The Effect Of Ridge Splitting With Laser Bio-Stimulation On Bone Loss Around Four - Implant Supported Mandibular Overdentures (Within- Patient Study)

Abstract

Purpose: This study aimed at assessing the radiographic consequences of implants supporting mandibular overdenture. Two implants located in expanded anterior– knife-edge ridges with crest ridge-splitting, bone graft, membrane placement followed by laser application. The anterior implants were compared to posterior ones implanted in unexpanded ridges with no modifications. Materials and methods: Twenty completely-edentate patients had anterior -knife-edge mandibles, two implants were received in the 1st premolar areas without ridgeexpansion or further alterations (Group I; control group). Another two implants (lateral-incisor areas) were placed. Ridge-expansion, bone graft, low-level laser therapy LLLT and membrane placement were all accomplished (Group II; test group). 6 months following placement of implants, Locator attachments were used to connect the mandibular overdentures to implants. Radiographic (Vertical bone loss; VBL and Horizontal bone loss; HBL) parameters were then respectively recorded at: overdentures delivery (baseline, T0), 6 months (T6), and 12 months (T12). Results: For each group, insignificant differences in HBL between observations were noted. Whereas, For Group I, VBL significantly increased (T6 to T12). Howbeit, insignificant differences in VBL and HBL among groups were revealed. Conclusion: Within this study limitation, mandibular knife-edge ridge expansion along with concurrent implants placement exhibited comparable radiographic outcomes to those implanted in unexpanded ridges. Yet, ridge-expansion together with LLLT seems advantageous respecting VBL. Denewar BA *1, El Waseef FA 2, El Mekawy N 3, Ahmed S.Salem 4, Hegazy SA 5 1 Assistant lecturer of Prosthodontics Department, Faculty of Dentistry, Mansoura University, Egypt. 2 Associate Professor of Prosthodontics Department, Faculty of Dentistry, Mansoura University, Egypt. 3 Professor of Prosthodontics Department, Faculty of Dentistry, Mansoura University, Egypt. 4 Associate Professor of Oral Surgery Department, Faculty of Dentistry, Mansoura University, Egypt. 5 Professor of Prosthodontics Department, Faculty of Dentistry, Mansoura University, Egypt. Submitted: 24 September 2021 Accepted: 30 September 2021 Published: 30 October 2021 www.ijsrm.humanjournals.com Citation: Denewar BA et al. Ijsrm.Human, 2021; Vol. 19 (4): 112-124. 113 INTRODUCTION: Obviously, osseointegrated dental implants supporting overdentures are being rendered a successful therapy respecting patients uttering denture problems related to mandibular alveolar ridge atrophy. Such treatment confers improved retention and stability, masticatory performance, quality of life, patient satisfaction coupled with the cost compared to conventional dentures (1, 2) . Attachments are authentically used to retain implant overdentures. Interestingly, various systems are readily gettable. Of these, Locator which becomes an increasingly popular attachment system can be used on free-standing, non-splinted implants. This system is categorized as universal hinge resilient overdenture attachment for endosseous implants. Locator attachments are common place low-profile attachment, besides, it can offset for angle corrections up to 40◦ . Plainly, ridge splitting technique results in lateral ridge expansion combined with creating a new implant bed via longitudinal osteotomy. This will allow the buccal (labial) cortex to be positioned laterally, eventually, form a space between the buccal and lingual cortical plates. This space is being filled with endosseous implant accompanied by graft material if needed. This technique is beneficial for enabling the simultaneous implant placement immediately, having minimal technical complications ,averting morbidity of the donor site, and having significant reduced treatment times . The validity of Low Level Laser Therapy (LLLT) upon regeneration of the bone has been currently spotlighted as it improves vascularization and enhances collagen synthesis . It modulates the inflammation, accelerates fibroblast proliferation and enhances wound healing . Additionally, it was demonstrated that LLLT stimulates the bone stem cells and accelerates their repair process. Apparently, immediate implant loading has become more popular and is better accepted by many patients. It obviates the need for second surgery where provisionalization is simplified by the immediate loading of the implant after surgery . The present study aimed to evaluate and compare radiographic outcomes of implants supporting mandibular overdentures; two placed in expanded knife-edge ridge of the mandible with conducting of ridge splitting, bone graft in addition to membrane placement followed by laser application, and those implants placed in unexpanded ridges. The null hypothesis was that no www.ijsrm.humanjournals.com Citation: Denewar BA et al. Ijsrm.Human, 2021; Vol. 19 (4): 112-124. 114 significant difference would be found in radiographic outcomes of implants positioned in expanded and unexpanded ridges throughout all time intervals. MATERIALS AND METHODS