Ridge Split - Posterior Mandible
This is a 62 year old gentleman who presents with missing teeth of the left posterior mandible. The ridge is deficient (Figures 1, 2) primarily in width and requires horizontal bone augmentation. One option would be a GBR approach, a second option would be a veneer autogenous block graft that could be harvested from the same side ramus buccal shelf. A third option is ridge split.
A ridge split was proposed and as you will see from Figures 3-6, our typical protocol of utilizing the piezosurgical tool and osteotomes was used to create a greenstick fracture of the buccal plate via crestal and vertical osteotomies. Figure 7 shows screw fixation that is important to maintain the intercortical distance during the grafting period. Figure 8 shows the graft complex used which was mineralized allograft (MinerOss) along with LPRF fragments. The site was then grafted (Figure 9) and LPRF membranes were utilized over the graft complex (Figure 10) with primary closure obtained after adequate flap relaxation both facial and lingual (Figure 11). Five months later the clinical and radiographic result is shown in Figures 12 and 13. Figure 14 also reveals the overall increase of approximately 5 mm. Implants were placed in a nonsumberged mode with primary closure obtained (Figures 15, 16). Approximately 1 month post graft, the mandibular left second molar was fractured resulting in extraction and socket grafting. An additional implant was then added to the treatment plan. Figures 17 and 18 show the healthy peri implant soft tissue drape prior to restoration. Generally speaking, the marrow component between the cortices of a ridge split provides excellent capacity for predictable bone formation. Although many clinicians limit ridge expansion to the maxillary arch with appropriate modifications, the mandible (in particular the posterior mandible) can also be used for this grafting technique.
The Surgical Protocol for Ridge Split is part of our Alveolar Ridge Augmentation course November 4-5, 2015. Click Here for more information.