Search

Implant placement in the esthetic zone is a complex procedure and requires a restoration-driven approach. Proper selection of patients and implant together with individual assessment of the risk of esthetic complications are very important. Correct 3D-implant positioning and sufficient bone volume should provide long-term esthetic and function. Esthetic region is a zone in which expectations and possibilities collide. Clinician should bring the important decision on the appropriate time of implant placement. Immediate implant placement is particularly challenging in the esthetic zone. Patient desire for reduced treatment time should be weighed against the possible risk factors. Protocol of immediate implant placement in conditions of unfavourable gingival biotypes, the lack of bone or soft tissue in patients with a high smile line lead to esthetic failure which is very important in the esthetic region.

Purpose: To evaluate stability and success rate of hydrophilic nanostructured implants placed via osteotome sinus floor elevation (OSFE) without grafting material or using beta-tricalcium phosphate (beta-TCP), deproteinized bovine bone (DBB), or their combination, and also to assess three-dimensional volumetric stability of endo-sinus bone gained in the aforementioned conditions. Materials and Methods: OSFE with simultaneous implant placement (10-mm long SLActive-BL (R), Straumann, Basel, Switzerland) was performed. Grafting materials were randomly allocated to implant sites, whereas one site was left without graft. Implant stability was measured by resonance frequency analysis over 6 months. Implant success was evaluated after 2 years of loading. Volume of new endo-sinus bone was calculated from CBCT images using 3D Slicer (R) software. Results: A total of 180 implants were inserted into posterior maxilla of 45 patients with 6.59 +/- 0.45 mm of residual bone height, and all remained successful after 2 years. Implant stability steadily increased during healing, without significant difference between groups (p =.658). After 2 years, endo-sinus bone significantly shrank (p lt .001) in all groups (DBB: 66.34%; beta-TCP: 61.44%; new bone formed from coagulum: 53.02%; beta-TCP + DBB: 33.47%). Conclusions: Endo-sinus bone gained after OSFE inevitably and significantly shrinks regardless of whether grafting material is applied or not. Grafting material offers no significant advantage to stability nor clinical success of hydrophilic and nanostructured implants placed simultaneously with OSFE.

Background/Aim. During drilling implant sites, mechanical energy is converted into thermal one resulting in transient rise in temperature of surrounding bone. The temperature of 47°C exeeding one minute impairs osseointegration, compromises mechanical properties of the local bone and could cause early implant failure. This in vitro study aimed to assess the effect of surgical drill guide and temperature of irrigans on thermal changes of the local bone during drilling implant sites, and to test the influence of irrigans temperature on the temperature of surgical drill guide. Methods. A total of 48 specimens obtained from bovine ribs were randomly allocated to four experimental conditions according to the 2 x 2 factorial design: drill guide (with or without) and saline (at 25°C or 5°C). Real-time infrared thermography was used as a method for temperature measurement. The primary outcome was bone temperature change during drilling implant sites measured at 3 osteotomy depths, whereas the second one was change in the temperature of the drill guide. Data were analyzed by Brunner and Langer nonparametric analysis and Wilcoxon test. Results. The effect of drill guide on the changes of bone temperature was significant at the entrance of osteotomy, whereas the effect of saline temperature was significant at all osteotomy levels (p lt 0.001). No significant interaction was found (p > 0.05). Guided surgery and irrigation with saline at 25°C were associated with the highest bone temperature increase. Increase in drill guide temperature was significantly higher when saline at 25°C was used (p lt 0.001). Conclusion. Guided implant site preparation generates higher temperature of the local bone than conventional drilling, not exceeding the threshold for thermal bone necrosis. Although saline at room temperature provides sufficient heat control during drilling, cooled saline is more effective regardless the use of surgical drill guide., Uvod/Cilj. Tokom preparacije ležišta za implantat mehanička energija pretvara se u toplotnu, što dovodi do prolaznog povišenja temperature okolne kosti. Temperatura od 47°C tokom više od jednog minuta narušava oseointegraciju, mehaničke osobine lokalne kosti i može dovesti do ranog neuspeha implantata. Cilj ove in vitro studije bio je da se ispita uticaj hirurškog stenta i temperature irigansa na termičke promene u kosti tokom preparacije ležišta za implantat, kao i uticaj temperature irigansa na temperaturu hirurškog stenta. Metode. Ukupno 48 uzoraka dobijenih od goveđih rebara bilo je podeljeno metodom slučajnog izbora u četiri grupe prema 2 x 2 faktorskom dizajnu: prisustvo hirurškog stenta (da/ne) i temperatura fiziološkog rastvora (25°C/5°C). Temperatura je merena infracrvenom termografijom u realnom vremenu. Primarni ishod bio je promena temperature kosti tokom preparacije ležišta implantata merena na tri dubine ležišta, a sekundarni ishod promena temperature hirurškog stenta. Podaci su analizirani Bruner-Langer neparametrijskom analizom i Vilkoksonovim testom. Rezultati. Uticaj hirurškog stenta na promenutemperature kosti bio je značajan na ulazu u ležište za implantat, dok je uticaj temperature irigansa bio značajan na svim dubinama ležišta (p lt 0,001). Međusobni uticaj ispitivanih faktora nije bio značajan (p > 0,05). Upotreba hirurškog stenta i ispiranje fiziološkim rastvorom temperature 25°C bili su praćeni najvišim porastom temperature kosti. Porast temperature hirurškog stenta bio je značajno viši kada je korišćeno ispiranje na temperaturi od 25°C (p lt 0,001). Zaključak. Tokom kontrolisane preparacije ležišta za implantat došlo je do većeg zagrevanja kosti u poređenju sa standardnom preparacijom, ne premašujući temperaturu kritičnu za termičku nekrozu kosti. Iako ispiranje na sobnoj temperaturi obezbeđuje dovoljno hlađenja kosti tokom preparacije ležišta za implantat, ohlađeni rastvor za ispiranje je efikasniji bez obzira na primenu hirurškog stenta.