Effectiveness of Using Implant Fixture as a Ridge Expander

Effectiveness of Using Implant Fixture as a Ridge Expander | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effectiveness of Using Implant Fixture as a Ridge Expander Abdusalam Alrmali, Fatemeh SamavatiJame, Alice Ou, Danyal Lohana, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4599782/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Aug, 2024 Read the published version in Clinical Oral Investigations → Version 1 posted 7 You are reading this latest preprint version Abstract Objectives Adequate bone thickness around dental implants is vital for their stability and to reduce resorption. This study evaluated the ability of implant fixtures to serve as ridge expanders by measuring width changes pre- and post-implantation. Materials and Methods Measurements including initial alveolar bone width, post-osteotomy width, post-expansion width, and buccal bone thickness were recorded for patients undergoing implant placement. Bone quality was assessed using established criteria. Results Of the 102 subjects (52% male, 48% female), significant ridge width increases at 0mm and 2mm levels were noted (p < 0.05). Larger implant diameters resulted in greater ridge expansion. Absence of prior augmentation was linked to higher bone quality (B = -1.684, p = 0.001), explaining 15% of bone quality variance. Ridge expansion effects also correlated with the site, implant diameter, and design. Conclusions Dental implant fixtures can effectively expand the ridge, with expansion influenced by implant diameter, anatomical location, prior augmentation, and implant design. These factors must be considered for tailored treatment planning in implant dentistry. Clinical Relevance: This study's clinical relevance lies in its exploration of the potential benefits of dental implant fixtures can effectively to expand the ridge taking into consideration implant diameter, anatomical location, prior augmentation, and implant design. osteotomy Alveolar Bone Grafting Dental Implants Single-Tooth Osteotomy Bone density Figures Figure 1 Figure 2 Figure 3 1. Introduction The long-term stability of dental implants is closely linked to maintaining adequate bone volume around the fixture. In the anterior region, it is recommended that a minimum bone thickness of 2mm at the buccal sites and at least 1mm at the lingual sites be ensured during implant placement. For the posterior region, at least 1mm of bone is suggested on both buccal and lingual sides [ 1 – 3 ]. However, maintaining these standards becomes challenging due to alveolar ridge resorption following tooth extraction. This resorption can lead to a significant loss in alveolar ridge volume, with a reduction of approximately 25% in the first year and 40% by the third-year post extraction [ 4 , 5 ]. To address the issue of inadequate ridge width for implant placement, various ridge expansion techniques have been developed. These include techniques such as ridge splitting, the use of osteotomes, and several other modified procedures [ 6 – 8 ]. The traditional ridge splitting technique involves sectioning the alveolar ridge into buccal and lingual parts before the placement of the implant, though this method has been linked to changes in crestal bone levels due to diminished bone vascularity, leading to bone loss before and after implant loading. By contrast, the osteotome technique utilizes a series of incrementally wider osteotomes following an initial drilling, to gradually expand and condense the bone within the osteotomy site. As an adjunct or alternative, threaded spreaders have also been employed for ridge expansion [ 9 , 10 ]. Clinical studies have reported significant increases in ridge width utilizing these methods [ 11 , 12 ]. Osteotomes and screw spreaders are designed with a tapered shape; their narrower tips are inserted into the osteotomy site first, while the larger portions are subsequently inserted to displace the bony walls and facilitate ridge expansion in both the buccal and lingual directions. This concept is akin to the placement of an implant into a slightly underprepared osteotomy site, a technique often used to achieve primary stability, especially in areas of lower bone density. However, to our knowledge, no study has yet evaluated the ridge expansion potential of the implant fixture itself. Thus, the purpose of this study is to investigate the changes in ridge width associated with osteotomy and implant placement surgery, both before and after the implant is inserted. 2. Materials and methods The Institutional Review Board (IRB) for the Medical Sciences at the University of Michigan, Ann Arbor, MI, reviewed and approved this study before enrollment of participants began (IRB number HUM00142371). In addition, the study was conducted according to the principles outlined in the Declaration of Helsinki on experimentation involving human subjects, as revised in 2000. Informed consent was obtained from all participants before involvement in the study. Inclusion criteria for study participants were as follows: individuals of any gender, aged 20 years or older, scheduled for implant surgery, and willing to comply with all study requirements. The exclusion criteria included patients undergoing immediate implant surgery, flapless implant procedures, surgeries involving a lateral sinus lift, individuals who were pregnant or planning to become pregnant, or uncertain about their pregnancy status, as well as patients with a history of intravenous bisphosphonate use or history of radiation therapy in the head and neck area within four years prior to implant placement. The surgical technique and research measurements involved in this study did not impact the standard patient care provided during the implant surgery visit. Measurements taken during surgery included the initial alveolar bone ridge width (RWt0), ridge width after osteotomy (RWt1), ridge width after expansion with the implant fixture (RWt2), buccal bone thickness post-osteotomy (BBTt1), and buccal bone thickness post-implant placement (BBTt2), as well as vertical soft tissue height and buccal soft tissue thickness (Figs. 1 and 2 ). These measurements were taken at various stages of the implant placement procedure to evaluate the changes in relation to factors such as implant site, diameter, design, bone density, and repeated use of the term "implant location" in points 1 and 4. Following flap reflection, reference points for measurement were marked 2mm below the crest on both the buccal and lingual sides of the osteotomy site. The initial ridge width (RWt0) was measured at this level using a ridge mapping instrument. RWt1 was captured after osteotomy completion by the attending clinician, using the same reference points. BBTt1 was gauged by placing a calibrated periodontal probe perpendicularly to the implant bed. Subsequent to implant placement using a tapered screw design, insertion torque values were recorded, along with RWt2 and BBTt2 measurements. Bone quality at the site was assessed and recorded according to the classification system proposed by Lekholm and Zarb [ 3 , 13 ], based on both preoperative radiographic appearances and the tactile feedback during site preparation and implant placement. Statistical analysis involved the use of a comprehensive statistical software package. Descriptive statistics were employed to summarize variables. Paired samples t-tests were utilized to ascertain the presence of significant differences between the ridge widths RWt0, RWt1, and RWt2, as well as between the buccal bone thickness measurements BBTt1 and BBTt2. A P-value of less than 0.05 was considered indicative of statistical significance. 