Technique for nasal floor elevation for implant placement in the atrophic anterior maxilla
Papilla regeneration technique for inter implant prosthetics
Implant Diameter Selection During Immediate Implant Placement
Implant surgery- Establishing and Maintaining Osseointegration
Topic: Lateral alveolar ridge augmentation
Author: Schwartz F.
Title: “Periodontally diseased tooth roots used for lateral alveolar ridge augmentation. A proof-of-concept study”
Source: J Clin. Periodontol. 2016; 43: 797-803. doi:10.1111/jcpe.12579
Type: Proof-of-concept study
Rating: Good
BG: The anorganic and organic composition of dentin closely resembles that of bone. It’s organic matrix is also dominated by collagen type I. Previous studies have reported that dentin used either as particulated or block autograft featured osteoconductive as well as osteoinductive properties. In a recent experimental study performed in dogs, extracted tooth roots were successfully used for localized horizontal alveolar ridge augmentation and staged Osseointegration of titanium implants. Histologically, the transplanted roots were replaced by newly formed bone and equally supported the early phase of Osseointegration.
P: To histologically evaluate the efficacy of periodontally diseased tooth roots used as autografts for lateral ridge augmentation and two-stage early Osseointegration of titanium implants in a canine model.
M&M: 8 foxhounds with a fully erupted permanent dentition were included. There were 3 experimental phases. Phase 1: in both upper quadrants, the maxillary premolars were randomly selected to either a ligature induction of periodontitis lesions (PM-P) or were left untreated. The mandibular premolars and molars were extracted after elevating a full thickness flap. Three standardized box-type bone defects were created on each side of the mandible, resulting in six defects per dog. Maxillary ligatures were removed after 4-6 months after 30% of the initial bone support was lost. Phase 2: Each of the available defects was randomly selected to be augmented with PM-P, PM-C (normal healthy tooth, which was a component of another study), or autogenous bone (AB). In the upper jaws, PM-P were extracted and the crown was horizontally decapitated at the CEJ. Each surface of the extracted roots were adequately debrided and planed. To support Ankylosis of these roots, the surface that would face downward toward the defect had the layer of cementum removed. The upward and lateral aspects of the roots had their cementum preserved. AB block graft was harvested from the Retromolar area. Whenever possible, two roots were aligned parallel to the alveolar bone crest. PM-P and AB grafts were fixed with titanium osteosynthesis screws. Phase 3: At 12 weeks, implant bed preparation was performed at the transition between the host bone and the grafted area. Two-piece Bone Level SLA titanium implants were inserted with primary stability. At the end of phase 3 animals were euthanized, and the jaws were dissected and blocks containing the experimental specimens were obtained.
R: Clinical Observations: Median Crestal width (CW) was 3.83mm in PM-P and 3.67mm in AB group. Median Augmented surface area (AA) was 10.18mm in the PM-P and 9.82mm in the AB group. Median bone-to-implant (BIC) was 50.00% in the PM-P and 35.12% in the AB group. There was no SSD between PM-P and AB in any of the parameters. Histological Description: PM-P grafts were gradually involved in the bone remodeling process. This was characterized by deposition of a parallel-fibered woven bone circumferentially along the external surface of the transplanted roots. In all specimens there were clear histological signs of replacement resorption of PM-P, but these varied considerably between grafts. The initial stages showed peripheral resorption of the transplanted roots by macrophages, accompanied by deposition of CT matrix exhibiting numerous spots of mineralization. At more advanced sites, the outer surface of the roots was replaced by a parallel-fibered woven bone. The interface between the root and the adjacent implant surface was homogeneously filled by a thin layer of BIC. In none of the sites investigated, PM-P grafts were associated with the establishment of any inflammatory cell infiltrates.
