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The International Journal of Periodontics & Restorative Dentistry

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565

A Three-Stage Split-Crest Technique:


Case Series of Horizontal Ridge Augmentation
in the Atrophic Posterior Mandible

Guei-Hua Hu, DDS, MS1 In patients with longstanding eden-


Stuart J. Froum, DDS2/Abdullah Alodadi, DDS1 tulism, extreme bone resorption (ver-
Fuyuki Nose, DDS, PhD1/Yung-Cheng Paul Yu, DDS3 tically, horizontally, or a combination
Takanori Suzuki, DDS, PhD4/Sang-Choon Cho, DDS5 of both) is frequently observed.1,2 The
use of augmentation techniques is
often necessary to create adequate
This paper introduces a three-stage split-crest (TSSC) technique for horizontal bone volume for implant place-
ridge augmentation in the atrophic posterior mandible. The first stage consists ment. The width of narrow posterior
of splitting the ridge. Following a 3- to 4-week healing interval, the second stage mandibular edentulous ridges can
consists of expansion of the cortical plate (without elevating the periosteum) and
be increased by four different hori-
placement of a bone replacement graft material. After 3 to 4 months of healing, the
implants are placed. The advantages of this three-stage technique are increased zontal augmentation procedures:
vascularization to the surgical area, a decrease in procedure complications, lateral augmentation using guided
and improved implant survival rates. An extended treatment time is the main bone regeneration,3 block grafting,4
disadvantage. The purpose of this retrospective case series is to review and discuss distraction osteogenesis,5 and inter-
a new step-by-step surgical procedure of a TSSC technique using a delayed implant positional augmentation.6 Guided
placement protocol. The results, advantages, and limitations are also presented.
bone regeneration is a predictable
Int J Periodontics Restorative Dent 2018;38:565–573. doi: 10.11607/prd.2907
procedure for horizontal ridge aug-
mentation, but its dependence on
the blood supply of the underlying
bone7 limits its use in an atrophic
mandible where there is limited mar-
row between the buccal and lingual
central plates. The same is true for
block grafting, which requires a sec-
ond surgery site if autogenous bone
1Resident, Advanced Program in Implant Dentistry, Department of Periodontology and
Implant Dentistry, New York University College of Dentistry, New York, New York, USA. is used.8 Distraction osteogenesis is
2Adjunct Clinical Professor and Director of Clinical Research, Department of Periodontology an effective technique for horizon-
and Implant Dentistry, New York University College of Dentistry, New York, New York, USA. tal ridge augmentation but requires
3Visiting Assistant Professor, Advanced Program in Implant Dentistry, Department of
precise execution; complications can
Periodontology and Implant Dentistry, New York University College of Dentistry,
New York, New York, USA. result in loss of large segments of
4Clinical Assistant Professor, Advanced Program in Implant Dentistry, Department of
bone.9 Interpositional augmentation
Periodontology and Implant Dentistry, New York University College of Dentistry, is a technique-sensitive procedure
New York, New York, USA.
5Director, Advanced Program in Implant Dentistry, Department of Periodontology and for ridge expansion using bone ex-
Implant Dentistry, New York University College of Dentistry, New York, New York, USA. panders or osteotomes with an ap-
proach known as the split-crest (SC)
Correspondence to: Dr Stuart J. Froum, 17 W 54th Street, Suite 1 C/D,
technique.10
New York, NY 10019, USA. Email: dr.froum@verizon.net
The SC technique consists of
©2018 by Quintessence Publishing Co Inc. segmenting the vestibular cortical

