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Background and Objectives: Smoking has been found to interfere with wound healing processes. Therefore, the purpose of this study was to compare surgical treatment of oroantral fistulae (OAFs) in smokers and non-smokers. Materials and Methods: Medical records of all consecutive patients who underwent surgical closure of OAFs between 2003 and 2016 at the oral and maxillofacial surgery department, Rabin Medical Center, Israel were reviewed. Patients&rsquo, demographic data, preoperative signs and symptoms, surgical method of repair, and postoperative complications were recorded. Results: The cohort consisted of 38 smokers and 59 non-smokers. Age and gender distributions were similar in both groups. The main etiology in both groups was tooth extraction, followed by pre-prosthetic surgery in smokers and odontogenic infection in non-smokers (p = 0.02). Preoperative conditions were not significantly different between smokers and non-smokers in terms of size of soft tissue fistula and bony defect, chronic sinusitis and foreign bodies inside the sinus. OAFs were repaired by local soft tissue flaps without consideration of smoking status. Smokers experienced more moderate-severe postoperative pain (p = 0.05) and requested more weak opioids (p = 0.06). Postoperative complications included infection, delayed wound healing, residual OAF, pain, sensory disturbances and sino nasal symptoms. These were mostly minor and tended to be more frequent in smokers (p = 0.35). Successful closure of OAFs was obtained in all patients except one smoker who required revision surgery. Conclusions: Smokers may be more susceptible to OAFs secondary to preprosthetic surgery. In this cohort, there was no statistically significant difference in outcome between smokers and non-smokers in terms of failure. However, smokers tended to have more severe postoperative pain and discomfort and to experience more postoperative complications. Further studies with larger sample sizes should be conducted to validate these results.

The aim of this systematic review was to assess the primary and secondary stability of dental implants placed at sites prepared with piezoelectric bone surgery (PBS) and conventional drilling (CD). The PubMed/MEDLINE and Cochrane Library databases were searched without date or language restriction up to June 2017. Controlled clinical trials in which each patient received implants placed at sites prepared with both PBS and CD were selected. Implant stability had to be measured on day 0 and during the osseointegration period. Methodological quality was assessed using the Cochrane Collaboration tool. A meta-analysis was performed to compare primary stability (on day 0) and secondary stability (after 2 and 3months) between the two groups. The studies included were determined to have a high risk of bias. There was no significant difference between the two groups for primary stability (on day 0) (P=0.51). After 2 and 3months, secondary stability was statistically higher in implants placed with PBS preparation (P=0.04 and P=0.01, respectively). The implant survival rate was 97.5% in the CD group and 100% in the PBS group. PBS preparation improves secondary stability after 2 and 3months in comparison to CD, with similar implant survival rates. Further studies are needed to determine whether implant osseointegration periods could be shortened with PBS preparation.

Purpose To answer the PICO question: “Among patients to whom an implant is placed, does the piezoelectric surgery (PS) compared to the conventional drilling (CS) achieve higher implant stability, increase surgical time or improve implant survival rate?” Study selection Two independent authors screened the literature through MEDLINE, Cochrane Library and Scopus. Randomized or non-randomized controlled trials, prospective and retrospective cohort studies comparing implant stability and/or clinical outcomes with PS versus CS used for implant site preparation published in the last 10 years were included in the search. Results Five of the 177 articles initially found were included in the meta-analysis. No statistically significant differences were found between PS and CS for implant stability quotient (ISQ) at baseline (SMD: 0.31; 95 %CI: −0.59 to 1.20; p = 0.5). However, ISQ values were significantly higher at 2 months (SMD: 0.52; 95 %CI: 0.03–1.00; p = 0.04) and at 3 months (SMD: 0.74; 95 %CI: 0.17–1.32; p = 0.01) for CS. PS needed significantly more time than CS (SMD: 1.74; 95 %CI: 0.42–3.06; p = 0.01) in order to be performed. No differences for implant survival rates were found when comparing both techniques (RR: 0.52; 95 %CI: 0.09–2.88; p = 0.45). Conclusions PS has not demonstrated superiority to conventional drilling for implant stability during the healing period. PS needs significantly longer surgery time than CS. Differences for implant survival rate were not found between the two techniques.

OBJECTIVES To evaluate the accuracy, safety, and anticipation effect of a novel electrical conductivity device (SG) in maxillary osteotomy preparation for placement of dental implants. MATERIALS AND METHODS Thirty-seven osteotomies were prepared by three operators with different levels of expertise, using the SG protocol in the maxilla of six fresh frozen cadavers. A pre-op CT measurement of the length of bone in the desired implant location was taken and compared with the final length of the osteotomy created using SG during surgery. A comparison was made between the results of the different operators. RESULTS The pre-op CT bone length measurements and the final depth assessment of the osteotomy with SG had a very high correlation level (0.977) with a significant mean difference of 0.639 mm (P

The present article on the history of dental implants spans beyond the past 100 years of the American Association of Oral and Maxillofacial Surgeons. It was not until the materials and methods became less traumatic to the bone that implants could become firmly attached to the surrounding bone. This phenomenon is now used to replace single and multiple teeth and restore the patient to function and well-being. Many of the methods used to increase denture function are still used with modifications to augment the environment for an implant. These technological changes have allowed patients to be treated efficiently, with the same need for a good treatment plan and physical evaluation by the clinician.

