What is Ridge Split Technique?

The implantation of root-form endosseous dental implants requires the establishment of a proper alveolar ridge. There are many surgical pre-implant bone augmentation techniques that are used for reconstructing the alveolar width, height, or both.

This technique of ridge splitting along with bone expansion manipulates bone to form receptor site for the implant. This is done without removing any bone from the implant site. Maxillary bone can be moulded to the desired location by using series of instruments like chisels and Osteotome. This helps in improving the quality of bone all around the implant, at the crest and the apex.

The ridge-split procedure, among the alveolar ridge augmentation techniques, has many benefits. There is no need of a second (donor) surgical site, lesser risk of inferior alveolar nerve injury, and very less pain and swelling than others. Lateral bone augmentation through the ridge-split is the best in a localized lateral bony defect where there is a need of 1 or 2 implants and where the ridge is vertically intact.

The Method

The Ridge Split Technique is carried out keeping the following 3 characteristics in mind:

• Bone Density: The maxillary alveolar ridge is generally less dense than the mandibular alveolar ridge.
• The Blood Supply: During this procedure, a buccal vascular bone flap is created. The muscular-periosteal soft-tissue envelope provides peripheral vascularization to the gingiva, to the cortical bone, and partly to the cancellous alveolar bone. Periosteum plays a critical role in vascularization of the buccal cortex and in graft osteogenesis.
• Treatment Of The Wound: This relates to the treatment of the wound as a result of this procedure and the wound healing by secondary intention. The alveolar ridges are treated openly and will heal by secondary to the grafted extraction socket. A resorbable or non-resorbable membrane is used to retain graft material, isolate the wound from the oral environment, and guide the soft tissue’s healing over the graft.

The Dental Ridge Split Procedure

The patient is administered preoperative antibiotics 1 hour before the procedure followed by a 1-week postoperative course of antibiotics as well as a chlorhexidine rinse for 3 days, before and 1 week after the procedure.

Preoperatively, the alveolar ridge is evaluated visually and by palpation. Palpating the ridge with 2 fingers sliding along the alveolar crest helps to develop a tactile sense of the ridge thinness and the presence of underlying bone cuts. Furthermore, a CBCT scan will give provide accurate details of the existing bone anatomy who h becomes a guide for the surgeon to proceed with the surgery.

The length of the implant and position of the inferior alveolar canal is usually used to determine the vertical dimension of the split. The length of the ridge to be expanded is practically unlimited and varies from a single tooth to a full arch.

Traditionally, the ridge-split technique consists of a single surgical stage in the maxilla and a two-stage approach in the mandible.

Ridge augmentation using autograft and block graft, and GBR using membrane have proved successful in highly resorbed ridges to achieve a result in horizontal and vertical dimension. More non-invasive technique of ridge splitting and expansion is carried out easily, without causing much trauma to the patient.

Authored by DR.NIRANJAN P