Search

Dental implant therapy is generally successful. However, when such therapy fails, considerations for implant replacement must be carefully considered. The survivability of implants placed into previously implanted sites must be considered. Appraisal of early implant loss versus late implant loss is important in presurgical planning for implant replacement. This review highlights the factors that can impact the success of implant reimplantation., Competing Interests: Disclosure The authors have no financial disclosures., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: The present study goal was to assess clinically and radiographically using simvastatin (SMV) loaded xenograft for guided bone regeneration (GBR) around simultaneously placed implants with alveolar ridge splitting in patients with horizontally atrophic jaw defect., Materials and Methods: Randomized distribution of the twenty-two patients into two groups (11 patients each) was performed. Group I participants received alveolar ride splitting (ARS) with GBR using SMV gel mixed bone graft and a barrier membrane with simultaneous implant placement. Group II received the same treatment protocol without SMV gel. At the baseline, 6- and 9-months post-surgery, clinical and radiological alterations were assessed., Results: Six months after therapy, PES records of group I were statistically significantly improved than those of group II (P < .001). Group I exhibited statistically significant expansion of the alveolar ridge over group II after 6 and 9 months (P < .001). When compared to group II over the evaluation interval between 6 and 9 months, group I demonstrated statistically substantially minimal loss of the mean marginal bone level (P < .001). At the 6- and 9-month observation periods, bone density gain was considerably higher in group I than that in group II (P < .001)., Conclusion: Alveolar ridge splitting along with GBR-augmented SMV improve the clinical and radiographical outcomes around dental implant over GBR alone., Clinical Relevance: Augmenting GBR with SMV in alveolar ridge splitting could boost implant osseointegration and enhance peri-implant tissue changes., Clinical Trial Registration: NCT05020405., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Complications after craniosynostosis surgery occur in 11% to 36% of cases and may be precipitated by poor soft tissue coverage and concomitant exposure of non-sterile regions; sequelae may result in infection, osteomyelitis, and bone loss requiring complex reconstruction. In the pediatric population, autologous cranioplasty remains the gold standard due to growth potential and a more favorable complication profile than synthetic cranioplasty. Virtual surgery planning (VSP) and computer-assisted design (CAD)/computer-assisted manufacturing (CAM) technology can be utilized to create innovative, patient-specific autologous solutions, similar to the approach with synthetic cranioplasty. A novel surgical approach using VSP was used for an 18-month-old female with near total bifrontal bone loss. Surface area measurements were used to determine the amount of bone available to replace the infected frontal bone. VSP was utilized to determine the most efficient construct configuration possible to achieve maximal coverage via calculation of cranial bone surface area measurements. Surgical reconstruction of the defect was planned as a Modified Visor Bone Flap with Posterior Brain Cage. A construct was fashioned from available cranial bone struts to obtain widespread coverage. 3D Recon images from before and after surgery demonstrate almost complete re-ossification of the cranial vault with significant resulting clinical improvement. Reconstruction of total frontal bone loss is possible by utilizing this technique. VSP can improve the safety and efficiency of complex autologous cranial bone reconstructions. We propose a treatment algorithm to address the problem of near total frontal bone loss in young children for whom alloplastic implants are not suitable., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This clinical report describes the oral rehabilitation of a 25-year-old male patient who lost the lower incisors, right canine, and a significant amount of anterior mandibular bony and soft tissue following severe dentoalveolar trauma due to a car accident. The patient's young age, anterior esthetic zone in the lower jaw, previous mandibular fracture, and extended bony and soft-tissue defect hindering ideal 3-dimensional implant placement oriented the therapeutic plan toward a staged approach, with several reconstructive surgical procedures before implant rehabilitation. The treatment involved deepening the labiobuccal vestibule and lingual sulcus to correct cicatricial shrinkage due to previous surgical fixation of the mandibular fracture, vertical guided bony augmentation to regenerate adequate volumes of bone, free gingival graft to achieve sufficient height and thickness of peri-implant soft tissues, and a prosthetic-driven surgical procedure to place the implants in a good functional and esthetic position. This therapeutic approach restored function and esthetics and achieved outcome stability at 3-year follow-up.

Introduction: This study aims to compare the surgical and clinical complications, and the dental implant survival rate after maxillary sinus floor augmentation using demineralized freeze-dried bone allografts (DFDBA) versus bovine derived xenografts., Material and Methods: A retrospective study enrolled 107 patients (52 males and 55 females, mean age group 1: 54,4 years; group 2: 56,4 years) requiring maxillary bone reconstruction prior to implantation. A total of 141 sinuses were grafted and 191 implants were placed. Data on various variables, including patient characteristics, implant placement details, and outcomes, were collected through medical records and patient questionnaires., Results: The study found no significant differences in implant survival rates between the two groups (94,0% versus 94,4%; p = 0,919). Overall complications were observed in 19.6% of patients, with a higher incidence in the allograft group (23,6% versus 15,4%; p = 0,283). Multiple logistic regression analysis identified a two-stage surgical protocol (OR= 2,8; p = 0,045), and a preoperative alveolar ridge height of less than 4 mm (OR= 5,3; p = 0,004) as significant predictors of complications. The risk of implant failure was raised by a preoperative alveolar ridge height of less than 4 mm (OR= 6,1; p = 0,038) and smoking (OR= 5,8; p = 0,012)., Discussion: DFDBA is a reliable treatment option for extensive rehabilitation of atrophic maxilla, with a success rate comparable to xenografts used in sinus augmentation. Implant failure was significantly correlated with smoking and a residual ridge height of less than 4 mm., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Objectives: Dental implants are believed to contribute to improved masticatory function and oral health-related quality of life (OHRQOL), but the details remain unclear. The aim of this study was to evaluate the clinical outcomes of dental implant prosthetic rehabilitation after bone graft at the anterior mandible/maxilla based on OHRQOL, particularly in young and middle-aged patients., Methods: This retrospective study included 11 patients who received bone grafts at the anterior mandible/maxilla and dental implant surgery. Chewing function score and OHRQOL (using the Oral Health Impact Profile-14 questionnaire) were evaluated before and after completion of an implant-retained bridge or removable implant-supported denture., Results: Chewing function score tended to improve slightly after dental implant prosthetic rehabilitation, but none of the observed differences were significant. In the assessment of OHRQOL, relatively worse domain scores before completion of dental implant prosthetic rehabilitation were seen for Functional limitation, Psychological discomfort, and Psychological disability. Conversely, Social disability seemed relatively unaffected by tooth loss. All domain scores and total scores for items other than Physical disability and Social disability were significantly improved after completion of dental implant rehabilitation., Conclusions: Tooth loss in the anterior region may not significantly affect chewing function score, but can have a significant impact on OHRQOL. Bone grafts and dental implant prosthetic rehabilitation can resolve these problems, and the results of this study will benefit both patients and medical professionals in terms of treatment planning and informed consent., (© 2023. The Author(s).)