Maxillary sinus lift surgery (MSLS) is considered to be a useful treatment method for patients with atrophic alveolar bone. Choosing a suitable surgical procedure to simultaneously decrease graft absorption and obtain long-term survival of dental implants is still a challenge. In this study, 20 patients received MSLS with graft of bone morphogenetic protein 2 (BMP2)-loaded calcium phosphate. Dental implants were placed simultaneously in 10 patients receiving MSLS (1-stage group), and in 10 patients receiving dental implants with a 3 to 6 months delay (2-stage group). The effects were evaluated based on clinical and radiographic examination during a 4 to 5 years follow-up. The results showed that only 1 perforation of the maxillary sinus mucosa was observed in 1-stage group, and was patched with a collagen membrane. An average bone gain of 6.8 mm was observed, and all implants exhibited no looseness, peri-implantitis, or fracture, all of which were stable during the follow-up and exhibited nice dental function during a 4 to 5 years follow-up. The loss of peri-implant bone height was 1.12 ± 0.47 and 1.10 ± 0.39 mm, the probing depth of periodontal pocket was 1.79 ± 0.62 and 1.81 ± 0.71 mm, the sulcular bleeding index was 1.63 ± 0.47 and 1.72 ± 0.54 in 1-stage group and 2-stage group, respectively, and no significant differences existed between these 2 groups. These findings implied that BMP2-loaded calcium phosphate may be a suitable material for MSLS, especially for patients with minimal bone height. Clinicians can use the 1- or 2-stage technique based on clinical condition, patients' choice and clinicians' experience. In patients where implants cannot be stabilized for patients with minimal bone height, 2-stage surgery may be more suitable.

Dentoalveolar surgeries are among the more common procedures performed by oral maxillofacial surgeons. It is only natural that there are several controversies associated with many aspects of this type of surgery. Although good scientific evidence is the basis of most oral maxillofacial procedures, some of what is accepted as common wisdom may not meet strict guidelines of evidence-based practice. This article explores some controversies that are relevant to the current practice of dentoalveolar surgery.

Severe vertical ridge deficiency in the anterior maxilla represents one of the most challenging clinical scenarios in the bone regeneration arena. As such, a combination of vertical bone augmentation using various biomaterials and soft tissue manipulation is needed to obtain successful outcomes. The present case series describes a novel approach to overcome vertical deficiencies in the anterior atrophied maxillae by using a mixture of autologous and anorganic bovine bone. Soft tissue manipulation including, but not limited to, free soft tissue graft was used to overcome the drawbacks of vertical bone augmentation (eg, loss of vestibular depth and keratinized mucosa). By combining soft and hard tissue grafts, optimum esthetic and long-term implant prosthesis stability can be achieved and sustained.

Nasoalveolar molding (NAM) is commonly employed to reduce the alveolar segments into proper alignment and to improve nasal symmetry in patients with cleft lip and palate. This study examines the periodical progression of NAM treatment over time. 20 patients with complete unilateral cleft lip and palate were prospectively recruited. A 2 stage NAM treatment protocol was applied. Stage 1 involved adjustment of the alveolar segments (mean age 15.6 days), while Stage 2 added nasal stents and started average 43 days after stage 1. 3D images (n = 241) were obtained prior to NAM initiation and weekly until the end of treatment. The cleft lip area, bilateral nostril areas, and the nostril height and width were measured. Treatment was assessed in the Cleft (C) side and the Non-cleft (N). There was significant difference in the C/N ratio of the nostril area, width, and height at pre-treatment (0.9 ± 0.3, 4.1 ± 1.1, and 0.5 ± 0.2), at the end of stage 1 (1.1 ± 0.3, 2.2 ± 0.6, and 0.8 ± 0.2), and at the end of stage 2 treatment (1.8 ± 0.3, 1.8 ± 0.4, and 1.2 ± 0.1); p

The objective of the present study was to test the hypothesis that the addition of hyaluronic acid-based matrix to collagenated heterologous bone graft for sinus augmentation would enhance bone formation compared to collagenated heterologous bone graft alone in the early healing period, by micro-computed tomography and histomorphometry. Thirteen systemically healthy patients requiring bilateral two-stage maxillary sinus augmentation (residual crest height≤4mm) were enrolled in this split-mouth prospective randomized controlled study. One sinus side as a control group was grafted with only collagenated heterologous bone graft; the other region as a test group was grafted with hyaluronic matrix and collagenated heterologous bone graft. Bone biopsy samples were taken after 4 months during the dental implant surgery and analyzed using micro-computed tomography and histomorphometric parameters. According to the micro-computed tomography and histomorphometric results, a significantly higher percentage of new bone was observed in the test group when compared to the control group after 4 months of healing. This study confirmed the hypothesis that the addition of hyaluronic matrix to collagenated heterologous bone graft for sinus augmentation enhances bone formation compared to collagenated heterologous bone graft alone in the early healing period.

Esthetic considerations are a significant contributing factor in the management of prosthodontic cases and an interdisciplinary approach is often necessary to achieve an optimal result. The visible soft-tissue architecture plays a key role in developing an esthetic smile. Furthermore, an understanding of the relationship between the restorative margin and the gingiva is important for long-term stability of the result. The gingival architecture and gingival health are important for ensuring optimal esthetics following prosthodontic work and close attention to both soft and hard tissues around the teeth, before, during and after restorative procedures, will greatly improve the likelihood of a successful outcome. Moreover, knowing the options available in periodontal plastic surgery is important in esthetic dentistry today. The relevant literature related to restorative and surgical procedures when performing esthetic dentistry are reviewed in this article, and different approaches are illustrated with appropriate cases to explain the treatment approach that was utilized to improve the esthetic appearance of the case.

The aim of the present study has been to analyze the influence of residual root number and bone density on the loading distribution of restorations combining implant and residual tooth after tooth hemisection using finite element analysis. Based on the image data of two patients, one has one distal root and the other has two distal roots in the mandibular right first molar, eight models were created (four models for each patient): a single crown was placed on the implant and residual tooth in two different bone densities; two separate crowns for the implant and residual tooth in two different bone densities. Vertical force of 100-N was applied on the crowns. The results show that the increase in number of residual roots decreased the magnitude of all biomechanical parameters. Higher values were observed in models with low bone density, especially in one distal root models. The maximum values of strains in spongious bone with the model (one distal root, low spongious bone density, a single crown was placed on the implant and residual tooth) even reached 9000μstrain. From a biomechanical point of view, when two residual roots exist, a single crown placed on the implant and distal half of the molar or two separate crowns for them seem to be an acceptable treatment option, regardless of the bone density. If there is one residual root and the bone density is low, the prosthesis which combines implant with the root might not be used.

