TITLE:
Flapless Piezotome-Enhanced Vertical Alveolar Crest-Split and Horizontal Distraction of Alveolar Crests (FPeCSWT) of Less than 2 mm Width: Results of a Prospective Comparative 3-Year Clinical Multicenter-Study with 239 Patients, 261 Crest-Split Sites and 488 Inserted Dental Implants
AUTHORS:
Angelo Troedhan, Andreas Kurrek, Marcel Wainwright, Izabela Schlichting
KEYWORDS:
Dental Implantology, Bone-Management, Guided Bone Regeneration, Piezosurgery, Ultrasonic Surgery, Crest-Split, Ridge-Split, Distraction Osteogenesis, Biomaterials, Dental Implants
JOURNAL NAME:
Open Journal of Stomatology,
Vol.5 No.7,
July
10,
2015
ABSTRACT: Alveolar crest-splitting and horizontal distraction is an established surgical technique to enable implant insertion into the narrow, lateral atrophic alveolar crest. This surgical technique is challenging for the oral surgeon and restricted to crest-widths of 3 - 5 mm: significant procedural bone loss at osteotomy, the need to prepare a full thickness mucoperiostal flap and milling a baseline-osteotomy to weaken the bone for distraction inhere significant risks of accidental fractures. Aim of the study was to investigate if the recently developed novel Flapless Piezotome enhanced Crest-Splitting and Widening Technique (FPeCSWT) could safely narrow down the indication for this procedure to narrow alveolar crests of widths of even less than 2 mm in a three-year survey-period. 239 patients underwent 261 FPeCSWT-surgeries and 488 implants were inserted simultaneously in the upper and the lower jaw and clinical parameters such as intrasurgical complications, patient morbidity, implant loss and vertical bone loss (VBL) in the first three years after surgeries were recorded comparing sites with less than 2 mm width with sites of more than 2 mm. After three years a significant difference (p = 0.24) of VBL could be observed between the group with less than 2 mm crest-width (mean: 0.97 mm, max: 2.0 mm/min: 0.0 mm; SD: 0.41) compared with the group with more than 2 mm crest-width (mean: 0.69 mm, max: 1.5 mm/min: 0.0 mm; SD: 0.36) but was still significant lower when compared with the results of similar studies published with a mucoperiostal-flap approach and baseline bone-cut. The cumulative 3-year-implant-survival-rate was 98.8%, no accidental fracture of the distracted buccal bone-plate occurred. The re-sults of the study suggest that the FPeCSWT narrows safely down the indication for crest-splitting to also crest-widths of only 1 mm. The procedure is highly predictable and significantly reduces the challenge of surgical skills and leads to negligible patient-morbidity. The higher VBL in crest-widths of less than 2 mm can easily be compensated by subcrestal placement of implants.