D: The clinical and histological outcomes of healing were comparable for PM-P and AB. Potential drawback of the study was the protocols lack of additional control group (PM-C). Compared with the data from a later study that included a PM-C, there doesn’t appear to be a difference in the histological outcomes of healing between PM-P and PM-P. This seems to indicate that meticulous SRP of the infected root appeared to be sufficient. Both PM-P and PM-C exhibited similar features of replacement resorption. It was also noted that roots in the PM-P group were more homogeneously replaced by newly formed bone than the AB grafts.
BL: PM-P autografts may reveal a structural and biological potential to serve as an alternative autograft to AB
Topic: Technique for nasal floor elevation for implant placement in the atrophic anterior maxilla
Authors: Sentineri, Lombardo, Celauro, Stacchi.
Title: Nasal Floor Elevation with Transcrestal Hydrodynamic Approach Combined with Dental Implant Placement: A Case Report
Source: Journal of Periodontics and Restorative Dentistry Vol. 36, Number 3, 2016.
Type: Case Report
Rating: Good
Reviewer: David Long
Purpose: To introduce a novel, minimally invasive technique for nasal floor elevation using transcrestal hydrodynamic elevation and a graft of osteoconductive biomaterial with simultaneous insertion of the implants.
M&M: 67 year old Female patient with 30 year history of maxillary edentulism was selected for this study. Patient presented with Cawood and Howell Class VI maxillary atrophy. Surgical plan included bilateral maxillary sinus augmentation with 9 Straumann SLActive implants placed overall in the maxilla. Restorative plan was implant supported maxillary hybrid.
Surgical procedure:
Full thickness trapezoidal flap was elevated, implant sites were prepared using piezoelectric devices until perforation of the nasal floor cortical plate was complete
Watertight hollow screw was placed in osteotomy and progressive hydrodynamic elevation of nasal mucosa was completed
The screw was sealed and procedure was completed at the other implant sites
Hollow screws was removed and collagenized porcine xenograft was injected into the osteotomies to graft the submucosal spaces
Implants were placed with high insertion torque (60Ncm) and ISQ (>65) due to bicortical stabilization
Area was sutured and patient was placed on 6 days amoxicillin 2g, 800mg ibuprofen prn pain
Results: After 5 months of uneventful healing, second-staged of surgery was performed. At 7-months post placement, maxillary hybrid restoration was seated. At 18-months follow up both clinical and radiographic examinations proved to be acceptable.
Conclusion: Transcrestal hydrodynamic nasal floor elevation, as described in this report could be a minimally invasive alternative to vertical bone augmentation up to 6mm in the anterior maxilla. However, randomized clinical trials are necessary to confirm these results.
Cahood and Howell Classification
Topic: Papilla regeneration technique for interimplant prosthetics
Authors: Froum, Lagoudis, Rojas, Suzuki, Cho
Title: New Surgical Protocol to Create New Interimplant Papilla: The Preliminary Results of a Case Series
Source: Journal of Periodontics and Restorative Dentistry Vol. 36, Number 2, 2016
Type: Case Series
Rating: Good
Reviewer: David Long
Purpose: To introduce a new surgical method to regenerate the papilla adjacent to multiple or single implants using a novel instrument and incision design
M&M: 10 patients were selected. These subject all had maxillary implant supported prosthetics with missing interproximal papilla. Baseline measurements were taken prior to the procedure and papilla height was classified using the Jemt Classification scale. The recipient site was prepared using an oblique incision apical to the mucogingival junction (to minimize compromising blood supply) and using a specialized instrument tunneling buccolingual deep to the the papilla deficient site exiting on the palatal aspect. A subepithelial connective tissue graft was harvested from the palate and placed in this prepared tunnel and sutured into place. Three-months post-op, final prosthetic was delivered to patient.
Results: 16 months after procedure, it was seen that the average improvement in papilla score went from 0.8 (baseline) to 2.4. In only one case was there no recorded improvement in papilla score.