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566

plate and displacing it buccally in approach has been proposed with • All patients received implants
the maxilla or mandible to create a splitting and expansion performed placed using the modified
gap to contain the placed implants. followed by implant placement after TSSC technique.
The space around the implants can a 3-week healing interval.13,20 This al- • Preoperative periapical
be filled with bone graft or bone lows re-establishment of the blood radiographs and cone beam
substitute materials such as autog- supply to the surgical site. However, computed tomography (CBCT)
enous,11 allogenic,12 or xenogeneic this staged technique was reported scan images of the posterior
graft materials.13 to have potential complications such mandible were available
The use of an ultrasonic cutting as infection and separation of bony prior to surgery for case
device makes the SC procedure less segments.20 To reduce the potential assessment.
traumatic when compared to con- for complications, this study intro- • Patients required single
ventional surgery using disks, burs, duces a modified three-stage SC or multiple implants in the
and chisels.14 Ultrasonic devices (TSSC) technique. The purpose of posterior mandible.
have the ability to cut mineralized this retrospective case series was to • A ridge width of < 4 mm was
hard tissues in a safe and precise describe this novel TSSC technique present in CBCT images as
way, with minor soft tissue dam- and report on patient outcomes measured 2 mm apical to the
age. Clinical studies evaluating the when TSSC was used in the atro- crest of the ridge.
potential of ultrasonic bone surgery phic posterior mandible. The step- • A ridge height of > 10 mm
with a split-crest expansion tech- by-step surgical procedure using was present as measured from
nique have reported satisfactory delayed implant placement is pre- the superior border of the
results.15 sented, along with the advantages mandibular canal to the crest of
The SC technique may be per- and limitations of this technique. ridge.
formed simultaneously with implant • The ridge had healed for at
placement,6,12,15–19 resulting in a short- least 3 months following tooth
ened treatment time. However, this Materials and Methods extraction.
approach has the potential for seri-
ous complications, including buccal Clinical data used in this study was Exclusion criteria were as follows:
bone fracture, prolonged pain or par- obtained from the Implant Data-
esthesia, and loss of bone height.16 base (ID) of the Ashman Depart- • Presence of uncontrolled
A minimum of 3 mm of bone width, ment of Periodontology and Implant diabetes, immunologic
including at least 1 mm of cancellous Dentistry at New York University diseases, or other systemic
bone, is indicated for this approach.17 College of Dentistry (NYUCD). This conditions that contraindicated
Implants placed in maxillary bone in data set was extracted as deidenti- surgery.
which the width was increased by fied information from the routine • Radiation therapy to the head
means of interpositional augmenta- treatment of patients in the de- and neck region in the 12
tion have demonstrated 5-year cu- partment. The ID was certified by months prior to the proposed
mulative success rates between 86% the Office of Quality Assurance at therapy.
and 99%.6,12,16,18 Attempts to use this NYUCD. This study is in compliance • Chemotherapy within a
procedure in denser bone, such as is with the Health Insurance Portability 12-month period prior to the
present in the mandible, have shown and Accountability Act (HIPAA). proposed therapy.
limited success to date.12,19 A total of 10 patients were con- • Patients currently on or with
A staged approach presents a secutively selected from the ID for a history of bisphosphonate
solution to the problems inherent in this case series based on the inclu- therapy.
the use of the SC technique in the sion and exclusion criteria. Inclusion • Presence of periodontal
mandible. Consequently, a staged criteria were as follows: disease, or unwillingness to

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567

Fig 1 Clinical intraoral view before Fig 2 Preoperative CBCT scan and Fig 3 Clinically very narrow alveolar width
treatment showing a severely atrophic periapical radiographic images of right was observed after flap reflection.
posterior mandible. posterior mandible. Note the 2-mm-thick
alveolar ridge.

