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This work evaluates the data gathered over a period of 10 years on implants placed with the edentulous ridge expansion (ERE) technique by a group of specially trained and experienced surgeons. Between January 1992 and December 2001, 1715 consecutive implants were placed with the ERE technique by nine different dental surgeons using a common surgical protocol. The implants were followed up using a common protocol and a specific database for the collection of clinical information on the patient, surgery, and follow-up, including the 1986 Albrektsson et al criteria for implant success. All data gathered at the end of the study period were placed in a common database. The overall success rate over the O-year follow-up period was 95.7%. [ABSTRACT FROM AUTHOR]

Background: Trans-crestal sinus lift procedures are well established., Purpose: to retrospectively analyse the efficacy of a flapless trans-crestal maxillary sinus floor elevation and simultaneous dental implant placement based on the Localised Management of Sinus Floor (LMSF) technique suitable for cases with sufficient width of keratinized tissue and of crestal bone but insufficient vertical dimensions of the bone below the sinus., Materials and Methods: 71 sinus elevations with simultaneous implant placement were performed on 52 consecutive patients. Following an initial pilot bur transmucosal perforation, the Magnetic Mallet was used with progressively larger osteotomes. The mallet osteotomes are initially directed palatally, towards the cortex of the medial wall of the sinus, below the palato-nasal recess (PNR) and then redirected in a more vertical direction to create the final osteotomy for implant placement., Results: No significant complications were reported in the post-operative phase. The cumulative success rate during the observation period was 95%. All successful implants were successfully loaded with metal-ceramic or monolithic zirconia crowns and bridges and remained in function during the observation period., Conclusions: Flapless Localised Management of Sinus Floor (LMSF) is a safe and effective surgical technique with minimal risks and with the advantage of low morbidity. Also, only native bone is used for augmentation and there is no need for additional grafting., Competing Interests: The authors declare no conflict of interest., (© 2021 The Authors. Published by Elsevier Ltd.)

Purpose: This study aimed to evaluate the radiographic bone level changes of implants positioned via the split-crest procedure both in the maxilla and mandible at a long-term follow-up., Materials and Methods: Seventy-one patients were retrospectively enrolled in the study. The placement of 137 dental implants was performed in the edentulous premolar or molar region after a split-crest ridge expansion procedure. Implants followed a delayed loading protocol. Intraoral digital radiographs were performed at baseline, upon implant placement, at 70 days (following placement of the provisional prosthesis), and on a yearly basis during followup. Crestal bone levels were evaluated at the baseline, upon provisional prosthesis placement, at 12, 36, and 60 months, and at the long-term follow-up of healing from implant placement., Results: The patients underwent a mean follow-up of 6.54 ± 1.32 years, from which the implant survival rate was reported at 98.54%. Within the first year from implant placement, a bone loss resulted at a mean value of -1.11 ± 0.44 mm. After almost 3 years from implant placement, a mean bone gain of +0.89 ± 0.39 mm was reported, which was statistically significant compared with 12-month values (P < .05). From this point, bone levels remained stable, reporting similar values over time, with no significant differences (P > .05)., Conclusion: A mean vertical bone gain of +0.89 ± 0.39 mm was observed after almost 36 months after implant positioning.

Since the presence of keratinized gingiva is so important for peri-implant outcome, the aim of this study is to describe a partial thickness flap design to increase the amount of keratinized peri-implant tissue as well as its thickness. A total of 131 implants were placed in 85 patients: 103 implants (78.63%) in the mandible and 28 implants (21.37%) in the maxilla. Before implant placement in edentulous ridge the residual keratinized mucosa usually was measured with a periodontal probe in a buccal-palatal direction. A palatal or lingual incision was made to raise a partial thickness flap with the residual keratinized tissue. After implant placement the flap was apically repositioned and secured with loose periosteal sutures. Keratinized tissue levels were calculated at baseline, at 6 months, and every year follow-up. Measurements were reported for each implant diameter. At 4-year follow-up, implant survival rate of 87.79% was reported. Peri-implant keratinized mucosa confirmed clinical gain in all cases; mean levels at 1- and 4-year follow-ups were 7.26 ± 2.01 mm and 7.37 ± 2.12 mm, respectively. The levels remained stable over time. This flap design allows immediate correction of adaptation of the keratinized tissue around the implant, increasing the thickness and amount of the keratinized tissue.

