Study: Analysing bone displacement during split crest procedure.

This is an established surgical technique for horizontal bone augmentation. It allows the placement of implants of adequate diameter, in sites where the bone would otherwise be too thin.

Two techniques are discussed: Threaded Bone Expanders (TBEs) and Ultrasonic Bone Surgery (UBS)

UBS is performed with our Piezotome Cube device and crest slitting tip kit.


Threaded conical bone expanders compress and compact the bone during the split crest procedure, thus producing an adequate space for the implant without bone loss [19]. The ultrasonic bone surgery exploits the inverse piezoelectric effect: an electric current is applied to piezoelectric crystals, generating a controlled vibration. Vibration is transferred to a working tip, whose oscillations are able to disrupt mineralized tissues [27]. Since the vibration frequency necessary to cut the bone ranges between 25 and 30 kHz, and the soft tissues are not damaged by oscillations below 50 kHz, the technique is completely safe for the surrounding tissues [28,29]. Furthermore, ultrasonic bone surgery is less technique-sensitive than traditional split crest, reducing the inter-operator differences while achieving similar results in terms of implant survival rate.

Although the ANOVA did not find significant differences between the displacement obtained with TBEs and the one obtained with UBS, the bar plots in figure 4 show that in most cases a slightly lower displacement was obtained with the UBS compared with TBEs, which suggests a different internal bone strain distribution induced by the two techniques.

Unexpected bone fracture occurred two times during split crest with TBEs, while it never happened with UBS. Both fractures occurred in presence of relief osteotomies, which reflects previous findings about the enhanced fracture risk when additional osteotomies are performed


This study explored bone behaviour during six different split crest procedures and highlighted the potentialities of the DIC application in the dental field. To the authors’ knowledge, this is the first work that applies DIC to measure the bone response to split crest. Within the limitations of this study, the Ultrasonic Bone Surgery was confirmed to be safer and easier to use in comparison with Threaded Bone Expanders. Further development might include the exploration of the bone behaviour at the bone-surgical tool interface during the split crest procedure. A combination of finite element modelling, digital image correlation, and microtomography could be a promising yet ambitious strategy to reach this goal.

Read the full study here


Creating a Perfect Margin using Newtron technology and ultrasonics tips

Daniel Caga shares with us his crown preparations using our Perfect margin ultrasonic tips and Newtron technology.

Daniel Caga

See the full case here


See why Oral Surgeon Richard Moore uses Piezotome Cube for Exodontia, block grafts and sinus lifts



Piezotome use