undergo needed periodontal informed consent was obtained traindicated. A midcrestal incision
therapy, around the remaining from each patient. All necessary was made along the ridge crest
teeth. periodontal and caries treatments slightly lingual to the midline, and
• Pregnancy or wish to become were performed prior to surgery. two vertical incisions were made at
pregnant within 1 year of Prior to surgery, a CBCT scan of the termination of the crestal inci-
therapy. the surgical site was taken for each sion (Fig 3). Alveolar ridge width
• Smoking habit of one pack or patient (Figs 1 and 2). was measured at the time of sur-
more per day and unwillingness gery at the crest of the planned im-
to enter a smoking cessation plant position from buccal to lingual
protocol. Surgical Procedure with an electronic caliper (Absolute
• Psychologic problems that, in 700-113-10, Mitutoyo) to the nearest
the opinion of the surgeons, The surgical procedures were stan- 0.5 mm. A full-thickness mucoperi-
would have rendered the dardized and were performed in osteal flap was elevated to expose
delivery of comprehensive three stages. the buccal aspect of the mandibular
therapy untenable. alveolar ridge. Rectangular corti-
• Unwillingness to commit to First Stage cotomies were made using a piezo-
a long-term posttherapy Patients were prescribed 2 g of electric saw (Mectron). A crestal
maintenance program. amoxicillin or, if allergic, 600 mg of horizontal corticotomy was started
clindamycin 1 hour prior to surgery 2 mm mesial or distal to the adja-
To be included for evaluation, im- and told to continue them (three cent teeth. The length of the hori-
plants and prostheses were re- times a day if amoxicillin 500 mg zontal cut was determined based
quired to survive and function for a and four times a day if clindamycin on the number of implants and the
minimum of 6 months from time of 150 mg) for 10 days postsurgery. space between the existing teeth or
completion of the final restoration. Local infiltration anesthesia of xylo- implants. The depth of the horizon-
A lack of neurosensory problems caine (Lidocaine HCl, Henry Schein) tal inferior cut was 2 mm coronal to
or other complications was also re- 2% containing epinephrine at a con- the inferior alveolar canal as mea-
quired for evaluation. centration of 1:100,000 was admin- sured on the CBCT scan. This apical
Following screening and ex- istered, or carbocaine (Mepivacaine cut averaged 10 mm in depth. Ver-
amination, an institutional review HCl, Carestream Health) 3% in cas- tical osteotomies were deepened
board–approved written and oral es where a vasoconstrictor was con- 1 to 2 mm using the piezoelectric

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568

Fig 4 A crestal horizontal corticotomy was Fig 5 The mucoperiosteal flap was sutured Fig 6 The healing ridge, 3 to 4 weeks after
made using a piezoelectric saw, followed using 4-0 chromic gut resorbable material. the primary surgery, prior to performing
by two vertical osteotomies that were ridge expansion and placing grafting
deepened 1 to 2 mm through the cortical material during the second-stage surgery.
bone along with a horizontal inferior cut.

greenstick fractured buccal seg-


ment was readapted with finger
pressure, and the mucoperiosteal
flap was sutured using 4-0 chromic
gut resorbable material (635-CG,
Henry Schein). Tension-free soft
tissue closure was achieved in all
a b cases (Fig 5).
Fig 7 (a) A 3.3-mm diameter split crest chisel (SCC33, EBI) was used during the second-
stage surgery. (b) A crestal incision to expose the initial crestal cut without elevation of a
buccal flap. This allowed conservation of the blood supply on the buccal aspect of the
Second Stage
displaced buccal plate. The displacement of the buccal plate to expand the ridge was Following a 3- to 4-week healing
achieved by using a 3.3-mm-diameter split crest chisel and a 15c blade. period, ridge expansion and place-
ment of the grafting material was
performed as part of the second-
stage surgery (Fig 6). A crestal in-
cision to expose the initial crestal
cut was performed without eleva-
tion of a buccal flap. A 3.3-mm-
diameter split crest chisel (SCC33,
EBI) and 15c blade were used to
carefully separate and mobilize the
Fig 8 A xenograft material (small particle Fig 9 Tension-free soft tissue closure was segmented bone, creating a green-
Bio-Oss, Geistlich) was packed in the achieved with 4-0 chromic gut.
created space.
stick fracture (Fig 7). This allowed
preservation of the blood supply on
the buccal aspect of the displaced
buccal plate. Small-particle (0.25 to
saw through the cortical bone to elevator (E301, Hu-Friedy) was used 1 mm) xenograft material (Bio-Oss,
intersect with the horizontal inferior to expand the buccal segmented Geistlich) was packed in the created
cut (Fig 4). These cuts were made bone approximately 3 mm, provok- space (Fig 8). The mucoperiosteal
through the cortical bone leaving ing a greenstick fracture. This seg- flap was sutured with 4-0 chromic
only the cancellous bone to be part ment remained stable due to the gut. Tension-free soft tissue closure
of the greenstick fracture. A #301 underlying cancellous bone. The was achieved in all cases (Fig 9).