Conclusion: Successful papilla regeneration in the esthetic area is obtainable with the procedure described in this study. This success was seen between implant and implant, implant and tooth, and implant and pontic. Through careful incision planning, atraumatic tissue handling, meticulous home care, success of papilla regeneration can be completed. Long term studies examining the effect of this technique is needed to verify its viability.
Topic: Localized Aggressive Periodontitis
Authors: Shaddox LM, Spencer WP, Velsko IM, Al-Kassab H, Huang H, Calderon N, Aukhil I, Wallet SM
Title: Localized Aggressive Periodontitis Immune Response to Healthy and Diseased Subgingival Plaque.
Source: J Clin Periodontol 2016; 43: 746–753
Quality: Good
Reviewer: Jenny Herman
PURPOSE: To evaluate the immunological response to health and disease-associated-plaque in LAP compared to periodontally healthy patients.
METHODS: This case-control study included African-Americans age 5-21 years. 13 patients with LAP, 14 healthy siblings of LAP subjects, and 6 age matched healthy controls were evaluated. Exclusion criteria: systemic disease/medication that could affect periodontal analysis, antibiotics within last 3 months, tobacco use, pregnancy/lactating. Med/Dental history completed as well as PD, CAL, BOP, plaque presence, and radiographic examination. Subgingival plaque collection/preparation: Plaque was collected from diseased sites in LAP individuals and healthy sites in siblings and healthy controls with paper points. Point inserted in pocket and moved laterally along axis of the tooth. Samples were placed in transport media, sonicated for 10 s in cold water, and optical density measured. Standardized to 10^4/mL. Detection of cyto/chemokines: 4 ml of blood was collected from each participant and diluted 1:4 in RPMI. Blood was challenged with TLR4 agonist, bacteria from diseased site, and bacteria from healthy site. After 24h, kit used to detect eotaxin, IFNg, IL-1b, IL-2, IL-6, IL-8, IL-10, IL-12(p40), IP10, GCSF, GM-CSF, MCP-1, MIP-1a, TNFa and quantified. The microbiome (species and amounts) of both types of plaque was characterized as well.
RESULTS: Differences were found between LAP and healthy individuals for all clinical parameters except plaque. The blood of participants with LAP expressed higher levels of, IFNg, IL-1b, IL-6, IL-8, IL-10, IL-12(p40), GCSF, MCP-1, MIP-1a, and TNFa. Within the LAP group, there were no difference in the levels of cyto/chemokines produced in response to plaque from diseased sites and healthy sites. Little response to plaque from diseased or healthy sites was observed in blood from unrelated healthy patients. Blood of siblings of those with LAP had elevated levels of INFg when stimulated with healthy plaque and elevated levels of IL6 when stimulated with plaque from diseased sites compared to unrelated healthy individuals.
DISCUSSION: LAP individuals showed a higher response to bacterial stimuli compared to the sibling and control groups, whether it was from healthy or diseased plaque. There was no significant difference in the level of response with either type of plaque. This hyper-response could be the reason LAP patients experience rapid tissue destruction. Healthy siblings of LAP subjects also demonstrated a strong inflammatory response (though not as strong as LAP subjects), suggesting that genetics plays a stronger role than previously suspected.
CONCLUSION/BL: LAP subjects display a hyper-inflammatory response to bacterial stimuli compared to healthy patients. The role of genetic susceptibility in the LAP disease process may be more significant than previously realized. This could put siblings of LAP patients at a higher risk for developing the disease since they also displayed a strong inflammatory response in this study.
Topic: GTR & Laser
Authors: Taniguchi Y, Aoki A, Sakai K, et al
Title: A Novel Surgical Procedure for Er:YAG Laser-Assisted Periodontal Regenerative Therapy: Case Series
Source: Int J Periodontics Restorative Dent 2016;36:507-515. Doi:10.11607/prd.2515
Type: Clinical
Rating: Good
Reviewer: Marlon Foote
Purpose: To evaluate an Er:YAG laser (ErL) application for periodontal regenerative surgery in angular bone defects at 9 sites in 6 patients.