3. Results 3.1. Demographic and Clinical Characteristics: A total of 102 patients participated in this study, comprising 52% males and 48% females. A notable 62.7% of these patients had previously undergone ridge augmentation procedures. Cancellous bone grafts were the most commonly used for alveolar ridge preservation, accounting for 42.2% of cases. While a majority of patients (65.7%) did not require a membrane, collagen membranes were the preferred choice when needed, constituting 69.6% of cases. The most frequent implant placement site was the posterior mandible, representing nearly half of the cases (49%). In terms of bone quality, type 3 bone was most common, present in 52% of patients. The implants used originated from a variety of manufacturers, with Zimmer being the predominant brand at 72.5% (Table 1 ). Table 1 Summarizes the demographic and clinical characteristics of all patients: variable frequency Percent Gender male 53 52 female 49 48 Previous ridge augmentation No 38 37.3 Yes 64 62.7 type of bone graft for ARP NA 0 0 Cancellous 43 42.2 Cortical + cancellous 8 7.8 Allograft 4 3.9 cortical 4 3.9 Membrane No 67 65.7 Yes 35 34.3 Type of membrane Collagen Membrane 25 69.6 Amnion chorion 6 24.5 site Mandible posterior 50 49 Maxilla posterior 34 33.3 Mandible anterior 8 7.8 Maxilla anterior 10 9.8 Bone quality 1 5 4.9 2 36 35.3 3 53 52 4 8 7.8 Implant characteristic TLX 6 5.9 BLX 13 12.7 NOBEL 3 2.9 BIOHORIZON 6 5.9 ZIMMER 74 72.5 3.2. Ridge Width Changes During Osteotomy and Implant Surgery: Measurements taken during the surgery included: Ridge width before osteotome use, before implant placement and after implant placement at the 0mm mark. Ridge width before osteotome use, before implant placement and after implant placement at the 2mm mark. Buccal bone thickness after osteotome use and after implant placement. Lingual bone thickness after osteotome use and after implant placement. For these four measurements, we employed a repeated measures analysis of variance (ANOVA) to evaluate ridge width changes during the surgical process. A significant increase in ridge width was noted at both 0mm and 2mm levels post-surgery (p < 0.05). The effect sizes (partial eta squared) for the first and second measurements were 0.519 and 0.175, respectively, suggesting that the surgical procedure accounts for 51.9% and 17.5% of the variance in ridge width, with a more substantial impact at the 0mm level (Table 2 ). However, the changes in buccal and lingual bone thickness post-implant placement (measurements 3 and 4) were not statistically significant (p > 0.05). Table 2 Demonstrated the results of the ridge width changes during osteotomy, before and after insertion of the implant: Case time mean Std.dev F Sig Partial eta square 1 Before osteotome 0mm 7.59 2.07 108.91 0.001 0.519 Before implant placement 0mm 8.17 1.91 after implant placement 0mm 8.77 2.05 2 Before osteotome 2mm 8.83 2.42 21.39 0.001 0.175 Before implant placement 2mm 9.21 2.48 after implant placement 2mm 9.64 2.26 3 Buccal bone after osteotome 2.27 1.07 2.31 0.131 0.022 Buccal bone after implant 2.32 1.14 4 Lingual bone after osteotome 2.41 1.04 0.188 0.666 0.002 Lingual bone after implant 2.44 1.08 3.3. Factors Impacting Ridge Width Changes: A repeated measures ANOVA was conducted considering factors such as implant site, bone quality, and implant characteristics (length and diameter). Both implant diameter and the anterior mandible site were associated with significant changes in ridge width at the 0mm level (p < 0.05). In contrast, the posterior maxilla experienced more robust and lasting ridge width changes post-osteotomy and post-implant placement. Notably, a larger implant diameter was correlated with a greater increase in ridge width (Table 3 ). Table 3 The results of the covariates including site, bone quality, implant characteristics, length and diameters. Case F Sig Partial eta square 0mm Implant characteristic 0.868 0.487 0.038 tapered 0.334 0.565 0.004 Site 3.535 0.018 0.108 Bone quality 1.321 0.273 0.043 Length 0.131 0.718 0.001 Diameter 8.704 0.004 0.090 2mm Implant characteristic 0.662 0.620 0.029 tapered 0.233 0.631 0.003 Site 2.372 0.076 0.075 Bone quality 1.614 0.192 0.052 Length 0.225 0.636 0.003 Diameter 11.220 0.001 0.113 Buccal bone Implant characteristic 0.487 0.745 0.022 tapered 0.001 0.987 0.00 Site 2.195 0.094 0.070 Bone quality 0.948 0.421 0.031 Length 0.154 0.695 0.002 Diameter 3.348 0.071 0.037 Lingual bone Implant characteristic 1.237 0.301 0.053 tapered 0.216 0.643 0.002 Site 2.041 0.114 0.065 Bone quality 2.318 0.081 0.073 Length 0.377 0.541 0.004 Diameter 6.228 0.014 0.066 A similar trend was observed for the 2mm level, with implant diameter again significantly influencing ridge width increase (p < 0.05). Although no significant factors were observed when analyzing buccal bone changes, an increase in implant diameter was significantly associated with greater changes in the lingual bone thickness (p < 0.05). 3.4. Effect of Previous Ridge Augmentation on Bone Quality: An ordinal regression analysis showed that the width, thickness, and vertical height of the keratinized mucosa did not significantly influence bone quality. However, prior ridge augmentation was a significant predictor of bone quality (B = -1.684, p = 0.001), with patients who had not undergone augmentation displaying better bone quality. The model explained approximately 15% of the variance in bone quality (Fig. 3 ). The type of bone graft used for augmentation (whether cancellous, combined cortical and cancellous, or allograft) did not show a significant impact on bone quality. 5. Discussion The long-term success of dental implants is highly dependent on the maintenance of adequate alveolar bone volume, from both prosthetic and esthetic perspectives. To prevent bone resorption and the associated soft tissue recession around an implant, a minimum buccal bone thickness of 1.5 to 1.8 millimeters at the crestal level is advisable (1,14,15). An earlier study introduced the notion that the implant fixture could act as a ridge expander (10). For cases requiring minimal ridge enhancement (less than 1 millimeter), an implant-only augmentation protocol may be considered a practical alternative. This approach allows the implant to serve a dual function—expanding the ridge and potentially promoting bone densification around the implant threads—enhancing support, stability, and esthetic results of the restoration (15). Consequently, this study aimed to evaluate the extent of ridge width changes during and after osteotomy in implant surgery. 