ORIGINAL ARTICLE
Lateral Ridge Splitting (Expansion) With Immediate Placement of Endosseous Dental Implant Using Piezoelectric Device: A New Treatment Protocol Firas A. Jamil, BDS, MSc and Sahar Shakir Al-Adili, BDS, MScy Abstract: Many treatment modalities have been introduced for correction of deficient alveolar ridge width. Bone expansion through the ridge split procedure is one of them. This technique was initiated in order to overcome many problems that usually associated with grafting procedures. The present study evaluated the effectiveness of piezoelectric device in performing ridge split using single-stage approach and assessed the outcomes during a period of about 4 months after surgery. A total of 23 patients aged in range between 18 and 60 years underwent ridge split procedure with immediate insertion of dental implants. A panoramic radiograph was obtained before surgery. The gained bone was measured and surgical complications were recorded. Implants stability was measured using Osstell device. Postoperative clinical complications were assessed. After a healing period of 16 weeks, all the implants were uncovered and evaluated regarding clinical, radiographic, and resonance frequency analysis findings. The totally implemented ridge split procedures were 26 cases including 57 implants inserted immediately at the time of surgery. The initial ridge width varied between 1 and 3.5 mm while the final width ranged from 5.5 to 8 mm. The minimum bone gain was 2.5 mm and the maximum value reached up to 7 mm. Few and insignificant clinical complications were recorded during the whole study. The survival rate was 100%. The study results indicated that piezoelectric ridge splitting technique is an effective, safe, and minimally invasive procedure. This technique has showed to be very successful in reducing the overall treatment period. Key Words: Immediate implant placement, piezoelectric ridge expansion, ridge split (J Craniofac Surg 2017;28: 434–439)
From the Department of Oral and Maxillofacial Surgery, Dental Teaching Hospital, College of Dentistry, University of Baghdad, Bab-Almoadham; and yDepartment of Oral and Maxillofacial Surgery, Dental Teaching Hospital, College of Dentistry, University of Baghdad, Baghdad, Iraq. Received July 15, 2016. Accepted for publication August 28, 2016. Address correspondence and reprint requests to Firas A. Jamil, BDS, MSc, Postgraduate Student, Department of Oral and Maxillofacial Surgery, Dental Teaching Hospital, College of Dentistry, University of Baghdad, Bab-Almoadham, P.O. Box 1417, Baghdad, Iraq; E-mail: [email protected] The authors report no conflicts of interest. Copyright # 2016 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000003229
R
idge resorption following long-standing period after teeth loss is commonly severe and unpredictable. Although bone collapse is usually 3-dimensional, the horizontal deficiency or width loss progresses to more level.1 Narrow alveolar ridges represent a hard challenge with extreme difficulty for successful insertion of endosseous dental implants. Various methods have been designated to augment the thin alveolar crest such as guided bone regeneration (GBR), bone block grafting, distraction osteogenesis, and ridge splitting for bone expansion. Most of the ridge augmentation techniques not only increase the morbidity but also the cost in addition to longer time taken. All these factors discourage patients from acceptance of the treatment plan.2 Ridge expansion technique was first described by Tatum3 and then modified by Summers4 using hand osteotomes. The main disadvantage of the traditional osteotome technique is the possibility of trauma and fracture of the cortical walls while separation causing total detachment with subsequent bone necrosis and implant failure.5 Ridge splitting technique produces a sagittal osteotomy with instruments inserted between the cortical plates expanding the bony ridge to allow for insertion of dental implants.6 Earlier procedures were achieved by means of oscillating saws, rotary handpieces, chisels, or burs. Rotating and oscillating instruments are effective tools but may harm the nerves and arteries.7 Conventional cutting or drilling osteotomes are relatively rough tools. Moreover, the rotating instruments have the ability to produce extremely high temperatures during osseous drilling leading to marginal osteonecrosis and impaired bony regeneration.8 As malleting of chisels is required, the tolerability and acceptance by patients was one of the problems that associated with these conventional techniques. In addition, the performance of procedure under local anesthesia makes the technique uncomfortable for most of the patients.9 In such a situation, piezoelectric cutters or disks can be very effective instruments. They are engineered to reduce heat and give a precise and nontraumatic incision very efficiently in highly mineralized structures as well as reducing the risk of fractures.10 Furthermore, the device causes minimal bleeding during and after the operation with shorter healing period.11 However, different modifications of the procedure have been discussed, with and without the use of bone graft, performing 1-stage or 2-stage techniques.12 The basis of the interpositional (sandwich) techniques is usually based on the theory of placing a biomaterial between 2 parts of bone with internal cancellous bone. Later on, this graft material will undergo rapid healing and incorporation with a lower percentage of resorption. The sandwich osteotomy technique permits the insertion of the graft in a well-enclosed area as well as offering sufficient blood supply to preserve the formation and growth of new bone.13 The addition of recombinant human bone morphogenetic protein-2 may aid in the success rate of the sandwich osteotomy technique by promoting osteogenesis at the osteotomy site and producing excellent bone regeneration in the treated area.14,15 A platelet-derived growth factor for bone graft coverage may be added to the collagen matrix where the results have shown that this addition appeared to accelerate soft tissue healing and enhance bone formation.16
434 The Journal of Craniofacial Surgery Volume 28, Number 2, March 2017 Copyright © 2017 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
The Journal of Craniofacial Surgery
Volume 28, Number 2, March 2017
Ridge Splitting With Piezosurgery
The present study evaluates the 1-stage split expansion technique using piezoelectric device for implants placement in patients having narrow bony ridges (