Method: Debridement was thoroughly performed using a combination of curettage with a Gracey-type curette and ErL irradiation at a panel setting of 70mJ/pulse and 20Hz with sterile saline. After applying an enamel matrix derivative and autogenous bone grafting, ErL was used to form a blood clot coagulation on the grafted bone surface at 50mJ/pulse and 20Hz without water spray for approximately 30s.
Results: 12 months after surgery the mean PD had improved from 6.2mm to 2mm, the mean clinical attachment level had reduced from 7.5mm to 3.4 mm, and BOP had improved from (+) to (-). Mean Infrabony defect depth decreased from 6mm to 1mm.
Conclusion: A novel procedure for periodontal regenerative surgery applying ErL irradiation for thorough decontamination during debridement as well as blood coagulation following autogenous bone grafting seems to have achieved favorable and stable healing of periodontal pockets with significant clinical improvement and desirable regeneration of angular bone defects, including 1-wall defects.
Topic: Regeneration
Authors: Ghezzi C, Ferrantino L, et al
Title: Minimally Invasive Surgical Technique in Periodontal Regeneration: A Randomized Controlled Clinical Trial Pilot Study
Source: The International Journal of Periodontics & Restorative Dentistry 2016;36:475-482. doi: 10.11607/prd.2550
Type: Clinical
Reviewer: Marlon Foote
Rating: Good
Purpose: To compare two minimally invasive surgical techniques (MISTs) for the treatment of periodontal defects: (1) guided tissue regeneration (GTR) using resorbable mini membrane and particulate xenograft (DBBM); and (2) inductive periodontal regeneration (IPR) using enamel matrix derivatives and DDBM.
Method: A sample of 20 infrabony periodontal defects in 20 pts were randomly assigned to either the GTR or the IPR group. A follow-up was performed at 12 months post-op.
Results: MIST + IPR group, PD improved from 8.2 to 3.3 mm. In the MIST + GTR group, PD improved from 7.8 to 3.1mm. Significant improvement in clinical parameters were observed in both groups, although no intergroup differences were found.
Conclusion: MIST with GTR or IPR demonstrated very good outcomes 1 year after surgery, with no differences between treatment groups.
Topic: Osteotome sinus floor elevation
Authors: Nakajima, Kusama
Title: CBCT Evaluation of bone remodeling following the osteotome sinus floor elevation technique for future site development.
Source: Int J Periodontics Restorative Dent Volume 36, Number 4, July/Aug 2016
Type: Retrospective study
Rating: Good
Reviewer: Rafik Dib
P: to determine the amount of postoperative maxillary sinus floor elevation that can be achieved using the osteotome approach; asses the incidence of complications, such as membrane perforation; and evaluate the degree of bone remodeling occurring during the 6 months period prior to implant placement.
M: 15 pt (4men, 11 women) aged 52-72yo, who received 2 stage maxillary sinus floor elevation using osteotome between oct 2006 – May 2013.
Inclusion criteria:
Age 18yo or older, in good health, or controlled medical condition.
Bone substitute: beta-tricalcium phosphate (B-TCP) or hydroxyapatite
(HA), blended with 30% to 50% autogenous bone collected from either the palatine
torus or retromolar region.
Surgical Procedure: a modified version of the summer’s method was performed. After the surgical procedure, pt were followed regularly with checkup from 3 to 12 months. After 6 months healing, implant were inserted.
Morphologic evaluation using CBCT: CBCT was performed before and after the sinus floor elevation as well as prior to implant placement. Measurement of residual bone height, increase in bone height, and total bone height were determined by CBCT.
R:
No perforation of the maxillary sinus mucosa was seen in any of the pts, as determined by the valsalva maneuver and the absence of nose bleeding during and after the surgery.
