A Modified Ridge Expansion Technique in the Maxilla

[DrAnil]

 

Case Report of Modified Surgical Technique

A 45-year-old woman presented with a narrow edentulous ridge in the maxilla (Figure 1). Following adequate anesthesia, a horizontal incision palatal to the crest and two vertical incisions were placed to outline the surgical field. A periodontal probe was used to measure the width of the alveolar crest at the most coronal dimension after a full-thickness flap was elevated (Figure 2). From the author’s experience, it was not necessary to maintain palatal bone-periosteum.

A long diamond bur was used to make a cut, which was 6-mm to 8-mm deep in the center of the alveolar ridge (Figure 3). The cut was made at least 1 mm away from the adjacent teeth in order to prevent any damage to them. A 4-mm wide bone-spreading chisel was used to mobilize and displace the buccal plate facially (Figure 4) so that a small, tapered osteotome for expansion could be used for implant site preparations. A 2-mm round bur was used to mark the implant location, and a 2-mm twist drill was used to guide the expansion with osteotomes.

Tapered osteotomes were used to expand the ridge completely to the working length, which was at least 10 mm (Figure 5). It should be noted that if too much resistance is encountered, a drill smaller in diameter than a previously used osteotome can be used along the palatal wall. An implant was then placed into the osteotomy created by tapered osteotomes (Figure 6). Minor cracks were found in the middle of the expanded buccal plate during and after implant placement. Particulate bone allograft (freeze-dried bone allograft) was used to fill the gap between buccal and palatal alveolar plates, and another bone graft (bovine bone mineral) was packed outside the expanded buccal plate. A resorbable membrane was placed over the buccal plate and bone grafts (Figure 7 and Figure 8).

Following bone grafting and adaptation of the barrier membrane, the overlying flap was coronally positioned to achieve primary closure of the split alveolar ridge. After 4 months of healing, the site presented with ideal hard- and soft-tissue profiles (Figure 9). The implant was uncovered and a taller healing abutment was placed. A single crown was delivered (Figure 10), and the patient was restored to form and function.

This modified ridge-splitting technique enabled the placement of an implant with proper positioning and allowed for maintenance of hard- and soft-tissue volume. The patient was very satisfied with the final esthetic results of the procedure.

Conclusions

A case study was presented to describe modifications to the original maxillary ridge expansion technique. Based on their experience, the authorlist believe that this modified maxillary ridge expansion technique offers the following advantages over the original technique:

• Better access and flap mobility: Clinicians are able to examine both buccal and palatal bone contours for more accurate implant placement and identification of any buccal plate fractures or dehiscences.
• Lower risk of complete bone fracture: By eliminating vertical intraosseous incisions, there is a decreased likelihood of complete fracture of the buccal plate.
• Improved implant stability: Because the osteotomy for implant placement is prepared by expansion with the use of an osteotome, the buccal plate remains intact, which allows for increased primary implant stability.
• Better maintenance of soft- and hard-tissue volume: Simultaneous bone grafting and membrane placement can compensate for any buccal bone resorption during the healing process and allow for the maintenance of ideal hard- and soft-tissue profiles.