Tooth hemisection preserves partial tooth structure and reduces the resorption of alveolar bone. The aim of this study was to analyze the feasibility of preserving a molar after hemisection and inserting a dental implant with different prosthetic superstructures by means of finite element analysis. First, the distance between the root of the mandibular second premolar and the distal root of the first molar were measured in 80 cone beam computed tomography (CBCT) data sets. Based on these data, the lower right posterior jaw segment was reconstructed and the geometries of the appropriate implant were imported. Four models were created: (1) Hemi-1: An implant (3.7×9mm) replaced the mesial root of the molar, and a single crown was placed on the implant and residual tooth. (2) Hemi-2: Two separate crowns were generated for the implant and the residual tooth. (3) Single: An implant (5.5×9mm) with crown replaced the whole molar. (4) FPD: A 3-unit fixed partial denture combined the distal residual part of the molar and premolar. The results indicated that stresses in the cortical bone and strains in the majority region of the spongious bone were below the physiological upper limits. There were higher stresses in implant with the Hemi-1 and Single models, which had the same maximum values of 45.0MPa. The FPD models represented the higher values of stresses in the teeth and strains in PDL compared to other models. From a biomechanical point of view, it can be concluded that a combination of an implant and residual molar after tooth hemisection is an acceptable treatment option.

Rationale: In this case study, a modified transcrestal approach was applied to the patient of extremely atrophic posterior maxilla. We analysis the Implant Stability Quotient values (ISQ) to monitor implant stability, and the cone-beam computer tomography (CBCT) to evaluate the bone regeneration. Patient concern: A 26-year-old female patient visited our hospital with no contraindications for dental implants and a loss of the maxillary right first molar. Diagnose: Examination by CBCT demonstrated the posterior maxilla was extremely atrophic, the residual bone height (RBH) of #16 was 3.5 mm. Intervention: Patient underwent a endoscopically controlled flapless sinus floor elevation. The maxillary sinus membrane was elevated by two-step, and an implant of 12 mm length was placed simultaneously. Outcomes: Twelve weeks post-surgery, the implant-level impression was finished and a full-ceramic crown was placed thereafter. Lessons: The modified transcrestal approach can be applied to augment maxillary sinus with a residual bone height less than 4 mm.

Objective To histomorphometrically compare the use of collagen-stabilized anorganic bovine bone (ABBM-C) (test) to anorganic bovine bone + autogenous bone (ABBM + AB) (control) in maxillary sinus augmentation. Materials and Methods Forty (n = 40 sinuses) patients underwent sinus augmentation and received either control (20 sinuses) or test bone graft (20 sinuses). Bone samples were harvested from the augmented sinuses 5 months postgrafting. The samples were processed for histomorphometry, which assessed within the primary region of interest (ROI-1), the area fraction of new bone (%NB), graft particle osseointegration (% OI), residual graft (%RG), and soft tissue components (% STM). The same analysis was also carried out in a second region of interest (ROI-2) located in a zone 1 mm proximal to the previous maxillary sinus floor. Results In both ROI-1 and ROI-2, the mean % NB, %RG, and %STM in the control group were similar to mean values in the test group. The % OI was significantly greater in the control group (42.0 +/− 26.8) when compared to the test group (19.6 +/− 27.3) in ROI-2 (P

Objective: To evaluate 2 iliac corticocancellous-block grafting techniques for dental implant placement in residual alveolar clefts. Design: Nonrandomized prospective clinical trial between March 2010 and December 2014. Setting: National Hospital of Odonto-Stomatology, Hanoi, Vietnam. Participants: Thirty-two patients (23 female, 9 male; mean age, 21.28 years; range, 16-31 years) with unilateral complete alveolar cleft after reconstructive surgery for cleft lip and palate (CLP). Interventions: Harvested iliac crest bone was cut into 2 corticocancellous blocks. The smaller block was adapted against the sutured nasal mucoperiosteum and overlaid with cancellous bone; the larger one overlapped the labial cleft margin and was fixed with screws. Endosteal dental implants were placed after 4 to 6 months, and final restorations were delivered 6 months later. Main Outcome Measures: Flap statuses were assessed clinically. Bone formation was assessed using the Enemark scale. Cone-beam computed tomography was used for graft height and width measurements. Implant health was assessed by the Misch criteria. Results: The mean postgrafting follow-up period was 36.7 ± 10.4 (range, 18-53) months. Three patients (9.4%) showed flap dehiscence but no infection 7 days after bone grafting. Twenty-nine patients (90.6%) had 75% to 100% bone fill (Enemark score of 1). The mean graft height and width were 11.4 ± 2.4 and 6.1 ± 1.0 mm, respectively. Sufficient bone for implant placement was noted in 29 patients (90.6%); the others required partially fixed prostheses. All implants functioned for at least 18 months. Conclusion: The proposed technique is reliable to reconstruct the alveolar cleft for implant placement in CLP patients.

OBJECTIVE The aim of this study was to evaluate bone resorption quantitatively during the healing period subsequent to ridge augmentation. MATERIALS AND METHODS Sixteen patients requiring vertical ridge augmentation before implant placement were recruited in the study. The study used an allograft and nonresorbable membrane. A custom acrylic stent was used to measure changes in bone volume. Augmented bone was compared with remaining bone 6 months after guided bone regeneration (α = 0.05 by means of the paired t test). RESULTS All sites following the six months post-surgery were analyzed. Overall changes in alveolar bone were observed with a mean resorption rate of 19.8% (p