Dental ankylosis often presents a significant vertical alveolar defect that is an esthetic problem for prosthetic rehabilitation. Moreover, surgical-orthodontic treatment by corticotomies and distraction devices provides special attention to avoid the loss of blood supply to the segment; furthermore, gingival recessions may appear because the gingival tissues cannot proliferate as fast as the immediate repositioning of the tooth. This case report presents a surgical technique for buccal, palatal, and vertical movements, and examines the effects of a tooth/arch-borne tooth distractor appliance, for the alignment of ankylosed teeth. The slow movements of tooth and bone block and fine cut simplifies orthodontic treatment in patients and makes it possible to achieve complex movements in a relatively short period. The reported dislocation procedure allows a use of buccal-lingual vertical osteotomy with horizontal osteotomy to correct tooth positions via bony block movement maintaining gingival tissues in position. The used sonic saw have proven to be a valuable alternative to manual or rotating tools, oscillating saws, or piezoelectric units because it is faster and easier for surgical approach.

The aim of this study was to evaluate the efficiency of electrical mallet for tooth extraction evaluating the integrity of fresh sockets walls. From July 2009 to February 2012, 427 hopeless teeth were extracted in 156 patients: 96 males and 60 females, with a mean age of 53.2 ± 26.4 years. Two hundred fifty teeth were extracted from the maxilla and 177 from the mandible. Extractions were performed using an electrical mallet. It pushed blade in a longitudinal movement along central axis, moving up and down toward the periodontal ligament space in a repetitive manner, providing a driving mechanism of longitudinal movements. Intraoral digital radiographic examinations were performed before and immediately after dental extractions to evaluate the lamina dura setting. No fracture or loss of cortical bone plate was observed in fresh sockets of teeth extracted by electrical mallet. All the alveoli revealed full soft tissue secondary healing 2 weeks after complete root extraction. During the healing period, there were no signs of inflamed tissue or exposed bone in any of the cases. As reported in this clinical study, maximum preservation of the alveolar housing and related gingival structures may be achieved following assisted atraumatic tooth extraction by electrical mallet.

Purpose: The aim of this study was to evaluate the radiographic bone level changes after delayed implant placement at medium-term follow-up, with three elements kept constant: keratinized gingiva thickness, implant axes perpendicular to the opposing occlusal surface, and implants with a collar of 2 mm., Materials and Methods: Patients treated in a private practice setting were retrospectively enrolled in the study. They underwent delayed placement (4 to 8 weeks after extraction) of dental implants in edentulous premolar or molar regions. Implants followed a delayed loading protocol. Crestal bone levels were measured at baseline; at provisional prosthesis placement; at 1, 3, and 5 years; and at medium-term follow-up of healing from implant placement., Results: One hundred twenty patients received 135 implants (one or two implants per patient); 3 implants were lost. After a mean follow-up period of 9.71 ± 4.88 years, a survival rate of 97.76% was reported. At 1 year after implant placement, mean bone loss of -1.5 ± 0.62 mm was found. At almost 3 years post-implant placement, a mean bone gain of +1.20 ± 0.49 mm was seen, which was statistically significantly different compared with 1 year. After this point, the bone levels remained stable; similar values were reported over time, with no significant differences., Conclusions: The mean vertical bone gain of +1.20 ± 0.49 mm seen at almost 3 years after implant placement in this study may be supported by both clinical parameters as presence of sufficiently thick keratinized gingiva (3 mm), implants with a 2-mm collar, and the axis of implant insertion perpendicular to the opposing occlusal surface.

Objective: A pilot in vivo study was conducted to evaluate (1) the rate of osseointegration at apical, middle, and coronal levels of oral implants immediately installed into fresh extraction sockets; (2) the maturation of the newly formed bone surrounding implants during 60 days of healing; and (3) the epithelium seal development., Study Design: The premolars of 8 male adult mini-pigs were extracted at each mandibular site under general anesthesia. In the experimental side, Frialit-2 implants were immediately inserted. The gap between bone and implants ranged between 3 and 6 mm circumferencially. Bone specimens were obtained at 7, 15, 30, and 60 days after surgery for histologic and histomorphometric studies. Bone-to-implant contact (BIC), bone volume, trabecular thickness, number, and separation were recorded. Nonparametric exact tests were used to evaluate data., Results: BIC at the coronal level was observed close to 0% at day 7 and increased up to 60% at day 60 after surgery on an average. BIC increased from 11.7% to 47.38% at middle level and from 53.4% to 67.38% at apical level from day 7 to day 60. With respect to bone maturation, in the earlier stages of healing, many thin trabeculae were observed, which, particularly at coronal level, became significantly fewer and thicker in more advanced stages. At day 60, the features of the bone were similar to those of baseline. The epithelium never migrated more than 1.8 mm apically to the top of the alveolar bone level., Conclusion: When implants are placed immediately into fresh extraction sockets, in minipig models osseointegration also occurs without initial bone contact.

