Osseodensification for Narrow Alveolar Ridge Expansion

This prospective clinical study follows a standardized protocol for alveolar ridge expansion using osseodensification. After local anesthesia and reflection of a full-thickness mucoperiosteal flap, the initial bone width is measured at the crest (0 mm) and 5 mm , at 10 mm apical to the crest using Micro Castroviejo Bone Calipers.

The implant site preparation begins with a pilot drill, followed by the use of densifying burs (e.g., Densah Burs) in a counter-clockwise direction (non-subtractive mode) with copious irrigation. This technique allows for lateral condensation and expansion of the bone as the burs advance. After reaching the final desired diameter, the bone width is measured again at the same three levels (0 mm ,5 mm and 10mm apical) to record the expansion gain.

Finally, the dental implant is placed, and primary stability is recorded using Insertion Torque . Post-operative care and follow-up follow standard dental implant protocols

Inclusion criteria

• Patients aged 18 years or older, including both genders.
• Healed edentulous sites (short or long spans, single or multiple missing teeth) in maxillary or mandibular arches.
• At least 6 months post-extraction period (delayed implant placement).
• Alveolar ridge width of 3-8 mm at the crest (buccolingually).
• Low-density jaw regions (D1-D5 according to Misch classification).
• Presence of ≥ 2 mm trabecular bone core and trabecular-to-cortical bone ratio of ≥ 1:1.
• Sufficient vertical dimensions as assessed via CBCT.
• Straightforward cases according to SAC classification (Beagle, 2013).
• Well-motivated patients willing to attend follow-up visits and maintain good oral hygiene.

Exclusion criteria

• Acute or chronic infection or pathological condition at the proposed implant site.
• Severe buccal plate undercut or concavity.
• Signs of active infection in the implant zone.
• Severe parafunctional habits such as bruxism or clenching.
• Heavy smoking (more than 10 cigarettes per day).
• Inadequate inter-ridge distance or insufficient vertical height for implant placement.
• Use of medications compromising bone healing (e.g., corticosteroids, hormone replacement therapy, or bisphosphonates).
• Uncontrolled systemic diseases (e.g., diabetes, immunocompromised states, hyperparathyroidism, or fibrous dysplasia).
• History of radiotherapy to the head/neck or chemotherapy within the past 5 years.
• Current pregnancy during the surgical procedure.