Ridge Splitting and Simultaneous Implant Placement With Autogenous Bone and Bioactive Glass for the Treatment of Maxillary Horizontal Bone Defects: A Randomised Clinical Trial

Participants' selection:

22 patients, aged from 18 to 50 years, were selected in this prospective, randomized and blinded clinical trial from the Outpatient Clinic of the Department of Oral Medicine and Periodontology, Faculty of Dentistry, Kafrelsheikh University. Those subjects had inadequate bone volume for implant placement due to width insufficiency of maxillary anterior alveolar ridges. The research ethical committee of Faculty of Dentistry, Kafrelsheikh University approved the study (KD/06/21). Research procedures were explained to all patients, and they agreed to participate in the study and signed the appropriate informed consent form. The inclusion criteria implemented for patient selection were good general health at the time of surgery; at least 3months postextraction healing period; and horizontally compromised maxillary anterior alveolar ridges (at least 3mm bone width and 13mm bone height). The criteria of patients exclusion were vertical bone defect; thick labial cortex with less cancellous bone inside; obvious undercut on the labial/buccal side; uncontrolled periodontal conditions; history of radiotherapy in the head and neck region; uncontrolled diabetes mellitus or other systematic disorders; smokers; pregnancy; non-compliant patients; and allergic reaction to the used medications.

Pre-surgical therapy and grouping Pre-surgical therapy consisted of a thorough full-mouth scaling and root planning. Patients were randomly assigned immediately before surgery into two groups (11 patients each) by computer-assessed randomization software (Random Allocation Software, Version 1.0). Control group received ridge splitting with simultaneous implant placement in combination with autogenous bone graft alone, while study group used (1:1) mixture of autogenous and bioactive glass bone grafts. Bone volume was assessed two weeks before operation using CBCT (Scanora 3D, Soredex Oy, Tuusula, Finland).

Surgical procedure:

Operations were performed under local anesthesia. Mid-crestal incision followed by full thickness flap reflection to expose surgical site. Mid crestal cut using piezo-surgery unit (Piezotome® Cube, ACTEON®, Acteon Group Ltd, Norwich, England). Then, the cut was extended deep to the length of implant. Then, ridge was expanded progressively using bone wedges (Microdent Implant System, Spain). Implant location was marked, with a buccal bony wall as uniformly thick (>1 mm) as possible to avoid bone fracture. The implant site was prepared and 3.75*13 mm dental implant fixture (Humana Dental Implants & Accessories GmbH, Germany) was placed stably in between the two bony plates.