C: 2 stage maxillary sinus elevation using the osteotome technique produces sufficient bone augmentation for successful implant placement. This approach was predictable, minimally invasive well tolerated and associated with high implant survival and success rate.
Topic: bone block graft
Authors: Gluckman, Salama
Title: the palatal bone block graft for onlay grafting combined with maxillary implant placement: A case series
Source: Int J Periodontics Restorative Dent Volume 36, Number 4, July/Aug 2016
Type: A prospective clinical case series
Rating: Good
P: to introduce an intraoral bone block harvesting technique- the palatal bone block (PBBG)- as an alternative harvest site for autogenous bone blocks. The PBBG was used to onlay graft esthetic zone defects simultaneous to implant placement in 5 pts.
PBBG was successfully harvested in all cases. No intra- or post-op complications occurred. Results remained stable after 6 years in all cases. Bone thicknesses varying from 1.5-3 mm.
C: the PBBG technique is a valid contribution to the options for harvesting intraoral bone, especially when treating facial defects of the maxilla at implant placement.
Topic: CTG at implant placement
Authors: Hanser T., Khoury F.
Title: Alveolar Ridge Contouring with Free Connective Tissue graft at Implant Placement: A 5-Year Consecutive Clinical Study
Source: The International Journal of Periodontics and Restorative Dentistry. Vol. 36, No. 4, 2016. Pg. 465-473.
Type: Consecutive clinical study
Rating: Good
Purpose: To evaluate long-term tissue stability after alveolar ridge grafting with connective tissue graft without additional guided bone regeneration procedures in single implants covered with at least 2 mm peri-implant local bone after insertion but showing buccal alveolar volume deficiencies
M&M: 52 single tooth edentulous spaces in the maxilla (12 centrals, 18 laterals, 2 canines, and 20 premolars) were treated in 46 patients (27W, 19M) with mean age 37.8 years. All edentulous spaces had an existing volume deficit with a noted buccal alveolar concavity. Tooth loss occurred at least 6 months prior to implant placement. Smokers and patients with active periodontal disease were excluded from the study. Included patients were healthy with no systemic disease. A pouch approach with a crestal incision was performed in combination with a buccal split-thickness tunnel preparation. Implants were placed with at least 2 mm peri-implant bone. A free CTG from the palate corresponding to the width of the edentulous gap and implant length was sutured in place to the buccal periosteum. Thickness was determined by the the lack of labial tissue volume with at least 3 mm to contour the missing alveolar convexity. The CTG was completely covered after suturing. Patients were instructed to use CHX 4 times a day. Sutures removed 7-14 days. Second stage surgery was performed using an H-incision at 3 months. An acrylic stent served as a reference point for standardized volumetric measurement during follow up. 6 reference points were checked at baseline (2 weeks after implant prosthetic placement), 1 year, and 5 year follow up.
Results: Thick gingiva represented 30 patients (65%). Thin gingiva represented 16 patients (35%). For all reference points, tissue volume significantly increased from before CTG to baseline. Reference points more apical (D,E,F) maintained their volume from baseline through years 1 and 5 but reference points more coronal (A,B,C) showed a significant decrease in volume. None of the reference points showed a significant increase from year 1 to year 5. There was NSSD between patients with thick and thin gingival biotypes. All sites at year 5 had a convex alveolar contour when compared to the original concave anatomy prior to the procedure. Implant survival rate was 100%.
Conclusion: Implant placement with simultaneous CTG appears to be an appropriate long-term means to contour pre-existing buccal alveolar volume deficiencies in single-tooth gaps without supportive bone grafting procedures in sites with at least 2 mm peri-implant bone after insertion.
Topic: Sinus lift perforations
Authors: Monje A., Monjie-Gil F., Burgueno M., Gonzalez-Garcia R, Galindo-Moreno P., Wang H-L
Title: Incidence of and Factors Associated with Sinus Membrane Perforation During Maxillary Sinus Augmentation Using the Reamer Drilling Approach: A Double-Center Case Series
Source: The International Journal of Periodontics and Restorative Dentistry. Vol. 36, No. 4, 2016. Pg. 549-556.
