Rahhal Mohamed M, Awad Rawda, Fayyad Ahmed, Nurrohman Hamid, Jurado Carlos A
Restorative Dentistry, A.T. Still University, Kirksville, USA.
Prosthodontics, Fayoum University, Fayoum, EGY.
Cureus. 2023 Sep 15;15(9):e45299. doi: 10.7759/cureus.45299. eCollection 2023 Sep.
The present report describes a technique in which the maxillary bone was molded to the desired location using a series of instruments for ridge-splitting procedures. This technique aims to improve bone quality all around the implants at both the crest and apex locations. In some clinical scenarios, insufficient horizontal bone with less than 3 mm prevents implant placement. Thus, ridge splitting is a treatment of choice, and this technique creates bone expansion to form a better receptor site for endosteal implants. A case report is presented involving a completely edentulous 52-year-old male patient presented to the clinic with a horizontal bone defect. The patient complained of having difficulty eating and wants to improve his smile. In this clinical case, a modified ridge-splitting technique was employed, differing from the conventional procedure that uses mallets, chisels, or osteotomes. A lancet and spatula were used for precise ridge splitting, followed by the placement of four endosseous tapered implants-two on each side (Dentis USA, La Palma, USA). Each implant had a diameter of 3.7 mm and a length of 10 mm. These implants were clinically placed in a single visit, with a torque of 30 N/cm² applied to ensure secure fixation. To accommodate the patient's unique maxillary bone anatomy, 25-degree angulated abutments were chosen for the four implants, ensuring a common path of insertion, and optimal angulation for long-term stability and aesthetics. Subsequently, a cemented provisional dental prosthesis restoration was fitted, and the patient reported satisfaction with both function and aesthetics. After a period of five months of osseointegration, the stability of the implants was assessed using a resonance frequency analyzer, yielding positive results. The average resonance frequency values for the maxillary left (canine and premolar) were ISQ 68 and ISQ 71, respectively, while for the maxillary right (lateral incisor and premolar), the values were ISQ 69 and ISQ 73. These readings indicate satisfactory implant stability following the osseointegration process. The postoperative cone-beam computed tomography (CBCT) showed gain to the bone width besides better function and good results concerning the esthetics. This report describes a modified ridge-splitting technique with a predictable and satisfactory outcome that fulfilled the patient's demands. The presented approach overcomes the disadvantages of two-staged implant placement bone grafting procedures and is also a more affordable option for the patient. CBCT evaluation confirmed bone gain with minimal morbidity after the procedure.
本报告描述了一种技术，即使用一系列用于牙槽嵴劈开术的器械将上颌骨塑形至所需位置。该技术旨在改善种植体周围牙槽嵴顶和根尖部位的骨质量。在某些临床情况下，水平骨量不足3毫米会妨碍种植体植入。因此，牙槽嵴劈开术是一种首选治疗方法，该技术可实现骨扩张，为骨内种植体形成更好的植入位点。本文报告了一例病例，一名52岁的男性患者全口无牙，因水平骨缺损前来就诊。患者主诉进食困难，并希望改善笑容。在该临床病例中，采用了改良的牙槽嵴劈开技术，与使用锤、凿或骨凿的传统方法不同。使用柳叶刀和刮匙进行精确的牙槽嵴劈开，随后植入4枚骨内锥形种植体，每侧各2枚（美国登蒂斯公司，美国拉帕尔马）。每枚种植体直径为3.7毫米，长度为10毫米。这些种植体在一次就诊时临床植入，施加30 N/cm²的扭矩以确保牢固固定。为适应患者独特的上颌骨解剖结构，为4枚种植体选择了25度角的基台，确保共同的植入路径以及最佳角度，以实现长期稳定性和美观性。随后，安装了粘结式临时牙修复体，患者对功能和美观均表示满意。经过5个月的骨结合期后，使用共振频率分析仪评估种植体的稳定性，结果呈阳性。上颌左侧（尖牙和前磨牙）种植体的平均共振频率值分别为ISQ 68和ISQ 71，而上颌右侧（侧切牙和前磨牙）的共振频率值分别为ISQ 69和ISQ 73。这些读数表明骨结合过程后种植体稳定性令人满意。术后锥形束计算机断层扫描（CBCT）显示骨宽度增加，功能改善且美观效果良好。本报告描述了一种改良的牙槽嵴劈开技术，其结果可预测且令人满意，满足了患者的需求。所提出的方法克服了两阶段种植体植入骨移植手术的缺点，对患者来说也是一种更经济实惠的选择。CBCT评估证实术后骨量增加且并发症极少。
