MUCOSAL FLAP VERSUS MUCOPERIOSTEAL FLAP IN RIDGE SPLITTING AND SIMULTANEOUS IMPLANT PLACEMENT USING PIEZOSURGERY (A RANDOMIZED CONTROLLED CLINICAL TRIAL)

Document Type : Original Article

Authors

1 Assistant Lecturer of Oral and Maxillofacial surgery, Faculty of Dentistry, Alexandria University.

2 Professor of Oral and Maxillofacial surgery, Faculty of Dentistry, Alexandria University.

3 Professor of Oral and Maxillofacial surgery, Faculty of Dentistry, Alexandria University

4 Visiting Professor of Oral and Maxillofacial surgery, Faculty of Dentistry, Alexandria University & University of Health Science Vientiane

Abstract

INTRODUCTION: Ridge split procedures are commonly performed for horizontal widening-augmentation of narrow ridges which would otherwise preclude implant placement. Post-surgical vertical and horizontal crestal bone loss that might occur secondary to ridge splitting techniques present a serious obstacle to the success of implant placement and prognosis. OBJECTIVES: The evaluation of the effectiveness of maintaining the periosteal attachment of the buccal and lingual cortical plates to reduce and/or prevent crestal bone loss that might occur at the crestal margin of dental implants placed immediately in posterior mandibular alveolar ridges splitted using piezosurgery. MATERIALS AND METHODS: That was a randomized controlled clinical trial. The study population included 16 patients with edentulous posterior mandibular alveolar ridges. The sample was selected conveniently to fulfill a list of inclusion and exclusion criteria. Then the selected participants were allocated randomly into two equal groups each including 8 patients. A full thickness mucoperiosteal flap were performed in the control group patients, while a split thickness mucosal flap was done in the study group patients. All patients had undergone a mandibular ridge splitting technique using piezoelectrical surgical device. After ridge-splitting-porcedure implants with interpositional grafts were placed immediately. Assessments included measurements of the linear changes in the marginal bone surrounding the implants immediately postoperative as baseline, 3, 6 and 9 months postoperative. RESULTS: The statistical analysis of measurements obtained from both groups showed no significant difference between control and study groups regarding pain and edema assessment, while probing depth, and marginal bone level showed significant difference between both groups in favor to the study group. CONCLUSIONS: The ridge splitting technique using a partial thickness flap could be a successful option for the reduction of marginal bone loss around immediately inserted implants

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References

1. Wang HL, Boyapati L. Principles of predict-able bone regeneration. Implant Dent 2006; 15:8-17:3. 
2. Cordaro L, Amade DS, Cordaro M. Clinical results of alveolar ridge augmentation with mandibular block bone grafts in partially edentulous patients prior to implant place-ment. Clin Oral Implants Res 2002;13: 103-14. 
3. Demarosi F, Leghissa GC, Sardella A, Lodi G, Carrassi A. Localised maxillary ridge expansion with simultaneous implant placement: a case series. Br J Oral Maxillofac Surg 2009; 47:535-40. 
4. Chin M, Toth BA. Distraction osteogenesis in maxillofacial surgery using internal devices: review of five cases. J Oral Max-illofac Surg 1996; 54:45-53.
5. 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; 21:561-7. 
6. Berengo M, Bacci C, Sartori M, Perini A, Della Barbera M, Valente M. Histomorphometric evaluation of bone grafts harvested by different methods. Minerva Stomatol 2006; 55:189-98. 
7. Chiapasco M, Romeo E, Vogel G. Tridimen- sional reconstruction of knife edge edentulous maxillae by sinus elevation, onlay grafts and sagittal osteotomy of the anterior maxilla: preliminary surgical and prosthetic results. Int J Oral Maxillofac Implants 1998; 13:394-9. 11. 
8. Simion M, Baldoni M, Zaffe D. Jaw bone enlargement using immediate implant place-ment associated with a split-crest technique and guided tissue regeneration. Int J Periodontics Restorative Dent 1992; 12:462-73. 
9. Duncan JM, Westwood RM. Ridge widening for the thin maxilla: a clinical report. Int J Oral Maxillofac Implants 1997; 12:224-7. 
10. Shimoyama T, Kaneko T, Shimizu S, Kasai D, Tojo T, Horie N. Ridge widening and immediate implant placement: a case report. Implant Dent 2001; 10:108-12. 
11. Scipioni A, Bruschi GB, Calesini G. The edentulous ridge expansion technique: A five-year study. Int J Periodontics Restorative Dent 1994; 14:451-9. 
12. Scipioni A, Bruschi GB, Calesini G, Bruschi E, De Martino C. Bone regeneration in the edentulous ridge expansion technique: Histologic and ultrastructural study of 20 clinical cases. Int J Periodontics Restorative Dent 1999; 19:269-77. 
13.Chiapasco M, Romeo E, Vogel G. Vertical distraction osteogenesis of edentulous ridges for improvement of oral implant positioning: A clinical report of preliminary results. Int J Oral Maxillofac Implants 2001; 16:43-51 
14. Lustmann J, Lewinstein I. Interpositional bone grafting technique to widen narrow maxillary ridge. Int J Oral Maxillofac Implants 1995; 10:568-77. 
15. Piccinini M. Mandibular bone expansion technique in conjunction with root form implants: a case report. J Oral MaxillofacSurg 2009; 67:1931-6 
16. Sohn DS, Lee HJ, Heo JU, Moon JW, Park IS, Romanos GE. Immediate and delayed lateral ridge expansion technique in the atrophic posterior mandibular ridge. J Oral Maxillofac Surg 2010; 68:2283-90. 
17. Deepak Agrawal, Alka Sanjay Gupta, Vilas Newaskar, Amit Gupta, Subhash Garg Deshraj Jain. Narrow Ridge Management with Ridge Splitting with Piezotome for Implant Placement: Report of 2 Cases. J Indian Prosthodont So 2012. DOI 10.1007/s13191-012-0216-8. 
18.Blus C, Szmukler-Moncler S. Split-crest and immediate implant placement with ultrason-ic bone surgery: a 3-year life-table analysis with 230 treated sites. Clin Oral Implants Res 2006; 17:700–7. 
19. Troedhan A, Kurrek A, Wainwright M. Vertical alveolar crest split and widening – an experimental study on cow ribs, ultrasonic tool development and test on human cadaver heads. Surg Tech Dev NA 2012, e10. doi:10.4081/std.2012.e10 
20. Suh JJ, Shelemay A, Choi SH, Chai JK. Alveolar ridge splitting: A new microsaw technique. Int J Periodontics Restorative Dent 2005;25: 65-171. 
21.Rossi Jr R. Performing ridge splitting to allow more bone for implant placement. Dent Implantol Update 1999; 10:12-3. 
22.Jensen OT, Cullum DR, Baer D. Marginal bone stability using 3 different flap approaches for alveolar split expansion for den‌tal implants: a 1-year clinical study. J Oral Maxillofac Surg 2009; 67:1921-30.
 

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