Type: Double-center case series
Rating: Good
Purpose: To investigate the incidence of membrane perforation when reamer instruments were used to prepare the lateral window sinus wall, and to assess the factors that might influence membrane perforation during reamer preparation.
M&M: 40 consecutive patients from two clinics in need of unilateral sinus lifts were recruited for a retrospective case series. Inclusion criteria: 18-80 years old, non-smokers or light-smokers (<10 cigarettes per day), no systemic disease. CBCT’s were taken from presurgical database. Maxillary sinuses between premolar and molar region were used with less than 8 mm residual ridge height and at least 15 mm of visible sinus from the floor of the sinus. All sinus lifts were performed using the SLA LS-reamer (Neobiotech). The length and width of the reamer was dependent on window extension needs. The sinus membrane was elevated using curettes. Sinus was grafted with Puros Allograft or Bio-Oss and a collagen membrane was placed on the floor of the sinus as well as the window and sutured closed.
Results: 40 patients were included in the study (15% light smokers). 15% of the patients had a membrane perforation. Five perforations were reported while drilling and two were reported during lifting of the membrane. Only one major complication was reported during the 6 months of healing (2.5%). The thinner the lateral wall thickness, the higher risk for perforation. Similarly the smaller the ridge height, the higher observed risk for membrane perforation
Conclusion: Within the limitations of this study, the reamer technique is safe and effective tool for sinus augmentation. However, when the lateral wall thickness is < 1.25 mm, caution should be used when using a reaming instrument. Future studies should be conducted to compare other instruments and to support the findings of this study.
Topic: Root coverage review
Authors: Cairo F, Pagliaro U
Title: “Root coverage procedures improve patient aesthetics. A Systematic Review and Bayesian network meta-analysis”
Source: J Clin Periodontol. 2016 Jul 25. doi: 10.1111/jcpe.12603.
Type: Systematic Review
Rating: good
Background: The aim of this study was to perform a systematic review (SR) of randomized controlled trials (RCTs) to explore if periodontal plastic surgery procedures for the treatment of single and multiple gingival recessions may improve aesthetics at patient and professional levels.
Material and Methods: In order to combine evidence from direct and indirect comparisons by different trials, a Bayesian network meta-analysis (BNM) was planned. A literature search on PubMed, Cochrane libraries, EMBASE, and hand-searched journals until January 2016 was conducted to identify RCTs presenting aesthetic outcomes after root coverage using standardized evaluations at patient and professional level.
Results: A total of 16 RCTs were selected in the SR; 3 RTCs presenting professional aesthetic evaluation with Root coverage Aesthetic Score (RES) and 3 showing final self-perception using the Visual Analogue Scale (VAS Est) could be included in a BNM model.
Best Root Coverage Esthetic Score (RES) -professional viewpoint: CAF+CTG And CAF+ADM+AF
(Coronally Advanced Flap plus Connective Tissue Graft /and/ CAF + Acellular Dermal Matrix + Autologous Fibroblasts) best probability = 24% and 64%, respectively
highest values of Visual Analogue Scale (VAS Est score) -patient viewpoint: CAF+CTG and CAF+CTG+EMD
(Coronally Advanced Flap plus
Connective Tissue Graft /and/ CAF+CTG+Enamel matrix Derivatives) best
probability = 44% and 26%, respectively
Conclusions: Periodontal Plastic Surgery techniques applying grafts underneath CAF with or without the adding of EMD are associated with improved aesthetics assessed by final patient perception and RES as professional evaluation system.
Topic: Turned Implants in Vertical Augmented Bone
Authors: Simion M, Ferrantino L, Idotta E, Zarone F.