Background: Different biomaterials were suggested for sinus floor augmentation (SFA). Recently, new materials were launched showing true bone formation without remnants., Purpose: The aim of this prospective study was to evaluate an hydroxyapatite-based, sugar cross-linked collagen sponge (OSSIX™ Bone) in transcrestal SFA (t-SFA)., Materials and Methods: Twenty-four patients with edentulous posterior maxilla and residual bone height (RBH) >4 mm underwent t-SFA with OSSIX™ Bone as grafting material and simultaneous implant placement. The implant Stability Quotient (ISQ) was measured by resonance frequency analysis (RFA) directly after implant insertion and at 6 months. Differences in bone height (BH) and volume were determined in CBCT and x-rays at baseline versus 1 year of follow-up. Graft volume was evaluated by tridimensional reconstructions. Linear regression analysis was used to evaluate the effect of bucco-palatal sinus dimension, RBH, and length of the implant protruding (PIL) into the sinus, on the graft height (GH) changes up to 1 year, and on the graft volume at 1 year. Autocorrelation between time lag and augmented bone volume was evaluated through time series analysis correlograms. Health-related quality-of-life outcomes were captured., Results: Twenty-two patients completed the study. The mean RBH measured at baseline was 5.81 ± 2.2 mm. The mean graft volume was 1085.8 ± 733.4 mm 3 . The mean GH, measured in the immediate post-operative period, at 6 and 12 months respectively, was 7.24 mm ±1.94; 6.57 mm ± 2.30; 5.46 mm ± 2.04. The mean ISQ measured after the implant placement was 62.19 ± 8.09, and 6 months later was 76.91 ± 4.50. There was a significant correlation between buccolingual dimension and graft volume at 1 year. Neither buccolingual volume nor RBH had a significant effect on GH change, while the PIL showed a significant positive correlation (P = 0.02 and P = 0.03 at 6 and 12 months, respectively). The correlograms indicated no significant correlation, meaning that there is no tendency for graft volume to increase or decrease over time, therefore suggesting graft stability, at least up to one year of follow-up. 86% of patients had no chewing interference., Conclusion: Within the limitations of the study, OSSIX™ Bone could be considered a valid material for SFA due to its manageability and its positive results in promoting new bone formation with long-term stability. T-SFA is confirmed as a less invasive and less painful method., (© 2023 The Authors. Clinical Implant Dentistry and Related Research published by Wiley Periodicals LLC.)

After tooth extraction, alveolar bone resorption and labial bone plate thinning occur due to the lack of periodontal ligaments. The socket shield method was developed to preserve the alveolar ridge. A split-mouth study was performed in which eight patients were treated using alloplast with socket shield on one side (alloplast group, control) and autogenous dentin graft with socket shield on the contralateral side (dentin group, test). After 3 months, a trephine bone core was collected from all sites and evaluated by histological, histomorphometric, and radiographic analysis. Thin bony trabeculae were formed surrounding the residual alloplast, while thicker trabeculae of bone formed and fused to the autogenous dentin. The percentage of newly formed bone was significantly higher in the dentin group when compared to the alloplast group (P = 0.020). Radiographically, there was no significant difference in the mean percentage increase in bone density from preoperative to post-grafting between the two groups. Moreover, when comparing the change in labial bone level from preoperative to 3 months post-grafting between the two groups, there was no significant difference. The autogenous dentin graft combined with socket shield could be a promising technique for socket preservation., (Copyright © 2023 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Bone augmentation procedures aim to regenerate the deficient alveolar ridge to properly place dental implants that are completely surrounded by bone. However, these are invasive and technically demanding surgeries that are not free of either complications or treatment errors. Careful patient selection and preparation is a mandatory process to reduce the rate of complications in bone regeneration procedures, irrespective of the technique used. It is important to assess the cost benefit of the intervention and to evaluate the potential impact on the patient's quality of life, especially in the elderly and medically compromised patients. Most common postoperative complications are wound dehiscences, which may be reduced, at least partially, by proper knowledge of the surgical technique and the craniofacial anatomy. Other complications that may appear are postoperative infections or nerve injuries. The aim of this narrative review is to summarize the best available scientific evidence on the incidence of complications, as well as the ideal strategies for their prevention and management. Depending on the severity of the complication, treatment approaches may vary and can include drug prescription or even surgical re-entries to remove exposed barrier membranes or contaminated bone grafts. Adequate prevention and proper management of complications associated with bone augmentation interventions are a requirement for clinicians carrying out these demanding procedures. A series of cases illustrating proper management of complications in different clinical scenarios is presented., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This study proposes a simple, off-the-shelf ancillary method for application in the dental rehabilitation of severe maxillary atrophy with zygoma implants, allowing simultaneous improvement of lip support in cases with a moderate lack of premaxillary projection. Three consecutive patients with an atrophic maxilla were evaluated retrospectively. All were treated with a fixed rehabilitation over four zygomatic implants and the pillow technique. The study variables included radiological assessment of the premaxilla volume, upper lip and perinasal soft tissue changes, clinical complications, and subjective evaluation of functional and aesthetic patient satisfaction based on a visual analogue scale. All of the zygomatic implants showed osseointegration. The survival rate was 100%. The immediate postoperative course was uneventful, and no surgical complications were noted at the follow-up visits. Radiological assessment of the premaxilla volume enhancement showed a final mean skeletal projection improvement of +9.4 mm, while the nasolabial angle decreased an average of + 0.6 mm. On the other hand, only small changes in nasal width were detected. Patient satisfaction with the functional and aesthetic outcomes at the 1-year follow-up was excellent. The pillow graft is an easy-to-handle technique that can be included in the armamentarium for moderately incrementing the maxillary sagittal dimension and enhancing lip support in the context of zygoma implant rehabilitation., (Copyright © 2022 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

The aim of this study was to investigate and compare the clinical and radiographic bone gain in guided bone regeneration with titanium mesh, for four different advancement techniques: periosteal releasing incision (PRI), double flap incision (DFI), modified periosteal releasing incision (MPRI), and coronally advanced lingual flap (CALF). Forty patients with a partially edentulous mandible were allocated randomly to four study groups (PRI, DFI, MPRI, CALF; 10 patients in each). Clinical bone gain (primary outcome) and radiographic bone gain were evaluated. In addition, correlations between study variables (clinical and radiographic bone gain, flap advancement, mesh exposure area and percentage exposure, pain, and swelling) were explored. CALF exhibited the highest mean clinical bone gain (4.12 ± 1.37 mm) and PRI the lowest (2.60 ± 1.36 mm); the mean clinical bone gain differed significantly among the groups (P < 0.001). The highest mean radiographic bone gain was seen in the CALF group (3.54 ± 1.65 mm) and the lowest in the PRI group (2.06 ± 1.11 mm); the mean radiographic bone gain also differed significantly among the groups (P < 0.001). The correlation analysis revealed positive correlations between flap advancement and radiographic bone gain (P = 0.003) and between swelling and pain (P = 0.007). An inverse correlation was found between flap advancement and swelling (P = 0.049), mesh exposure area and clinical bone gain (P = 0.022), and mesh exposure percentage and clinical bone gain (P = 0.017). In summary, the highest clinical and radiographic bone gain was observed for CALF, while the lowest was observed for PRI., Competing Interests: Competing interests None., (Copyright © 2022 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Aim: To histologically evaluate the influence of (1) loading and (2) grafting on osseointegration and peri-implant soft-tissue healing at immediately placed, self-cutting progressive tissue-level implants (TLX) in a minipig model., Materials and Methods: TLX implants (n = 56) were immediately placed following the extraction of the mandibular first and second premolars, bilaterally, in a total of n = 14 minipigs. In each animal, the implant sites were allocated to the following four groups: (1) unloaded with simultaneous grafting using a bovine bone mineral; (2) unloaded without grafting; (3) loaded with simultaneous grafting; and (4) loaded without grafting. Histomorphometric assessments at 4 and 12 weeks (n = 7 animals each) included primary (i.e., bone-to-implant contact [BIC]) and secondary outcome measures (e.g., first BIC [fBIC], junctional epithelium length [JE], connective tissue contact length [CTC], biological width [BW = JE + CTC])., Results: At 4 weeks, mean BIC values ranged from 74.5 ± 11.6% in Group 2 to 83.8 ± 13.3% in Group 1, and, at 12 weeks, from 75.5% ± 7.9% in Group 2 to 79.9 ± 8.6% in Group 1. Multivariate linear mixed regression did not reveal any associations between BIC and implant loading or grafting at 4 and 12 weeks. At 12 weeks, significantly higher fBIC values were noted in Group 2 when compared with Group 1. All groups showed comparable JE, CTC, and BW values., Conclusions: Implant loading and grafting had no major effects on osseointegration and peri-implant soft tissue healing at TLX implants., (© 2022 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