The objective of this systemic review was to perform a comprehensive overview of systematic reviews and meta-analyses of the maxillary sinus augmentation procedure for implant rehabilitation in humans. The following were evaluated in this overview: (1) anatomic variables affecting sinus augmentation, (2) histomorphometric analysis of the grafted sinus, (3) volumetric changes after sinus grafting, and (4) implant survival beyond 1 year.Electronic databases were searched for systematic reviews and meta-analyses of implant-related sinus augmentation published from 1976 to September 2015. The studies selected must identify itself as a systemic review or meta-analysis in the title or abstract and must pertain to sinus augmentation.Thirty-three publications fulfilled the review criteria. The AMSTAR ratings for the 33 chosen reviews scored greater than 3 of 11, with 8 reviews scoring greater or equal to 8 of 11.The outcome of this overview suggested that the following will increase the success of sinus augmentation and survival of implants placed in the grafted sinus: (1) the use of barrier membranes over the lateral window when using a lateral approach to graft the sinus, (2) the use of particulate autogenous bone with or without other substitute graft materials, (3) sinus augmentation without the use of grafting materials may be considered provided that the space between the sinus membrane and floor can be maintained, (4) the use of rough-surfaced implants, (5) simultaneous implant placement with residual bone height greater than 4 mm, and (6) the cessation of smoking.

Introduction Invasive cervical resorption (ICR) has an unknown aetiology, yet it exhibits very aggressive behaviour compared with typical external root resorption, posing a high risk of tooth loss. Aim To investigate the number of patients at the Dublin Cleft Prosthodontic Department with an oro-facial cleft who experienced ICR and to identify any possible aetiological factors. Materials and method A retrospective investigation of all oro-facial cleft patients treated at the Dublin Cleft Prosthodontic Department, St James’s Hospital, Dublin. All patients’ clinical and radiological records were reviewed. Patients where tooth loss became inevitable due to Class 4 ICR were analysed. Results From 588 oro-facial cleft patients, 14 (2.38%) patients with ICR were identified. Of these eight (57%) were female and six (43%) were male. Mean age at diagnosis was 28 years (range = 16–49 years). Cleft type: six (42.1%) unilateral cleft lip and palate, eight (57.9%) bilateral cleft lip and palate. Seventeen ICR affected teeth in total, with eleven (65%) maxillary central incisors, two (12%) maxillary lateral incisors, four (23%) maxillary canines, and one (7%) central, lateral and canine affected. Some, (N = 10, 71.4%) presented with ICR resulting in immediate tooth loss. Other patients (N = 4, 28.6%) developed ICR during or following prosthodontic treatment at the Cleft Centre. Tooth loss for this cohort, though not immediate, was inevitable. All had undergone fixed orthodontic appliance treatment and twelve had received dento-alveolar bone grafts. A number (N = 7, 50%) had undergone osteotomy, two (14%) had received night guard vital dental whitening and one had a history of trauma. Conclusions ICR, given its aggressive nature and ill-understood aetiology, poses significant treatment challenges. The most severe form of ICR (Class 4) leads inevitably to tooth loss. The slow–moderate progression of ICR may explain the late presentation found in this study, reinforcing the importance of long-term follow-up of this special dental care group.

The maxillary sinus augmentation procedure has become a predictable treatment to regenerate bone for implant placement. The purpose of this study was to evaluate the effect of recombinant human platelet-derived growth factor BB (rhPDGF-BB) combined with a deproteinized cancellous bovine bone graft for sinus augmentation. The lateral window approach was used for maxillary sinuses with minimal residual bone. After a healing period of 4 months, dental implants were placed and then restored following a 2-month osseointegration period. The result demonstrated increased bone height and ISQ values and a 100% survival rate. This study indicates that the addition of rhPDGF-BB to deproteinized cancellous bovine bone accelerated the healing period in maxillary sinuses with minimal native bone.

Contains fulltext : 137380.pdf (Publisher’s version ) (Closed access) We present the preliminary results of a study involving a group of consecutive patients who underwent lower border onlay grafting, limited to the symphyseal area, in preparation for implant insertion. This technique allows for maximum-sized implants, followed by prosthetic rehabilitation. The main advantage of this method is the minimal risk of damage to the mental nerve. Sixteen patients were followed for a period of 6 months to 4 years and all were free of neurosensory disturbances. Eight had a removable overdenture placed and were satisfied with the result. This surgical approach allows the patient to wear their dentures during the healing period. A further advantage of lower border grafting over intraoral upper border grafting is that mucosal dehiscences are not seen.

A mixture of mineralized allograft cortical and cancellous chips was used to augment the maxillary sinuses of 10 patients. Eleven sinus augmentation procedures were performed, and 19 bone cores were obtained at reentry after 6 to 7 months. Computed tomography at 6 months postaugmentation demonstrated bone formation in all sites. Light microscopic and histomorphometric evaluation confirmed bone formation at the treatment site that would receive osseointegrated implants to replace the missing maxillary posterior teeth. These encouraging results support the use of a mixture of mineralized allograft cortical and cancellous chips for sinus augmentation.

PubMedID: 25041273 Objectives: The objective of this prospective, controlled clinical study was to determine the outcomes of dental implant therapy with staged guided bone regeneration procedures in patients with type 2 diabetes. Patients and methods: Twenty-four patients were included in the study. Half of the patients were diagnosed with type 2 diabetes mellitus (group 1) while the other half (group 2) of the patients consisted of patients without diabetes. The edentulous maxillary anterior/premolar regions with sufficient vertical height but inadequate horizontal width were treated with staged guided bone regeneration technique and with one or two implant-supported fixed restorations. The patients were followed up at least for 12 months. The parameters that were evaluated were radiographic evaluations on CBCT images and periapical radiographs, histomorphometric analysis, resonance frequency analysis (RFA) and wound-healing parameters. The data were analyzed statistically. Results: A total of 43 implants were placed in 24 patients (22 implants in group 1 and 21 implants in group 2). The survival rates of implants were 100% for both groups. The success rate of implants was 95% for group 1 and 100% for group 2. None of the parameters including CBCT findings, RFA values, success rates and wound-healing scores showed a significant difference between the two groups. Conclusion: Staged guided bone regeneration is a feasible augmentation procedure for the treatment of horizontal bone deficiencies of the maxillary anterior/premolar regions in well-controlled type 2 diabetic patients. © 2015 John Wiley & Sons Ltd.