The International Journal of Periodontics & Restorative Dentistry

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569

Fig 10 (left) A CBCT scan was taken prior Fig 12 (below) Two Straumann bone-level
to implant placement. implants (3.3 × 10 mm, mandibular right
second premolar and first molar) were
Fig 11 (below) Reentry after 4 months of placed.
healing showing an enhanced bone width
of 4 mm.

Fig 13 (a) Clinical occlusal view of the


mandibular right second premolar and first
molar porcelain-fused-to-metal bridge.
(b) Clinical buccal view of the mandibular
right second premolar and first molar
porcelain-fused-to-metal bridge. a b

Fig 14 CBCT
Third Stage scan images
After 3 to 4 months, a CBCT scan taken before
treatment,
was taken prior to implant placement after the
(Fig 10). A full-thickness flap was re- second stage,
and 4 months
flected, and landmarks such as the
after delivery
mental foramen and inferior alveolar of the final
nerve were identified (Fig 11). Alveo- restoration,
showing the
lar ridge width was measured to the desirable result.
nearest 0.5 mm and recorded again
at the crest of the ridge using the
same method described in the first-
stage procedure. A round bur was
used to mark the initial osteotomy,
and a Lindemann drill (EBI) was used
to achieve a depth of 6 mm into the
bone. Depending on the width of Restorative Procedure metal crowns, which were splinted,
the bone, standard-width implants cemented, or screw retained ac-
(3.3 to 4.1 mm) were inserted in the The implants were allowed to inte- cording to the restorative dentist’s
area, achieving primary stability, and grate for 3 to 4 months. Impressions preference (Fig 13). A CBCT scan
the surgical site was sutured with were then taken using polyether was taken after prosthesis delivery
4-0 chromic gut and allowed to heal material and sent to the lab for and compared to the presurgical
(Fig 12). fabrication of porcelain-fused-to- scan (Fig 14).

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570

a b c

d e f
Fig 15 The three-stage split-crest technique. (a) Presurgical atrophic posterior mandibular ridge. (b) Rectangular osteotomies are made
using the piezoelectric saw, provoking a greenstick fracture. (c) Second surgery, using a 3.3-mm-diameter chisel to separate the buccal
fractured segment. (d) Suturing following placement of the bone substitute graft. (e) Placement of implants in the augmented ridge.
(f) Flap suturing following implant placement.

The technique as performed is allowed successful implant place- Discussion


illustrated in Fig 15. ment. All implants were loaded
for a minimum of 6 months, and all The TSSC technique as described
implants and prostheses survived. was applied in severely buccolin-
Results No implant failure or neurosensory gually atrophied posterior man-
impairment was reported. There dibular edentulous regions as a
In this retrospective study, a total were no complications with the three-stage procedure. The out-
of 10 subjects received 20 implants surgery or the restorations (such as comes of the 20 implants in 10 pa-
placed using the TSSC technique. broken, fractured, or chipped res- tients presented were all positive,
All patients showed substantial re- torations) during the follow-up pe- with a 100% implant survival rate
construction of alveolar crest defi- riod (6 to 24 months) during which and no reported complications.
ciencies with an average increase in the final restorations were in func- The lateral ridge expan-
ridge width of 2.5 to 4 mm, which tion (Table 1). sion technique with simultaneous

