Author
Dr. Pil Lim, DDS, MDS
DDS, School of Dentistry, Wonkwang University MSD, Postgraduate School of Dentistry, Catholic University Clinical Professor of Catholic University Diplomate of NYU Continuing Dental Education Program Diplomate of International Congress of Oral Implantologists (ICOI)
Seoul, Korea
One of the most important factors in a successful implant will be,
first of all, securing sufficient available bone. In order to have enough
available bone for implant placement, dentists use a variety of bone
augmentations such as GBR, Ridge split and Block bone graft, etc.
Among them, the ridge split technique is an excellent technique in terms of extending the alveolar bone of the patient and completing the bone
wall surrounding the implant with the patient’s own cortical bone. In this
regard, we will look into the clinical case using Neobiotech’s Ridge Wider
Kit, which makes the ridge split procedure more convenient and safe.
The patient in this case who was a female in her
40s came to the clinic to remove the old bridge
on #34-#38 and replace it with implant on
#36 and 37. #38 was extracted and crown was
planned to place on #34, 35 natural teeth then
implant placement was planned on #36 and 37.
To level the alveolar ridge, use the bone trimmer in
Ridge Wider Kit to make the area flat, then use safe disk
to cut the width of buccal and lingual area. The protective
covers in a semi-circular form are fitted to prevent any
injury caused by sharp disc, so if only the handpiece is
ensured, the alveolar bone can be cut safely.
Osteotomy for implant placement is performed by 1.5mm initial
drilling. Then continue to use the safe disk to make a cut little by
little. The horizontal osteotomy as well as the vertical osteotomy
need to be performed to achieve sufficient bone expansion for
implant placement, because unlike the maxilla, the mandible has
less cancellous bone and lacks the elasticity of the bone. In this
case, two vertical osteotomy were done on mesial and distal side.
After cutting with a disc, use a chisel to perform slight
bone expansion initially.Then increase the bone expander
sequentially by diameter, and perform the expansion
gradually.The implant is placed after the bone expansion and is
performed very slowly using a bone expander at 25~35rpm
similar to that of implant placement.
After greenstick separation of buccal plate, screw was used for fixation of
buccal bone wall. At this time, the sharp
cortical plate that protrudes into buccal area due to vertical
osteotomy must be gently trimmed to avoid soft tissue
perforation even after suturing. Then allografts were placed
between the space of bone.
The fixing screws that had been fixed to the buccal area
were removed and healing abutment was placed. The
greatest advantage of ridge splitting is that the buccal
wall surrounding the implant is pristine cortical bone. It is
difficult to obtain a cortical bone of buccal wall in a short
period of time in GBR with alloplastic bone or xenograft.
Horizontal bone augmentation was achieved by ridge splitting.
However, the keratinized gingiva around the implant was so
insufficient, so free gingival graft was done after.
Although keratinized gingiva is not essential to the success of
implant, it helps to stabilize the implant for a long-term period,
so it is better to secure it if possible.
Currently, a variety of bone augmentation are being performed in implant
cases and there are pros and cons in each procedures. GBR is the most
widely used technique, but ridge splitting is also very useful one if only
the proper instruments are equipped in situations where horizontal bone
augmentation is required.In particular, the advantage of ridge splitting
is that, bone augmentation can be achieved by preserving the condition of cortical bone of the patient, whereas in GBR, bone grafting that may
causes decreasing of bone quality is needed.In Neobiotech’s Ridge Wider
Kit, it is composed of bone trimmer, safe disk, chisel, bone expander. So
it is very convenient and safe instrument to execute the ridge split.Ridge
splitting is a very good horizontal bone augmentation in a horizontal
bone deficiency case, if applied to appropriate indications.
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