The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 21 , ISSUE 1 ( January, 2020 ) > List of Articles


Minimal Invasive Flapless Piezotome Alveolar Crest Horizontal Split Technique: Preliminary Results

Keywords : Abfraction, Bone graft, Cone-beam computed tomography, Dental implants, Flapless surgery, Piezosurgery, Split crest

Citation Information : Minimal Invasive Flapless Piezotome Alveolar Crest Horizontal Split Technique: Preliminary Results. J Contemp Dent Pract 2020; 21 (1):28-35.

DOI: 10.5005/jp-journals-10024-2743

License: CC BY-NC 4.0

Published Online: 01-06-2017

Copyright Statement:  Copyright © 2020; The Author(s).


Introduction: Alveolar split crest is an established surgical technique to enable implant insertion into narrow and atrophic alveolar crest. This surgical technique is adopted to position standard or large implants so that postextractive anatomy compromises with this attempt. The aim of this study was to evaluate the horizontal alveolar bone augmentation and its stability along time with a minimally invasive flapless technique. Materials and methods: Twenty-four implants were inserted in 10 patients during a 15-month period. Clinical parameters such as horizontal bone augmentation, intrasurgical complications, patient morbidity, implant loss, and vertical bone loss (VBL) were recorded in the first 3 years after surgery. Using cone-beam computed tomography (CBCT), alveolar bone width was measured for both implants position and bone reconstructions. 6 months later, at the time of implant integration, a new low-dose CBCT was performed. Implant survival (IS) and VBL were evaluated radiographically for 3 years. Results: The initial bone thickness measured on the ridge is between 0.82 mm and 5.40 mm (average 2.43 mm), after the split crest the bone width is between 4.65 mm and 8.09 mm (average 6.39 mm). This leads to an increase in the alveolar bone width of between 0.80 mm and 6.01 mm (average 3.71 mm) on the ridge. No implant was lost at 3 years, and all implants are stable at the end of the study. Three years after the surgery, controls showed a VBL of between 0.0 mm and 1.2 mm (average 0.63 mm) around the inserted implants. These parameters suggest using a flapless technique to reduce bone resorption around the implant neck. Conclusion: A minimally invasive approach allows to reduce the surgical trauma and postsurgical discomfort. The complete vascular supply is maintained, the bone resorption is reduced, and the connective epithelium does not undergo postsurgical retraction, achieving the full maintenance of the residual keratinized gingiva. Clinical significance: A technique such as split crest can be a valid option to avoid autologous or heterologous bone grafts.