Title: Turned Implants in Vertical Augmented Bone: A Retrospective Study with 13 to 21 Years Follow-Up
Source: Int J Periodontics Restorative Dent. 2016 May-Jun;36(3):309-17. doi: 10.11607/prd.2851
Type: Retrospective study
Rating: Good
Purpose: To document the clinical and radiographic outcomes of turned implants placed in vertically augmented bone by means of vertical GBR (v-GBR) with a follow up ranging from 13 to 21 years.
Materials and Methods: 76 patients were treated with v-GBR between 1993 to 2000. A total of 197 implants were placed in the augmented area, with an osseointegration rate of 97% (Simion, 2001). Between April 2013 and December 2014, all these patients were recalled for a follow up visit. Surgical technique: All v-GBR was performed by the same surgeon. FTF was reflected and an e-PTFE titanium reinforced membrane was fixed with tacks as needed (buccal and or palatal). Tenting screws were used as needed as well. Area was grafted with autograft or a mixture with bovine xenograft. The healing period range between 6-8 months, depending on the bone volume augmented. Membrane was removed at time of DI placement. 2 examiners performed clinical and radiographic assessment.
Results: 33 Patients with 91 DI were able to participate during the recall period. A total of 34 surgical sites in 31 patients healed uneventfully. In 2 patients, membrane exposure occurred after 2 and 6 weeks, respectively. Both surgeries used a single-stage approach. In one case, the small soft tissue dehiscence was carefully cleaned with 0.2% chlorhexidine solution. A total of 88 implants were in function (97% survival rate), whereas 9 showed peri-implantitis (9.9%). A mean radiographic bone loss of 1.02 mm between the baseline evaluation (1 year after loading) and the final visit (13 to 21 years later) was recorded.
Conclusion: Turned implants placed in vertically augmented bone seem to remain stable after many years of function.
Topic: Dental Implants
Authors: Rosa AC, da Rosa JC, Dias Pereira LA, Francischone CE, Sotto-Maior BS
Title: Guidelines for Selecting the Implant Diameter During Immediate Implant Placement of a Fresh Extraction Socket: A Case Series.
Source: Int J Periodontics Restorative Dent. 2016 May-Jun;36(3):401-7. doi: 10.11607/prd.2381.
Type: Prospective study
Rating: Good
Purpose:
to aid in selecting the implant diameter for immediate placement in a fresh
extraction socket in the esthetic zone.
Materials and Methods 20 patients who required immediate post-extraction implants in maxillary anterior teeth were recruited. The implant diameter was selected using the buccolingual distance (BLD) of the socket. The BLD was measured based on a CBCT cross-sectional image. The diameter of the DI was selected to maintain a 3mm gap between the implant buccal surface and the socket buccal bone wall. (if buccal bone wall was not present, the gap was measure to the internal portion of the buccal soft tissue). If the total BLD of the socket was < 7 mm: the selection of the DI diameter was around 3.5 mm. 7 mm: around 4.3 mm. If > 7 mm: around 5.1 mm. The length of the DI must be 2 or 3 mm longer than the socket length to obtain primary stability. The same surgeon performed all operations. The teeth were removed with as little trauma as possible. The DI shoulder was placed in the palatal bone wall allowing the 3-mm gap to the buccal wall to be obtained. The primary stability should range from 30 to 65 Ncm. After DI insertion, the gap was grafted using particulate autogenous cancellous bone harvested from the tuberosity. Immediate provisionalization was provided and no sutures were placed. CBCT scans were acquired with a mean follow-up time of 35.45 months in order to measure the B-L distance of the postoperative socket size. This distance was measure at the implants platform, 2 and 4mm apically.
