Horizontal Ridge Expansion (ridge split)
Horizontal ridge expansion is done with 3-5mm.
4mm min for Class 1-2
3mm min for Class 2-3
Flex case has little cortical and nice cancellous bone.
How prevent rebound = wood screw not lag screw.
BTI Ultrasonic
General rules
- Ab 1 hour prior and 1 week
- CHX before and 1 week
- Max more likely single stage and mand more likely 2 stage
- (less than 5mm width do this or GBR) 3-5mm ideal but some can do 2mm
Single stage ridge expansion
Max (less than 4 teeth) 1st case should be 4-5mm wide and go to 7-8mm
- Crestal incision with papilla sparing no buccal flap
- Bone cut 8-12mm deep. Docs like mectron and cube about same.
- Optional mini screw stabilize plates open 10-12mm long
- Pack graft
- Collagen or PTFE
- Suture w/o tension and Periacryl
- 4-6 months later place implants
Two stage ridge expansion
- Full thickness flap
- Peripheral buccal corticotomy creating buccal door 10-12mm below crest. 2mm deep
- Observe mental nerve location
- 3-5 weeks but 4 is ideal.
- Crestal incision with papilla sparing very minor buccal and lingual release
- Split 8-10mm with PTFE membrane used
- 4-6 months later place implants
buccal door |
2 stage split ridge technique
First stage
- Full thickness flap
- Ultrasonic spoon around bone bed to stimulate bleeding
- Starting drill punch where future implants go
- Flat chisel side-to-side cut to connect all holes
- Expanders
- Graft everywhere
Second stage 4-6 months later
- BTI extraction kit to retrieve implants
- Repeat
Expect more bone loss in first year Bassetti 2014 JOMI
Some Horizontal Ridge Expansion References
Nice thread on DT from Sheldon