The objective of this study was to perform a comparative evaluation of the radiographic outcomes of lateral sinus floor elevation with and without bone window repositioning (BLSFE and LSFE, respectively) when applied concomitantly with implant placement. A randomized controlled clinical trial was conducted between February 1, 2016 and May 1, 2017 including 26 individuals with at least one missing tooth. Participants were randomized 1:1 to undergo BLSFE (10 participants, 16 implants) or LSFE (13 participants, 19 implants). Bovine-derived xenograft was used in both groups and the implants were inserted concomitantly. In the BLSFE group, the antrostomy was covered with a repositioned bone window and then with a concentrated growth factors (CGF) membrane. In the LSFE group, the antrostomy was covered with a CGF membrane. Panoramic radiographs were taken before surgery (T0), immediately postoperative (T1), and at 12 months postoperative (6 months after loading) (T2). Marginal bone loss (MBL), apical bone gain, augmented alveolar bone height, and intra-sinus bone augmentation were evaluated on panoramic radiographs at T2. A linear regression analysis with generalized estimating equation models was performed. The implant survival rate was 100% at 1 year after implant surgery. The residual alveolar bone height at T0 was comparable in the BLSFE and LSFE groups (3.58 ± 1.49 mm vs 4.12 ± 1.61, P = 0.32), as was the alveolar bone height at T1 (13.61 ± 1.82 mm vs 12.38 ± 1.82 mm, P = 0.06). At T2 , significantly higher alveolar bone height, intra-sinus bone augmentation, and apical bone gain, and lower distal MBL were observed in the BLSFE group when compared to the LSFE group, with adjusting for covariates (β = 2.44, 95% CI 1.42-3.46, P < 0.0001; β = 2.38, 95% CI 1.35-3.41, P < 0.0001; β = 2.33, 95% CI 1.23-3.42, P < 0.0001; and β = -0.43, 95% CI -0.83 to -0.02, P = 0.038, respectively). No significant difference was observed for mesial MBL or apical bone resorption at T2. Lateral sinus floor elevation with bone window repositioning may result in higher bone augmentation after 1 year than the traditional approach. Further research is needed to elucidate the effect of lateral sinus floor elevation with bone window repositioning., (Copyright © 2022 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

This systematic review addressed the implant success rate after mandible reconstruction with vascularized fibula bone graft. Therefore, preferred reporting items for systematic review and meta-analysis guidelines were used to perform the systematic review, and the search included following databases: PubMed, Lilacs, Google Scholar, Open Gray, Science Direct and Cochrane. A search of medical subject headings (MeSH) and related terms (fibula) OR (vascularized) OR (microvascularized) AND (implant) OR (rehabilitation) OR (osseointegrated) AND (mandible) OR (jaw) OR (maxillofacial), without any language or time restrictions until October 2017 was carried out. The eligible studies primarily consisted of clinical cohorts designed to evaluate the feasibility of mandible reconstruction using vascularized fibula bone grafts and implant-supported rehabilitations, with a minimum observation period of 12 months. After screening, 13 eligible cohort studies for this review were selected (3 retrospective and 10 prospective). Of 285 vascularized fibular reconstructions, only 6 failures were reported with a success rate of approximately 98% after a mean follow-up period of 40 months. In total, 910 implants were placed in vascularized fibular grafts with a success rate of 92.6% (range, 82%-100%) after 40 months. Also, similar success rates for primary (95%; range, 93%-100%) and secondary (91%; range, 83%-100%) implant surgeries have been demonstrated. Considering risk factors, implant survival in irradiated patients was usually lower (76%; range, 38%-88%) than nonirradiated patients (90%; range, 83%-94%); however, it was significantly different in only 1 study. Alcohol and tobacco use has shown no significant association with implant failure in any study. Hence, implant placement in vascularized fibula bone graft presented similar success rates relative to native mandible bone rehabilitations.

The aim of this study was to compare the clinical effects of osteotome sinus floor elevation (OSFE) combined with concentrated growth factor (CGF) and simultaneous implant placement with or without bone grafting in the maxillary posterior region, where the residual bone height (RBH) was 4-6 mm. A total of 44 patients who underwent OSFE combined with CGF and the simultaneous placement of 60 implants (group A, 31 implants with bone grafting; group B, 29 implants without bone grafting) were included in this retrospective study. The clinical indicators of implants were observed for 24 months. Sinus floor lift height was 6.02 ± 0.99 mm in group A and 5.81 ± 0.72 mm in group B (P = 0.360) after surgery. There was no significant difference in the vertical bone resorption between the two groups at 24 months (P = 0.097). Postoperative pain at 14 days (visual analogue scale) was significantly greater in patients with bone grafting when compared to those without bone grafting (P < 0.001). There was no significant difference in marginal bone loss (MBL) between the two groups (P = 0.707 for MBL during the first 12 months, P = 0.922 for MBL during months 12-24). The implant success rate was 100% with or without bone grafting. The technique of OSFE with CGF, either with or without bone grafting, is safe and reliable in patients with RBH 4-6 mm., (Copyright © 2021 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Aim: The aim of this systematic review is to evaluate the survival rate of dental implant placed using different maxillary sinus floor elevation techniques., Setting and Design: PRISMA guidelines were used for this systematic review and meta-analysis., Materials and Methods: Relevant articles were searched from Medline, PubMed, Google Scholar, ScienceDirect, and Cochrane trials. Articles published in English language were selected. Hand search was further conducted. For risk of bias, two tools were used, i.e., Cochrane tool for randomized controlled trials (RCTs) and new castle Ottawa quality assessment tool for non-RCTs., Statistical Analysis: For statistical meta-analysis RevMan 5.4 software was used., Results: Seventeen studies were finalized. All studies were included in the meta-analysis to check the implant survival rate. There is no statistical difference between direct and indirect techniques, and forest plot was derived for direct approach (P = 0.688, 95% confidence interval [CI] 0.9691) and for indirect approach (P = 0.686 and 95% CI 0.970)., Conclusion: There is no statistically significant difference in the survival rate of implant placed using direct or indirect sinus lift approach procedures. Hence, the technique is selected as per the indications given for each direct and indirect procedure., Competing Interests: None

