JIACD
The Journal of Implant & Advanced Clinical Dentistry
Ridge Split: What is the success and the risks?
Sat, 03/14/2009 - 11:28 — Dr. Pratt
One of the periodontist I refer to does ridge splitting. I am wary the this procedure as I think it is risky and can possible see the ridge that your breaking out necrose and leaving the patient with a larger defect. I of course dont have experience in these procedure but would like to be educated in order to explain to my patient. What is the success, risks and protocol of a ridge split?
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Ridge expansion
I have found ridge expansion to be very predictable. You do have to take your time. You need the proper training, understanding of the applications and limitations, instruments and tactile feel. To quote Clint Eastwood in Dirty Harry "Every man has to know their own limitations."
Ridge Splitting..technique sensitive but VERY predictable.
I have been placing implants for over a decade. My theory is BONE BONE BONE before implants. Allographic bone is extremely limited in handling properties and predictability, and I feel is generally used by less experienced clinicians who are reluctant and undertrained in autogenous bone grafting. My mainstay of width augmentation has always been block grafting from ramus or iliac crest. However, in maxillary posterior or large edentulous mandibular posterior spans where vertical height is not compromised, my first choice for width augmentation has been ridge splitting with simultaneous implant placement. Over the last 10 years, my implant "loss" has been ZERO percent with this technique. However, if the expansion leaves a thin buccal plate which tends to be knife edged superiorly, I have found that in many cases there is crestal resorption and exposure of 2 to 3 threads postinsertion. Clinically significant? MAYBE....but thorough patient education with respect to hygiene and the lack of esthetic demands in these areas diminish postoperative morbidity with this procedure. Use the procedure with confidence.
Splitting a Ridge and Placing the implants is risky
I to think ridge splitting is a great treatment option however I think placing the implants at the same time you risk failure.
My recommendation is split the ridge, get your bone width then come back and place you implants later.
One miracle at a time.
ridge splitting and implant placement
There are certain rules to follow: 1) Only every other site does one place an implant. 2)"D" implants are best suited for this procedure (Tatum Surgical). 3) A release cut may have to be made to relieve strain in the bone.
Ridge split still used?
Sorry for my ingnorance, but I am relatively new to implants. A colleague told me that ridge split is an old technique developed for placing the very old style blade a long time ago. Is this true? If so, why is ridge split still being used if we now use root form implants?
Ridge Splitting: How do you avoid making the buccal plate.......
How do you avoid making the buccal plate to thin. If you have a 3mm ridge the plate is going to be 1.5mm or less.
Is there a minimum ridge with you need in order to split safely?
Lauren
Ridge Split failures and success: depends
I have seen both failures and success with this. I am very wary about this technique especially if you place implants at the same time.
What is the best technique to assure success?
Ridge Split -Viable Technique
I have been doing ridge splitting in the past 15 years mostly in the upper jaw.To my experience it is the most predictable procedure for gaining sufficient width. The biggest advantage of this procedure is the ability to insert the implants simultaneously.
In order to have the same rate of success(close to 100%)you need to use the right instrumentation. I do all my splits with ultrasonic bone device,using chisels and screw type bone expanders.Often one will need to add vertical bone cuts to facilitate bone manipulation reducing potential fracture.In the worse case you switch from split to bone block fixation.
Ridge splits: Viable but not without risks
As Dr. Misch is now saying one miracle at a time. I think ridge splitting is fine, in the maxilla, very difficult in the mandible, but to place implants at the same time is risky.
I have seen not only loss of the implants but loss of the plate from the splitting and placing at the same time.
Dont you feel it is better to split the ridge let it heal and then 4-6 months later place the implants?
Shaz
Ridge splitting: No reason to do this.
Why split the ridge when you can augment it with particulate bone. This procedure is to risky and should be avoided.
John
Ridge splitting is incredible treatment
People "poo-pooing" ridge splitting have either never done one or have only done a few (I am guessing).
I have done over 50 ridge splits. There is a world of difference between ridge split bone and particulate grafted sites. Particulate sites result in type 3,4 bone while ridge split sites result in type 1,2 bone. Plus, you can get alot more lateral augmentation with ridge splitting than with simple particulate.
The key with ridge splitting is case selection.
Ridge Split: To risky and leads to implant failure.
Ridge splitting has become a risky venture for me. I have had more failures doing this procedure. I usually split and place the implants and my implant success is 75%. What am I doing wrong?
Don't do them simultaneously. Your success rate will increase
75% is low. Something is wrong.
If you are getting success that low, don't do simultaneous placement. I guarantee your success rate will increase.
Ridge Split:::::Works well if you know what you are doing
I have done a couple of these in my time. My success rate is about 90%. I have had a few failure. Failure can make a small defect larger and harder to deal with. In residency I had the buccal plate sequester on one case. The key is taking your time during the expansion. Make clean cuts and avoid compromising blood supply.
Ridge Splitting: A vaible option a patient can benefit from.
Ridge splitting is a viable option if the clinician know the limits and the technique. It certainly can be risky, if you dont know what you are doing.
I usually use a sagital saw and make 3 cuts: crestal, mesial and distal to the area I want to expand. I obviously elevate a buccal flap only leaving the blood supply intact on the lingual/palatal. I then take a round bur and score the apical aspect. I then begin my expansion starting with a 15 blade down the crest and increase the expansion with osteotomes. I usually move seguentially along my crestal incision as to move the pressure along the crestal incision to prevent fracture.
Once I expand to my desired width, I usually graft with bio-oss or FDBA and cover with a membrane. I never place the implants as I air on the conservative side, although some authors do.
Here is a couple of decent articles that are good reviews:
Koo S, Dibart S, Weber HP. Ridge-splitting technique with simultaneous implant placement.Compend Contin Educ Dent. 2008 Mar;29(2):106-10.
Guirado JL, Yuguero MR, Carrión del Valle MJ, Zamora GP.maxillary ridge-splitting technique followed by immediate placement of implants: a case report.Implant Dent. 2005 Mar;14(1):14-20.
Coatoam GW, Mariotti A. The segmental ridge-split procedure.J Periodontol. 2003