The edentulous ridge expansion (ERE) technique is a partial-thickness flap procedure for implant surgery that was developed in 1986. The ERE technique permits the use of osseointegrated implants at sites whose minimal orofacial dimensions are insufficient for traditional implant surgery. The present work is a histologic and ultrastructural study of hard tissue repair modalities at edentulous sites that were treated with the ERE technique in 20 humans. Biopsies were obtained from the tissue regenerating within the surgically created bone gap between the mobile buccal and nonmobile lingual or palatal bone-periosteum plates ("bone flaps") on days 40, 90, 120, 150, and 480 (day 0 = day of implant insertion). The results suggest that osteoblasts differentiate from preexisting mesenchymal cells located on the original fissure walls, with consequent deposition of new bone in the surgically created intrabony defect.

Localized management of sinus floor (LMSF) achieves implant placement and sinus lifting simultaneously. LMSF is a further application of the principles of the edentulous ridge expansion (ERE) technique. It comprises the dissection of a partial-thickness flap, the buccal expansion of the residual alveolar bone, and the fracture and elevation of the sinus floor with simultaneous implant placement. Three hundred three patients were treated with 499 implants placed using the LMSF between April 1988 and December 1993. The selected patients, who showed no signs of sinus pathology, exhibited insufficient vertical alveolar bone dimensions for the placement of dental implants with the traditional technique. The minimal residual alveolar bone height was between 5 and 7 mm. Based on the criteria established by Albrektsson and his coworkers in 1986, the success rate of the 499 implants placed with the LMSF was 97.5%.

The aim of the present investigation in the dog was to study: (i) if it was possible by the use of EREt to predictably expand the compromised alveolar ridge; (ii) if proper osseointegration also occurred at sites where the implant following installation was devoid of direct bone contact. 5 beagle dogs, about 1-year old, were included in the study. During a preparatory period, the mandibular premolars were extracted and the ridge in the edentulous regions markedly reduced. After 3 months of healing, ridge expansion surgery was performed. A partial thickness flap was raised on the buccal and lingual surfaces for the soft tissue preparation. The buccal part of the ridge was mobilised and the bone plate with its periosteum displaced in the buccal direction. In each quadrant, 2 fixture sites were prepared in the mandibular bone apical of the displaced bone plate. 2 unthreaded titanium plasma sprayed fixtures were installed in such a way that the coronal border of the fixture was flush with the level of the lingual and buccal bone plate. The "internal" distance between the mobile buccal and the non-mobile lingual bone plates was identical to the diameter of the fixtures, i.e., 3.3 mm, while the distance between the mesial and distal borders of the 2 implants and the mesial or distal bone was > 5 mm. In each quadrant, 1 additional fixture was installed in the non- reduced mesial part of the alveolar ridge (control site). 3 months after fixture installation, abutment connection was performed. Following abutment connection, a plaque control program was initiated and maintained for 4 months, at which time, the dogs were re-examined and biopsies obtained for histological examination. It was observed that bone regeneration and osseointegration may occur to titanium fixtures placed in surgically-created bone defects. The amount of bone that was in intimate contact with the fixture surface was similar in test and control sites. In addition, the periimplant mucosa at test and control implants had similar dimensions and composition in terms of junctional epithelium and connective tissue.

This study presents the clinical results of a surgical technique that expands a narrow ridge when its orofacial width precludes the placement of dental implants. In 170 people, 329 implants were placed in sites needing ridge enlargement using the endentulous ridge expansion procedure. This technique involves a partial-thickness flap, crestal and vertical intraosseous incisions into the ridge, and buccal displacement of the buccal cortical plate, including a portion of the underiying spongiosa. Implants were placed in the expanded ridge and allowed to heal for 4 to 5 months. When indicated, the implants were exposed during a second-stage surgery to allow visualization of the implant site. Occlusal loading was applied during the following 3 to 5 months by provisional prostheses. The final phase was the placement of the permanent prostheses. The results yielded a success rate of 98.8%.

The authors present several significant photographs of the apical anatomy of a tooth made using a stereo-microscope in the course of surgery. The authors generally use the stereo-microscope from the time of preparation of the apex to the retrograde filling. One of the changes which the authors have brought to traditional surgical procedures, the use of endodontic cement to improve the amalgam seal is illustrated. It consists of a modification which they introduced into their practice more than six years ago and even though it may be a simple clinical technique to use, it assured a significant long-term improvement in the cases treated.