The atrophic maxilla frequently requires bone grafting using an onlay graft (OG) or sinus lifting (SL) before implant rehabilitation. The resorption of bone grafts is influenced by the time until implantation, quality of donor bone, and grafting technique. The aim of this study was to investigate the impact of both grafting techniques on the time-related resorption of autologous iliac bone graft. Forty-three patients underwent either onlay grafting or a sinus lift at 73 sites in the maxilla. Graft height was measured by cone beam computed tomography after augmentation and during follow-up for up to 12 months prior to implant insertion. The effect of time and technique on graft resorption was evaluated retrospectively. The reduction in bone graft height was greater for OG than SL over the investigated time intervals (OG = 51%, SL = 28%; P = 0.002). Each technique followed a specific course of resorption, which was independent of the initial graft height and could be calculated by a non-linear regression model. Iliac bone graft undergoes rapid resorption when used as an OG prior to implant insertion. For SL, this resorption is reasonably lower. This is especially crucial to determine the optimal time for implant insertion after graft healing to improve implant survival., (Copyright © 2021 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Bone-regenerative interventions aiming to restore deficient alveolar ridges, such as the use of block grafts or through the application of guided bone-regeneration principles, have reported positive outcomes in the published scientific literature. These interventions, however, are invasive, and hence, intraoperative and/or postoperative complications may occur. The types of complications and their severity may vary from the exposure of the biomaterial (membrane or graft) to postsurgical infections, neurosensorial disturbances, occurrence of hemorrhage, and pain, etc. The aim of the present narrative review was to search the available scientific evidence concerning the incidence of these complications, their effect on treatment outcomes, their clinical management and, finally, strategies aimed at prevention. Exposure of the barrier membrane or the block graft is the most common complication associated with oral regenerative interventions. To manage these complications, depending on the extent of the exposure and the presence or absence of concomitant infections, therapeutic measures may vary, from the topical application of antiseptics to the removal of the barrier membrane or the block graft. Regardless of their treatment, the occurrence of these complications has been associated with patient selection, with compliant patients (eg, nonsmokers) having a lower reported incidence of complications. Similarly, surgical factors such as correct flap elevation and a tensionless closure are of obvious importance. Finally, to prevent the incidence of complications, it appears prudent to utilize whenever possible less invasive surgical interventions., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: This systematic review assesses dental implant survival, calculates the incidence rate of osteoradionecrosis, and evaluates risk factors in irradiated head and neck cancer patients., Materials and Methods: Various databases (e.g., Medline/Embase using Ovid) and gray literature platforms were searched using a combination of keywords and subject headings. When appropriate, meta-analysis was carried out using a random effects model. Otherwise, pooled analysis was applied., Results: A total of 425 of the 660 included patients received radiotherapy. In total, 2602 dental implants were placed, and 1637 were placed in irradiated patients. Implant survival after an average follow-up of 37.7 months was 97% (5% confidence interval, CI 95.2%, 95% CI 98.3%) in nonirradiated patients and 91.9% (5% CI 87.7%, 95% CI: 95.3%) after an average follow-up of 39.8 months in irradiated patients. Osteoradionecrosis occurred in 11 cases, leading to an incidence of 3% (5% CI 1.6%, 95% CI 4.9%). The main factors impacting implant survival were radiation and grafting status, while factors influencing osteoradionecrosis could not be determined using meta-analysis., Conclusion: Our data show that implant survival in irradiated patients is lower than in nonirradiated patients, and osteoradionecrosis is-while rare-a serious complication that any OMF surgeon should be prepared for. The key to success could be a standardized patient selection and therapy to improve the standard of care, reduce risks and shorten treatment time., Clinical Relevance: Our analysis provides further evidence that implant placement is a feasible treatment option in irradiated head and neck cancer patients with diminished oral function and good long-term cancer prognosis., (© 2021. The Author(s).)

Background: Transcrestal sinus floor elevation is a reliable procedure when additional bone height is needed for maxillary implant placement. However, the grafted bone undergoes remodeling and the dimensional stability of grafted bone height may be affected by several clinical factors, including graft material, sinus anatomy and the morphology of grafted space., Methods: This retrospective study examined patients who had undergone transcrestal sinus floor elevation with synthetic biphasic calcium phosphate and single implant placement. The reduction of sinus graft height (GHR) after 6-8 months healing period was measured with cone-beam computed tomography (CBCT) images. Correlating factors, including vertical amount of implant protrusion (IP), sinus width, and the morphology of grafted space were analyzed by Spearman's correlation test., Results: A total of 25 implant sites were analyzed. The mean GHR was 0.57 ± 0.49 mm, which was positively correlated with IP, vertical elevation height (VEH), and the ratio of vertical to horizontal elevation of the grafted space. However, GHR was not correlated with sinus width and mesial-distal or buccal-palatal width of the grafted space., Conclusions: Synthetic biphasic calcium phosphate used in transcrestal sinus floor elevation underwent shrinkages and graft remodeling. Grafted height reduction was associated with IP, VEH, and the ratio of vertical to horizontal elevation of the grafted space., Competing Interests: Conflicts of interest The authors reported no conflicts of interest related to this study., (Copyright © 2020 Chang Gung University. Published by Elsevier B.V. All rights reserved.)

Ridge augmentation for implant procedures has been shown to be highly successful. There are several techniques available to the dentist, but they require some degree of surgical expertise and experience. No particular technique has been shown to be superior. This article presents the indications, techniques, and complications of the various procedures for alveolar ridge augmentation. This information will educate the general dental practitioner of the techniques available and provide information on the surgical procedures that could be used to discuss with patients when they are being referred to a specialist., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The placement of short implants, which measure less than 10 mm in length, requires the practitioner to have a thorough comprehension of implant dentistry to achieve acceptable results. Innovation of the rough-surface implant and the progression of the implant-abutment interface from an external hex to an internal connection have considerably influenced the longevity of short implants. Dentists are better equipped to serve their patients because the utilization of short implants may preclude the need for advanced surgical bone-grafting procedures., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: The shell technique is a well-established procedure for GBR with which extensive osseous defects can be predictably restored by using cortical bone struts harvested from various intraoral aspects. Recent publications have demonstrated comparable results for autologous and allogeneic bone grafts, whereas the evidence on allogeneic cortical struts remains limited., Clinical Considerations: In this case series, we demonstrate the regeneration of five complex alveolar bone defects in four patients with subsequent insertion of fixed dental implants. In all cases, cortical struts made from human donor bone were applied in combination with allogeneic bone granules and collagen membranes., Conclusions: Similar to autologous cortical shells, the allogeneic struts functioned by creating an immobile container with which the osseous defects in all patients could be successfully restored, enabling placement of dental implants in accordance with the treatment plan. Even when the containers were solely filled with allogeneic granules, vascularized healthy tissue was present at re-entry, demonstrating the vast potential of these materials for applications in dentistry., Clinical Significance: Especially when it comes to regeneration of complex alveolar bone defects, autologous bone grafts are often outlined as the only treatment modality. Here we show that innovative biomaterials like allogeneic bone grafts hold the potential to mimic the functions of autologous bone transplants and provide excellent clinical results without the requirement of a second surgical side for bone harvesting and no risk of donor-site morbidity., (© 2020 The Authors. Journal of Esthetic and Restorative Dentistry published by Wiley Periodicals LLC.)

