Split-crest technique is the splitting of the vestibular cortex through a green wood fracture, which creates the right width to insert osseointegrated implants. The use of piezosurgery-assisted ultrasound devices allows to plan and perform the micro-osteotomies needed to obtain an atraumatic increase in bone volume through correct implant localization and angulation, avoiding uncontrolled fractures of the vestibular wall and reducing the intra- and post-operative complications.

The aim of the present study is to evaluate the advantages of piezosurgery-assisted “split crest” technique compared to traditional devices, in order to insert osseotintegrated implants in patients with horizontal resorption of alveolar crests.

Piezosurgery-assisted “split crest” was performed in 2 patients, one male and one female, requiring implant rehabilitation in the frontal sector; after full-thickness flap, a first sagittal crest osteotomy was performed by means of ultrasound devices, with a 2/3 depth compared to the implant length. It was followed by two vertical osteotomies in order to reduce the risk of complete fracture of the bone segment.
The vestibular bone wall was split by means of a scalpel, the implant tunnel was prepared and the osseointegrated implants were contextually inserted.

Osteodistraction allowed to obtain a satisfactory increase in the bone crest thickness, creating the ideal conditions to sustain the implant with an adequate primary stability.
The four-month follow-up showed complete implant osseointegration in both cases, and significantly reduced healing time since this technique involves a minimally invasive tissue approach, due to the cut selectivity and greater patient’s comfort.

The use of piezosurgery, compared to traditional devices used for osteotomies, such as scalpels, surgical burs or rotating disks, mainly allows to remove less bone tissue with an high-precision micrometric cut. It also guarantees a minimally invasive approach and a satisfactory primary stability of the osseointegrated implant, which reduce the risk of complete fracture of the vestibular cortex.
The selective cut allows the operator to treat only the hard tissues and to safeguard soft tissues, thus significantly reducing the risk of intraoperative complications.
The morbidity is considerably reduced, thanks to shorter surgical times and to the lack of macro-vibrations caused by percussions; finally, the cavitation effect provides better visibility of the operative field.

Università degli Studi di Bari “A. Moro” Dipartimento di Odontostomatologia e Chirurgia
XX Congresso nazionale Docenti di Odontoiatria

INCHINGOLO Francesco, INCHINGOLO Alessio Danilo, COLELLA Alessandro, MARRELLI Massimo, PALLADINO Antonio, TATULLO Marco, INCHINGOLO Angelo Michele, CARBOTTI Filippo, MALCANGI Giuseppina, SCHINCO Fabio, SERAFINI Maurizio, MARINELLI Grazia, DIPALMA Gianna

Belleggia F, Pozzi A, Rocci M, Barlattani A, Gargari M. Piezoelectric surgery in mandibular split crest technique with immediate implant placement: a case report. Oral Implantol (Rome). 2008 Oct;1(3-4):116-23. Blus C, Szmukler-Moncler S, Vozza I, Rispoli L, Polastri C. Split-crest and immediate implant placement with ultrasonic bone surgery (piezosurgery): 3-year follow-up of 180 treated implant sites. Quintessence Int. 2010 Jun;41(6):463-9 Kelly A, Flanagan D. Ridge expansion and immediate placement with piezosurgery and screw expanders in atrophic maxillary sites: two case reports. J Oral Implantol. 2013 Feb;39(1):85-90 Danza M, Guidi R, Carinci F. Comparison between implants inserted into piezo split and unsplit alveolar crests. J Oral Maxillofac Surg. 2009 Nov;67(11):2460-5


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