In contemporary dentistry, the aim is to replace missing teeth with prosthetics or to
remove diseased teeth from the patient and return them to normal in terms of shape,
function, comfort, appearance, speech, and health. Why implant dentistry is different is
the capacity to fulfill this objective despite atrophy, illness, or harm to the
stomatognathic apparatus.
Implant-based dental rehabilitation of partly or completely edentulous areas has become a
frequent procedure with consistent long-term outcomes in recent decades. Nevertheless,
alveolar ridges are frequently impaired with horizontal inadequacy as a result of bone
resorption, which has an impact on implant application.
The resorption of alveolar bone is a common sequelae of tooth loss and presents a
clinical problem for implant placement. Implants must be placed with at least 1 mm of
bone on the buccal and lingual aspects to maintain crestal bone levels.
Narrow edentulous ridges less than 5 mm wide present a challenge to the clinician for
implant placement. Hence, lateral bone augmentation procedures are necessary to overcome
maxillary and mandibular bone deficiencies. These procedures involve the use of bone
augmentation, such as guided bone regeneration (GBR), bone block (autogenous or
non-autogenous), and conventional onlay/inlay graft. Those procedures have many drawbacks
such as longer healing time (6-9 months) for adequate bone regeneration before implant
placement, the possibility of membrane exposure, an increased risk of infection, high
cost, and rapid graft resorption; thus leading to inadequate bone regeneration or loss of
the newly formed bone.
Based on previous knowledge, ridge split/expansion was introduced as an alternative to
treat the width insufficiency of alveolar ridges with specific indications. The basic
procedure includes a sagittal osteotomy in the center of the edentulous ridge, where the
two cortical plates are expanded to increase the width and thereby simultaneous implant
insertion with an appropriate diameter could be achieved.
Due to double cellularity and double vascularity gained from the lateral bony plate, bone
healing, and regeneration tendency were significantly improved without the need for bone
graft or membrane. A shorter treatment period, no need for donor sites, and the
possibility of simultaneous implant placement are among the merits of ridge splitting
over different augmentation techniques.
For successful ridge split with simultaneous implantation, the alveolar ridge width
should be 3 mm or more with at least 1 mm trabecular bone between the cortical plates.
The splitting could be performed using the chisel and mallet, the surgical disc,
ultra-fine fissure burs, and recently the piezoelectric surgical devices and the
electromagnetic mallet. Osteotomes, chisels, bone spreaders, and engine-driven expanders
were utilized for Ridge expansion.
The traditional ridge split technique might be performed simultaneously with implant
placement, resulting in a shortened treatment time. However, this approach has the
potential for serious complications, including buccal bone fracture, prolonged pain or
paresthesia, and loss of bone height. On the other hand, the staged approach has been
proposed with splitting and expansion performed followed by implant placement after a
3-week healing interval to allow re-establishment of the blood supply to the surgical
site.
Linear Micro-Perforation Osteotomy (LMPO) has emerged as a less invasive alternative,
promoting natural bone expansion through controlled micro-perforations in the cortical
bone, allowing for ridge widening without extensive grafting. However, the precision
required for LMPO can be difficult to achieve manually, especially in anatomically
complex or narrow ridge areas, leading to variability in outcomes and potential risks
such as bone fractures or inadequate expansion.
Computer-guided technology presents an opportunity to enhance LMPO by providing a
structured, pre-planned guide for split-osteotomy and expansion. Utilizing 3D imaging
data, a computer-guided splint can be custom-fabricated to fit each patient's unique
anatomy, offering unparalleled accuracy in osteotomy execution and minimizing the risk of
error. Additionally, performing LMPO without flap elevation with the assistance of this
guided splint further reduces surgical trauma, preserves periosteal blood supply, and
promotes faster healing, making it a more patient-friendly option.
Limited clinical data are available about LMPO. Our study aims to evaluate the efficacy,
clinical, and radiological outcomes of the flapless AI-powered/computer-guided LMPO ridge
split/expansion technique compared to the traditional LMPO ridge split/expansion method
for lateral ridge reconstruction of mandibular horizontal ridge deficiencies.