Objective: To investigate the effect of three anatomical parameters (maxillary sinus width, maxillary sinus angle, and residual bone height) on the outcomes of transcrestal sinus lift with simultaneous implant placement., Methods: A total of 60 maxillary sinuses in 42 patients were included in this study. All patients were treated with transcrestal sinus lift procedure associated with simultaneous implant placement using a composite graft material of autogenous bone and Bio-Oss. For each patient, beam computed tomography (CBCT) scans were performed preoperatively, immediately after surgery, and 6 months after surgery. The parameters were measured on the preoperative and postoperative CBCT images. The correlation of three anatomical parameters with graft resorption was analyzed using Pearson's correlation test., Results: The average residual bone height was (4.46±1.55) mm. The average width of maxillary sinus was (13.86±2.71) mm. The average sinus angle was 78.09°±10.27°. A significant positive correlation was observed between maxillary sinus width and graft resorption (P<0.01). A positive association was also found between sinus angle and graft resorption (P<0.01)., Conclusions: The findings show that graft bone resorption in elevated sinus has a positive correlation with the sinus width and sinus angle.

Objective: The sources of iliac crest bone grafts are limited. Alternatives are evaluated due to the progress in biomaterial sciences. Synthetical hydroxyapatite (HA), ß-tricalcium phosphate (ß-TCP) or biphasic compounds, or even a mélange of HA and ß-TCP will replace bovine ceramics. The goal is maintenance of replica-based-bone formation (RBBF) for bone augmentation., Methods: 2 female and 2 male patients between 41 and 73 years with 5 sinus elevations were evaluated. Sinus elevations with lateral fenestration, trapezoidal-muco-periosteal flaps and filling with micro-chambered beads (1.5 mm) was performed. A porcine-collagenous membrane and the refixated flap covered the defect. A biopsy program over 20 months was confirm confirm the maintenance of the newly formed bone., Results: A fast bone formation was pronounced. The biopsies revealed mature lamellar bone and full osseointegration of the ß-TCP implant. The biopsy after 20 months showed compact bone with osseointegration of minor rests of the ceramic implant. The defect revealed a mature bone stock already after 5 weeks., Significance: The introduction of the replica-based-bone formation (RBBF) around micro-chambered beads will change the paradigm of bone augmentation. The next step of the ongoing study has to redefine the interval for implant insertion. The clinical approach confirms the breakthrough to primary mature lamellar bone formation and will permit reduction of placement time for a dental implant., (Copyright © 2020 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the histological and microtomographic response of peri-implant bone tissue around titanium implants with different surface treatments, placed in bone defects filled or not filled with bone substitute materials., Materials and Methods: Thirty rabbits were divided into two groups according to the implant surface treatment. A bone defect was created in both tibias of all the rabbits, followed by the placement of one implant in each of these defects. On the left tibia, the defect was filled with a blood clot (BC), and on the right tibia, the defect was filled with biphasic hydroxyapatite/β-tricalcium-phosphate (HA/TCP); thus, there were four groups in total: BC-N: bone defect filled with a BC and porous surface titanium implant (control group); BC-A: bone defect filled with a BC and porous-hydrophilic surface titanium implant; HA/TCP-N: bone defect filled with a bone substitute material and porous surface titanium implant; HA/TCP-A: bone defect filled with a bone substitute material and porous-hydrophilic surface titanium implant. The animals were submitted for euthanasia at three distinct periods: 15, 30, and 60 days after implant installation. The samples were evaluated histologically and histometrically, to assess the quantity and quality of cells and the remaining bone substitute material in the grafted areas. The bone quantity was assessed by micro-computed tomography (CT)., Results: For both surface types, the presence of a bone substitute material led to higher values in all evaluated micro-CT parameters, except in the bone surface/volume ratio parameter. No significant statistical difference was found for new bone formation between the four groups (P < .05; CI 95%). At all periods, the HA/TCP-A group had a higher percentage of new bone formation., Conclusion: These results suggest that a porous hydrophilic surface in the presence of bone substitute material can accelerate peri-implant bone tissue formation., (© 2020 Wiley Periodicals, Inc.)

Objective: To evaluate posterior implant placement feasibility shortly after tooth extraction in non-grafted sockets with and without dehiscence at the time of extraction., Design: Ninety-five patients requiring posterior extractions entered this cross-sectional study. They were divided in three groups after extraction: G1 without dehiscence, G2 with dehiscence ≤5 and G3 > 5 mm. CBCT were taken prior to implant placement at an average of 12-weeks post-extraction to evaluate the need for grafting, cortical bone formation and bucco-lingual width (BLW). Actual BLW (n = 60) were compared to minimum expected BLW in 3 scenarios of BLW thickness averaging 6.4-7.4-8.4 mm. Peri-implant tissues were assessed for pocket formation and inflammation following established success criteria., Results: New cortical bone formation and sufficient BLW made implant placement feasible in sites with and without dehiscence at the time of extraction after an average healing time of 11.9 ± 2.4weeks (range: 8-18). Total average CBCT BLW was 10.1 ± 1.6 mm. All groups had a significantly higher BLW, than scenarios 1-3 (p < 0.0001). Molars were 20 times more likely than premolars to heal with BLW>10 mm (OR = 20; RR = 4.2; CI95 %: 5.3-74.2; p < 0.0001). Dehiscence sockets were 1.5 times more likely than non-dehiscenced sockets to present BLW ≤ 10 mm (OR = 1.5; RR = 0.6; CI95 %:0.9-2.5; p = 0.08). A band of keratinized tissue was present in all implants and success rates were 100 % at an average follow-up of 51.0 ± 23.4 months., Conclusion: Implant placement is feasible without socket grafting shortly after tooth extraction. Non-grafted sockets present a significant osteogenic potential. Dehiscence sockets are likely to self-repair by forming a new cortical plate. The unassisted regenerated intra-socket bone allows for functional implant stability long-term., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

The purpose of this article is not to discuss the success of short dental implants versus standard/long dental implants, but to compare short dental implants with standard/long dental implants in areas that necessitated adjunctive bone grafting or augmentation procedures and as a way to avoid the need for advanced surgical procedures and their associated risks. It can be concluded that short dental implants are a viable alternative in sites that would have required additional complex and costly augmentation procedures. Short dental implants resulted in comparable survival and success rates with faster, less expensive treatment with fewer surgical complications and morbidity., Competing Interests: Disclosure The author has nothing to disclose., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: The objective of this study was to evaluate the peri-implant bone tissue formation around titanium implants with different surface treatments, placed in bone defects filled or not with bone substitute material (BSM)., Materials and Methods: Ten animals were divided into two groups according to implant surface treatment. In each tibia, a bone defect was created followed by the placement of one implant. On the left tibia, the defect was filled with blood clot (BC), and on the right tibia, the defect was filled with biphasic hydroxyapatite/β-tricalcium-phosphate (HA/TCP) generating four subgroups: BC-N: blood clot and porous surface; BC-A: blood clot and porous-hydrophilic surface; HA/TCP-N: BSM and porous surface; HA/TCP-A: BSM and porous-hydrophilic surface. The animals were submitted to euthanasia 60 days after implant installation. After light-curing resin inclusion, the blocks containing the implant and the bone tissue were stained and evaluated by means of histomorphometry to assess the percentages of bone implant contact (% BIC). Data was normally distributed and the group differences were examined using the parametric tests of Two-Way ANOVA., Results: The BC-A group presented the higher mean value of BIC (46.43%). The HA/TCP-A group presented the higher mean value of BIC. The porous-hydrophilic surfaces presented better results of BIC when compared to the porous surface in both conditions of defect filling. No statistically significant differences were found among all groups (95% confidence interval and P < .05)., Conclusion: According to histomorphometric analysis, after 60-days in a rabbit model, hydrophilic and hydrophobic surfaces have the same behavior in the presence or absence of HA/TCP., (© 2019 Wiley Periodicals, Inc.)

