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Purpose: The aims of this study were to investigate the best two of five common methods of collecting autologous bone (preliminary study [PS]) and to test clinically the effects of autografts harvested using a trephine bur or bone scraper for sinus augmentation surgery (main study [MS])., Materials and Methods: In the PS, five autograft samples from five patients (n = 25) were harvested with a bone scraper, round bur, piezoelectric device, implant bur, and trephine bur and were processed for histomorphometric analysis. In the MS, sinus augmentation was performed on 20 patients using bovine-derived bone substitute and autograft collected with a trephine bur (group A, n = 10) or collected with a bone scraper (group B, n = 10). Narrow implants were also placed. At 6 months, changes in graft volume were evaluated with cone beam computed tomography. The amounts of regenerated bone, residual graft, and osseointegration of the implants were assessed histologically., Results: In the PS, the trephine bur and bone scraper harvested bone chips that were medium to large and more vital than those obtained with the other tools. In the MS, no significant differences were seen between groups in terms of the amount of residual biomaterial, regenerated bone, change in graft volume, and osseointegration., Conclusion: Biologic differences between these two bone particulates may not influence regeneration and implant osseointegration in sinus augmentation when mixed with xenograft bone.

The sinus lift technique, introduced in 1976 by Tatum and subsequently described by Boyne in 1980, is nowadays considered a safe and reliable procedure for the rehabilitation of the atrophic upper posterior maxilla. The alveolar antral artery (AAA) is anastomoses between the posterior superior alveolar artery (PSAA) and the infraorbital artery (IOA) and may be present in the sinusal antrostomy. The haemorrhage of this vascular bundle represents the second intra-operatory complication in term of frequency during sinus lift procedure. Purpose of this study was to illustrate and describe a new technique allowing the AAA isolation during sinus lift procedure in cases in which the artery is clearly present inside the surgical area, detectable through CT scan exam. Presence, course and possible identification of the alveolar antral artery are also discussed, according to the studies present in the literature.

Correct pre- and postimplant hard and soft tissue management is prerequisite to achieving optimal esthetic and functional outcomes after implant-prosthesis treatment. Various different methods for preimplant hard tissue augmentation in alveolus maxillary atrophy are described. In some cases, non-resorbable titanium-reinforced membranes are employed for vertical augmentation of the edentulous crest. Also well documented is soft tissue management through mucus-gingival surgery techniques that increase the thickness of peri-implant keratinized gingiva, enhancing soft tissue esthetic and health. These methods also include the use of epithelial-connectival grafts collected from the palate. Here we present a clinical case of severe bone vertical resorption in edentulous areas treated with two vertical ridge augmentations by means of non-resorbable membranes in the retromandibular area and deferred insertion of six implants. Peri-implant plastic surgery techniques to improve the quantity of keratinized mucosa during the second surgery phase are also discussed. Combination of the two techniques resulted in harmonic tissue architecture and adequate presence of keratinized gingiva.

Purpose: To assess the long-term stability of gingival grafts placed around dental implants at the time of second surgery uncovering and to further investigate the association between mucosal thickness (MTh) by demographic variables and clinical investigation., Materials and Methods: Fourteen patients with submerged dental implants covered by inadequate keratinized mucosa were studied. The subjects underwent a periimplant plastic surgery (PPS) at the second-stage dental implant surgery and free gingival autograft orsubepithelial connective tissue graft were used according to the patients' clinical situation. Clinical measurement of MTh was assessed by bone sounding with a periodontal probe using customized acrylic stents andthe values were recorded at baseline (day of graft) and at 0.5, 1.5, 4, 12, 24 and 36 months after grafting., Results: At 12 months postoperatively, the mean MTh was 2.89 mm, with a mean additional increase of 1.75 mm when compared with baseline (P=0.0001). No statistically significant differences in MTh were found between the 12- and the 36-month observations (P=0.09). In addition, at 36 months, a thin mucosa was associated with a greater increase in the MTh compared with a thick mucosa (2.14 and 0.64 mm, respectively, P=0.006). Similarly, the mandibular sites were associated with a greater increase in the MTh in comparison with the maxillary sites (2.17 and 0.81 mm, respectively; P=0.02)., Conclusions: Within the limitations of this investigation, the data suggest that PPS at the second-stage dental implant surgery could results in additional increases in MTh, especially when it is performed in areas where the mucosa is of a thin biotype.