Horizontal Alveolar Ridge Distraction in an Edentulous Patient

Purpose: Full fixed dental rehabilitation, including attachment based over denture (to dental implants) is the optimal solution for edentulous patients, although the insertion of implants will be impossible when the alveolar ridge has been horizontally and severely absorbed. A full arch narrow (knife-edge) alveolar crest creates a borderline condition. Dental implants cannot be inserted into a narrow ridge, which is also at risk of rapid absorption, especially under the pressure of a full denture. Current clinical solutions have been limited. In bone augmentation, the bone absorption rate has been approximately 50%, requiring 6-month therapy prolongation for the grafted bone to consolidate. Materials and Methods: We have described an edentulous patient whose knife-edge maxillary alveolar crest was widened with crest expanders (horizontal distractors). Results: Only 6 weeks after initiation of the distraction, a wide enough ridge had been created, allowing bilateral insertion of implants, followed by attachment-based full dental rehabilitation. Bone augmentation was avoided, and the implants were placed in the correct lateral position, with sufficient attached gingiva obtained. Conclusions: Horizontal crest expanding in narrow-alveolar edentulous patients can significantly reduce both morbidity and the therapeutic period and substantially increase the therapeutic success rate, based on both soft tissue and bone distraction. With this technique, our patient was without the denture for only 6 weeks. (C) 2011 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac, Surg 69:502-506, 2011