Maxillary and Mandibular Split Crest Technique with Immediate Implant Placement: A 5-Year Cone Beam Retrospective Study

Purpose: This study aimed to test the effectiveness and reliability of the alveolar ridge-splitting technique in atrophic posterior arches, investigating the middle-term volumetric and clinical outcomes. Materials and Methods: Atrophic alveolar ridges in the maxillary and mandibular posterior areas were treated with the alveolar ridge-splitting/expansion technique (ARST), immediate implant placement, collagen sponges covering the defect, and healing by secondary intention. Areas were rehabilitated by fixed dental prostheses supported by dental implants. Changes in volume and width of the alveolar ridge were retrospectively calculated by comparing the x-ray tomography scans obtained before and 5 years after surgery. Report of failure in the case sheets was taken into account. Cross-sectional images were also used to assess the thickness of the labial alveolar plates at the implant shoulder. Nonparametric analyses of variance with post hoc and pair-comparison tests were performed with a level of significance of .05. Results: A total of 38 patients were retrospectively selected (23 women and 15 men). Six patients underwent ARST surgeries in both the maxilla and the mandible and were excluded from statistical analysis. Differences between 16 maxillae and 16 mandibles and between 12 single crowns and 20 fixed partial dentures (FPDs) were searched. Episodes of minor swelling occurred within the first 2 days after surgery. Neither mucositis nor flap dehiscence had been registered.The mean values of buccal cortical thickness were 2.46 +/- 0.49 mm and 1.15 +/- 0.33 mm, respectively, in the maxillary and mandibular areas. After 5 years of survey, maxillary increases in alveolar ridge width and volume were +4.4 +/- 0.4 mm and +295 +/- 45 mm(3), respectively, whereas the same outcome variables (+3.5 +/- 0.7 mm and +217 +/- 53 mm(3)) measured in the mandible appeared to be significantly smaller than those in the maxilla (P < .0001). One maxillary single implant failed. Cumulative survival rates at 5 years were 100% for mandibles and 95.5% (95% CI: 86.8% to 100%) for maxillae. Conclusion: Posterior areas of the maxilla displayed a higher increase in alveolar width and volume than mandibular areas, and even if it would be premature to draw survival conclusions at this stage without any statistical support, a lower cumulative survival rate was reported for the maxillary single implants.