Purpose: The present study was conducted to evaluate the amount of bone height gain, density values, and implant stability after maxillary sinus floor elevation using graftless tenting technique or the use of Hydroxyapatite Nanoparticles bone substitute for augmentation with simultaneous implant placement., Materials and Methods: A total of 20 sinuses with a residual alveolar bone height ranging from 4-6 mm were divided into two groups and underwent sinus augmentation using nano hydroxyapatite bone substitute material and the graftless tenting technique with simultaneous implant placement. Computed tomography CT scans and ISQ measurements were conducted to evaluate bone quality, quantity, and implant stability., Results: Radiographic analysis revealed that the mean bone height gain of the nano group was (7.0 ± 0.8 mm) compared to (5.0 ± 1.5 mm) in the tent group, which was statistically significant (P = .002) being higher in the nano group. The mean bone density value of the nano group was (548 ± 25 HU) compared to (420 ± 23 HU) in the tent group, which was statistically significant (P < .001) being higher in the nano group. The mean ISQ value after 6 months in the nano group was (78 ± 5) compared to (77 ± 5) in the tent group, which was statistically nonsignificant (P = .901)., Conclusion: Nano hydroxyapatite bone graft offered superior results in terms of the bone height gain and the relative bone density as compared to graftless tenting technique. However, both techniques showed accepted results regarding implant stability., (© 2019 Wiley Periodicals, Inc.)

Ridge preservation and bone augmentation techniques in implant dentistry are designed to preserve and augment existing alveolar ridge to prepare it for implant treatment. Bone stock is an essential component for a long-term success of dental implants. This article provides a prosthetically driven step-by-step surgical restorative decision tree algorithm to diagnose and treat an edentulous condition in implant dentistry.

The purpose of this study was to determine the effectiveness of dental implants placed in the bone graft area of cleft patients. Electronic databases and relevant journals were searched to the end of August 2018. A total of 11 articles were eligible for systematic review considering the previously established inclusion and exclusion criteria, and then underwent risk of bias assessment. A total of 483 implants were placed and showed a survival rate of 93% after a mean follow-up of 60.5 months. The iliac bone was the most used for the reconstructive surgery in cleft patients, followed by the mandible. There is a high survival rate of dental implants placed in areas of bone grafts in patients with alveolar clefts. However, more studies with high methodological quality and with a longer follow-up are needed to offer more safety for practitioners and patients regarding the placement of dental implants in areas of alveolar clefts with bone grafting., (Copyright © 2019 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Edentulous sites are often characterized by inadequate bone volume for dental implant therapy. Bone augmentation procedures for site development involve longer healing period and are often invasive, costly, and associated with postoperative morbidity. This article discusses alternatives to invasive bone grafting procedures that are often used to develop implant sites. Owing to the broad nature of this topic, it is presented in two articles. In part I, the use of short and narrow-diameter implants are discussed. Part II reviews the use of tilted as well as fewer implants to support a prosthesis., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: The transition from a tooth requiring extraction to its replacement (with a dental implant) requires a series of clinical decisions related to timing, approach, materials, cost-effectiveness and the assessment of potential harm and patient preference. This workshop focused on the formulation of evidence-based consensus statements and clinical recommendations., Methods: Four systematic reviews covering the areas of alveolar ridge preservation/bone grafting, immediate early and delayed implant placement and alveolar bone augmentation at the time of implant placement in a healed ridge formed the basis of the deliberations. The level of evidence supporting each consensus statement and its strength was described using a modification of the GRADE tool., Results: The evidence base for each of the relevant topics was assessed and summarized in 23 consensus statements and 12 specific clinical recommendations. The group emphasized that the evidence base mostly relates to single tooth extraction/replacement; hence, external validity/applicability to multiple extractions requires careful consideration. The group identified six considerations that should assist clinicians in clinical decision-making: presence of infection, inability to achieve primary stability in the restoratively driven position, presence of a damaged alveolus, periodontal phenotype, aesthetic demands and systemic conditions., Conclusions: A substantial and expanding evidence base is available to assist clinicians with clinical decision-making related to the transition from a tooth requiring extraction to its replacement with a dental implant. More high-quality research is needed for the development of evidence-based clinical guidelines., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

With aging populations and increasing oral rehabilitation, use of dental implants for oral reconstruction is increasing. Adequate hard/soft tissue are required to support use of titanium implants. Bone augmentation is sometimes a necessary procedure to supplement existing alveolar bone. With a wide variety of biomaterials available for clinical use, we focus on the enhancement of bone graft materials, targeting new technologies with potential clinical use. Clinical indications supported by research studies are provided for platelet-rich fibrin, various growth factors, and newly emerging scaffolds. Interestingly, modified biomaterials are being developed and have potential clinical use as more data become available., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Bone grafting has become an integral part of implant dentistry. To achieve a predictable long-term outcome for osseointegrated implants, a sufficient volume and quality of alveolar bone must be present at implant recipient sites. Resorption of the alveolar ridge and postsurgical or post-traumatic defects of the residual alveolar bone can prevent ideal placement of a dental implant. Thus, in many cases, alveolar bone grafting is the real challenge in implant reconstruction. This article will discuss the various techniques and graft materials for alveolar ridge reconstruction of the mandible. It also compares and contrasts these techniques by reviewing the current literature., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: Various biomaterials have been successfully applied in alveolar bone regeneration, however, the reconstruction of extensive osseous defects remains challenging and is often unfeasible with granular grafting materials. Several studies have outlined allogenic bone blocks as valid alternative to autologous block grafting., Clinical Considerations: In this report, we demonstrate the regeneration of two large osseous defects in the maxilla with allogenic bone blocks made from human donor bone. The bone blocks were customized using the CAD/CAM technology in order to enable the insertion of four dental implants., Conclusions: Both blocks perfectly matched the defect geometry, showed limited resorption, led to the formation of sufficient amounts of mineralized bone in both horizontal and vertical dimensions and enabled the installation of implants according to the treatment plan. The implementation of innovative technologies for individualization of allogenic bone blocks simplifies the restoration of complex and extensive osseous defects and poses great benefits for both practitioners and patients., Clinical Significance: The here presented procedure demonstrates the successful regeneration of two extensive osseous defects in a patient suffering from hypodontia using two CAD/CAM manufactured allogenic bone blocks, rendering the procedure far less invasive as compared to guided bone regeneration carried out with autologous transplants. Furthermore, to the best of our knowledge, this is the first case report that radiographically demonstrates the new formation of a cortical bone layer following block grafting with solely cancellous bone blocks., (© 2019 Wiley Periodicals, Inc.)