Lateral Ridge Splitting (Expansion) With Immediate Placement of Endosseous Dental Implant Using Piezoelectric Device: A New Treatment Protocol Firas A. Jamil, BDS, MSc and Sahar Shakir Al-Adili, BDS, MScy Abstract: Many treatment modalities have been introduced for correction of deficient alveolar ridge width. Bone expansion through the ridge split procedure is one of them. This technique was initiated in order to overcome many problems that usually associated with grafting procedures. The present study evaluated the effectiveness of piezoelectric device in performing ridge split using single-stage approach and assessed the outcomes during a period of about 4 months after surgery. A total of 23 patients aged in range between 18 and 60 years underwent ridge split procedure with immediate insertion of dental implants. A panoramic radiograph was obtained before surgery. The gained bone was measured and surgical complications were recorded. Implants stability was measured using Osstell device. Postoperative clinical complications were assessed. After a healing period of 16 weeks, all the implants were uncovered and evaluated regarding clinical, radiographic, and resonance frequency analysis findings. The totally implemented ridge split procedures were 26 cases including 57 implants inserted immediately at the time of surgery. The initial ridge width varied between 1 and 3.5 mm while the final width ranged from 5.5 to 8 mm. The minimum bone gain was 2.5 mm and the maximum value reached up to 7 mm. Few and insignificant clinical complications were recorded during the whole study. The survival rate was 100%. The study results indicated that piezoelectric ridge splitting technique is an effective, safe, and minimally invasive procedure. This technique has showed to be very successful in reducing the overall treatment period. Key Words: Immediate implant placement, piezoelectric ridge expansion, ridge split (J Craniofac Surg 2017;28: 434–439)
From the Department of Oral and Maxillofacial Surgery, Dental Teaching Hospital, College of Dentistry, University of Baghdad, Bab-Almoadham; and yDepartment of Oral and Maxillofacial Surgery, Dental Teaching Hospital, College of Dentistry, University of Baghdad, Baghdad, Iraq. Received July 15, 2016. Accepted for publication August 28, 2016. Address correspondence and reprint requests to Firas A. Jamil, BDS, MSc, Postgraduate Student, Department of Oral and Maxillofacial Surgery, Dental Teaching Hospital, College of Dentistry, University of Baghdad, Bab-Almoadham, P.O. Box 1417, Baghdad, Iraq; E-mail: [email protected] The authors report no conflicts of interest. Copyright # 2016 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000003229
R
idge resorption following long-standing period after teeth loss is commonly severe and unpredictable. Although bone collapse is usually 3-dimensional, the horizontal deficiency or width loss progresses to more level.1 Narrow alveolar ridges represent a hard challenge with extreme difficulty for successful insertion of endosseous dental implants. Various methods have been designated to augment the thin alveolar crest such as guided bone regeneration (GBR), bone block grafting, distraction osteogenesis, and ridge splitting for bone expansion. Most of the ridge augmentation techniques not only increase the morbidity but also the cost in addition to longer time taken. All these factors discourage patients from acceptance of the treatment plan.2 Ridge expansion technique was first described by Tatum3 and then modified by Summers4 using hand osteotomes. The main disadvantage of the traditional osteotome technique is the possibility of trauma and fracture of the cortical walls while separation causing total detachment with subsequent bone necrosis and implant failure.5 Ridge splitting technique produces a sagittal osteotomy with instruments inserted between the cortical plates expanding the bony ridge to allow for insertion of dental implants.6 Earlier procedures were achieved by means of oscillating saws, rotary handpieces, chisels, or burs. Rotating and oscillating instruments are effective tools but may harm the nerves and arteries.7 Conventional cutting or drilling osteotomes are relatively rough tools. Moreover, the rotating instruments have the ability to produce extremely high temperatures during osseous drilling leading to marginal osteonecrosis and impaired bony regeneration.8 As malleting of chisels is required, the tolerability and acceptance by patients was one of the problems that associated with these conventional techniques. In addition, the performance of procedure under local anesthesia makes the technique uncomfortable for most of the patients.9 In such a situation, piezoelectric cutters or disks can be very effective instruments. They are engineered to reduce heat and give a precise and nontraumatic incision very efficiently in highly mineralized structures as well as reducing the risk of fractures.10 Furthermore, the device causes minimal bleeding during and after the operation with shorter healing period.11 However, different modifications of the procedure have been discussed, with and without the use of bone graft, performing 1-stage or 2-stage techniques.12 The basis of the interpositional (sandwich) techniques is usually based on the theory of placing a biomaterial between 2 parts of bone with internal cancellous bone. Later on, this graft material will undergo rapid healing and incorporation with a lower percentage of resorption. The sandwich osteotomy technique permits the insertion of the graft in a well-enclosed area as well as offering sufficient blood supply to preserve the formation and growth of new bone.13 The addition of recombinant human bone morphogenetic protein-2 may aid in the success rate of the sandwich osteotomy technique by promoting osteogenesis at the osteotomy site and producing excellent bone regeneration in the treated area.14,15 A platelet-derived growth factor for bone graft coverage may be added to the collagen matrix where the results have shown that this addition appeared to accelerate soft tissue healing and enhance bone formation.16
434 The Journal of Craniofacial Surgery Volume 28, Number 2, March 2017 Copyright © 2017 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
The Journal of Craniofacial Surgery
Volume 28, Number 2, March 2017
Ridge Splitting With Piezosurgery
The present study evaluates the 1-stage split expansion technique using piezoelectric device for implants placement in patients having narrow bony ridges (