Results: No surgical and prosthetic complications were observed. Of the implants placed, 5 were: 3.5 mm, 13 were 4.3 mm, and 2 were 5.1 mm, according to the socket diameter. The lengths ranged from 11.5 to 16.0 mm, according to the available apical bone. At the preoperative period: the mean width of the extraction socket en-trance was 7.07 ± 0.37 mm. After a follow-up healing period: the mean implanted socket entrance width was 7.09 ± 0.35 mm. The difference was not significant (P = .931). The mean buccal bone plate measurements were 3.01 ± 0.18 mm, 2.92 ± 0.38 mm, and 2.83 ± 0.42 mm in the crestal bone at the implant platform and 2 and 4 mm apically, respectively.
Conclusion: The described method for selecting the diameter of single immediate anterior implants in fresh extraction sockets seems to show favorable results in buccal plate preservation after a mean follow up period of 34.45 months.
Topic: Implant surgery
Title: Establishing and Maintaining Osseointegration within the Functional Matrix
Author: Martin Chin
Source: International Journal of Periodontics and Restorative Dentistry, vol. 36, no.1, Jan-Feb 2016, pg 29-37
Type: Case study
Rating: Good
Background: This article explains how the underlying mechanism that regulates bone physiology can be recruited to improve the response to surgical healing and presents the theoretical basis of this treatment method. The environment into which the bone develops must include: a. anatomic volume sheltered from physical forces, b. source of bone forming cells, c. source of NM input, d. absence of pathology. The case demonstrates that if this treatment method is followed, successful healing can be achieved.
Purpose: To replace implant in a single stage surgery designed to meet the essential requirements of bone forming environment.
M&M: 80 year old woman presents with fractured implant at #14, the implant was removed with trephined bur resulting in 6.5 mm diameter defect that penetrated the sinus floor. The implant was suspended in the center of the defect and secured with titanium mesh bone plate ensuring no contact between the implant and the bone. Antibiotics and primary closure were strategized to prevent infection.
Results: When site was opened after 10 weeks and the bone plate was removed, implant was fully invested in the normal appearing bone. Regenerated sinus floor had formed immediately to the implant apex.
Discussion: The ability to regenerate a skeletal unit from bone precursor cells represents a departure from conventional practice. The amount of native bone at the site was sufficient, no additional cells were necessary. NM regulation of the region was maintained under the primary direction of PDL system of premolar. Penetrating sharpey fibers from alveolar mucosa and sinus membrane participated in the process. Age did not compromise the healing.
Topic: Implant surgery
Title: A Palatal Approach for a Sinus Augmentation Procedure
Author: Hector Sarmiento, Badr Othman, Michael Norton, Joseph Fiorellini
Source: International Journal of Periodontics and Restorative Dentistry, vol. 36, no.1, Jan-Feb 2016, pg 111-115
Type: Case study
Rating: Good
Purpose: The purpose of this article is to demonstrate an alternative method for sinus augmentation through a palatal approach when complications do not allow the use of traditional approaches.
M&M: A 50-year-old male patient presented with multiple previous sinus augmentation attempts. A cone beam computed tomography scan revealed bone graft material had consolidated on the buccal aspect of the lateral sinus wall only, preventing implant placement while not allowing access via a conventional lateral window technique to improve the graft bulk. Mid crestal incision was made with sulcular incision on #23, 25, 27 with palatal vertical incision. FTF reflected, lateral window was created exposing the sinus membrane. Elevation of membrane through blunt dissection, protected using BioGide, osteotomy drilled and implant (5.4x10mm, Biomet 3i) inserted to 45 Ncm. Extrasinusoidal space grafted with BioOss.
Results: 6 month CBCT and radiograph revealed adequate healing of the sinus with well localized and consolidated graft material on buccal and palatal aspect. Implant was restored after 12 months.
Discussion: A palatal approach was adopted as an alternative method of sinus entry. The authors suggest that a palatal approach technique is a safe and effective method to complete a sinus augmentation where a buccal approach is impractical. The CBCT scan revealed that the palatal wall was thinner than the grafted buccal wall and this was the main determining factor.
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