What Is A Ridge Split Procedure During Dental Implant Surgery?

Replacing missing teeth using implants can be tricky, especially when the tooth or teeth to be replaced have been missing for a long time.

As soon as a tooth is extracted, the bone surrounding that tooth starts undergoing remodeling, rapidly losing its height and width during the first three to four months. This process slowly progresses, until all the bone normally needed to hold a tooth in place is lost. During remodeling, the width of bone is lost more rapidly than its height, especially in the upper jaw.

What is a ridge split procedure?

A ridge split procedure is a method to increase the width of the jaw bone to provide adequate bulk of bone around the implant screw. This technique uses the inherent flexibility of the bone to separate it into to two vertical halves and get enough space to place an implant.

When is a ridge split procedure advised?

Ideally, there should be bone with a minimum of 1.5 mm thickness all around the implant when it is in its final position. This ensures good initial stability and a good prognosis for the longevity of the implant.

When the tooth has been missing for a long time, especially in the molar region of the lower jaw and front region of the upper jaw, there is a rapid and extensive change in the shape of the bone, and especially the width of the bone is reduced very fast. Also in cases of trauma to teeth, it may so happen that the bone plates are destroyed, causing decreased bone width, and necessitating a ridge split procedure.

Can all patients undergo a ridge split procedure?

The presence of at least 3 to 4 mm of bone width, with 1mm of "soft bone" that has a good blood supply, is absolutely necessary for the success of a ridge split procedure. Smokers, alcoholics, and patients with uncontrolled systemic diseases are generally avoided for this procedure.

How is a ridge split procedure performed?

If your surgeon feels that the width of your jaw bone is less than ideal to receive an implant of the required diameter, you may be advised to undergo a ridge split procedure. Theoretically, all cases — from a single tooth to the full jaw —can be treated with the ridge split technique.Here's what patients should know:

Here's what patients should know: 

• The procedure is carried out under local anesthesia. The surgeon numbs the area to be operated.
• After that, a surgical blade is used to cut through the gums in order to expose the bone beneath the gums and reflect the flap.
• Once the bone is exposed, the surgeon uses a bur or an instrument known as a piezosurgery unit, whose vibrating tip is used to cut through the bone horizontally and vertically to a depth of around 8 to 10 mm. The length of the cut depends on the number of implants being placed.
• Once the cut is made, the surgeon gently separates the two plates in order to create a space between the two halves. The space created between the two plates is filled with artificial bone material in order to maintain the width gained by the procedure.
• The implant is placed during the same sitting or after a couple of months, as deemed necessary by the surgeon.
• The surgical site is then covered using a membrane, and sutures are placed to secure the membrane and the artificial bone.

Before and after ridge split implant surgery: What patients need to be aware of

• You can expect some mild swelling and pain for a couple of days after the surgery. However, it is easily manageable by following the dentist’s post-surgery instructions.
• Your surgeon is likely to prescribe antibiotics a couple of days prior to the surgery, to be continued after the procedure, along with pain medication.
• After a couple of days, start using mouthwash and other aids to maintain meticulous oral hygiene.
• The dentist will schedule a follow-up visit seven to 10 days after the surgery to check the healing and remove the stitches.

Advantages of ridge splitting procedure

Ridge splitting helps avoid major surgeries in order to gain the width of the jaw bone. It is a relatively faster and cheaper method to gain adequate bone so that a wider implant can be placed to gain good stability of the final prosthesis. There are enough studies showing us the definitive advantage of placing a wider implant over a thinner implant to leave no doubt about that. In fact, having a wider implant is even more important than having a taller implant.

Complications: Should you be scared?

Like all surgical procedures, ridge splitting has its own set of complications. Along with the usual possible complications like uncontrolled bleeding and secondary infection, there are a couple of specific complications associated with ridge splitting.

• If ridge splitting is attempted in a bone that has insufficient vertical height, it can cause damage to underlying nerves and cause neuropathy.
• A ride split procedure is pretty technique-sensitive and there are a number of small variations that could lead to one or both plates of the jaw bone being fractured.

Conclusion

A ridge-split procedure is an accessory surgical procedure carried out to facilitate successful dental implant treatment. The procedure is relatively complex however can be carried out successfully in the majority of cases by an experienced and skilled surgeon.