Ridge splitting using autogenous bone wedge versus the conventional intercortical augmentation technique in horizontally deficient anterior maxilla: a randomized clinical trial

TL;DR

This study compares two bone augmentation techniques in the upper jaw and finds that using a bone wedge helps maintain better bone width and quality over time.

Contribution

A novel two-stage ridge-splitting technique using an autogenous bone wedge is shown to maintain bone width and quality better than mixed bone particles.

Findings

The control group showed greater immediate bone width gain but significant loss at 6 months.

The bone wedge group maintained more bone width and showed higher quality mature bone formation.

Histological analysis revealed better bone quality in the bone wedge group compared to the control group.

Abstract

This study aims to evaluate the quality and quantity of gained and maintained bone width after Ridge splitting utilizing autogenic bone wedge versus mixed bone particles for horizontal ridge augmentation in the anterior aesthetic zone.

This randomized clinical trial included 20 patients with horizontally deficient anterior maxillary alveolar ridges. Patients were divided equally into two groups. Group I received an autogenous bone wedge harvested from the chin area to be placed intercotically after ridge splitting (intervention group). Group II received mixed bone particles of autogenic and xenogeneic bone placed intercortically after ridge splitting (control group). Radiographic assessment of gained and maintained alveolar bone width at three vertical levels was performed using CBCT at three-time intervals (preoperative, immediate postoperative, and 6 months postoperative). Histologic and histomorphometric analysis of core biopsy harvested immediately before implant placement was also performed to assess bone quality and % of newly formed bone area using H&E and Mansons trichrome stains. Collected data were conducted for statistical analysis.

The outcome of the studied grafts showed a significant increase of the immediate postoperative bone width in the control group more than the intervention group, with a mean difference from the preoperative bone width (2.17 ± 1.10) mm for the control group and only (1.44 ± 0.66) for the intervention group. In contrast, the 6-month postoperative bone width was decreased in both groups with a mean difference from the immediate postoperative bone width (1.21 ± 0.54) in the control group (p-value < 0.001) compared to only (0.41 ± 0.50) in the intervention group (p value = 0.135); this statistical data revealed that the bone wedge technique of the intervention group helped to maintain the gained bone width more than the packed bone particles of the control group. Moreover, the intervention group showed higher value and quality of newly formed mature bone with well-formed havarsian canals than the control group, which showed lower bone quality of osteoid and fibrous tissue with remnants of xenogenic bone particles microscopically.

The two-stage ridge-splitting procedure using an interposition bone wedge is an effective method for horizontal ridge augmentation in the horizontally deficient anterior maxilla.

The two-stage Ridge splitting with an inter-positional bone wedge ensures better bone width maintenance and quality.

The study was registered on ClinicalTrials.gov on 24/07/2024 under the registry number “NCT06529653”. It adhered to the Declaration of Helsinki on medical research ethics and received approval from the Institutional Research Ethics Committee of the Faculty of Dentistry, Cairo University (IRB number: 161022).

The online version contains supplementary material available at 10.1186/s12903-025-06345-z.

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