5.1. Ridge Width Changes and Surgical Considerations: Our study revealed significant increases in ridge width at the 0mm and 2mm levels relative to the surgical site, suggesting that implant surgery can positively affect ridge width—a key factor for stable implant placement and optimizing aesthetic results (19,20). The variance in ridge width changes at these specific levels highlights the importance of selecting appropriate surgical techniques and implant designs based on the anatomical location. Notably, changes were more significant in the maxillary posterior sites, underscoring the need for tailored planning and careful implant choice. 5.2. Implant Characteristics and Surgical Outcomes: The analysis identified a clear influence of implant dimensions on ridge width alterations, with larger diameters correlating with more substantial changes. This insight underscores that implant selection should be informed by the current ridge width and the anticipated postoperative dimensions. It corroborates other research advocating for the effectiveness of using osteotomes to expand horizontally atrophic alveolar ridges, offering a more straightforward alternative to complex procedures and improving bone support quality (21). Importantly, implant length and taper appeared less impactful on ridge width, suggesting that diameter is a more critical factor to consider. 5.3. Bone Quality and Augmentation Techniques: A notable conclusion from this study is the deleterious impact of prior ridge augmentation on bone quality. Patients without previous augmentation procedures exhibited better bone integrity. This implication is significant as it suggests that augmentation might affect the bone's quality and, consequently, the success of future implants (17). Intriguingly, the type of augmentation material did not significantly affect bone quality, which may indicate that the choice between materials such as cancellous, cortical, cortical plus cancellous, or allograft is not a determinant in the final bone quality. This is consistent with findings from Basma et al., which reported no significant difference in bone density at implant placement among various augmentation groups (18). 6. Clinical Implications and Future Directions These findings have important clinical ramifications. Practitioners should consider a patient's history of ridge augmentation, which seems to influence bone quality. Site-specific surgical planning and implant selection, particularly in the maxillary posterior region, are crucial. The impact of implant diameter on ridge width alterations must be considered. Future research should focus on the long-term outcomes of implants in various scenarios of bone quality and ridge width changes. Investigating the effects of different augmentation materials and methods on bone quality is also recommended to enhance our understanding of implant surgery and refine evidence-based clinical practices. 7. Conclusion The study reveals that dental implant fixtures can double as ridge expanders, with the extent of expansion being influenced by implant diameter, anatomical location, prior augmentation history, and implant design. Wider implants and the upper posterior region are associated with more significant expansion, while previous ridge augmentation and tapered designs tend to limit expansion. These insights emphasize the need for personalized treatment planning and further studies to enhance clinical practices and patient outcomes in implant dentistry. Declarations Conflict of Interest: The authors declare no conflict of interest with this study. The authors do not have any financial interests, either directly or indirectly, in the products or information listed in the paper. Funding : This study was partly supported by the Graduate periodontics fund, University of Michigan School of Dentistry. Ethical Approval: The Institutional Review Board (IRB) for the Medical Sciences at the University of Michigan, Ann Arbor, MI, reviewed and approved this study before enrollment of participants began (IRB number HUM00142371). Informed Consent: Informed consent was obtained from all participants before involvement in the study. Conflict of Interest: The authors declare no conflict of interest with this study. The authors do not have any financial interests, either directly or indirectly, in the products or information listed in the paper. Funding : This study was partly supported by the Graduate periodontics fund, University of Michigan School of Dentistry. Ethical Approval: The Institutional Review Board (IRB) for the Medical Sciences at the University of Michigan, Ann Arbor, MI, reviewed and approved this study before enrollment of participants began (IRB number HUM00142371). Informed Consent: Informed consent was obtained from all participants before involvement in the study. Availability of data : Original raw data collected is available from the corresponding author upon reasonable request. Authors contribution: Authors AA, FS, DM, DL and HL W contributed to the conception, design, and data acquisition. AO contributed to monitor study and data acquisition. FS completed data insertion and data analysis. AA manuscript writing and interpretation of data. HL W final revision and approval. All authors gave final approval and agreed to be accountable for all aspects of the scientific work. 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Periodontol 2000 00:1–22 Basma HS, Saleh MHA, Geurs NC, Li P, Ravidà A, Wang HL, Abou-Arraj RV (2023) The effect of bone particle size on the histomorphometric and clinical outcomes following lateral ridge augmentation procedures: A randomized double-blinded controlled trial. J Periodontol 94:163–173 Chiapasco M, Romeo E, Vogel G (2001) Vertical distraction osteogenesis of edentulous ridges for improvement of oral implant positioning: a clinical report of preliminary results. Int J Oral Maxillofac Implants 16:43–51 Chappuis V, Engel O, Reyes M, Shahim K, Nolte L-P, Buser D (2013) Ridge alterations post-extraction in the esthetic zone: a 3D analysis with CBCT. J Dent Res 92:195S–201S Shaik LS, Meka S, Kattimani VS, Chakravarthi SP, Kolli NN, Lingamaneni KP, Avvaru S, Tiwari R (2016) The Effect of Ridge Expansion on Implant Stability in Narrow Partially Edentulous Ridges - A Preliminary Clinical Study. J Clin Diagn Res 10:ZC28–ZC33 Additional Declarations No competing interests reported. Supplementary Files STROBEchecklistcohort.docx Cite Share Download PDF Status: Published Journal Publication published 30 Aug, 2024 Read the published version in Clinical Oral Investigations → Version 1 posted Editorial decision: Revision requested 13 Jul, 2024 Reviews received at journal 06 Jul, 2024 Reviewers agreed at journal 02 Jul, 2024 Reviewers invited by journal 02 Jul, 2024 Editor assigned by journal 25 Jun, 2024 Submission checks completed at journal 25 Jun, 2024 First submitted to journal 18 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4599782","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":326589268,"identity":"59003779-c4cd-4607-9ee5-3155d81537f0","order_by":0,"name":"Abdusalam Alrmali","email":"","orcid":"","institution":"University of Michigan","correspondingAuthor":false,"prefix":"","firstName":"Abdusalam","middleName":"","lastName":"Alrmali","suffix":""},{"id":326589275,"identity":"bb8eb93b-2ed9-45c2-bb0f-49614c441a48","order_by":1,"name":"Fatemeh SamavatiJame","email":"","orcid":"","institution":"University of