  1. Jafarian M, Mirhashemi FS, Emadi N. Finite element analysis of stress distribution around a dental implant with different amounts of bone loss: an in vitro study. Dent Med Probl 2019;56(1):27–32. DOI: 10.17219/dmp/102710.
  2. Venino PM, Citterio CL, Pellegatta A, et al. A micro-computed tomography evaluation of the shaping ability of two nickel-titanium instruments, HyFlex EDM and ProTaper next. J Endod 2017;43(4): 628–632. DOI: 10.1016/j.joen.2016.11.022.
  3. Świder K, Dominiak M. Er:YAG and diode laser application in implant bed preparation and implant uncovering: a case report. Dent Med Probl 2019;56(1):111–116. DOI: 10.17219/dmp/100386.
  4. Maddalone M. The association between the psychological status and the severity of facial deformity in orthognathic patients. Angle Orthod 2012;82(3):396–402. DOI: 10.2319/060211-363.1.
  5. Maddalone M, Gagliani M, Citterio CL, et al. Prevalence of vertical root fractures in teeth planned for apical surgery. A retrospective cohort study. Int Endod J 2018;51(9):969–974. DOI: 10.1111/iej.12910.
  6. Porcaro G, Busa A, Bianco E, et al. Use of a partial-thickness flap for guided bone regeneration in the upper jaw. J Contemp Dent Pract 2017;18(12):1117–1121. DOI: 10.5005/jp-journals-10024-2186.
  7. Bianco E, Rota D. Oral findings in Rett syndrome: an update and review of the literature. Dent Med Probl 2018;55(4):441–445. DOI: 10.17219/dmp/99203.
  8. Bianco E, Maddalone M, Porcaro G, et al. Treatment of osteoradionecrosis of the jaw with ozone in the form of oil-based gel: 1-year follow-up. J Contemp Dent Pract 2019;20(2):270–276. DOI: 10.5005/jp-journals-10024-2508.
  9. Koç N, Çağırankaya LB. Investigation of the determinants of the mandibular cortical morphology. Dent Med Probl 2019;56(1):21–25. DOI: 10.17219/dmp/102262.
  10. Nedir R, Bischof M, Briaux JM, et al. A 7-year life table analysis from a prospective study on ITI implants with special emphasis on the use of short implants. Results from a private practice. Clin Oral Implants Res 2004;15(2):150–157. DOI: 10.1111/j.1600-0501.2004.00978.x.
  11. Scipioni A, Bruschi GB, Calesini G. The edentulous ridge expansion technique: a five-year study. Int J Periodontics Restorative Dent 1994;14(5):451–459.
  12. Chiapasco M, Zaniboni M, Rimondini L. Dental implants placed in grafted maxillary sinuses: a retrospective analysis of clinical outcome according to the initial clinical situation and a proposal of defect classification. Clin Oral Implants Res 2008;19(4):416–428. DOI: 10.1111/j.1600-0501.2007.01489.x.
  13. Jensen SS, Terheyden H. Bone augmentation procedures in localized defects in the alveolar ridge: clinical results with different bone grafts and bone-substitute materials. Int J Oral Maxillofac Implants 2009;24(Suppl):218–236.
  14. 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(6):700–707. DOI: 10.1111/j.1600-0501.2006.01206.x.
  15. Horton JE, Tarpley Jr TM, Wood LD. The healing of surgical defects in alveolar bone produced with ultrasonic instrumentation, chisel, and rotary bur. Oral Surg Oral Med Oral Pathol 1975;39(4):536–546. DOI: 10.1016/0030-4220(75)90192-9.
  16. Horton JE, Tarpley Jr TM, Jacoway JR. Clinical applications of ultrasonic instrumentation in the surgical removal of bone. Oral Surg Oral Med Oral Pathol 1981;51(3):236–242. DOI: 10.1016/0030-4220(81)90051-7.
  17. Curie J, Curie P. Contractions et dilatations produites par des tensions dans les cristaux hémièdres à faces inclinées. CR Acad Sci Gen 1880;93:1137–1140.
  18. Vercellotti T, De Paoli S, Nevins M. The piezoelectric bony window osteotomy and sinus membrane elevation: introduction of a new technique for simplification of the sinus augmentation procedure. Int J Periodontics Restorative Dent 2001;21(6):561–567.
  19. Harder S, Wolfart S, Mehl C, et al. Performance of ultrasonic devices for bone surgery and associated intraosseous temperature development. Int J Oral Maxillofac Implants 2009;24(3): 484–490.
  20. González-García A, Diniz-Freitas M, Somoza-Martín M, et al. Ultrasonic osteotomy in oral surgery and implantology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108(3):360–367. DOI: 10.1016/j.tripleo.2009.04.018.
  21. Vercellotti T. Piezoelectric surgery in implantology: a case report – a new piezoelectric ridge expansion technique. Int J Periodontics Restorative Dent 2000;20(4):358–365.
  22. Sethi A, Kaus T. Maxillary ridge expansion with simultaneous implant placement: a 5-year result of an on going clinical study. Int J Oral Maxillofac Implants 2000;15(4):491–499.
  23. Simion M, Baldoni M, Zaffe D. Jawbone enlargement using immediate implant placement associated with a split-crest technique guided tissue regeneration. Int J Periodontics Restorative Dent 1992;12(6):462–473.
  24. Scipioni A, Bruschi GB, Calesini G, et al. Bone regeneration in the edentulous ridge expansion technique: histologic and ultrastructural study of 20 clinical cases. Int J Periodontics Restorative Dent 1999;19(3):269–277.
  25. Brugnami F, Caiazzo A, Mera P. Piezosurgery-assisted, flapless split crest surgery for implant site preparation. J Maxillofac Oral Surg 2014;13(1):67–72. DOI: 10.1007/s12663-012-0377-3.
  26. Danza M, Guidi R, Carinci F. Comparison between implants inserted into piezo split and unsplit alveolar crests. J Oral Maxillofac Surg 2009;67(11):2460–2465. DOI: 10.1016/j.joms.2009.04.041.
  27. Studer S, Naef R, Scharer P. Adjustment of localized alveolar ridge defects by soft tissue transplantation to improve mucogingival esthetics: a proposal for clinical classification and an evaluation of procedures. Quintessence Int 1997;28(12):785–805.
  28. Vercellotti T, Nevins ML, Kim DM, et al. Osseous response following resective therapy with piezosurgery. Int J Periodontics Restorative Dent 2005;25(6):543–549.
  29. Araùjo M, Lindhe J. The influence of Bio-Oss collagen on healing of an extraction socket. An experimental study in dogs. Int J Periodontics Restorative Dent 2008;28(2):123–135.
  30. Longoni S, Maroni I, Baldini A, et al. Retrospective radiographic study of marginal bone changes of 88 implants placed with split crest technique in the maxillary latero-posterior area. Journal of Osseointegration 2016;8(1):8–13. DOI: 10.23805/jo.2016.08.01.02.
  31. Galluzzi F, Pignataro L, Maddalone M, et al. Recurrences of surgery for antrochoanal polyps in children: a systematic review. Int J Pediatr Otorhinolaryngol 2018;106:26–30. DOI: 10.1016/j.ijporl.2017.12.035.
  32. Ambu E, Citterio CL, Pellegatta A, et al. The use of limited CBCT in the early diagnosis of root vertical fracture: a case report. Glob J Oral Sci 2018;4:18–24. DOI: 10.30576/2414-2050.2018.04.4.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.