Aim: This study aimed to compare modified ridge splitting (RS) and distraction osteogenesis (DO) for horizontal ridge expansion clinically (bone width, pain, and soft tissue healing) and radiographically (bone width).
Material and methods: This randomized clinical trial was conducted on fourteen patients who had a partial edentulous narrow mandibular posterior alveolar ridge (not less than 4-mm width and 12-mm height). All patients were divided randomly into two equal groups: Group I was treated with a modified bone-splitting technique, and group II was treated with DO technique by the fabricated device as AlveoWider®, and without any graft material for both groups. All patients were followed up clinically to evaluate the increase of bone width at preoperative measurement (T0) and 6 months postoperative (T6), and radiographically by cone-beam computed tomography (CBCT) at T0, 3 months postoperative (T3), and T6. Descriptive and bivariate statistics were computed using the SPSS version (SPSS, IBM Inc., Chicago, IL, USA), and p ≤ 0.05 was considered an indicator of statistical significance.
Results: All patients were female. Patients’ ages ranged from 18 to 45 years, with a mean age of 32.07 ± 5.87 years. Radiographically, there is no significant statistical difference in comparing between two groups for the creation of a horizontal alveolar bone; however, there was a highly significant statistical difference (p < 0.001) in each group between different interval periods (T0, T3, and T6) with mean start 5.27 ± 0.53, and 5.19 ± 0.72 at T0 reaching to 7.60 ± 0.89 and 7.09 ± 0.96 at T3, and slightly decreases to 7.52 ± 0.79 and 7.02 ± 0.79 in T6 with radiographic evaluation, and it represented clinically in each group with mean 3.57 ± 0.313 and 4.0 ± 0.58 at T0 increase to 6.55 ± 0.395 and 6.52 ± 0.45 at T6 for both groups, respectively. There is a statistically significant difference in soft tissue healing with the average mean of 4.57 ± 0.24 and 3.57 ± 0.509 and pain with an average mean of 1.66 ± 0.22 and 4.74 ± 0.55 with p = 0.001 and p < 0.001 when comparing between both groups, respectively, that is, p = 0.001 is considered to be statistically significant.
Conclusion: Both techniques seem to be useful as augmentation techniques for dental implant placement in a narrow alveolar ridge. Techniques are sensitive and need good experience. The modified splitting technique has fewer complications, less pain, and better soft tissue healing when compared with the DO technique.
Clinical significance: Both techniques are alternative methods for the treatment of the atrophic alveolar ridge with uneventful healing except for minor complications that do not interfere with dental implant placement.
Atwood DA. Reduction of residual ridges: A major oral disease entity. J Prosthet Dent 1971;26(3):266–279. DOI: 10.1016/0022-3913(71)90069-2.
Cawood JL, Howell RA. A classification of the edentulous jaws. Int J Oral Maxillofac Surg 1988;17(4):232–236. DOI: 10.1016/s0901-5027 (88)80047-x.
Oikarinen KS, Sàndor GKB, Kainulainen VT, et al. Augmentation of the narrow traumatized anterior alveolar ridge to facilitate dental implant placement. Dent Traumatol 2003;19(1):19–29. DOI: 10.1034/j.1600-9657.2003.00125.x.
Atwood DA. Bone loss of edentulous alveolar ridges. J Periodontol 1979;50(Suppl. 4S):11–21. DOI: 10.1902/jop.1979.50.4s.11.
Garcia–Garcia A, Somoza–Martin M, Gandara–Vila P, et al. Horizontal alveolar distraction: A surgical technique with the transport segment pedicled to the mucoperiosteum. J Oral Maxillofac Surg 2004;62(1):1408–1412. DOI: 10.1016/j.joms.2004.07.004.
Triplett RG, Schow SR. Autologous bone grafts and endosseous implants: Complementary techniques. J Oral Maxillofac Surg 1996;54(4):486–494. DOI: 10.1016/s0278-2391(96)90126-3.
Sethi A, Kaus T, Dent M. Ridge augmentation using mandibular block bone grafts: Preliminary results of an ongoing prospective study. Int J Oral Maxillofac Implants 2001;16(3):378–388. PMID: 11432657.
Jovanovic SA, Nevins M. Bone formation utilizing titanium-reinforced barrier membranes. Int J Periodontics Restorative Dent 1995;15(1): 56–69. PMID: 7591524.
Zitzmann NU, Schärer P, Marinello CP. Long-term results of implants treated with guided bone regeneration: A 5-year prospective study. Int J Oral Maxillofac Implants 2001;16(3):355–366. PMID: 11432655.
