Ridge Preservation, Expansion and Split

After the extraction, alveolar ridge goes through bone remodeling, which frequently results in alveolar bone resorption. For this reason, it is critical to preserve the hard and soft tissue immediately after the extraction. One of the techniques to maintain the alveolar ridge is ridge preservation bone graft (RPBG). This technique has been proven to be a predictable treatment modality for maintaining the alveolar bone for delay implant placement after the extraction. However, can RPBG done in teeth that have gingival recession, very poor soft tissue, buccal fistula or swelling, periapical infection or sinus infection? Is there any difference in flap or flapless extraction? How can I extract anterior and posterior teeth without removing any bone? Do different bone grafting materials make any difference? Is there any difference in the alveolar ridge remodeling in single vs multiple extractions?

For moderate to severe deficient alveolar ridges, if RPBG was not performed, more commonly discussed surgical options are GBR or cortico-cancellous block. All these are sound options but all these surgical options have disadvantages as well. Cortico-cancellous block increases the surgical time and requires a site to harvest the block graft, which can increase the potential complications in the harvested site, such as nerve injury and infection. GBR is a less invasive technique but has a potential for increased bone resorption, which can result in additional bone grafting and implant complications.

For minor deficient (2-3 mm) alveolar ridges, ridge expansion (RE) is a simpler, predictable, and minimally invasive surgical technique to increase the width of alveolar ridge for implant placement, which results in less post-op complications. Ridge split (RS) is also a predictable surgical technique for cases that have more than 3 mm deficient alveolar ridge. These techniques utilize expanded or split autogenous cortico-cancellous bone and require less or no additional non-autogenous bone grafting materials or membranes. This reduces the cost and surgical time due to less complexity of the surgical technique, which results in a more predictable clinical outcome.

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