Michigan","correspondingAuthor":false,"prefix":"","firstName":"Fatemeh","middleName":"","lastName":"SamavatiJame","suffix":""},{"id":326589276,"identity":"0276b39d-9002-4d21-8ebc-36578f0e5cf8","order_by":2,"name":"Alice Ou","email":"","orcid":"","institution":"University of Michigan","correspondingAuthor":false,"prefix":"","firstName":"Alice","middleName":"","lastName":"Ou","suffix":""},{"id":326589277,"identity":"cd174289-ba73-4217-b6a6-9d56056e56da","order_by":3,"name":"Danyal Lohana","email":"","orcid":"","institution":"University of Michigan","correspondingAuthor":false,"prefix":"","firstName":"Danyal","middleName":"","lastName":"Lohana","suffix":""},{"id":326589278,"identity":"eeaeb0e4-94b0-407c-8509-f1009f391c30","order_by":4,"name":"Dhiraj Mallala","email":"","orcid":"","institution":"University of Michigan","correspondingAuthor":false,"prefix":"","firstName":"Dhiraj","middleName":"","lastName":"Mallala","suffix":""},{"id":326589279,"identity":"29e701dd-100a-4d23-97bf-6e1e7b17bcb8","order_by":5,"name":"Hom-Lay Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuUlEQVRIiWNgGAWjYBACAwYGxgMMDDYMDMwMbAwgkhgtDEAtaaRrOQxiE6nFnL074cDPtvOJa9uZnz1gqLBObCCkxbLn7IaDvW23E7cdZjM3YDiTTliLwY3cDQd4wVp42CQY2w4Tp+Xg37ZzUC3/iNRymLftAFRLAzFazpzdcFjmXLIx0C9mEgnH0o0Jazneu/HhmzI72W3nDz+T+FBjLUtQCxgwskEZCUQpB4M/xCsdBaNgFIyCEQgAs5BGGjMFGYwAAAAASUVORK5CYII=","orcid":"","institution":"University of Michigan","correspondingAuthor":true,"prefix":"","firstName":"Hom-Lay","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2024-06-18 11:53:52","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4599782/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4599782/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00784-024-05896-9","type":"published","date":"2024-08-30T15:57:38+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60633244,"identity":"2c47b2ff-fc40-4d3e-b516-515c8b180925","added_by":"auto","created_at":"2024-07-19 01:37:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":143229,"visible":true,"origin":"","legend":"\u003cp\u003eImplant placement and measurement. (a) The initial ridge. (b) Initial ridge width measurement 2 mm apical to the crest on the buccal and lingual plates. (c) Actual ridge width in mm. (d) Measurement of the soft tissue thickness using the same caliber.\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4599782/v1/d085112e3ad155993e45cc37.png"},{"id":60633246,"identity":"47749b19-4d1c-4c5a-8e46-d6c4fe24ba8b","added_by":"auto","created_at":"2024-07-19 01:37:33","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":630430,"visible":true,"origin":"","legend":"\u003cp\u003e(a) Measurement of vertical soft tissue height after buccal flap reflection. (b) Ridge width measurement after osteotomy preparation. (c) Ridge width measurement after fixture insertion. (d) Ridge measurement using the same caliber.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4599782/v1/42aca89b3ea7fa5a7fc00ab1.jpeg"},{"id":60633245,"identity":"8608fa45-a7ed-4bb6-b6fb-cee72df7496d","added_by":"auto","created_at":"2024-07-19 01:37:32","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":3643,"visible":true,"origin":"","legend":"\u003cp\u003eBar chart of bone quality by previous ridge augmentation\u003c/p\u003e","description":"","filename":"Onlinedrawingimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4599782/v1/bdb82b9f9cd3f0bcc10e510d.png"},{"id":63821712,"identity":"a69d4e90-f53a-4cd2-a8b9-392f6fc8d707","added_by":"auto","created_at":"2024-09-02 16:14:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1373367,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4599782/v1/17447631-97cf-4d9f-8793-27942cbcd99b.pdf"},{"id":60633242,"identity":"9f9577d9-ce87-49b6-a579-82c86b15f578","added_by":"auto","created_at":"2024-07-19 01:37:32","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":33612,"visible":true,"origin":"","legend":"","description":"","filename":"STROBEchecklistcohort.docx","url":"https://assets-eu.researchsquare.com/files/rs-4599782/v1/ea77c7685e7afd219f036c4c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effectiveness of Using Implant Fixture as a Ridge Expander","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe long-term stability of dental implants is closely linked to maintaining adequate bone volume around the fixture. In the anterior region, it is recommended that a minimum bone thickness of 2mm at the buccal sites and at least 1mm at the lingual sites be ensured during implant placement. For the posterior region, at least 1mm of bone is suggested on both buccal and lingual sides [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, maintaining these standards becomes challenging due to alveolar ridge resorption following tooth extraction. This resorption can lead to a significant loss in alveolar ridge volume, with a reduction of approximately 25% in the first year and 40% by the third-year post extraction [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo address the issue of inadequate ridge width for implant placement, various ridge expansion techniques have been developed. These include techniques such as ridge splitting, the use of osteotomes, and several other modified procedures [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The traditional ridge splitting technique involves sectioning the alveolar ridge into buccal and lingual parts before the placement of the implant, though this method has been linked to changes in crestal bone levels due to diminished bone vascularity, leading to bone loss before and after implant loading. By contrast, the osteotome technique utilizes a series of incrementally wider osteotomes following an initial drilling, to gradually expand and condense the bone within the osteotomy site. As an adjunct or alternative, threaded spreaders have also been employed for ridge expansion [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Clinical studies have reported significant increases in ridge width utilizing these methods [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOsteotomes and screw spreaders are designed with a tapered shape; their narrower tips are inserted into the osteotomy site first, while the larger portions are subsequently inserted to displace the bony walls and facilitate ridge expansion in both the buccal and lingual directions. This concept is akin to the placement of an implant into a slightly underprepared osteotomy site, a technique often used to achieve primary stability, especially in areas of lower bone density. However, to our knowledge, no study has yet evaluated the ridge expansion potential of the implant fixture itself. Thus, the purpose of this study is to investigate the changes in ridge width associated with osteotomy and implant placement surgery, both before and after the implant is inserted.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cp\u003e The Institutional Review Board (IRB) for the Medical Sciences at the University of Michigan, Ann Arbor, MI, reviewed and approved this study before enrollment of participants began (IRB number HUM00142371). In addition, the study was conducted according to the principles outlined in the Declaration of Helsinki on experimentation involving human subjects, as revised in 2000. Informed consent was obtained from all participants before involvement in the study.