Lustmann J, Lewinstein I. Interpositional bone grafting technique to widen narrow maxillary ridge. Int J Oral Maxillofac Implants 1995;10(5):568–577. PMID: 7591001.
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(4):491–499. PMID: 10960981.
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(3):445–449. PMID: 16796289.
Takahashi T, Funaki K, Shintani H, et al. Use of horizontal alveolar distraction osteogenesis for implant placement in a narrow alveolar ridge: A case report. Int J Oral Maxillofac Implants 2004;19(2):291–294. PMID: 15101603.
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. PMID: 7751111.
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(6):462–473. PMID: 1298734.
Sohn DS, Lee HJ, Heo JU, et al. Immediate and delayed lateral ridge expansion technique in the atrophic posterior mandibular ridge. J Oral Maxillofac Surg 2010;68(9):2283–2290. DOI: 10.1016/j.joms.2010.04.009.
Saulacic N, Iizuka T, Martin MS, et al. Alveolar distraction osteogenesis: A systematic review. Int J Oral Maxillofac Surg 2008;37(1):1–7. DOI: 10.1016/j.ijom.2007.07.020.
McCarthy JG, Schreiber J, Karp N, et al. Lengthening the human mandible by gradual distraction. Plast Reconstr Surg 1992;89(1):1–8. PMID: 1727238.
Chin M, Toth BA. Distraction osteogenesis in maxillofacial surgery using internal devices: Review of five cases. J Oral Maxillofac Surg 1996;54(1):45–53. DOI: 10.1016/s0278-2391(96)90303-1.
Kheur M, Gokhale S, Sumanth S, et al. Staged ridge splitting technique for horizontal expansion in mandible: A case report. J Oral Implantol 2014;40(4):479–483. DOI: 10.1563/AAID-JOI-D-12-00068.
Robiony M, Toro C, Stucki–Mccormick SU. The “FAD” (Floating Alveolar Device): A Bidirectional Distraction System for Distraction Osteogenesis of the Alveolar Process. J Oral Maxillofac Surg 2004;62 (9 Suppl. 2):136–142. DOI: 10.1016/j.joms.2004.06.039.
Lingamaneni S, Mandadi LR, Pathakota KR. Assessment of healing following low-level laser irradiation after gingivectomy operations using a novel soft tissue healing index: A randomized, double-blind, split-mouth clinical pilot study. J Indian Soc Periodontol 2019;23(1):53–57. DOI: 10.4103/jisp.jisp_226_18.
Breivik H, Borchgrevink PC, Allen SM, et al. Assessment of pain. Br J Anaesth 2008;101(1):17–24. DOI: 10.1093/bja/aen103.
Bulut E, Muglali M, Celebi N, et al. Horizontal alveolar distraction of the mandibular canine regions for implant placement. J Craniofac Surg 2010;21(3):830–832. DOI: 10.1097/SCS.0b013e3181d7f1d1.
Chiapasco M, Abati S, Romeo E, et al. clinical outcome of autogenous bone blocks or guided bone regeneration with e-PTFE membranes. Clin Oral Implants Res 1999;10(4):278–288. DOI: 10.1034/j.1600-0501. 1999.100404.x.
H Tatum Jr. Maxillary and sinus implant reconstructions. Dent Clin North Am 1986;30(2):207–229. PMID: 3516738.
Funaki K, Takahashi T, Yamauchi K. Horizontal alveolar ridge augmentation using distraction osteogenesis: Comparison with a bone-splitting method in a dog model. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107(3):350–358. DOI: 10.1016/j.tripleo.2008.10.005.
Agabiti I, Botticelli D. Two-stage ridge split at narrow alveolar mandibular bone ridges. J Oral Maxillofac Surg 2017;75(10):1–12. DOI: 10.1016/j.joms.2017.05.015.
Korsakova AI, Zhadobova IA, Klochkov AS, et al. Modified two- stage split technique for controlled ridge augmentation in horizontally atrophic posterior mandible: The first stage of research. Sovrem Tehnologii Med 2020;12(4):40–46. DOI: 10.17691/stm2020.12.4.05.
Tair JAA. Modification of mandibular ridge splitting technique for horizontal augmentation of atrophic ridges. Ann Maxillofac Surg 2014;4(1):19–23. DOI: 10.4103/2231-0746.133066.
Yamauchi K, Takahashi T, Nogami S, et al. Horizontal alveolar distraction osteogenesis for dental implant: Long-term results. Clin Oral Impl Res 2012;24(5):563–568.