The Efficiency of Computer Guided Ridge Splitting Using Piezosurgery in Horizontally Deficient Posterior Mandible

Study Overview
=================
Brief Summary
-----------------
The use of implants has significantly increased prosthetic options for edentulous patient. However, implant placement in the Posterior mandibular region is often hampered significantly by insufficient atrophic width limitations

Detailed Description
-----------------
Ridge splitting technique causes lateral ridge expansion which creates new implant bed by longitudinal osteotomy, positioning buccal cortex laterally. The buccal cortex is positioned laterally to create space between buccal and lingual cortical plates, which is filled by an endosseous implant with or without any graft material limitations. Ridge split technique is a very predictable procedure that can achieve substantial gains in horizontal ridge width of the edentulous posterior mandible without associated morbidity. This technique allows the clinician to augment the site and do the implant insertion in a single stage surgery, shortening the healing period drastically. In the conventional ridge splitting technique, a complete flap is raised to allow adequate visibility of the bone defect which can result in disturbance of vascular supply and increase bone resorption rates. In this case report, a new innovative computer guided closed alveolar ridge splitting flapless technique has been advocated to avoid this disruption. As Guided implant placement showed a statistically superior accuracy when they are compared with freehand placement after guided osteotomy Computer guided ridge splitting may have a superior accuracy than the freehand ridge splitting and may reduce the time of surgery, healing period and post-operative pain.

Official Title
-----------------
The Efficiency of Computer Guided Ridge Splitting Using Piezosurgery in Horizontally Deficient Posterior Mandible

Conditions
-----------------
Edentulous Patients, Atrophic Posterior Mandible With Insufficient Width

Intervention / Treatment
-----------------
* Device: Computer Guided ridge splitting in posterior mandible


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients with edentulous posterior area of the mandible insufficient width less than 5m, Both sexes. No intraoral soft and hard tissue pathology No systemic condition that contraindicate implant placement. Exclusion Criteria: Heavy smokers more than 20 cigarettes per day. Patients with systemic disease that may affect normal healing. Psychiatric problems. Disorders to implant are related to history of radiation therapy to the head and neck neoplasia, or bone augmentation to implant site. Immunodeficiency pathology, bruxism, stress situation (socially or professionally), emotional instability, and unrealistic aesthetic demands.

Ages Eligible for Study
-----------------
Minimum Age: 25 Years
Maximum Age: 60 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Computer Guided ridge splitting in posterior mandible<br>fabrication of a computer aided surgical guide and performing ridge splitting in posterior mandible using piezosurgery | Device: Computer Guided ridge splitting in posterior mandible<br>* The computer guided ridge splitting for patients with atrophic posterior mandible and with residual bone width at least 3 to 5mm of residual ridge. The selected patients will be informed of the nature of the research work and informed consent will be signed. Radiographic examination included preoperative digital panoramic radiograph with 1:1 magnification for each patient as a primary survey to obtain an approximation of the available bone height and detect the presence of remaining roots and localized pathosis. Computer surgical guides are fabricated for partially edentulous patients using teeth and tissue as support for the guide. The same surgeon performed all surgeries. All surgical procedures were performed under strict aseptic conditions, all patients received nerve block local anesthesia (Articaine 4% 1:100 000 epinephrine). A crestal incision is made using No. 15 blade extending over the posterior mandible using computer guided surgical stent. no flap elevation .<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time of the procedure ,pain and edema | the time of the procedure will be measured numerical using visual analogue scan | 4 month |