Modified alveolar ridge split with sticky bone and PRF in the posterior mandible: a CBCT-based retrospective case series

This retrospective case series described radiographic horizontal ridge-width changes after a modified alveolar ridge split technique (ARST) using piezosurgery and AFG/i-PRF sticky bone in the atrophic posterior mandible. The exploratory relationship between baseline ridge width and 6-month ridge width was also assessed. Eleven patients with horizontal ridge deficiency in the posterior mandible, contributing 22 treated sites, were included. All sites were treated with a modified ARST protocol involving piezoelectric osteotomy, gradual ridge expansion, AFG/i-PRF sticky bone placement, and collagen membrane coverage. Ridge width was measured on registered CBCT scans before surgery (T0) and 6 months after augmentation (T1). Because two sites were included per patient, the findings were interpreted primarily as descriptive and exploratory. Mean ridge width increased from 4.09 ± 0.93 mm at baseline to 7.85 ± 1.09 mm at 6 months, corresponding to a mean site-level gain of 3.77 ± 0.86 mm (95% CI, 3.39–4.15 mm). In an exploratory linear mixed-effects analysis accounting for within-patient clustering, greater baseline ridge width was positively associated with greater 6-month ridge width. Twenty-two implants were placed after healing and remained in function during a mean follow-up of 20.3 ± 5.1 months. Implant survival was therefore 100% according to the definition of implants remaining in situ and functionally loaded at the last follow-up. Implant success could not be assessed because standardized success criteria, marginal bone loss thresholds, peri-implant probing data, and prosthetic complication data were not available. Within the limitations of a small retrospective case series without a control group, this modified ARST protocol was associated with clinically useful horizontal ridge widening at 6 months in selected posterior mandibular sites. The findings should be considered exploratory and require confirmation in larger controlled studies accounting for patient-level clustering and including standardized implant success outcomes.