The alveolar bone-splitting technique: An alternative to horizontal augmentation

Abstract

Implant placement is considered a safe and predictable treatment option for the rehabilitation of edentulous patients. A prerequisite for successful implant placement is the presence of a sufficient amount of bone to allow for good primary implant stability. Tooth loss leads to resorption of the alveolar crest, resulting in reduction of bone volume in the horizontal and vertical dimensions. Guided bone regeneration (GBR) has been used in implant therapy for some time now and has shown very good clinical results [1,2]. In guided bone regeneration, the use of membranes (resorbable or non-resorbable), fixation pins and bone graft is required, and an extended healing period must be allowed for [3,4]. Last but not least, the cost of the surgical procedure will also be higher. An alternative to horizontal augmentation is the bone-splitting technique. This technique can be applied where the alveolar crest has been resorbed in the horizontal dimension, leaving a dense alveolar process of reasonable height and without any fenestrations [5]. In these cases, the outer labial cortex plate can be separated from the inner cortex using a narrow chisel, resulting in a "green stick" bone fracture. It is necessary to leave the outer cortex attached to the overlying periosteum, so that the use of a flap with minimum periosteal detachment is advocated. The objective of this paper is to describe the surgical and prosthetic steps in treating a patient with a narrow alveolar crest in the posterior area.