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571

Table 1 Summary of the Study Sample and Outcomes of the TSSC Techniques
Bone width (mm) Implants
Surgical (SC) or
Location Diameter Length Follow-up prosthetic (PC)
Subject Sex Age (y) Pre Post Gain (FDI) (mm) (mm) (mo) complications
1 F 34 3 6.5 3.5 45 3.3 10 34 None
3 6 3 46 3.3 10 None
2 M 55 2 6 4 45 3.3 10 38 None
3 6 3 46 3.3 10 None
3 F 46 3.5 6.5 3 37 4.1 10 31 None
3.5 6.5 3 36 4.1 10 None
4 M 52 4 7 3 36 4.1 10 29 None
5 F 45 3 6 3 45 4.1 10 28 None
3 6 3 46 4.1 10 None
6 F 42 3 6 3 37 4.1 10 22 None
3.5 6 2.5 36 4.1 10 None
7 F 70 2.5 5.5 3 45 3.3 10 21 None
3 6.5 3.5 46 4.1 10 None
8 F 58 3 6 3 36 4.1 10 20 None
3 5.5 2.5 35 4.1 10 None
3.5 6 2.5 34 3.3 10 None
9 M 45 3 6.5 3.5 36 4.1 10 20 None
3.5 6.5 3 35 4.1 10 None
10 F 50 3 6 3 37 4.1 10 20 None
3 6 3 36 4.1 10 None
Mean ± SD 49.7 ± 9.88 3.1 ± 0.42 6.15 ± 0.37 3 ± 0.36 26.3 ± 6.62

immediate implant placement is buccolingual and/or apicocoronal was reported using a two-stage
often performed because it short- direction.12,16,18 Some studies recom- procedure20 and Scarano et al13 re-
ens the total treatment time.15–19,21–23 mend a staged approach to avoid ported an early implant failure rate
However, the risk of fracture of the postoperative complications such of 3.12% at 3 months using the two-
osteomized segment is increased as bone sequestrum of the buccal stage procedure in the posterior
in the mandible because the man- segment.24,25 Although a two-stage mandible. Moreover, there is uncer-
dibular bone has a more rigid cor- approach increases treatment time, tainty as to the amount of bone the
tical bone and a thicker cortical it also allows for subsequent evalu- clinician can expect prior to stage 2
plate. Several complications have ation of the expanded ridge and of two-stage technique.
been reported for ridge expansion avoidance of other complications. The TSSC technique described
with simultaneous implant place- With this approach, the location in this case series provides a sub-
ment, such as a lack of initial stabil- of the greenstick fracture is pre- stantial improvement in diagnosing
ity for the implants, fracture of the determined, and blood supply for and planning implant positioning,
buccal segmented bone, and com- the buccal segment remains intact. reducing potential implant com-
promised implant placement in the However, buccal bone resorption plications and failures. Enhanced

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572

bone volume during implant place- ity to oscillate at the same speed knowledge, skill, and experience
ment provides a greater potential and amplitude as the cutting tip of on the part of the operator. Further
for implant stability and long-term the instrument.29 Successful results studies are recommended to deter-
results. In addition, a more robust have been reported using these mine whether these results can be
blood supply is expected within 3 cutting instruments with a split- achieved in additional cases.
weeks to achieve revascularization. ridge technique.14,15
Some studies described revascular- However, the TSSC technique
ization at 9 days with normal histo- increases the time until final prosthe- Acknowledgments
logic and microvascular appearance ses delivery and surgical exposure.
at 14 days.26 This is the rationale Additionally, the clinical cases in this The authors reported no conflicts of interest
for the 3-week waiting period used report were treated by surgeons related to this study.

