Student Lincoln Memorial University Knoxville, Tennessee, United States
Purpose of the Study: Alveolar ridge resorption after tooth loss frequently results in insufficient bone volume for implant placement. Conventional osteotomy, performed with sequential rotary drills, removes bone and may compromise density and primary stability, particularly in narrow ridges (Pius et al., 2022). Modern bone expansion techniques, including osseodensification burs, threaded expanders, and ultrasonic devices, compact and laterally displace bone rather than removing it. This approach enhances bone density, improves implant stability, and enables controlled ridge splitting with fewer complications compared to malleting or chiseling (Manekar et al., 2023; El Khoury et al., 2022).
Methods: Evidence was synthesized from three key sources. First, a comparative clinical study evaluated implant stability and bone-to-implant contact (BIC) following osteotomy versus bone expansion (Pius et al., 2022). Second, a systematic review and meta-analysis compiled outcomes of ridge width gain, implant survival, and complications across modern expansion devices (Manekar et al., 2023). Third, a clinical report provided insight into modified ridge-split and grafting techniques, emphasizing procedural risks and indications (El Khoury et al., 2022).
Results: The clinical comparison demonstrated superior outcomes with expanders: higher implant stability quotient (ISQ) values at placement (71.4 vs 65.6) and at three months (74.8 vs 71.8), as well as significantly greater BIC (84.7% vs 66.3%) compared with conventional drilling (Pius et al., 2022). Meta-analysis confirmed mean horizontal ridge-width gain of 3.35 mm and implant survival rates of 98.1% using modern devices (Manekar et al., 2023). While complications such as cortical plate fractures, dehiscence, and transient paresthesia were reported, they were relatively infrequent and generally linked to over-expansion or excessive force (El Khoury et al.,
Conclusion: Modern bone expansion methods offer biological and clinical advantages over conventional osteotomy by preserving bone, increasing density, and improving implant stability. Consistent evidence demonstrates higher ISQ values, greater BIC, reliable ridge-width gain, and high survival rates with expansion approaches (Pius et al., 2022; Manekar et al., 2023). Clinical reports further highlight their applicability while underscoring the need for careful technique (El Khoury et al., 2022). Although additional randomized controlled trials are warranted, current data support expansion techniques as a preferable alternative in suitable implant cases.
Articles: Pius G, Bhat V, Shetty R, et al. Comparative evaluation of primary stability in implants placed with osteotomes versus bone expanders: an ex vivo and clinical study. J Oral Biol Craniofac Res. 2022;12(4):529-534. doi:10.1016/j.jobcr.2022.07.005
Manekar VS, Nagvekar A, Daryanani H, et al. Modern devices in alveolar ridge split and expansion: a systematic review and meta-analysis. Natl J Maxillofac Surg. 2023;14(1):6-14. doi:10.4103/njms.njms_13_22
El Khoury S, Abdallah J, Abboud N. Modified ridge split technique and grafting for horizontal ridge augmentation: clinical considerations and outcomes. Int J Oral Maxillofac Surg. 2022;51(10):1282-1289. doi:10.1016/j.ijom.2022.03.015