\u003c/p\u003e \u003cp\u003eInclusion criteria for study participants were as follows: individuals of any gender, aged 20 years or older, scheduled for implant surgery, and willing to comply with all study requirements. The exclusion criteria included patients undergoing immediate implant surgery, flapless implant procedures, surgeries involving a lateral sinus lift, individuals who were pregnant or planning to become pregnant, or uncertain about their pregnancy status, as well as patients with a history of intravenous bisphosphonate use or history of radiation therapy in the head and neck area within four years prior to implant placement.\u003c/p\u003e \u003cp\u003eThe surgical technique and research measurements involved in this study did not impact the standard patient care provided during the implant surgery visit. Measurements taken during surgery included the initial alveolar bone ridge width (RWt0), ridge width after osteotomy (RWt1), ridge width after expansion with the implant fixture (RWt2), buccal bone thickness post-osteotomy (BBTt1), and buccal bone thickness post-implant placement (BBTt2), as well as vertical soft tissue height and buccal soft tissue thickness (Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). These measurements were taken at various stages of the implant placement procedure to evaluate the changes in relation to factors such as implant site, diameter, design, bone density, and repeated use of the term \"implant location\" in points 1 and 4.\u003c/p\u003e \u003cp\u003eFollowing flap reflection, reference points for measurement were marked 2mm below the crest on both the buccal and lingual sides of the osteotomy site. The initial ridge width (RWt0) was measured at this level using a ridge mapping instrument. RWt1 was captured after osteotomy completion by the attending clinician, using the same reference points. BBTt1 was gauged by placing a calibrated periodontal probe perpendicularly to the implant bed. Subsequent to implant placement using a tapered screw design, insertion torque values were recorded, along with RWt2 and BBTt2 measurements. Bone quality at the site was assessed and recorded according to the classification system proposed by Lekholm and Zarb [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], based on both preoperative radiographic appearances and the tactile feedback during site preparation and implant placement.\u003c/p\u003e \u003cp\u003eStatistical analysis involved the use of a comprehensive statistical software package. Descriptive statistics were employed to summarize variables. Paired samples t-tests were utilized to ascertain the presence of significant differences between the ridge widths RWt0, RWt1, and RWt2, as well as between the buccal bone thickness measurements BBTt1 and BBTt2. A P-value of less than 0.05 was considered indicative of statistical significance.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Demographic and Clinical Characteristics:\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eA total of 102 patients participated in this study, comprising 52% males and 48% females. A notable 62.7% of these patients had previously undergone ridge augmentation procedures. Cancellous bone grafts were the most commonly used for alveolar ridge preservation, accounting for 42.2% of cases. While a majority of patients (65.7%) did not require a membrane, collagen membranes were the preferred choice when needed, constituting 69.6% of cases. The most frequent implant placement site was the posterior mandible, representing nearly half of the cases (49%). In terms of bone quality, type 3 bone was most common, present in 52% of patients. The implants used originated from a variety of manufacturers, with Zimmer being the predominant brand at 72.5% (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummarizes the demographic and clinical characteristics of all patients:\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003evariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003efrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrevious ridge augmentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003etype of bone graft for ARP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCancellous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCortical\u0026thinsp;+\u0026thinsp;cancellous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAllograft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecortical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMembrane\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eType of membrane\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollagen Membrane\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmnion chorion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003esite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMandible posterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaxilla posterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMandible anterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaxilla anterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eBone quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eImplant characteristic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTLX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBLX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNOBEL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBIOHORIZON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eZIMMER\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Ridge Width Changes During Osteotomy and Implant Surgery:\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eMeasurements taken during the surgery included:\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eRidge width before osteotome use, before implant placement and after implant placement at the 0mm mark.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eRidge width before osteotome use, before implant placement and after implant placement at the 2mm mark.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eBuccal bone thickness after osteotome use and after implant placement.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eLingual bone thickness after osteotome use and after implant placement.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eFor these four measurements, we employed a repeated measures analysis of variance (ANOVA) to evaluate ridge width changes during the surgical process. A significant increase in ridge width was noted at both 0mm and 2mm levels post-surgery (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The effect sizes (partial eta squared) for the first and second measurements were 0.519 and 0.175, respectively, suggesting that the surgical procedure accounts for 51.9% and 17.5% of the variance in ridge width, with a more substantial impact at the 0mm level (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). However, the changes in buccal and lingual bone thickness post-implant placement (measurements 3 and 4) were not statistically significant (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemonstrated the results of the ridge width changes during osteotomy, before and after insertion of the implant:\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003etime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003emean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStd.dev\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSig\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePartial eta square\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore osteotome 0mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e108.