Buccal plate fracture during dental implant insertion after mandibular alveolar ridge splitting and expansion managed with bone grafting alone: A case report.

Introduction and importance: After tooth extraction, horizontal bone loss and a reduction in the bucco-lingual ridge dimension may occur. This often necessitates bone augmentation to enable implant placement. For this reason, techniques such as ridge splitting and expansion have been developed; however, they present challenges in single-tooth sites and in the mandible. Complications such as buccal plate fractures remain a concern.

Case presentation: A 49-year-old female, seeking fixed replacement of a missing mandibular molar, presented with a narrow alveolar ridge at the extraction site. Alveolar ridge splitting and expansion were performed to facilitate simultaneous implant placement. During the procedure, a buccal plate fracture occurred. Management did not involve plate fixation; instead, the resulting gap was filled with bone graft. Four months after the procedure, a significant net horizontal bone gain of 3.6 mm was observed. A follow-up at 10 months post-surgery showed successful clinical and radiographic results for both the implant and the prosthetic restoration.

Clinical discussion: A buccal bone fracture occurred during implant placement following ridge splitting. Such fractures can result from mechanical stress exceeding the bone's structural integrity, particularly after splitting and expansion procedures. The mandibular buccal cortical plate is more susceptible to fracture. Management typically involves rigid fixation of the fractured plate with screws, especially in cases of complete fractures. In this report, bone grafting alone was sufficient. The fracture was incomplete, so no fixation was needed. The wound was securely sutured, which allowed for predictable graft containment and healing.

Conclusion: Alveolar ridge splitting is an effective technique for managing narrow ridges and facilitating implant placement. However, complications such as buccal plate fractures may occur. Non-fixation can be considered a viable management strategy in cases where the fracture is incomplete, stable, and soft tissue closure is secure and free of tension. Despite potential challenges, alveolar split can be performed in mandibular single-tooth sites. Careful follow-up is crucial to ensure predictable healing.