Professor Dr. Rainer Schmelzeisen, University of Freiburg, and his team conduct alveolar ridge splitting in an atrophic maxilla, both in the posterior and the anterior region. In the same session, implants are placed immediately within the split and expanded ridge. Before wound closure, the implants are surrounded with bone substitute material. To begin with, a mucoperiosteal flap is prepared to expose the edentulous bone in the posterior region. Now the crest of the atrophic maxillary ridge is split longitudinally with a piezotome. First with a narrow, then with a wider chisel, which is inserted in the initial crestal incision, the gap is expanded carefully. The process is repeated in the anterior region except for the median area, where a non-split bone ridge is left. The split alveolar bone is expanded using chisels and a careful knocking technique, paying attention that the bone remains connected in the apical area.