| Objective The insufficient thickness of alveolar ridge at absent tooth area commonly caused by congenital absence, trauma, inflammation, tumor or tooth extraction injuries, which showed knife-edging in serious condition. It can be hardly implanted in an ideal position and direction, and cause a series of repair issues. severe patients even cannot be implanted appropriately. The buccolingual osteone of alveolar process was thick cortical bone, which was hardly manipulated at mandibula due to absence of elasticity, poor blood supply and less vascular anastomotic branches by traditional split-crest technique. In addition, the osteone can easily get fracture and necrosis since the insufficient blood supply. The aim of this article was to evaluate and discuss the application on a two-stage ridge splitting technique in the edentulous mandible,which is a reliable approach to rebuild modified bone thickness for a narrow edentulous ridge in the buccolingual direction.Methods Eleven patients(4 males and 7 females), mean age was 53.36y(range from38-71y), were selected from the Department of Dental Implantology, dental hospital of Henan Province from December 2013 to December 2015. Nine were in the lateral mandible and 4 were in the anterior mandible. They were treated with a two staged ridge splitting and simultaneous placement of dental implants. The preoperative thickness of alveolar ridge was 2-4 mm by cone beam computed tomography(CBCT),and 13 bone level dental implants from Ankylos were used. Surgery procedures: the rectangle incision was performed separately at the crestal, apical, and lateral aspects of the buccal cortical plate by a simple corticotomy on the first surgery and then mucoperiosteal flap was sutured. Implants were placed in the preplanned positions after performing the crestal incision to maintain the periosteum onto the bone at 4-6weeks postoperatively. Following 5-6 months do stage-two surgery. All the cases were done successfully and followed up for 6-12 months after prosthetic rehabilitation.The evaluation methods and measurement contents:1. Implant success criteria evaluation;2. Measurements of bone tickness by CBCT(1) Measurements of the thickness of the alveolar bone before and after the operation.(2) Measurements of the absorption amount of the lingual bone plate of the lip(buccal) at stage-two surgery.3. ISQ(stability quotient implant) for measuring the stability of implant boneResults1. Thirteen single implants were healed well, and repaired by whole porcelain,which can bear weight and function well after the two-stage ridge splitting surgery.The implant cumulative survival rate at the end of follow-up was 100%.2. Measurements and analysis of bone mass by CBCT.(1) preoperative postoperative CBCT measurements under cultivation and crestal plane 0mm, 3mm, 6mm buccolingual increased thickness of the alveolar ridge to 3.71± 0.71 mm, 2.25 ± 0.58 mm, 1.22 ± 0.34 mm, three bits points compared with the preoperative bone mass, P < 0.05, differences in bone mass changes have statistical significance.(2) after operation and stage-two surgery CBCT measurement plane 0mm, 3mm,6mm at the site were absorbed to the buccal and lingual alveolar crest thickness were absorbed 0.52 ± 0.28 mm, 0.38 ± 0.22 mm, 0.27 ± 0.20 mm, and after six months after the bone mass difference was statistically significant.(3) stage-two surgery to measure implant neck under the surface of 0mm, 3mm,6mm, lip(buccal) to the bone plate thickness were 1.62 ± 0.58 mm, 1.96 ± 1.05 mm,2.59 ± 1.59 mm. The thickness of 0mm,3mm and 6mm in the lingual side of the lingual bone plate was 1.52 ± 0.32 mm, 2.05 ± 0.35 mm, 2.44 ± 0.71 mm. The thickness of the bone plate is more than 1.5mm, which ensures the stable cortical bone mass around the implants.(4) after operation and stage-two surgery planting neck plane body 0mm, 3mm,6mm buccal hyoid bone plate absorption were paired t-test: planting neck plane 0mm buccal bone plate and lingual bone plate, are absorbed by a small amount, P > 0.05,the difference is no statistical significance; planting neck plane 3mm, 6mm at that kind of plane body 3mm, 6mm buccal bone plate and lingual bone plate, are absorbed by a small amount of vegetation, P < 0.05, lip(buccal) absorption than the lingual, the difference is statistically significant.3. measurement of modified osteotomy at impression taking after the implant stability coefficient(ISQ), the average value is 77.62 + 1.71. With the similar.Conclusion This novel technique is a modification of the conventional split ridge technique through a two-stage procedure, it’s reliable and effective approach to create adequate bone volume in the edentulous alveolar ridge of mandible. Two-Stage Ridge Splitting Technique adapt to the on the buccal and lingual bone plate is thick, the lack of elasticity of the mandibular alveolar ridge. After the implant osseointegration with the buccal lingual bone plate are larger than 1.5mm, to meet the long-term stability of the implant requirements. The use of this technique offers several advantages: it’s relatively easy to operate for dentists and also shorten treatment time for patients,this approach is extremely worth popularization. But the high requirement for surgery,therefore need preoperative assessment and surgical planning of planting sites,reasonable, accurate operation, it has a good clinical effect. |
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