br Conclusion br Introduction Atrophic maxilla or mandible c

Conclusion
Introduction Atrophic maxilla or mandible can lead to lack of prosthesis retention because of an inadequate bearing area causing both functional and physiological problems for patient, these problems can be treated for patient satisfaction with an implant supported fixed or removable complete or partial denture. Atrophic edentulous jaws can represent a significant challenge to the successful use of endosseous implants for prosthetic reconstruction of the edentulous mandible [1,2]. An implant must be surrounded by at least 1 mm of cortical bone in buccal and lingual sides; if the alveolar ridge is narrower than 5 mm, it is difficult to insert an implant to replace posterior teeth [3,4]. Alveolar ridge volume reduction is a direct consequence of tooth loss [5,6]. This dimensional change occurs mainly at the expense of bone remodeling [7,8]. The limited amount of remaining bone volume may compromise conventional implant placement and, subsequently, the functional and esthetic rehabilitation of the edentulous span. Bone collapse after tooth loss in a horizontal and vertical direction, the horizontal deficiency or bone width loss develops in a larger extent [9,10]. Alveolar width deficiency represents loss of buccal (labial) cortical or medullary bone, or both. Deficiency of the buccal AG-14361 (cortical plate) after tooth extraction can present significant difficulty in implant reconstruction [11,12]. The buccal cortical plate with a thickness < 2 mm next to an implant appears to have a higher risk of subsequent resorption [13]. A variety of implant-driven bone augmentation techniques for the deficient alveolar bone have been proposed [14,15]. Four of these techniques are frequently performed: (1) guided bone regeneration (GBR)/particulate bone grafting; [16,17] (2) onlay (veneer) block bone grafting with intraoral sources, such as chin, ramus, posterior mandible, zygomatic buttress, and maxillary tuberosity; [18–20] (3) ridge split; [21–23] and (4) alveolar distraction osteogenesis [24]. These techniques are designed to improve horizontal bone loss before or simultaneously with dental implant placement. Ridge splitting can be performed by splitting the cortical plate and further opening the space between the tables with Summers\'s osteotomes [25]. This creates room for implant placement with sufficient surrounding bone. Splitting can be performed with chisels and hammers [26] or with rotating [27] or oscillating saws [28]. The use of bone chisel can cause trauma and stress to the patient. Fine tuning of the splitting is difficult when the crest is dense, especially in the mandible [29]. Ultrasonic bone surgery (USBS) represents a valid alternative to this procedure [30]. The principle of USBS consists of inducing energetic micro-vibrations with an ultrasonic of 20–32 kHz frequency.
Material and method
Result
Discussion Alveolar split expansion is an excellent tool for regaining alveolar ridge width but the procedure should avoid bone fragment dislodgment or flap detachment of the out-fractured plate, which leads to bone devitalization and subsequent remodeling resorption. When implants are placed simultaneously, primary fixation of the implant must be obtained apically other else osseointegration will be jeopardize. The partial-thickness flap reflection and/or osteoperiosteal flap with minimal flap reflection at the crest is most likely to maintain bone vitality, as well as alveolar width stability. Splitting of a thin buccal plate fragment from a crest width of 3 mm or less that becomes separated from both the buccal and the endosteal blood supply will lead to complete buccal bone resorption even if bone is grafted [33]. The development of osseointegration is not a valid measure for judging split bone graft technique success because osseointegration is not differentially influenced by the flap or grafting approach as long as apical implant fixation occurs. Therefore, the method to ascertain alveolar width expansion success is not by implant success, but by marginal bone dimensional stability [33].