Management of Atrophic Maxillary Ridge Using the Split-Crest Technique Associated with Motorized Expansion: A Case Report

Abstract

Maxillary atrophy resulting from prolonged edentulism poses a significant challenge to the proper three-dimensional positioning of osseointegrated implants, particularly in cases with severe horizontal deficiency and associated vertical bone loss. In this context, minimally invasive techniques capable of predictably restoring alveolar width are essential for successful oral rehabilitation. This case report aims to describe the surgical management of a 59-year-old melanodermic patient presenting with moderate-to-severe maxillary ridge atrophy, treated with a combined protocol involving piezoelectric osteotomy, motorized ridge expansion, immediate implant placement, and autogenous particulate bone grafting. Clinical examination, phonetic assessment, and cone-beam computed tomography revealed reduced vestibulo-palatal thickness, advanced vertical resorption, sinus mucosal thickening, and intimate contact of previously placed implants with adjacent anatomical structures. Under local anesthesia, a full-length piezoelectric ridge osteotomy was performed, followed by expansion using motorized rotary expanders and insertion of GrandMorse implants with satisfactory primary stability. A fracture of the buccal cortical plate in the region of the right canine pillar occurred during expansion and was stabilized using a 1.5 mm × 9 mm titanium fixation screw. The resulting gaps were filled with autogenous particulate bone harvested from vertical excess areas of the maxillary ridge, and the site was closed with absorbable sutures. After 90 days, panoramic and cone-beam computed tomography confirmed complete osseointegration of all implants and maintenance of the horizontal gain achieved, allowing the patient to proceed with fabrication of a full-arch implant-supported fixed prosthesis. This case demonstrates that the combination of piezosurgery, motorized ridge expansion, and autogenous grafting constitutes an effective, safe, and predictable approach for implant rehabilitation in severely atrophic maxillae, yielding favorable biological, functional, and aesthetic outcomes.