Alveolar ridge splitting technique is a commonly used procedure for horizontal ridge augmentation of narrow ridges to allow placement of implants. However, the commonly used one-stage technique can cause malfracture and subsequent necrosis of the fractured part.

Twelve patients were selected randomly having posterior mandibular narrow edentulous ridge. The sample were selected to match a list of inclusion and exclusion criteria. In the first stage, all patients will underwent a mandibular ridge splitting technique using piezotomes. In the second stage, ridge expansion and implants were placed with only envelope flap. Assessment were included measurement of the buccal and lingual bone surrounding the implants and amount of increase in the bone width from the cone beam computed tomography.

Inclusion Criteria:

• Adult patients aged 18-60 years old with no gender predilection.
• Patients presenting with posterior mandibular (premolar-molar area) narrow alveolar ridge
• that requires dental implantation.
• Minimum bone width of 3 mm
• Minimum bone height of 10 mm
• Proper inter-occlusal space

Exclusion Criteria:

• Uncontrolled diabetes.
• Heavy smokers.
• Current chemotherapy or radiotherapy.
• Alcohol or drug abuse.
• Pregnant women.
• Active infection.
• Inter-occlusal space not less than 7-8 mm.
• Parafunctional habits.