in this protocol to ensure sufficient experienced in implant placement


blood supply to the mucogingival and ridge-splitting techniques. It is
flap and underlying bone. The use unclear whether these results can References
of a crestal incision only, avoiding be obtained by less experienced
flap reflection and preserving the operators. In the present study, the 1. Cawood JI, Howell RA. A classification
of the edentulous jaws. Int J Oral Maxil-
periosteum during the second sur- TSSC technique was proven to be
lofac Surg 1988;17:232–236.
gical procedure, when the bone safe and merits further studies. Ran- 2. Schropp L, Wenzel A, Kostopoulos L,
substitute graft is performed, avoids domized clinical trials are needed Karring T. Bone healing and soft tissue
contour changes following single-tooth
scar tissue formation and improves to validate the effectiveness of this extraction: A clinical and radiographic
the healing response. This tech- procedure. 12-month prospective study. Int J Peri-
odontics Restorative Dent 2003;23:
nique differs from the piezoelectric The preliminary results of this in-
313–323.
hinge-assisted ridge split technique vestigation indicated that the modi- 3. Buser D, Brägger U, Lang NP, Nyman S.
in that it adds an additional surgical fied staged split-crest technique can Regeneration and enlargement of jaw
bone using guided tissue regeneration.
step but avoids the use of a mem- be a safe and successful procedure Clin Oral Implants Res 1990;1:22–32.
brane barrier, which eliminates pos- and may reduce the reported com- 4. Misch CM. Autogenous bone graft-
ing for dental implants. In: Fonseca RJ,
sible complications. Moreover, in plications associated with single- or
Marciani RD, Turvey TA (eds). Oral and
the TSSC technique, grafting and two-stage spilt crest procedures Maxillofacial Surgery. Vol 1: Anesthesia
further widening of the ridge are without causing significant delay in and Pain Control, Dentoalveolar Surgery,
Practice Management, Implant Surgery,
performed during stage 2 surgery treatment. ed 2. St Louis: Saunders, 2009:344–370.
without flap reflection. This allows 5. Takahashi T, Funaki K, Shintani H, Ha-
ruoka T. Use of horizontal alveolar
the healing of the graft and ridge
distraction osteogenesis for implant
to take place under an intact perios- Conclusions placement in a narrow alveolar ridge:
teum, connective tissue, and epithe- A case report. Int J Oral Maxillofac Im-
plants 2004;19:291–294.
lium cover, providing an improved The TSSC technique used in this 6. Scipioni A, Bruschi GB, Calesini G. The
blood supply during this critical step study in 10 patients with 20 implants edentulous ridge expansion technique:
A five-year study. Int J Periodontics Re-
in healing.27 proved to be an effective method
storative Dent 1994;14:451–459.
The use of ultrasonic cutting for horizontal augmentation in se- 7. Misch CM. Complications of autog-
devices is advocated with the TSSC verely atrophic posterior mandibu- enous bone grafting. In: Froum SJ (ed).
Dental Implant Complications: Etiology,
procedure due to their ability to cut lar ridges. The TSSC technique can Prevention, and Treatment, ed 2. Hobo-
mineralized hard tissues with minor be used safely and predictably in ken: John Wiley & Sons, 2016:332–361.
soft tissue damage.14,28 Vital soft tis- patients with dense and thick cor-
sue structures such as nerves and tical bone and narrower ridges in
blood vessels are not damaged by the posterior mandible. However,
the cutting tip because of their abil- this technique requires planning,

