systematic Review

Objectives

The objective of the present systematic review was to test the hypothesis of no difference in implant treatment outcome after maxillary alveolar ridge expansion with split-crest technique compared with lateral ridge augmentation with autogenous bone block graft.

Material and Methods

A MEDLINE (PubMed), Embase and Cochrane Library search in combination with a hand-search of relevant journals was conducted. Human studies published in English until 8th of February, 2018 were included.

Results

One comparative and four noncomparative studies fulfilled the inclusion criteria. Both treatment modalities disclosed high survival rate of implants with few complications. High survival rate of prosthesis, implant stability values, limited peri-implant marginal bone loss and gain in maxillary alveolar ridge width were reported with the split-crest technique. Patient-reported outcome measure and length of patient treatment time was not assessed in any of the included studies.

Conclusions

The split-crest technique seems to be useful for horizontal augmentation of maxillary alveolar deficiencies with high survival rate of prosthesis and implants. However, further long-term randomized controlled trials with larger patient sample as well as assessment of patient-reported outcome measures and patient treatment time are needed before well-defined conclusions can be provided about the two treatment modalities.