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.519\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore implant placement 0mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eafter implant placement 0mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore osteotome 2mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e21.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.175\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore implant placement 2mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eafter implant placement 2mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBuccal bone after osteotome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBuccal bone after implant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLingual bone after osteotome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLingual bone after implant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Factors Impacting Ridge Width Changes:\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eA repeated measures ANOVA was conducted considering factors such as implant site, bone quality, and implant characteristics (length and diameter). Both implant diameter and the anterior mandible site were associated with significant changes in ridge width at the 0mm level (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In contrast, the posterior maxilla experienced more robust and lasting ridge width changes post-osteotomy and post-implant placement. Notably, a larger implant diameter was correlated with a greater increase in ridge width (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe results of the covariates including site, bone quality, implant characteristics, length and diameters.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSig\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePartial eta square\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e0mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImplant characteristic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.868\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etapered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.334\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.565\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.535\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.108\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBone quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLength\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.718\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.704\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.090\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e2mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImplant characteristic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.662\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.620\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etapered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.631\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBone quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.614\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLength\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eBuccal bone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImplant characteristic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.745\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etapered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.987\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBone quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.948\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.421\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLength\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.695\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eLingual bone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImplant characteristic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etapered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.643\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBone quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLength\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.541\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA similar trend was observed for the 2mm level, with implant diameter again significantly influencing ridge width increase (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Although no significant factors were observed when analyzing buccal bone changes, an increase in implant diameter was significantly associated with greater changes in the lingual bone thickness (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Effect of Previous Ridge Augmentation on Bone Quality:\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eAn ordinal regression analysis showed that the width, thickness, and vertical height of the keratinized mucosa did not significantly influence bone quality. However, prior ridge augmentation was a significant predictor of bone quality (B = -1.684, p\u0026thinsp;=\u0026thinsp;0.001), with patients who had not undergone augmentation displaying better bone quality. The model explained approximately 15% of the variance in bone quality (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The type of bone graft used for augmentation (whether cancellous, combined cortical and cancellous, or allograft) did not show a significant impact on bone quality.\u003c/p\u003e \u003c/div\u003e "},{"header":"5. Discussion","content":"\u003cp\u003eThe long-term success of dental implants is highly dependent on the maintenance of adequate alveolar bone volume, from both prosthetic and esthetic perspectives. To prevent bone resorption and the associated soft tissue recession around an implant, a minimum buccal bone thickness of 1.5 to 1.8 millimeters at the crestal level is advisable (1,14,15).\u003csup\u003e\u0026nbsp;\u003c/sup\u003eAn earlier study introduced the notion that the implant fixture could act as a ridge expander (10). For cases requiring minimal ridge enhancement (less than 1 millimeter), an implant-only augmentation protocol may be considered a practical alternative. This approach allows the implant to serve a dual function\u0026mdash;expanding the ridge and potentially promoting bone densification around the implant threads\u0026mdash;enhancing support, stability, and esthetic results of the restoration (15).\u003csup\u003e\u0026nbsp;\u003c/sup\u003e Consequently, this study aimed to evaluate the extent of ridge width changes during and after osteotomy in implant surgery. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e5.1. Ridge Width Changes and Surgical Considerations:\u003c/em\u003e Our study revealed significant increases in ridge width at the 0mm and 2mm levels relative to the surgical site, suggesting that implant surgery can positively affect ridge width\u0026mdash;a key factor for stable implant placement and optimizing aesthetic results (19,20).