The purpose of this systematic review was to evaluate clinical studies on the follow-up survival of implants inserted in the zygomatic bone for maxillary rehabilitation. A comprehensive search of studies published from 2000 to July 2012 and listed in the PubMed/MEDLINE, Embase, and Cochrane Library databases was performed in accordance with the PRISMA statement. Relevant studies were selected according to predetermined inclusion and exclusion criteria. The initial database search yielded 751 titles. After filtering, 313 abstracts were selected, culminating in 42 full text articles. Application of eligibility criteria led to the elimination of 17 articles. Hence 25 full-text articles were considered clinically relevant and were included. Calculations of the interval survival rates and cumulative survival rates of implants could be carried out on the data extracted from the final list of included studies for the different time intervals. These studies reported the insertion of a total of 1541 zygomatic implants and 33 implant failures. Failure generally occurred during the first year interval and was related to clinical complications, such as recurrent acute and chronic sinusitis. After a 36-month follow-up, the survival rate was 97.86%. Additional studies with longer follow-up periods, including the number of zygomatic implants inserted and details of the variations in the surgical techniques used and the impact of the maxillary morphology are still required.

This retrospective study demonstrates, by clinical and histologic evaluation, the benefit of the replaceable bony window as a homologous bony barrier in lateral sinus augmentation.A total of 103 maxillary sinus augmentations were performed using a piezoelectric device and a Er,Cr:YSGG laser apparatus. The detached bony windows were repositioned over various bone grafts. Sixteen bone biopsy specimens were harvested at the time of uncovering or implant placement.Three sinuses developed postoperative infections (2.91%). After 6 to 8 months of healing, uncovering procedures were carried out. Radiographically, reconstruction of the lateral sinus wall was observed in all cone-beam computed tomogram. Clinically, complete bone healing between the replaceable bony window and the lateral sinus wall was observed in all cases, except for the 3 infected sinuses (100 sinuses, 97.09%). Histologically, favorable new bone formation was observed in all specimens without any fibrous connective tissue invagination. More mature bone was observed along the floor of the replaceable bony window than at the center of the graft site.This study demonstrates that the replaceable bony window acts as an osteoinductive homologous barrier membrane over various bone graft materials and accelerates new bone formation in lateral sinus augmentation.

This clinical report illustrates a modern method for oral rehabilitation of severe edentulous atrophic ridge. Shallow vestibule and small denture-bearing area of the maxilla provide insufficient retention, and only the symphyseal region of the mandible has obvious alveolar ridge. The surgery of deepening vestibule of the maxilla ridge was done by using tentative miniscrew combined with old denture and soft liner. The osseointegrated dental implants were installed over symphyseal region of the mandible to act as retentive devices for prostheses. In addition, functional reline with rebase material to build buccal-tongue contact over the retromolar area after denture delivery obtained high satisfaction from the patient. Many clinical conditions cannot be managed solely with implants or preprosthetic surgery alone, whereas a combination of the 2 can achieve successful outcome.

The aim of this work was to investigate, through histological evaluation, the in vivo behavior of fresh frozen bone (FFB) used as particulate bone substitute in intraoral regenerative procedures. A total of 10 patients (group 1) received particulate FFB graft for bone regeneration in postextractive sockets, and 10 (group 2) underwent maxillary sinus augmentation by using the same bone substitute as filling. Fresh frozen bone was supplied from the Tissue Bank of the Veneto Region, Treviso Section.Healing was uneventful for all the patients and was monitored by periodical radiographs. Patients were scheduled for implant insertion according to the radiographic aspect. However, the mean healing time for group 1 was 45 days, whereas for group 2 patients, it was 100 days. At the moment of implant insertion, bone specimens were collected at the site of implant placement, from both groups and processed for histological analysis.Histological analysis after hematoxylin-eosin staining obtained from group 1 patients showed the presence of newly formed bone tissue, still well distinguishable from the grafted bone substitute. In samples from group 2 patients, a better integration could be recognized associated with active bone remodeling phenomena.These results showed a good integration of the considered FFB graft within the host tissue both at 45 and 100 days after grafting, displaying this biomaterial as suitable for preimplant regenerative procedures.

The success of implant-supported restorations depends on the treatment planning and the transfer of planning through the surgical field. Recently, new computer-aided design and manufacturing (CAD/CAM) techniques, such as stereolithographic (SLA) rapid prototyping, have been developed to fabricate surgical guides to improve the precision of implant placement. The objective of the present case is to introduce a recently developed SLA surgical guide system into the rehabilitation of a 62-year-old male patient with mandibular edentulism. After obtaining a cone-beam computerized tomography (CBCT) scan of the mandible with a radiographic template, the images were transferred into a 3-dimensional (3D) image-based software for implant planning. The StentCad Beyond SLA surgical guide system, which is a combination of a currently used surgical template with pilot hollows and a surgical handpiece guidance apparatus, was designed to transfer a preoperatively defined implant position onto the surgical site without any drill-surgical guide contact. For the fabrication of this system, a surgical handpiece was scanned by a laser optical scanner and a mucosa-supported surgical guide was designed according to the patient's 3D model, which was attained from the CBCT images. Four dental implants were inserted through the SLA surgical guide system by a torque-controlled surgical handpiece to the interforaminal region via a flapless surgical procedure. Implants were assessed 3 months after surgery, and an implant-retained mandibular overdenture was fabricated. The present case emphasizes that CAD/CAM SLA surgical guides, along with CBCT images and scanning data, may help clinicians plan and place dental implants.

Rehabilitation of severely atrophic jaws is facilitated when basal disk implants are used after activation of the future bony implant bed with a purpose-designed instrument (Osteotensor) 45 to 90 days before implant surgery. Fabrication of a highly rigid, screw-secured fixed prosthesis that acts as an external orthopedic fixator permits immediate functional loading. This protocol also represents a second chance for patients who have experienced complete implant loss and/or bone graft failure.

