The purpose of this study was to evaluate the efficacy of the ridge-splitting technique in the anterior maxilla, using piezoelectric surgery for immediate implant placement. Study outcomes were compared with those of implant placement in the same patients using the conventional drilling technique. Materials and Methods: Ten patients received a total of 22 implants in the anterior maxilla, 11 of which were placed using a ridge-splitting procedure (test group) and the other 11 using the conventional drilling procedure (control group). Ridge width (RW), crestal bone level (BL), and implant stability quotient (ISQ) were measured at different points in time. Data were analyzed and compared between the groups using analysis of variance (ANOVA) and paired-sample t tests at a significance level of 5%. Results: For the test group, the gain in RW was not stable in time because at 6 months postoperatively, the RW lost some of the initial gain; however, the net gain was still significant. At 6 months postoperatively, BL was similar for both groups. The net bone loss on the mesial aspect and the average of the mesial and the distal measures did not differ significantly between both groups. ISQ values sharply increased at 3 months postoperatively in the test group. All implants met the modified Albrektsson criteria (1989) for success. Conclusion: The results from this study support the efficacy and safety of ridge expansion using piezoelectric surgery for implant insertion in the anterior maxilla. The modest net gain in bone width suggests that additional hard and soft tissue augmentation may be necessary, especially in the esthetic zone. ISQ values suggest a minimum healing time of 3 months before loading the implants that have been inserted using this ridge-splitting protocol.
Introduction
Bone remodeling after tooth extraction and immediate implant placement will occur nonetheless and as a result, additional hard and soft tissue augmentations are often necessary to compensate for the loss of alveolar ridge dimension. The socket shield (SS) technique has shown encouraging clinical results in maintaining original ridge morphology, and thus, may be used as an alternative protocol for the conventional immediate implant placement in the esthetic zone.
Case Series
The authors report three cases of SS technique used in conjunction with immediate implant placement in an anterior maxilla. The patients were followed for a period of 2 to 6 years, and the evolution of the soft and hard tissue surrounding the implants was documented.
Conclusions
The SS technique produces virtually no change in the hard and soft tissue dimensions with relatively minimal invasive surgical interventions and shorter treatment time.
This prospective study compared the stability of implants placed using piezoelectric surgery (piezo group) and those placed using conventional rotary drills (bur group) during the first 90 days postoperatively. Teeth in the posterior maxillary regions of twenty-one patients were randomly assigned to two groups. The implant stability quotient (ISQ) was measured at days 0, 7, 14, 21, 28, 42, 56 and 90 postoperatively. Twenty eight out of 29 implants were successfully integrated at day 90 (one implant in the test group was lost). Although both groups showed a significant overall increase in implant stability with time (p< 0.0001) and a high final mean ISQ value, no statistically significant difference in stability was seen between groups. The bur group showed greater variance in ISQ values than the piezo group (p< 0.001) at all time points. Long-term studies with larger samples are needed to investigate the bone response to the use of piezoelectric surgery for implant preparation.
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