Research AppraisalRandomised Controlled Trial

Novel Double Expansion Technique (Khalifah's Technique) Versus Ridge Splitting in Immediate Implant Placement in Narrow Ridges: A Randomized Clinical Trial

The International journal of oral & maxillofacial implantsKhalifah, Mosaad Abdaljawwad2 Apr 2026DOI

Clinical Snapshot

45CEBM
Evidence: WeakRandomised Controlled Trial

PICO Framework

P — Population40 patients with narrow ridges requiring immediate dental implant placement (57 implants total)
I — InterventionNovel double expansion technique (DET) - Khalifah's technique
C — ComparatorRidge splitting technique (RST) - control group
O — OutcomesPrimary: implant stability, marginal bone loss, keratinized mucosa width. Secondary: plaque index, bleeding index, probing depth, postoperative pain, analgesic consumption

Bottom Line

This RCT suggests a novel double expansion technique may offer advantages over traditional ridge splitting for immediate implant placement in narrow ridges, including reduced postoperative pain, improved implant stability, and less marginal bone loss. However, the abstract provides insufficient methodological detail for robust quality assessment. Key limitations include unclear randomisation procedures, lack of statistical precision measures, and absence of quantified effect sizes. While the comprehensive outcome assessment and 12-month follow-up are strengths, clinicians should await full publication with detailed methodology before considering technique adoption. The clinical significance of reported differences remains unclear without statistical analysis. Further validation studies would strengthen the evidence base for this technique.

Evidence: Weak

Key Findings

  • P Value: Not reported

  • Effect Size: Not quantified - described qualitatively only

  • Primary Outcome: Implant stability and marginal bone loss favoured double expansion technique

  • Nnt Or Sensitivity: Cannot be calculated from available data

  • Confidence Interval: Not reported

Clinical Application

Requires specialised surgical technique and training; limited to experienced implant surgeons Relevant to Australian oral surgery and periodontal practice; technique training would need TGA-approved continuing education; cost-effectiveness unclear for PBS consideration Patients requiring immediate implant placement in narrow alveolar ridges

Abstract

PURPOSE: To present and compare the novel double expansion technique (DET) (Khalifah's technique) and the ridge splitting technique (RST) in cases of narrow ridges. MATERIALS AND METHODS: A total of 40 patients (57 dental implants [DIs]) with narrow ridges were randomly allocated to a control group, which employed the RST, and to a study group, which employed the DET. Secondary stability, marginal bone loss (MBL), keratinized mucosa width (KMW), Plaque Index (PI), bleeding index (BI), and probing depth (PD) were assessed at baseline (time of definitive abutment and temporary crown placement) and then at 3, 6, and 12 months. Pain and the number of analgesic tablets consumed were assessed daily during the first postoperative week. RESULTS: The study group had lower pain levels during the first 2 days postoperatively and presented with greater primary and secondary stability at baseline and at 3 months. Moreover, patients in that group had less MBL at all time points and greater KMW at 6 and 12 months postoperatively. Otherwise, both groups showed comparable results regarding PI, BI, and BD. CONCLUSIONS: The study group had superior performance, which may be attributed to the lower degree of trauma with the DET.

References

  1. 1.Khalifah, M. A. (2026). Novel Double Expansion Technique (Khalifah's Technique) Versus Ridge Splitting in Immediate Implant Placement in Narrow Ridges: A Randomized Clinical Trial. The International Journal of Oral & Maxillofacial Implants. https://doi.org/10.11607/jomi.11388
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