Heroin induced palatal perforation is a very infrequent complication. The authors report in this study a patient who suffered palatal perforation as a result of long time of snorting Heroin. He presented complaining of liquid passage from the oral cavity into the nasal cavities and hypernasality during speech. An immediate transparent acrylic partial obturator was constructed and fitted. It was successful in sealing the defect. However after 4 months an enlargement in the perforation was evident due to failure to cease the habit from the patient. It required the fabrication of new palatal obturator to seal the enlarged perforation and enhance the speech. This report discusses the possible lines of treatment of such complication. The report pointed out the possible prosthetic options. It also, emphasizes the importance of a multidisciplinary approach in management of drug abuse patients and complications encountered in their treatment. The use of palatal obturators improves patient quality of life, avoiding socially embarrassing situations such as the passage of fluids and solids into the nasal passages and maxillary sinuses, or a nasal tone.

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Statement of problem:-The maxillary ridge split treatment options, which include different flap techniques with simultaneous implant placement, may help eliminate the current undetermined best choice of treatment plan. Purpose: -The aim of this systematic review was to evaluate outcome of simultaneous implants placement in alveolar ridge split carried out by different flap approaches on marginal bone changes and survival rate. Materials and Methods: -English publications on the subject were searched to select articles up to December 2015. Articles in peerreviewed journals were searched in an electronic database (MEDLINE, Pub-Med and Cochran). Also, a manual search studies on humans was carried out. Two independent reviewers screened 855 papers. Result: -843 articles were excluded on the basis of the title and abstract. Full-text articles were obtained for the 12 selected publications. The 12 full texts were assessed by the two reviewers and 3studies were found fitting for inclusion. Conclusion: -The limited data indicates that the flap design does not affect bone changes and survival rate in ridge split procedure with simultaneous implant placement. …………………………………………………………………………………………………….... Clinical implications:-No current consensus has been published on which the more effective flap option in ridge split with simultaneous implant placement. Ridge Split Techniques show no significant difference in bone loss and high survival rates and therefore seems to be a predictable treatment modality for implant placement in narrow alveolar ridges.

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