Maxillary Ridge Split and Expansion Augmented by Autologous Tooth Graft: Randomized Controlled Clinical Trial

Abstract

OBJECTIVES: The current trial investigated the clinical and radiological effectiveness of utilizing un-demineralized autologous tooth graft as a graft material after ridge split and expansion approach combined with simultaneous dental implant placement compared to autologous bone graft (harvested from the chin) for reconstructing horizontally deficient alveolar ridges. MATERIALS AND METHODS: Fifty-two individuals with a total of 60 horizontally compromised alveolar ridge sites in the maxillary anterior region were recruited for this study. Participants were randomly assigned to two groups: the control group (each 30 implants in 26 patients) received autologous bone graft for peri-implant augmentation following ridge split and expansion with simultaneous implantation, while the study group used un-demineralized autologous tooth graft. Quotient of implant stability, horizontal ridge width, marginal bone level, vertical defect depth, and bone density was recorded and assessed throughout the study period. RESULTS: The Amount of Expansion of Both Groups Immediately After Surgery Revealed a Non-Significant Difference (B = 0.02, p = 0.760), while 12 Months Later a Significant Higher Ridge Expansion Values Was Observed in the UATG Group Over the ABG Group (B = 1.66, p < 0.001). The Implant Stability Quotient in the UATG Group Demonstrated a Significant Rise After 6- and 12-Months From Surgical Intervention Compared to the ABG Group as (B = 5.75, p < 0.001), (B = 7.46, p < 0.001) Respectively. Upon Comparing the Marginal Bone Loss, Non-Significant Difference Was Detected Either 6 or 12-Months Postoperatively (B = 0.03, p = 0.339, B = 0.03, p = 0.425, Respectively) The Peri-Implant Bone Defects in the UATG Group Showed Significantly Higher Bone-Fill Compared to the ABG Group by the End of the Study (B = -1.08, p < 0.001) Moreover, the UATG Group Demonstrated a Significant Gain in the Mean Bone Density After 6- and 12-Month Post-Surgically Over the ABG Group (B = 367.30, p < 0.001, B = 408.44, p < 0.001, Respectively). CONCLUSIONS: Applying un-demineralized autologous tooth graft in bony defects surrounding implants after ridge split/expansion and simultaneous implantation for the reconstruction of ridge defects horizontally enhanced the peri-implant outcomes clinically and radiographically. As far as we know, this was the first attempt to utilize an un-demineralized autologous tooth graft with ridge split and expansion with simultaneous implantation to reconstruct laterally compromised alveolar ridge defects.