### Key Points
- Research suggests that managing narrow alveolar ridges for dental implants is challenging, often requiring specialized techniques like ridge splitting.
- It seems likely that such cases involve complex surgical steps, including bone grafting and careful expansion to avoid complications.
- The evidence leans toward successful outcomes with proper technique, as seen in a case of a 60-year-old woman with a narrow ridge, where bone width increased from 4.9 mm to 7.6 mm after one year.
#### Case Details
This case study involves a 60-year-old woman who had her right maxillary second premolar extracted eight months prior due to a periapical lesion, with suspected root caries in the adjacent first molar, leading to a narrow ridge. The procedure used a modified ridge splitting technique with the ESSET Kit® and Ridge Split Kit® from Osstem, Korea, including vertical and lateral osteotomies, bone grafting with OraGraft® and Bio-Oss®, and placement of two implants with full zirconia crowns. At the one-year follow-up, no complications were reported, and the bone width increased significantly.
#### Unexpected Detail
An unexpected detail is that the technique minimized vertical osteotomy to reduce the risk of buccal bone fracture, which is not commonly emphasized in standard implant procedures.
#### Supporting Resources
- Case study: [Narrow Alveolar Ridge Management](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10072968/)
- Video demonstration: [Ridge Splitting Technique](https://www.youtube.com/watch?v=-WfNV2Zxzu0)
---
### Detailed Analysis of Difficult Dental Implant Cases
This note provides an in-depth exploration of dental implant cases, focusing on a challenging scenario involving a narrow alveolar ridge, in response to the interest in procedural flow and case details often sought by dentists online. The analysis aims to offer comprehensive insights, including patient history, surgical procedures, and challenges, drawing from recent research and case studies to address the need for detailed information.
#### Introduction and Context
Dental implants are a common solution for tooth replacement, but certain cases present significant challenges, particularly when anatomical conditions like narrow alveolar ridges are involved. Dentists frequently search online platforms, including YouTube, for procedural guidance and case details prior to implant cases, yet detailed information can be scarce. This note examines a specific case to illustrate the complexity and procedural flow, providing a resource for professional reference.
The case selected involves a 60-year-old woman with a narrow maxillary ridge, a scenario that requires advanced surgical techniques due to limited bone width. This choice aligns with the user's request for deeper insight into difficult cases, offering a practical example of procedural challenges and outcomes.
#### Methodology and Source Selection
The analysis was conducted by reviewing online content, focusing on peer-reviewed case studies and clinical reports accessible through academic databases and professional dental websites. Key search terms included "dental implant case study with narrow ridge," "difficult dental implant cases," and related phrases to identify relevant examples. The selected case, "Narrow Alveolar Ridge Management with Modified Ridge Splitting Technique: A Report of 3 Cases" ([Narrow Alveolar Ridge Management](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10072968/)), was chosen for its detailed documentation and relevance to the query.
#### Case Study: Narrow Ridge Management
##### Patient History
The patient, a 60-year-old woman, had no significant systemic diseases beyond hormone drug use, which did not contraindicate implant surgery. Eight months prior, her right maxillary second premolar was extracted due to a periapical lesion, and there was a suspicion of root caries in the right maxillary first molar. This history contributed to the narrow ridge condition, with an initial average alveolar bone width of 4.9 ± 0.5 mm, posing a challenge for standard implant placement.
##### Surgical Procedure
The procedure employed a modified ridge splitting technique to address the narrow ridge, detailed as follows:
- **Instrumentation:** Utilized the ESSET Kit® and Ridge Split Kit® from Osstem, Korea, for precision in ridge expansion.
- **Osteotomies:** Performed vertical and lateral osteotomies using a microsaw, expanding the ridge by 3–4 mm. The vertical osteotomy was minimized to reduce the risk of buccal bone fracture and ensure adequate blood supply.
- **Bone Grafting:** Applied a combination of 0.25 g OraGraft® (autogenous bone substitute) and 0.25 g Bio-Oss® (xenograft), covered with a Bio-Gide® membrane to promote bone regeneration and protect the graft site.
- **Implant Placement:** Two implants, TSIII SA 4.0×8.5 mm and 5.0×10 mm, were placed simultaneously, achieving an Implant Stability Quotient (ISQ) of 75–80, indicating good primary stability for immediate or early loading.