Dental implant therapy in the non-cleft patient is familiar to most oral and maxillofacial surgeons. Understanding the differences in surgical treatment planning in the cleft patient versus the non-cleft patient is the key to highly functional and esthetic long-term outcomes. CBCT and computer-assisted planning, as well as improved technology in grafting and implant materials, result in excellent outcomes. Communication with the restorative team remains of paramount importance in planning treatment., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: The aim of this systematic review was to determine the most effective alveolar augmentation technique for vertical bone gain., Materials and Methods: A systematic search to select clinical trials and retrospective studies done on patients with reduced vertical bone height was conducted. The intervention of interest was autogenous block graft done compared to procedures such as distraction osteogenesis (DO), particulate grafting, block plus particulate grafting with titanium mesh, and tent pole technique in systematically healthy adult patients age 18 and older. The following electronic databases were explored: PubMed, CINAHL, and Dental and Oral Science. A supplementary manual search of published full-text articles from January 2005 to December 2017 was done using Google Scholar. Grey literature was also sought using greylit.org. The review protocol was registered at the Prospero registry (CRD # 42017072432). The risk of bias of the included studies was assessed using EPOC criteria. Meta-analysis was performed using Review Manager for studies with quantitative data on mean values of vertical bone gain and bone resorption achieved with various bone augmentation techniques. Random effect model was used. Heterogeneity among studies was evaluated using the I 2 statistic., Results: A total of 2322 articles were found. After excluding the irrelevant papers, only 8 papers were finally selected for the detailed evaluation. Of these 8, 5 were clinical trials, and 3 were retrospective studies. Four studies were on DO, 2 on particulate grafting, 1 on autogenous block grafting plus particulate grafting, and 1 on tent pole grafting. The control group in all studies were autogenous block graft. Meta-analysis revealed no significant difference between DO and autogenous block grafting for vertical bone gain (mean difference 0.82 [-1.28, 2.91]). Similarly, no significant difference was observed in the 2 techniques for bone resorption (mean difference 0.38 [-0.23, 0.99])., Conclusions: DO was not superior to autogenous block grafting for vertical bone augmentation. Both techniques were associated with a number of complications. There was no difference in the bone resorption observed in the 2 techniques. No conclusive results can be drawn on other techniques on account of limited data., (© 2019 by the American College of Prosthodontists.)

Background: The chemical surface structure of the porous titanium grafts has not been found to study in the literature on the similarity of chemical surfaces of different commercial dental implants., Purpose: The purpose of this study is to investigate the chemical composition and surface energies of white (WPTG) and black porous titanium granules (PTG) by energy dispersive x-ray spectrometry (EDX) analysis to compare with different commercial dental implant surface., Materials and Methods: The surface chemical compositions of six commercially available dental implants with different surface structures, PTG and WPTG were examined by EDX analysis. Surface analyzes were performed on the apical, middle, and coronal parts of each implant and on the top, flank, and valley regions on each side. Surface analyzes of dental implants were evaluated at ×200 and ×2000 magnifications. The EDX evaluation of PTG grafts were evaluated at ×250, ×2000, ×5000, and ×50 000 magnifications., Results: PTG grafts showed elements of Na (8.88 ± 9.98%), Cl (2.44 ± 1.96%), and Al (0.99 ± 0.37%) as well as Ti (90.06 ± 11.34%) molecule at ×5000 magnification. In WPTG, Ti (%34.55 ± 6.41%) and O (%65.44 ± 6.42%) molecules were detected., Conclusions: It has been found that PTG surface was not made of pure titanium, it has different chemical molecules at larger magnifications. Cell culture and experimental studies are needed to establish a relationship between the different commercial implants and the surface structure of the titanium granules., (© 2019 Wiley Periodicals, Inc.)

Background: Implant placement in the posterior maxilla is often complicated by the insufficient bone volume. While transalveolar sinus floor elevation (TSFE) has been proven as a predictable surgical procedure to increase the bone height in the posterior maxilla, questions in regard to the necessity of the bone grafting during the sinus lift and the question of whether TSFE could be performed when the residual bone height is below 5 mm are still debated. Furthermore, high-quality evidence comparing the clinical outcome of transalveolar sinus floor elevation with osteotome and modified sinus floor elevation with crestal non-cutting drills is limited., Methods/design: One hundred twenty adult patients who fit the inclusion criteria are being recruited from the Peking University Hospital of Stomatology First Clinical Division (Beijing, China). All patients are assigned to one of four groups according to a table of random numbers. Participants will receive (1) TSFE using osteotomes with bone grafting, (2) TSFE using osteotomes without bone grafting, (3) modified TSFE with bone grafting, or (4) modified TSFE without bone grafting. In a one-year follow-up period, implant survival rates, complications, implant stability, bone remodeling around the implant, and patient-reported outcome (visual analog scale for intraoperative discomfort and postoperative pain) will be observed and documented. The implant stability will be gauged by the resonance frequency analysis six times (at baseline and weeks 6, 8, 12, 16, and 26), and the bone remodeling will be observed and compared via radiographic examinations., Discussion: The result of the trial will potentially contribute to better decision making in atrophic posterior maxilla when implant placement is needed. Therefore, if the outcome is deemed favorable, the use of the modified TSFE would achieve an outcome equivalent to that of the traditional TSFE while introducing less trauma and postoperative discomforts. Separately, whether the bone graft procedure is necessary for the TSFE will also be discussed., Trial Registration: The study has been registered in ClinicalTrials.gov under the identifier number NCT03445039 . Registered on 26 February 2018.

The reconstruction of severely atrophic ridges is often challenging and complicated. We searched the Medline, Embase, and Cochrane databases for articles up to October 2015 that reported the success of all types of tenting for bony regeneration. We extracted data on the size and site of the defect, the number of patients, vertical and horizontal augmentation, survival of dental implants, and complications. Thirteen studies were included, which yielded data on 423 patients with 1111 dental implants. Follow-up periods were more than five years, severely resorbed mandibles were augmented vertically by up to 10mm, and the survival rate of the implants was over 97%. The mean (SD) gain in horizontal width by screw tenting was 3 (0.63)mm, and over 97.6% of dental implants in cortical tenting investigations survived. A tenting approach may reduce the need for large autogenous bone grafts in the reconstruction of severely atrophic ridges and local bony defects, and improves the survival of implants., (Copyright © 2017 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objective: To assess the impact of a hydrophilic implant surface (SLActive ® ) placed into augmented maxillary sinuses on bone-to-implant contact (BIC) and surrounding tissue composition when compared to a hydrophobic surface (SLA ® )., Material and Methods: Four sheep underwent bilateral sinus augmentation. Each sinus received anorganic bovine bone mineral + autogenous bone (ABBM + AB). Sixteen implants were subsequently placed 12 weeks postgrafting with each sinus receiving a control (SLA ® ) and test implant (SLActive ® ). Two animals were sacrificed at 2 weeks and another two animals were sacrificed at 4 weeks postimplantation. The eight sinuses and 16 implants were processed for histomorphometry, which assessed bone-to-implant contact (%BIC) and tissue elements (woven bone - WB, lamellar bone - LB, soft tissue - ST) in the interthread region of implants within the augmented sinus., Results: There was a statistically significant increase in %BIC at week 4 compared to the week 2 animals in both test (P < 0.005) and control (P < 0.005) groups. There was a statistically significant greater %BIC around test implants when compared to control implants in both week 2 (P < 0.05) and week 4 animals (P < 0.05). Greater %WB (11.17% ±6.82) and %LB (11.06% ±3.67) were seen in the test implants when compared to the control implants independent of time. This was only statistically significant for %LB (P < 0.05). A statistically significant reduction of 16.78% (±6.19) in %ST was noted in test implants when compared to control implants (P < 0.05) independent of time., Conclusion: Both time and the use of hydrophilic implant surface had a positive impact on %BIC around implants placed into augmented maxillary sinuses. Hydrophilic implant surfaces also had a positive impact on surrounding tissue composition. Larger trials are needed to better assess and detect differences between these two surfaces in augmented maxillary sinuses., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Cone-beam computed tomography can accurately show anatomic structure of intrabony nerve canals in mandibular interforaminal region., Purpose: The aim was to evaluate the characteristics of intrabony nerve canals in mandibular interforaminal region by using cone-beam computed tomography (CBCT) and determine a safe zone for implant and bone harvesting., Materials and Methods: Hemimandibles (824) CBCT images were obtained. The length of the anterior loop (AL), the length and diameter of the mandibular incisive canal (MIC) and its spatial distance in various landmarks were measured., Results: The prevalence of the AL was 93.57%, and the MIC was 97.33%. The mean lengths of the anterior extension of the anterior loop (aAL), caudal extension of the anterior loop (cAL) and the MIC were 2.53 ± 1.27 mm, 6.04 ± 1.66 mm, 9.97 ± 5.15 mm, respectively. The MIC was closer to buccal border and inferior margin of mandible. The length of the AL and diameter of the MIC varied with gender., Conclusions: The safe zone recommended for implant surgery is 4 mm anterior and 8 mm inferior to the mental foramen, and 10 mm above the inferior margin of mandible. The chin bone should be harvested at least 10 mm below the tooth apices along with a limited depth of 4 mm., (© 2017 Wiley Periodicals, Inc.)