Various techniques have been proposed for the fabrication of surgical guide templates in implant dentistry. The objective of this paper is to review the associated literature and recent advancements in this field, based on design concept. An electronic and hand search of the literature revealed 3 categories, namely, nonlimiting, partially limiting, and completely limiting design. Most clinicians still adopt the partially limiting design due to its cost-effectiveness and credibility. Moreover, clinicians use cross-sectional imaging during the preimplant assessment of surgical sites.

The aim of this pilot study was to present a novel technique for the management of the Schneiderian membrane during maxillary sinus lift surgery using plasma rich in growth factors (PRGF). Eight maxillary sinuses were augmented in 8 patients. Two small perforations of the Schneiderian membrane occurred during the lifting procedure, which were solved using the PRGF clot before grafting the site with PRGF and anorganic bovine bone. With the exception of 1 patient who experienced pain following an acute sinus infection after 3 days of uneventful healing, the patients' postoperative quality of life was generally good. The most common complication (50% of cases) was hematoma, which disappeared after 1 week. Despite the limitations of this study concerning the sample size and the study design, the use of PRGF may be helpful in reducing complications following sinus lift surgery. More well-designed studies, with larger sample size, are needed to validate this protocol.

The aim is to describe bilateral vertical ridge augmentation with intraoral block grafts and guided bone regeneration in the posterior mandible in preparation for implant placement. A 61-year-old woman, edentulous in the posterior mandible, presented for implant rehabilitation. The radiographic study showed 3 to 6 mm of bone height from the ridge to the mandibular canal. Autogenous bone block grafts from the chin and the mandibular ramus, harvested with ultrasonics, were used to augment the alveolar ridge. To reduce resorption, the grafts were covered with particulate alloplastic material and a collagen membrane. Delayed implants were placed 6 months after vertical augmentation, and 3 months later implants were loaded with a fixed prosthesis. A temporary sensory complication occurred, but 12 months after implant loading, there were no failures. In this case report block bone grafting was a feasible option to vertically augment the alveolar ridge in the posterior mandible.

Context: The maxillary sinus elevation procedure has become an important pre-prosthetic surgical procedure for the creation of bone volume in the edentulous posterior maxilla for the placement of dental implants. Research and clinical experience over the past 30 years has increased the predictability of this procedure as well as reduced patient morbidity. Evidence Acquisition: Data on grafting materials and implant survival rates comes from 10 published evidence-based reviews that include all relevant published data from 1980 to 2012. Supporting clinical material comes from the experience of the authors. Evidence synthesis: The evidence-based reviews report and compare the implant survival rates utilizing various grafting materials, implant surfaces, and the use or non-use of barrier membranes over the lateral window. Clinical studies report on complication rates utilizing piezoelectric surgery and compare them to complication rates with rotary instrumentation. Conclusions: The conclusions of all the evidence-based reviews indicate that the utilization of bone replacement grafts, rough-surfaced implants, and barrier membranes result in the most positive outcomes when considering implant survival. Further, the utilization of piezoelectric surgery, rather than rotary diamond burs, for lateral window preparation and membrane separation leads to a dramatic reduction in the occurrence of the intraoperative complications of bleeding and membrane perforation.

Objectives The aim of this study was to evaluate the extent and quality of new bone 6 months after sinus lift with biphasic micro- and macroporous calcium phosphate combined with fibrin sealant (MBCP-FS) and the 1-year implant success rate in the augmented site. Material and methods MBCP-FS was applied to one sinus in 96 subjects requiring augmentation for delayed dental implant placement. In subjects who required bilateral lifts (N = 33), the MBCP-FS sinus was randomly selected; the contralateral sinus was grafted with autologous bone (mixed with Bio-Oss when harvested bone volume was insufficient. Panoramic views were taken periodically prior to and up to 18 months post-lift. Histomorphometric analysis was conducted on biopsies taken during implant placement 6 months after augmentation. Implant functionality and prosthesis success were assessed clinically 1 year after implant placement. Results In MBCP-FS sinuses, 20.6 ± 8.5% new, mainly lamellar bone was observed. Implants were placed as planned in 78/85 evaluable subjects (91.8%) 6 months after sinus lift. Graft heights remained stable 1 year after placement; 94.7% (142/150) of implants were functional. The amount and quality of new bone and implant success rates with MBCP-FS were similar to autologous bone graft (mixed with Bio-Oss in 30/31 evaluable subjects). MBCP-FS was safe and well-tolerated. Conclusions MBCP-FS is safe and effective in sinus floor elevation for dental implant placement, supporting bone regeneration and with high 1-year implant success rates similar to autologous bone mixed with Bio-Oss.

Panfacial fractures involve trauma to the lower, middle, and upper facial bones and often require a team approach for management. Early and complete restoration of preinjury facial contours and function should be the goal of the oral and maxillofacial surgeon and the prosthodontist. When the intraoral landmarks are lost, overall facial anatomic landmarks can be used to restore the oral cavity. A patient with complex clinical panfacial fractures, including a vertically and horizontally malpositioned native alveolar bone and severe facial asymmetry, is presented. A functional and esthetic rehabilitation was successfully accomplished by using a partial removable dental prosthesis retained with telescopic crowns and magnetic attachments in the maxilla and osseointegrated implants to support a definitive dental prosthesis in the mandible.

The use of autologous calvarian split thickness bone grafts is a well accepted preprosthetic surgical procedure for reconstruction of the severely atrophied maxilla. Although generally accepted as being a superior bone graft regarding long-term stability, the reported risks in the literature may dissuade the surgeon. A modified cone-beam computed tomography (CBCT) scanning protocol (extended field of view starting from 1 cm below the occlusal plane up to the limit of the cranial vault, 0.4 voxel) is proposed that allows assessment of both the cranial donor site as the maxillary receptor site and the sinus conditions with a single scan. Issues regarding quality of the data, radiation dose and clinical practicability are discussed.

