Table of Contents
Introduction
The alveolar ridge split technique is one of the most common surgical techniques employed by both oral and maxillofacial surgeons, as well as implant dentists, in the management of horizontally deficient alveolar ridges that are not suited to dental implantation. To overcome the drawback, in patients who need dental implant rehabilitation, such as those with narrow alveolar ridges, this surgical procedure works mainly on the rationale of the horizontal crystal osteotomy. The instruments and methodology of Piezosurgery, oscillating saws, diamond burs, and chisels would be utilized for the initial osteotomy technique.
The dental or surgical operator orally uses different chisels of increasing width progressively to produce a space effectively between the buccal and palatal or lingual plates. After this, the technique relies on interposition grafting if needed, and then immediate dental implant placement is applied into the operator-created gap in the same sitting. This can reduce surgical time and promote post-operative healing with the added benefit of patients having improved primary dental implant stability, with research showing long-term success rates in terms of prosthetics. This concept is mainly based on the osseous plasticity of the jaw bones' trabecular density. The minimum indication, however, is that there should be at least a 3 to 5 mm residual crest width, which would be required for the procedure. If the residual ridge width is insufficient, fractures can occur in such ridges with extremely low widths due to less plasticity of the trabecular bone. Hence, the maxillofacial surgeon should carefully select patients for this procedure to avoid complications or errors in the post-operative room.
How Does the Ridge Split Technique Enhance Dental Implant Load Bearing Capacity?
Clinical experience has indicated that the ridge splitting technique can be one of the most beneficial techniques in the field of both oral surgery and reconstructive surgery, commonly used for the rehabilitation of dental prosthetics, such as dental implants, where there is an innate need for management when the residual ridge would be narrowed. Through the operator's careful preparation of the bone and the proper maintenance of the attached periosteum layer, the surgeon ensures that the critical formation of new bone occurs in the patient's jawbone around the dental implants. The process where the induction or the formation of osteoblasts or new bone takes place is an analogy, just like the physiologic process induced for the fracture repair of bone. When the blood clot eventually forms between the two bone plates, an organized structure or matrix is later replaced with the woven bone. This woven bone is formed after the final phases of bone remodeling, then at last converted into the lamellar bone that can bear masticatory loads at the level of the implant soft tissue interface, thereby ensuring that the implants have good primary stability in the bone and can also tolerate stress on them.
According to Revered Scipioni, the research studies demonstrate that the average ridge width is almost tensed through this technique, increasing post-surgery roughly from 2.4 to 6.0 mm. These measurements indicate that the amount of direct bone contact or fusion with the dental implants along the mesial and distal surfaces is similar to the fusion along the buccal and lingual surfaces. This means the ridge split technique can be quite a succession of molding and bone formation alongside the dental implant threads.
What Are the Indications of the Ridge Split Technique?
This technique is indicated mainly when the ridge is too narrow or lacks width. Also, patients with narrowed ridges do not possess adequate height and are without any vertical defects. These are the ideal cases that are indicated for the ridge split technique.
This technique is more commonly performed in the maxilla (upper jaw) than the mandible (lower jaw). The cancellous nature of the maxillary or upper jawbone ensures that bone expansion is more easily achieved without any post-operative complications.
What Are the Advantages and Disadvantages of the Ridge Split Technique?
Further advantages of this technique include the fact that there is no second surgery for performing the dental implantation. They can usually be accommodated within the same surgical sitting, reducing patient operator chair time. It is also considered an economic procedure that can be a good option given by many surgeons to their patients who have complications of narrow alveolar ridges.
Further, this rehabilitating operative technique for the jaw's alveolar ridge can be successful in most documented cases in dental implant literature because it benefits increased implant stability primarily due to the new bone formation between the jaw's cortical plates.
The technique's disadvantages usually include the fact that the surgical procedure can fail when the ridge defects are more severe. Hence, this entirely depends upon the individual's case. Pre-surgery operator evaluation of the patient is a must to avoid these failures or post-operative complications, such as difficulty with primary closure for unsuitable patients. That doesn't fit into the enlisted criterion for the ridge split technique.
Conclusion
The ridge splitting techniques not only give the dental or oral surgical operator the advantage of ridge expansion and simultaneous dental implant placement in the same surgical setting for the management of narrower ridges, but they can also be used in the proper patient selection criterion according to dental research to attain successful post-operative outcomes surgically as well as prosthetically. However, one of the minor drawbacks is that the success rates are higher for maxillary dental rehabilitation because the cancellous bone nature shows improved post-operative healing compared to the less successful outcomes sometimes observed in mandibular rehabilitation, where ridge defects are often severe.
