Delayed lateral ridge split technique for implant placement in the atrophic posterior mandible by means of piezosurgery

Abstract

Reconstruction of posterior edentulous mandible with dental implants requires residual ridge width of 5,5 mm or more. To
achieve such crestal dimension two-stage ridge splitting technique has been used at our patients (n=4) with piezoelectric
bone surgery. The first stage consisted of full mucoperiosteal flap elevation to expose the vestibular aspect of the posterior
mandible. Two horizontal (crestal and apical) and two vertical corticotomies were created, than the mucoperiosteal
flap was reapproximated. After 35 days of healing period using crestal incision lingually full-thickness flap, vestibularly
partial-thickness flap was elevated with intact periosteum on the buccal bone plate. In order to separate and lateralize
the vestibular cortical plate, the crestal cut was refreshed and with bone expanders widened until a gap of 4-5 mm was
established. Implants were inserted conventionally and followed by tension free soft tissue closure. After 5-6 months
elapsed, periapical radiographs depicted bone loss of maximum 1,0-1,5 mm around the neck of the implants. At the exposure
no implant mobility was observed. Prosthetic loading with final crowns and fixed partial prostheses was successful
in all cases, no more bone resorption was registered during the 6 month follow-up. Nevertheless, bone graft application
seems to be advisable.