Is a ridge split possible and predictable in this case?

Leave this narrow ridge for the clinician experienced in bone expansion/development. There is not enough medullary bone for a Densah technique, so bone scalpels and socket formers must be used. There are several different ridge development techniques/strategies depending on whose training you follow. If you don't have the training, stick with block grafting. If you don't have in-depth training for that, refer.

Too thin for immediate placement. Flaplessly cut through the crestal cortex with a #15 scalpel this takes about 60 seconds of continuous pushing. Never move the scalpel F-L it will break the blade. Take the scalpel down to the hilt then you are done with that. Then advance a flat chisel to separate the F and L cortices about 2mm. Pack the void with particulate graft material of any kind. Cover the opening with a thin strip of collagen barrier membrane and suture (you may not need the barrier and suture). Wait 3 months then split it again and immediately place the implants. 3.2mmX10mm would be OK.

A ridge split is possible using a precise surgical guide (2ingis) to drill holes of 1,5 mm then using a piezo to cut the bone from hole to hole . This all procédure can be done with minimal supra crestal flap. After this the Densah drills or bone expanders can be used to split the bone and place the implants.

3.5-4 milimeter B-P thickness is a minimal margin for ridge split but copious buccal bone graft will help better prognosis. Or try tunneling technique for buccal expansion, search Youtube. Just make sure decoticate enough so that blood supply from recipient bone connects to grafted bone site. Or you will see floating grafted bone attatched to only periosteum, not recipient bone side after 6 months.

Since you are planning a small implant and only need a few mm I would use the BTI expander technique and inlay graft with prgf. Possible immediate placement if the bone expands well or pack the site with a cortical plug or particulate. Primary closure is key for a more predictable result. Learning to do a split thickness released flap for that is a more advanced procedure in experienced hands but is basic to bone grafting. I would not recommend blindly sinking a scalpel blade into the crest and pushing down for 60 seconds, use a periotome or chisel with gentle malleting. You could slip and lacerate a blood vessel. I think this ridge will expand nicely not condense or split. Tough to do a narrow split without using lateral cuts in the bone, it will fracture. Scapels are not designed for “pushing” but for cutting soft tissue not bone. Chisels, saws and piezosurgery is a better choice for bone. Be safe be smart, good luck or refer to colleague best for all involved especially the patient.

Hi, see Osstem (hiossen) ridge split kit, works a dream, it’s not complicated, quick learning curve, one of the safest techniques for patient, great results ST