Ridge Split vs. GBR vs. Block vs. Ti-Mesh

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Posted on By Maurice Salama In Bone Grafting

Which way would you treat a horizontal deficiency in the posterior mandible like this one and what methods and materials would you utilize? An open discussion for all XP members.
Dr. Salama

Ridge Split Cuts
Sonic Weld GBR Before

Sonic Weld GBR After
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Thoughts on how would this situation best be managed amongst many alternatives today? Which method would be most predictable and conservative?
Dr. Salama


I would prefer the split ridge split technique. Bone manipulation techniques like ERE show more stable long term results in my short experience (11 yrs).
However in this region the ERE is very technique sensitive.
I have seen personally great results with GBR (particulate+membranes) and significant resorption after 4-5 years. This is especially true for vertical augmentations that I have been avoiding doing if possible the last few years. I would be really interested in others opinion on the long term stability of the regenerated bone with different techniques.



Maurice, From this point forward, I would perform pilot osteotomies and place particulate allograft. Then 16 -20 weeks later expand osteotomies at pilot sites and place implants (into under prepared sites with in softened bone) thru small crestal access with minimal(or no)flap reflecton.Chuck


Screw guided fast bone regeneration (SGFBR) also called screw tenting technique. using Ti screw, resorbable membrane, allogenic particulate bone (0.25-0.5).
Keys for success :overbuild, tension free closure.
Predictability: medium to high
risk:exposure of tenting screw, less frequent in horizontal augmentation.
Time duration before implant placement: 5-6 months



Omar; I like your suggestion. Take a look at a similar case with tenting screws gere on previous Forum post;



What was vertical height prior to graft? and how long are your implants-

With a tooth as a distal stop, I think multiple options- I like the sonic weld ( how long did you wait- I just did a case waited 4.5 months- could still see head of pins but didnt hinder) I like Omar's plan and prob would do very similar- do not think mesh would be necessary because of distal stop and the fact that not alot of bone width was needed- would utilize modifiers also

I have a good friend - OS that would most likely manage with a superiosteal tunnel making sure to elevate over crest to lingual and use a low turnover product


Dear Mourice, my first choice is ridge split with simultaneous implant placement. Simple is the best..thank you.. DS


Hi dr Salama,

I usually don't use ridgesplit procedures in the mandible love them in the maxilla buccal contour of the mandible is often concave so additional grafting on the buccal side is often needed.
Sonicweld is a great and reliable method for bone augmentation only drawback is the relatively high costs of the material. A straightforward GBR procedure with or without tenting screws would be my first choice. I really like the periosteal pouch technique for cases like this.
If there is only a small band of keratinised tissue I would opt for a bonegraft through a subperiosteal tunnel. That way no keratinised tissue is lost through the incision and no soft tissue graft is needed post implant placement.
Nice case.

Melvin Maningky


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