Purpose: The aim of this study was to evaluate the efficacy of autologous intraoral onlay bone grafting (OBG) in correlation with long-term survival rates of dental implants placed in the augmented bone., Materials and Methods: A retrospective study was conducted on 214 patients who received a total of 633 dental implants placed in 224 autologous intraoral block OBG augmentations, combined with Bio-Oss - mixed with platelet-rich plasma (PRP) and covered by platelet-poor plasma (PPP) - as scaffold, with a follow-up time up to 137 months (mean 39.9 ± 30.9 months)., Results: A total of 216 OBG cases were successful (96.4%), and most of the augmentations were uneventful (88.4%). Bone graft exposure was moderately associated with bone graft failure (χ(2)  = 3.76, p = .052). The healing period after implant placement was 4-6 months (mean 5.6 ± 2.56). The majority of the 591 implants survived (93.4%). The cumulative survival rate of the implants was 83%., Conclusions: We suggest that augmentation of severely atrophied jaw bone through the placement of horizontal and/or vertical intraoral OBGs in combination with Bio-Oss saturated with PRP and covered by PPP should be considered a reliable, safe, and very effective surgical technique for obtaining high bone graft survival rate and high long-term implant survival rate., (© 2014 Wiley Periodicals, Inc.)

Background: Little is known about the long-term outcome of implants placed in the atrophic maxilla using osteotome sinus floor elevation (OSFE) without grafting., Purpose: The study aims to evaluate the long-term efficiency of the procedure and stability of the peri-implant bone formed following implant placement without grafting into resorbed posterior maxilla., Materials and Methods: Twenty-five implants (≤10 mm in length) were placed in 17 patients using OSFE without grafting. The mean residual bone height was 5.4 ± 2.3 mm. Bone levels were evaluated at 1, 3, 5, and 10 years using periapical radiographs., Results: Fifteen patients (23 implants) participated in the 10-year examination. All implants fulfilled the survival criteria. Following surgery, the implant sites gained endo-sinus bone (mean: 3.0 ± 1.4 mm). The mean crestal bone loss (CBL) was limited to 1.0 ± 0.9 mm. The difference in mean endo-sinus bone gain and CBL was statistically significant between 1 and 10 years, but not between 3 and 5, 3 and 10, and 5 and 10 years., Conclusions: At 10 years, the implant survival rate was 100%. Endo-sinus bone was mainly gained during the first year. This study demonstrates the long-term predictability of OSFE without grafting and simultaneous implant placement., (© 2015 Wiley Periodicals, Inc.)

Objectives: A sloped shoulder might improve the congruence between extraction socket and dental implant and may add to a better circumferential support of the peri-implant structures. Therefore, this study evaluates the 3-year clinical outcome (survival and success rates, marginal bone levels, and Pink Esthetic Score (PES)) of immediately inserted and provisionalized OsseoSpeed(™) Profile implants in the anterior maxilla., Material and Methods: Twenty-one implants were inserted in 16 patients. All implants were immediately placed into extraction sites with and without facial bone deficiencies. A flapless procedure was utilized, and the implants were provisionalized immediately. Facial gaps were grafted with autogenous bone chips from the mandibular ramus. Implant survival and success, the interproximal bone levels, the thickness of the facial bony wall, and the PES were evaluated., Results: After a mean follow-up period of 43 months, 19 implants were still in function. One patient with 1 implant did not follow the study protocol (dropout) and 1 implant was lost at 10 weeks. Interproximal marginal bone levels measured -0.2 ± 0.4 mm (range, -1.0-0.4 mm) apical to the implant shoulder. The mean PES ratings were 11.9 ± 1.4 (range, 8-14) at the final examination., Conclusions: Clinical and radiographic results provide evidence that sloped implants can preserve the marginal bone circumferentially and are able to maintain soft tissue esthetics when inserted and provisionalized immediately, even in the presence of facial bony wall defects., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: Bone grafts are often used to enhance bone volume/quality prior to implantation insertion. This systematic review compares the histomorphometric effectiveness of bone grafts in an evidence-based manner., Data: Randomized clinical trials comparing histomorphometrically the % of newly-formed bone between two grafts were included. Risk of bias within and across studies was assessed with the Cochrane tool and the GRADE approach, respectively. Random-effects pairwise meta-analyses were conducted, followed by network meta-analysis, network meta-regression and sensitivity analyses., Sources: Four electronic databases were searched from inception to June 2015 without limitations., Study Selection: A total of 12 trials (5 parallel; 7 cluster) with a total of 231 patients (302 grafted sites) were included. No statistically significant differences were found in the % of new bone from pairwise comparisons between any two bone grafts. Treatment ranking based on the evidence network indicated that autografts presented the highest percentage of new bone, followed by synthetic grafts, xenografts, and allografts. No differences according to patient age, sex, healing time, membrane used or kind of surgical graft use were identified. Our confidence on pairwise comparisons was moderate to very low due to study limitations, inconsistency, and imprecision; our confidence on graft ranking was moderate due to study limitations., Conclusions: No significant differences were found in the percentage of new bone between any two grafts., Clinical Significance: Synthetic bone substitutes or xenologous bone grafts can be used as an alternative to autologous graft in order to overcome problems of additional surgeries or limited graft availability., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: The question whether a minimal maxillary residual bone height (RBH) allows the predictable use of osteotome sinus floor elevation (OSFE) remains unresolved., Purpose: To evaluate the efficacy of short implants placed with OSFE in an RBH of ≤4 mm and to compare bone levels around implants placed with (control) or without (test) grafting after 3 years., Materials and Methods: Eight-millimeter implants were placed by OSFE in sinuses randomized to receive anorganic bovine bone or no grafting material. Healing time before prosthetic rehabilitation was 10 weeks. Peri-implant bone levels were measured on standardized periapical radiographs., Results: Thirty-seven implants (17 test, 20 control) were placed at a mean RBH of 2.4 ± 0.9 mm. Three implants failed during the 3-year follow-up. After 3 years, all implants had gained endosinus bone (test: 4.1 ± 1.0 mm; control: 5.1 ± 1.2 mm; p = .001). Mean bone gain was stable between 1 and 3 years in both groups., Conclusions: Grafting is unnecessary to achieve bone augmentation of 4.1 mm; however, more bone is gained with grafting. Bone gained over 1 year was retained. Atrophic posterior maxillae can be predictably rehabilitated using OSFE and simultaneous placement of 8-mm implants., (© 2015 Wiley Periodicals, Inc.)