\u003csup\u003e\u0026nbsp;\u003c/sup\u003eThe variance in ridge width changes at these specific levels highlights the importance of selecting appropriate surgical techniques and implant designs based on the anatomical location. Notably, changes were more significant in the maxillary posterior sites, underscoring the need for tailored planning and careful implant choice. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e5.2. Implant Characteristics and Surgical Outcomes:\u003c/em\u003e The analysis identified a clear influence of implant dimensions on ridge width alterations, with larger diameters correlating with more substantial changes. This insight underscores that implant selection should be informed by the current ridge width and the anticipated postoperative dimensions. It corroborates other research advocating for the effectiveness of using osteotomes to expand horizontally atrophic alveolar ridges, offering a more straightforward alternative to complex procedures and improving bone support quality (21). Importantly, implant length and taper appeared less impactful on ridge width, suggesting that diameter is a more critical factor to consider. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e5.3. Bone Quality and Augmentation Techniques:\u003c/em\u003e A notable conclusion from this study is the deleterious impact of prior ridge augmentation on bone quality. Patients without previous augmentation procedures exhibited better bone integrity. This implication is significant as it suggests that augmentation might affect the bone\u0026apos;s quality and, consequently, the success of future implants (17).\u003csup\u003e\u0026nbsp;\u003c/sup\u003eIntriguingly, the type of augmentation material did not significantly affect bone quality, which may indicate that the choice between materials such as cancellous, cortical, cortical plus cancellous, or allograft is not a determinant in the final bone quality. This is consistent with findings from Basma et al., which reported no significant difference in bone density at implant placement among various augmentation groups (18). \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e"},{"header":"6. Clinical Implications and Future Directions","content":"\u003cp\u003eThese findings have important clinical ramifications. Practitioners should consider a patient's history of ridge augmentation, which seems to influence bone quality. Site-specific surgical planning and implant selection, particularly in the maxillary posterior region, are crucial. The impact of implant diameter on ridge width alterations must be considered. Future research should focus on the long-term outcomes of implants in various scenarios of bone quality and ridge width changes. Investigating the effects of different augmentation materials and methods on bone quality is also recommended to enhance our understanding of implant surgery and refine evidence-based clinical practices.\u003c/p\u003e"},{"header":"7. Conclusion","content":"\u003cp\u003eThe study reveals that dental implant fixtures can double as ridge expanders, with the extent of expansion being influenced by implant diameter, anatomical location, prior augmentation history, and implant design. Wider implants and the upper posterior region are associated with more significant expansion, while previous ridge augmentation and tapered designs tend to limit expansion. These insights emphasize the need for personalized treatment planning and further studies to enhance clinical practices and patient outcomes in implant dentistry.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u0026nbsp;\u003c/strong\u003eThe authors declare no conflict of interest with this study. The authors do not have any financial interests, either directly or indirectly, in the products or information listed in the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e This study was partly supported by the Graduate periodontics fund, University of Michigan School of Dentistry.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u003c/strong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eThe Institutional Review Board (IRB) for the Medical Sciences at the University of Michigan, Ann Arbor, MI, reviewed and approved this study before enrollment of participants began (IRB number HUM00142371).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent:\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from all participants before involvement in the study.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u0026nbsp;\u003c/strong\u003eThe authors declare no conflict of interest with this study. The authors do not have any financial interests, either directly or indirectly, in the products or information listed in the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e This study was partly supported by the Graduate periodontics fund, University of Michigan School of Dentistry.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u003c/strong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eThe Institutional Review Board (IRB) for the Medical Sciences at the University of Michigan, Ann Arbor, MI, reviewed and approved this study before enrollment of participants began (IRB number HUM00142371).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent:\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from all participants before involvement in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eOriginal raw data collected is available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contribution:\u003c/strong\u003e Authors AA, FS, DM, DL and HL W contributed to the conception, design, and data acquisition. AO contributed to monitor study and data acquisition. FS completed data insertion and data analysis. AA manuscript writing and interpretation of data. HL W final revision and approval. All authors gave final approval and agreed to be accountable for all aspects of the scientific work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSpray JR, Black CG, Morris HF, Ochi S (2000) The influence of bone thickness on facial marginal bone response: stage 1 placement through stage 2 uncovering. Annals Periodontology 5:119\u0026ndash;128\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSu CY, Fu JH, Wang HL (2014) The role of implant position on long-term success. Clin Adv Periodontics 4:187\u0026ndash;193\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLekholm U, Zarb E (1985) Patient selection and preparation. In: Br\u0026aring;nemark P-I (ed). Tissue-Integrated Prostheses: \u003cem\u003eOsseointegration in Clinical Dentistry Chicago: Quintessence\u003c/em\u003e :199\u0026ndash;209\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarlsson GE, Bergman B, Hedeg\u0026aring;rd B (1967) Changes in Contour of the Maxillary Alveolar Process Under Immediate Dentures a Longitudinal Clinical and X-Ray Cephalo-Metric Study Covering 5 Years. Acta Odontol Scand 25:45\u0026ndash;75\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePietrokovski J, Massler M (1967) Alveolar ridge resorption following tooth extraction. J Prosthet Dent 17:21\u0026ndash;27\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScipioni A, Bruschi G, Calesini G (1994) The edentulous ridge expansion technique: