The Monocortical Window (MCW): A Modified Split-Crest Technique Adopting Ligature Osteosynthesis

Split-crest procedures performed with ultrasonic devices have proven to be a viable and effective surgical treatment when the alveolar ridge shows forms of resorption in thickness while its height remains virtually unchanged. However, in the case of stiff, type 1, corticalized mandibular bone, it may be very difficult or even impossible to have any elasticity and lateral augmentation in between the split bone walls. Furthermore, a complete detachment of the outer lamellae may also occur during expansion maneuvers or during implant insertion. This study describes the use of a steel-wire ligature osteosynthesis technique to give primary stability both to the expanded cortical window and to the implants themselves when they have none at all. This osteosynthesis is simple, quick, safe, and bone-saving in force delivery. It is also extremely cheap as well as being effective in obtaining ridge expansion, bone regeneration, and implant positioning in an all-in-one procedure. This article describes the foundations in the literature as well as new elements in the technique. Three short case studies are used by way of example.