Purpose The severely atrophic edentulous maxilla imposes a challenge for dental implant rehabilitation. Nasal floor augmentation (NFA) is a method of augmenting bone height in the anterior maxilla. Autogenous bone has been commonly used as a graft material. Because of variations in results and lack of insufficient studies reporting the use of bone substitutes to graft the nasal floor, this study aims to evaluate the survival and success of dental implants placed in nasally grafted maxillae with osteoconductive bone substitutes. Materials and Methods Six patients with completely edentulous maxillae and inadequate height in the anterior to support implants underwent NFA. The nasal floor was exposed through an intraoral approach and grafted with osteoconductive bone graft substitutes. Twenty-four dental implants were placed, restored with a bar-retained implant-supported overdenture after a traditional healing period, and followed up after prosthetic loading. Patient satisfaction was evaluated with a questionnaire, and responses were expressed on a visual analog scale from 1 to 10. Bone levels were quantified radiographically based on a score ranging from 1 to 3, where 3 represented the highest bone support. Implants were evaluated for thread exposure and soft tissue health and were considered successful if the following criteria were met: absence of mobility; lack of symptoms; bone score of 3; and healthy peri-implant soft tissue without thread exposure. Results The age of patients ranged from 48 to 84 years, with a mean of 71.2 years. Three patients underwent NFA and simultaneous implant placement, whereas the other 3 had a mean healing period of 6.5 months before implant placement. Post-loading follow-up ranged from 4 to 29 months, with a mean of 14.2 months. The implant survival rate was 100%, with no complications. Ninety-three percent of the responses to the treatment satisfaction questionnaire had a score of 7 or greater. Bone scores ranged from 2 to 3, with 87.5% of implants having a score of 3 and 12.5% having a score of 2. None of the implants had a bone score of 1. Conclusions The use of osteoconductive bone substitutes for NFA, as shown in this small case series, is a reliable method for reconstruction of the anterior atrophic maxilla for implant-supported overdentures.

Purpose Sinus lifting without graft materials allows new bone formation in the sinus, but the amount of bone formation varies. This study aimed to investigate whether nongrafted sinus lifting using a titanium bone fixation device can promote bone formation in the sinus. Materials and Methods Patients with atrophic posterior maxillae jeopardizing implant stability were included. After nongrafted sinus lifting in combination with implant placement, repositioning of the bone window and additional space-maintaining management were performed by use of the bone fixation device. The primary variables recorded retrospectively included implant survival and preoperative and postoperative alveolar crest height with and without Schneiderian membrane perforation. Independent variables included patient demographics, position and dimension of the implants, complications, and follow-up period. The t test was used for comparing differences in bone levels. The implant survival rate was estimated by uses of Kaplan-Meier statistics. Results The study included 11 patients (4 men and 7 women) and a total of 21 implants. Radiographically, new bone formation around the implant was generally observed in accordance with the implant apex. Postoperative alveolar crest height (mean, 10.9 ± 2.2 mm) was significantly higher compared with residual alveolar crest height (mean, 4.7 ± 1.4 mm), and no significant difference in bone formation was seen according to membrane perforation. The cumulative survival rate was 95.2%. Conclusions This nongrafted sinus-lifting procedure using a bone fixation device could attain predictable bone formation. Additional space-maintaining management using a bone fixation device in a nongrafted sinus lift offers a useful technique for promoting bone formation in the sinus.

Ridge preservation can minimize the loss of alveolar bone subsequent to tooth extraction in preparation for implant therapy. The purpose of this study is to histologically and clinically compare human demineralized bone matrix (DBM) putty with one size of bone particles (SPS) to human DBM putty with two different sizes of bone particles (multiple particle sizes [MPS]) in ridge preservation after molar extractions.Molar tooth extraction and ridge preservation were performed in 20 participants for each treatment group. Approximately 20 weeks after grafting, core biopsies were obtained during implant placement and analyzed under light microscopy. Specimens were analyzed for the percentage area of vital bone, residual graft particles, and non-mineralized structures (connective tissue/other non-mineralized tissue [CT]). Changes in alveolar ridge dimensions were also determined.Sixteen participants in the SPS group and 14 in the MPS group completed the study. The SPS group had a mean of 49% vital bone, 8% residual graft, and 43% CT. The MPS group had 53%, 5%, and 42%, respectively. Patients in both groups lost a mean of1 mm alveolar height on the buccal and lingual aspects and1.5 mm of total ridge width. There were no statistically significant differences between the two groups for any clinical or histologic parameters.The results of this study suggest that addition of larger bone particles to DBM putty does not offer additional benefit in the preservation of alveolar bone after the extraction of molar teeth.

There is limited information regarding marginal bone-level changes around immediately loaded implants placed with the osteotome technique. The aim of this case series is to prospectively evaluate the clinical and radiographic outcome of immediately loaded implants placed with the osteotome technique over a 12-month period.Eighteen patients in need of oral prosthetic rehabilitation that included single implant placement in positions #4 to #13 and/or #20 to #29 participated in this prospective trial. A modified implant installation procedure with an under preparation of the implant bed using the osteotome technique and immediate loading of the implant was performed. Clinical examinations were performed at 2 weeks, 6 months, and 12 months of follow-up. Radiographic examinations were performed at implant installation and at the 6- and 12-month follow-up visits.One implant failed to integrate and was removed at 3 months after implant installation. Four of 20 implants had insertion torque value35 Ncm. The mean marginal bone loss was -0.09 mm at the 6-month and -0.19 mm at the 12-month follow-up visits.The present case series indicates that implants placed with the osteotome technique and immediately loaded did not demonstrate a high insertion torque and exhibited minimal marginal bone loss.

The 2-piece surgical guide introduced in this article is designed for guiding implant placement in the edentulous arch. With the aid of embedded magnets, this guide can be easily and quickly assembled and disassembled during the surgical procedure without losing the predetermined guidance for the implant placement.