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573

8. Buser D, Dula K, Hirt HP, Schenk RK. 15. Blus C, Szmukler-Moncler S. Split-crest 23. Calvo Guirado JL, Saez Yuguero MR,
Lateral ridge augmentation using auto- and immediate implant placement with Carrión del Valle MJ, Zamora GP. A max-
grafts and barrier membranes: A clini- ultra-sonic bone surgery: A 3-year life- illary ridge-splitting technique followed
cal study with 40 partially edentulous table analysis with 230 treated sites. Clin by immediate placement of implants: A
patients. J Oral Maxillofac Surg 1996;54: Oral Implants Res 2006;17:700–707. case report. Implant Dent 2005;14:14–20.
420–432. 16. Engelke WG, Diederichs CG, Jacobs 24. Enislidis G, Wittwer G, Ewers R. Prelimi-
9. Jensen OT. Avoiding complications HG, Deckwer I. Alveolar reconstruction nary report on a staged ridge splitting
of alveolar segmental osteoperiosteal with splitting osteotomy and microfixa- technique for implant placement in the
flaps. In: Froum SJ (ed). Dental Implant tion of implants. Int J Oral Maxillofac mandible: A technical note. Int J Oral
Complications: Etiology, Prevention, and Implants 1997;12:310–318. Maxillofac Implants 2006;21:445–449.
Treatment, ed 2. Hoboken: John Wiley & 17. Koo S, Dibart S, Weber HP. Ridge- 25. Elian N, Jalbout Z, Ehrlich B, et al. A
Sons, 2016;383–395. splitting technique with simultaneous two-stage full-arch ridge expansion
10. Bruschi GB, Scipioni A. Alveolar augmen- implant placement. Compend Contin technique: Review of the literature and
tation: New Applications for Implants. Educ Dent 2008;29:106–110. clinical guidelines. Implant Dent 2008;
In: Heimke G (ed). Osseo-integrated 18. Sethi A, Kaus T. Maxillary ridge expan- 17:16–23.
Implants. Vol 2. Implants in Oral and sion with simultaneous implant place- 26. Kon S, Caffesse RG, Castelli WA, Nas-
ENT Surgery. Boca Raton: CRC, 1990: ment: 5-year results of an ongoing jleti CE. Revascularization following a
35–61. clinical study. Int J Oral Maxillofac Im- combined gingival flap-split thickness
11. Calvo Guirado JL, Pardo Zamora G, plants 2000;15:491–499. flap procedure in monkeys. J Periodon-
Saez Yuguero MR. Ridge splitting tech- 19. Chiapasco M, Ferrini F, Casentini P, Ac- tol 1984;55:345–351.
nique in atrophic anterior maxilla with cardi S, Zaniboni M. Dental implants 27. Holtzclaw DJ, Toscano NJ, Rosen PS.
immediate implants, bone regenera- placed in expanded narrow edentulous Reconstruction of posterior mandibu-
tion and immediate temporisation: A ridges with the Extension Crest device. lar alveolar ridge deficiencies with the
case report. J Ir Dent Assoc 2007;53: A 1–3-year multicenter follow-up study. piezoelectric hinge-assisted ridge split
187–190. Clin Oral Implants Res 2006;17:265–272. technique: A retrospective observa-
12. Langer B, Langer L, Sullivan RM. 20. Sohn DS, Lee HJ, Heo JU, Moon JW, tional report. J Periodontol 2010;81:
Planned labial plate advancement with Park IS, Romanos GE. Immediate and 1580–1586.
simultaneous single implant placement delayed lateral ridge expansion tech- 28. Berengo M, Bacci C, Sartori M, Perini
for narrow anterior ridges followed by nique in the atrophic posterior mandibu- M, Della Barbera M, Valente M. Histo-
reentry confirmation. Int J Periodontics lar ridge. J Oral Maxillofac Surg 2010;68: morphometric evaluation of bone grafts
Restorative Dent 2012;32:509–519. 2283–2290. harvested by different methods. Miner-
13. Scarano A, Piattelli A, Murmura G, Iezzi 21. Simion M, Baldoni M, Zaffe D. Jawbone va Stomatol 2006;55:189–198.
G, Assenza B, Mancino C. Delayed ex- enlargement using immediate implant 29. Harder S, Wolfart S, Mehl C, Kern M.
pansion of the atrophic mandible by placement associated with a split- crest Performance of ultrasonic devices for
ultrasonic surgery: A clinical and histo- technique and guided tissue regenera- bone surgery and associated intraosse-
logic case series. Int J Oral Maxillofac tion. Int J Periodontics Restorative Dent ous temperature development. Int J Oral
Implants 2015;30:144–149. 1992;12:462–473. Maxillofac Implants 2009;24:484–490.
14. Vercellotti T. Piezoelectric surgery in im- 22. Shimoyama T, Kaneko T, Shimizu S,
plantology: A case report—A new piezo- Kasai D, Tojo T, Horie N. Ridge widen-
electric ridge expansion technique. Int ing and immediate implant placement:
J Periodontics Restorative Dent 2000; A case report. Implant Dent 2001;10:
20:358–365. 108–112.

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