a five-year study. Int J Periodontics Restor Dent 14:451\u0026ndash;459\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVercellotti T (2000) Piezoelectric surgery in implantology: a case report\u0026ndash;a new piezoelectric ridge expansion technique. Int J Periodontics Restor Dent 20:358\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSethi A, Kaus T (2000) Maxillary ridge expansion with simultaneous implant placement: 5-year results of an ongoing clinical study. Int J Oral Maxillofac Implants 15:491\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNishioka RS, Souza FA (2009) Bone spreader technique: a preliminary 3-year study. J Oral Implantology 35:289\u0026ndash;294\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan H-L, Fu J-H, Koticha T, Benavides E, Wang H-L (2013) Ridge width gain with screw spreaders: a cadaver study. Implant Dent 22:552\u0026ndash;558\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChiapasco M, Casentini P, Zaniboni M (2009) Bone augmentation procedures in implant dentistry. Int J Oral Maxillofacial Implants 24\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDonos N, Mardas N, Chadha V (2008) Clinical outcomes of implants following lateral bone augmentation: systematic assessment of available options (barrier membranes, bone grafts, split osteotomy). J Clin Periodontol 35:173\u0026ndash;202\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Ekrish AA, Widmann G, Alfadda SA (2018) Revised, Computed Tomography-Based Lekholm and Zarb Jawbone Quality Classification. Int J Prosthodont 31:342\u0026ndash;345\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMonje A, Chappuis V, Monje F, Mu\u0026ntilde;oz F, Wang HL, Urban IA, Buser D (2019) The Critical Peri-implant Buccal Bone Wall Thickness Revisited: An Experimental Study in the Beagle Dog. Int J Oral Maxillofac Implants 34:1328\u0026ndash;1336\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMonje A, Roccuzzo A, Buser D, Wang HL (2023) Influence of buccal bone wall thickness on the peri-implant hard and soft tissue dimensional changes: A systematic review. Clin Oral Implants Res 34:157\u0026ndash;176\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeblebicioglu B, Tatakis DN (2023) Complications following alveolar ridge augmentation procedures. Periodontol 2000 00:1\u0026ndash;15\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu S-H, Saleh MHA, Wang H-L (2023) Simultaneous or staged lateral ridge augmentation: A clinical guideline on the decision-making process. Periodontol 2000 00:1\u0026ndash;22\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBasma HS, Saleh MHA, Geurs NC, Li P, Ravid\u0026agrave; A, Wang HL, Abou-Arraj RV (2023) The effect of bone particle size on the histomorphometric and clinical outcomes following lateral ridge augmentation procedures: A randomized double-blinded controlled trial. J Periodontol 94:163\u0026ndash;173\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChiapasco M, Romeo E, Vogel G (2001) Vertical distraction osteogenesis of edentulous ridges for improvement of oral implant positioning: a clinical report of preliminary results. Int J Oral Maxillofac Implants 16:43\u0026ndash;51\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChappuis V, Engel O, Reyes M, Shahim K, Nolte L-P, Buser D (2013) Ridge alterations post-extraction in the esthetic zone: a 3D analysis with CBCT. J Dent Res 92:195S\u0026ndash;201S\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShaik LS, Meka S, Kattimani VS, Chakravarthi SP, Kolli NN, Lingamaneni KP, Avvaru S, Tiwari R (2016) The Effect of Ridge Expansion on Implant Stability in Narrow Partially Edentulous Ridges - A Preliminary Clinical Study. J Clin Diagn Res 10:ZC28\u0026ndash;ZC33\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"osteotomy, Alveolar Bone Grafting, Dental Implants, Single-Tooth, Osteotomy, Bone density","lastPublishedDoi":"10.21203/rs.3.rs-4599782/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4599782/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eAdequate bone thickness around dental implants is vital for their stability and to reduce resorption. This study evaluated the ability of implant fixtures to serve as ridge expanders by measuring width changes pre- and post-implantation.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eMeasurements including initial alveolar bone width, post-osteotomy width, post-expansion width, and buccal bone thickness were recorded for patients undergoing implant placement. Bone quality was assessed using established criteria.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf the 102 subjects (52% male, 48% female), significant ridge width increases at 0mm and 2mm levels were noted (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Larger implant diameters resulted in greater ridge expansion. Absence of prior augmentation was linked to higher bone quality (B = -1.684, p\u0026thinsp;=\u0026thinsp;0.001), explaining 15% of bone quality variance. Ridge expansion effects also correlated with the site, implant diameter, and design.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eDental implant fixtures can effectively expand the ridge, with expansion influenced by implant diameter, anatomical location, prior augmentation, and implant design. These factors must be considered for tailored treatment planning in implant dentistry.\u003c/p\u003e\u003ch2\u003eClinical Relevance:\u003c/h2\u003e \u003cp\u003eThis study's clinical relevance lies in its exploration of the potential benefits of dental implant fixtures can effectively to expand the ridge taking into consideration implant diameter, anatomical location, prior augmentation, and implant design.\u003c/p\u003e","manuscriptTitle":"Effectiveness of Using Implant Fixture as a Ridge Expander","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-19 01:37:28","doi":"10.21203/rs.3.rs-4599782/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-13T20:30:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-06T19:30:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"160516121630261242651950172127698373811","date":"2024-07-03T00:19:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-02T13:43:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-25T10:24:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-25T10:24:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"Clinical Oral Investigations","date":"2024-06-18T11:52:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"061eb3d4-e76f-42d3-8c13-aaa189d588e3","owner":[],"postedDate":"July 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-02T16:11:19+00:00","versionOfRecord":{"articleIdentity":"rs-4599782","link":"https://doi.org/10.1007/s00784-024-05896-9","journal":{"identity":"clinical-oral-investigations","isVorOnly":false,"title":"Clinical Oral Investigations"},"publishedOn":"2024-08-30 15:57:38","publishedOnDateReadable":"August 30th, 2024"},"versionCreatedAt":"2024-07-19 01:37:28","video":"","vorDoi":"10.1007/s00784-024-05896-9","vorDoiUrl":"https://doi.org/10.1007/s00784-024-05896-9","workflowStages":[]},"version":"v1","identity":"rs-4599782","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4599782","identity":"rs-4599782","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}