- **Prosthetic Rehabilitation:** Completed with full zirconia crowns, ensuring aesthetic and functional restoration.
The procedure was conducted under ethical standards per the World Medical Association Declaration of Helsinki, with IRB approval (No. SEUMC 2023-01-024).
##### Challenges and Technical Considerations
The primary challenge was the narrow ridge, with an initial width of 4.9 mm, necessitating careful expansion to avoid complications such as buccal bone fracture, poor blood supply, and potential sequestrum formation. The modified ridge splitting technique addressed these issues by:
- Minimizing vertical osteotomy to reduce risk, as noted in the case report.
- Ensuring simultaneous ridge preservation during extraction to maintain bone volume.
- Using microsaw for precise cuts, enhancing control over the expansion process.
Post-surgery, the bone width increased to 8.3 ± 1.1 mm, and at the one-year follow-up, it stabilized at 7.6 ± 1.0 mm, demonstrating successful integration and maintenance of the augmented ridge.
##### Comparative Analysis with Other Difficult Cases
To contextualize, other challenging cases were considered, such as:
- A case involving Medication-Related Osteonecrosis of the Jaw (MRONJ) with zygomatic implants, requiring multiple surgeries due to necrotic bone removal ([Zygomatic Implant Insertion in MRONJ](https://www.mdpi.com/2077-0383/12/9/3300)).
- Cases with complications like implant failure and periimplantitis, as seen in "Complications of Zygomatic Implants: Our Clinical Experience with 4 Cases" ([Complications of Zygomatic Implants](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5108285/)), detailing four patients with issues like cutaneous fistulas and osseointegration failure.
These cases highlight different dimensions of difficulty, such as medical conditions (MRONJ) and post-operative complications, but the narrow ridge case was selected for its focus on procedural flow and surgical technique, aligning with the user's interest.
#### Discussion and Implications
The narrow ridge case exemplifies the procedural complexity dentists face, requiring specialized tools and techniques like ridge splitting and bone grafting. The success, with no reported complications and significant bone width increase, underscores the importance of meticulous planning and execution. This case addresses the gap in online content, offering detailed steps that dentists might seek on platforms like YouTube, enhancing procedural understanding.
The findings suggest that such cases, while challenging, can achieve favorable outcomes with appropriate techniques, potentially encouraging further research into ridge expansion methods. The detailed documentation, including exact measurements (e.g., initial 4.9 mm, post-surgery 8.3 mm, follow-up 7.6 mm), provides a benchmark for clinical practice.
#### Table: Summary of Case Details
| **Aspect** | **Details** |
|--------------------------|-----------------------------------------------------------------------------|
| **Patient Age/Gender** | 60-year-old female |
| **Medical History** | Hormone drugs, no significant systemic diseases |
| **Initial Condition** | Right maxillary second premolar extracted, narrow ridge (4.9 mm width) |
| **Surgical Technique** | Modified ridge splitting, ESSET Kit® and Ridge Split Kit® (Osstem, Korea) |
| **Bone Grafting** | 0.25 g OraGraft® + 0.25 g Bio-Oss®, Bio-Gide® membrane |
| **Implants Placed** | TSIII SA 4.0×8.5 mm, 5.0×10 mm, ISQ 75–80 |
| **Prosthetic Outcome** | Full zirconia crowns |
| **Follow-up Outcome** | Bone width 7.6 mm at 1 year, no complications |
#### Conclusion
This note provides a comprehensive overview of a difficult dental implant case involving a narrow alveolar ridge, detailing patient history, surgical procedure, and challenges. It addresses the user's request for deeper insight, offering a resource that complements the often limited online content, particularly on platforms like YouTube. The case's success highlights the potential for advanced techniques to manage complex scenarios, supporting dentists in their procedural planning.
### Key Citations
- [Narrow Alveolar Ridge Management with Modified Ridge Splitting Technique: A Report of 3 Cases](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10072968/)
- [Zygomatic Implant Insertion in MRONJ: A Case Report with a Follow-Up of 3 Years](https://www.mdpi.com/2077-0383/12/9/3300)
- [Complications of Zygomatic Implants: Our Clinical Experience with 4 Cases](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5108285/)
- [Ridge Splitting Technique Video Demonstration](https://www.youtube.com/watch?v=-WfNV2Zxzu0)
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