HUSSEIN ABDEL-HAK281 - (12/1/2015 10:28 PM)

Very well done presentation. So many pearls on the technique. Thank you so much.

Eric Pena - (4/6/2015 1:50 AM)

Good points of comparison between GBR and ridge split . Great presentation . Thank you

Isaac Tawil - (4/2/2015 1:15 AM)

Thank you Dr Moghaddaa. In those cases of 4mm and less - If the position of the crest is in a favorable prosthetic position then I prefer to split. If the bone is more ligualized than I elect to augment. Using proper cuts with piezo along with bone expanders we can prevent labial fractures. Often just a horizontal cut can be enough. Omitting inferior cuts as well. Secondly we must use a narrower implant as to not over expand the plates. Therefore platform switch implant that can handle molar forces is pre requisite. Thank for your question. Hope to see you in NY for symposium. -isaac

Omid Moghaddas - (4/1/2015 9:52 AM)

Isaac , congrats, very well documented . my question: in cases with ridge width less than 4mm, by considering the possible risks like fracture of the buccal plate,do you prefer to go for ridge splitting or you prefer to do the GBR ? all the bests Dr Moghaddas

Isaac Tawil - (4/1/2015 1:23 AM)

Dr Salama - my humble thanks for your comments and questions. They are some of the more common and important questions regarding this technique. Minimum crestal ridge thickness would be 3mm. 1 mm cancellous 1 mm cortical on each side. There can be incredible regenerative potential when splitting and grafting as long as we don't pack our graft too tightly between the 2 cortical segments. I've found that the access to the medullary blood supply is even greater than when we decorticate during ridge augmentation procedures. Keeping the periosteum intact works wonderfully as long as we have enough bone remaining on both sides of our implants. If there is 6mm of crestal bone we can simply split without a full thickness flap as you mentioned quite predictably. With less thickness often cortical vertical releases are necessary and reinforcing those cuts with mineralized grafting material enhances our alveolar outcome. We've seen many cases with bone loss when too much stress on the crestal ridge is employed. Using a narrow implant design is paramount to avoid stress so a platform switching implant is important to provide an appropriate occlusal restorative table for our molars. In addition the increasing development of piezo devices has reduced necrosis in these cases. Regards -isaac

Maurice Salama - (3/31/2015 3:16 PM)

There are so many different versions of ridge splitting/expansion. I like your technique and excellent documentation. A few questions for you; 1. What is your "minimum" ridge thickness that you would consider splitting the ridge? 2. Many maintain the periosteum on the buccal segment, do you feel it is important? 3. Many have reported some crestal bone loss with this approach after healing and loading? Have you seen a similar result? thanks Dr. Salama

Isaac Tawil - (3/26/2015 10:54 PM)

Ronni - zirconia abutments must have ti base as well. Full zirconia abutments are subject to fracture. The key is that the ti base must be tall enough. Often labs will shorten them thus loosing surface area for zirconia to bond with. Ti base should be treated with monobond or z-prime and a good cement like multi link hybrid should be employed. Of course this is all done at the lab level. There is nothing wrong with screw retained emax either although zirconia does handle stronger compressive forces. I've had only 2 come off on several hundred implants over the last 4 years and a simple recementation was done in office. Happy implanting.

Ronni Deniger - (3/26/2015 8:50 PM)

I have been using zirconia abutments for a little while and in the posterior I recently had two implant crowns become loose and the problem was the Zirconia internal hex broke away from the abutment so in the posterior crowns I went back to screw retained emax with titanium base.

Arturo Meijueiro - (3/25/2015 11:39 PM)

Excelent work, congratulations!