WOS: 000296071200015 PubMed ID: 21798642 Purpose: The purpose of this study was to compare Unilab Surgibone (USB) (Mississauga, Ontario, Canada), a bone xenograft (bovine), with platelet-rich plasma (PRP) and USB without PRP to augment the human maxillary sinus in preparation to receive dental implants. Patients and Methods: Patients who had bilateral pneumatized maxillary sinuses were included. Sinuses on one side were augmented with the USB-PRP combination and formed the study group, whereas the opposite-side sinuses were augmented with USB alone and served as controls. Bone biopsy specimens were taken during implant placement at 6.8 +/- 0.9 months after maxillary sinus floor augmentation. Resonance frequency analysis measurements were performed at implant placement (first control) and before the prosthetic stage (second control), at 6.5 +/- 0.7 months after implant surgery. Results: There were 10 patients (7 men and 3 women; mean age, 53.7 +/- 0.8 years). Integration between new bone and residual grafts was histologically observed in all samples. The volumes of soft tissue were 59.9% +/- 7.5% and 57.8% +/- 4.4% in the control and study groups, respectively; residual graft, 21.9% +/- 6.6% and 23.6% +/- 5.9%, respectively; new bone, 15.8% +/- 4.8% and 16.0% +/- 3.8%, respectively; and trabecular bone, 64.7% +/- 22.5% and 69.1% +/- 18.6%, respectively. A positive correlation was found between new bone volume and trabecular bone volume (P = .0001). The mean Implant Stability Quotient (ISQ) values were 71.7 +/- 4.9 and 70.3 +/- 5.7 in the control and study groups, respectively, at first control and 75.4 +/- 6.4 and 74.4 +/- 6.4, respectively, at second control. The mean ISQ values at second control in both groups were significantly higher than at first control (P = .043 and P = .028, respectively). No statistically significant differences were observed between groups (P > .05). Conclusion: The combination of USB and PRP does not have any effect on new bone formation and implant stabilization. (C) 2011 American Association of Oral and Maxillofacial Surgeons J Oral Mcaillofac Surg 692537-2547, 2011

Objectives The purpose of this study was to investigate the effect of simultaneous bone-augmentation procedures, and their combination, on the survival of dental implants and on the incidence of complications. Material and methods Within a retrospective analysis, 958 implants placed in 404 patients (mean age 58.18) were selected from a prospective clinical study. In 304 cases of reduced bone width, bone spreading (n = 217) with hand osteotomes, or bone splitting (n = 15), or guided bone regeneration (n = 72) combined with autogenous bone grafts were also performed. Eighty-eight implants were placed in combination with simultaneous internal sinus floor elevation without using graft material. For 194 additional implants, several augmentation procedures were combined because of extensive bone deficits. Three-hundred and seventy-two conventionally placed implants served as controls. Implant failures and complications were recorded after a mean observation period of 2.1 years (maximum 6.9 years). Results Seventeen failures and nine additional implant-related complications were observed. After 4 years, Kaplan–Meier curves revealed a probability of survival without complication of 97.5% for conventionally placed implants, and 95.8% for implants placed in combination with a single augmentation technique. If several augmentation techniques were combined, success decreased to 94.1%. Complication-free survival differences between combined augmentation techniques and conventionally placed implants were significant (P = 0.004). Age, gender, and location showed no effect on implant survival. Conclusions It can be concluded that simultaneous bone-augmentation techniques slightly reduce short-term prognosis for dental implants. This effect was more pronounced when advanced defects required the combination of several augmentation procedures.

Purpose The purpose of this study was to evaluate the amount of bone formation under a sinus membrane tented with implants and filled with venous blood as a graft material. Materials and Methods Fourteen patients (17 sinus augmentations) were consecutively treated with sinus floor elevation via the lateral window approach. The lateral bony window was created using a piezoelectric saw, and the sinus membrane was elevated to make a new compartment. After resorbable blast media–surfaced dental implants were placed simultaneously, the collected peripheral venous blood was applied to support the sinus membrane over the implant apex, and the bony portion of the lateral window was repositioned to seal the lateral window. In 6 cases, samples were taken for biopsy at the time of second stage surgery. Results An average of 6.8 months after the sinus augmentation, new bone consolidation in the maxillary sinus was observed by radiographic and histologic evaluation. Vital bone formation was 38.70% according to the histomorphometric data. Of the 31 implants placed, 2 failed. The overall implant survival rate was 93.5%. All failures occurred when implants were placed into the extraction socket and were associated with poor initial stability. Conclusion This study suggests that simultaneous placement of dental implants and injection of peripheral venous blood as a graft material appears to be a safe alternative procedure for maxillary sinus augmentation.

When immediate implant placement is considered for teeth with close proximity to the sinus floor, apical extension of the osteotomy is significantly limited, and often a staged approach is used. Implant placement into fresh extraction sockets and sinus floor manipulation using bone-added osteotome sinus floor elevation with implant placement are techniques most often used independently or sequentially. Very few reports have described the combined use of immediate implant placement in fresh sockets and the bone-added osteotome sinus floor elevation technique.We present five cases in which a maxillary premolar was extracted and an implant placed into the extraction site with simultaneous abfracture of the sinus floor using osteotomes. All teeth were extracted atraumatically, and sockets carefully debrided and checked for integrity of the walls. After ideal osteotomy preparation, particulate bone graft was placed in the osteotomy and appropriately sized osteotomes were used for sinus floor elevation. After sufficient elevation, implant placement was completed and particulate bone was packed in the bone-implant gap when indicated.All implants were restored after a minimum healing period of 6 months. At the time of final restoration, bone was seen surrounding the implants from the apical portion to the most coronal thread. All five implants healed without complications and were in function for periods ranging from 6 to 12 months.Immediate implant placement with simultaneous osteotome sinus floor elevation is an advantageous combination of two successfully used techniques. This combined approach can significantly reduce the treatment time for implant therapy in teeth with close sinus proximity and provide the operator with the ability to place implants of desired length.