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Background. Short implants have been proposed as an alternative solution for the rehabilitation of atrophic posterior region. Purpose. To compare the clinical outcomes between 6 mm short implants and conventional implants placed under similar conditions of bone quality and occlusal loading. Materials and Methods. Nine patients received atone 6 mm implant and one standard-length (8 mm length or longer) implants in a total of 10 partially edentulous areas. Implants were left submerged for 3–6 months healing period and the screw-retained splinted prostheses were delivered. When the provisional or final restoration was placed, and at each year after loading, standardized intraoral radiograph was taken for themarginal bone level (MBL) changes around the implants. Subsequently, the patients were recalled for the clinical examination evaluating the implant survival, sulcus bleeding index, suppuration, and the incidence of prosthetic complications at every 6 months after the definitive crown delivery. The observation period was continued to 3 years (mean follow-up was 3.4 ± 0.3 years) after functional loading. Results. Nine patients (10 short implants and 10 standard length implants) were selected in this study. Cumulative survival rates of the short implants and standard-length implants were 100% in both groups, and no biological and prosthetic complication were found in 3 years observation period. Cortical bone thickness of implant insertion sites was 1.39 ± 0.45 mm at short implants and 1.38 ± 0.69 mm at standard-length implants, and trabecular bone computed tomography values of implant insertion sites was 424.1 ± 290.1 at short implants and 410.9 ± 267.9 at standard-length implants. The MBL changes were −0.30 ± 0.71 mm at short implants and −0.19 ± 0.78 mm at standard-length implants at 3 years follow-up visit. No significant difference was found in the average of MBL changes between implant length. Conclusions. Within the limits of this study, it can be concluded that 6 mm short implants in a posterior edentulous region showed excellent results compared with conventional implants.

Abstract Background During implant treatment in the maxillary molar area, maxillary sinus floor augmentation is often performed to ameliorate the reduced alveolar bone height attributable to bone remodeling and pneumatization-induced expansion of the maxillary sinus. However, this augmentation may cause complications such as misplaced implants, artery damage, and maxillary sinus mucosal perforation; infections like maxillary sinusitis; and postsurgical complications such as bone graft leakage and postoperative nasal hemorrhaging. To reduce the complications during maxillary sinus floor augmentation and postoperative infections, we performed retrospective investigations of various systemic and local factors that influence pre-operative sinus mucosal thickness (SMT) by using cone-beam computed tomography (CBCT). Subjects included patients who underwent maxillary sinus floor augmentation in an edentulous maxillary molar area with a lateral approach. Pre-operative SMT, existing bone mass, and nasal septum deviation were measured using CBCT images. Relationships between SMT and the following influencing factors were investigated: (1) age, (2) sex, (3) systemic disease, (4) smoking, (5) period after tooth extraction, (6) reason for tooth extraction, (7) residual alveolar bone height (RBH), (8) sinus septa, and (9) nasal septum deviation. Correlations were also investigated for age and RBH (p < 0.05). Results We assessed 35 patients (40 sinuses; 11 male, 24 female). The average patient age was 58.90 ± 9.0 years (males, 57.9 ± 7.7 years; females, 59.9 ± 9.4 years; age range, 41–79 years). The average SMT was 1.09 ± 1.30 mm, incidence of SMT > 2 mm was 25.0%, incidence of SMT < 0.8 mm was 50.0%, and the average RBH was 2.14 ± 1.02 mm. The factors that influenced SMT included sex (p = 0.0078), period after tooth extraction (p = 0.0075), reason for tooth extraction (p = 0.020), sinus septa (p = 0.0076), and nasal septum deviation (p = 0.038). Conclusions Factors associated with higher SMT included male sex, interval following tooth extraction < 6 months, periapical lesions, sinus septa, and nasal septum deviation. Factors associated with SMT > 2 mm were sex and reason for tooth extraction, while factors associated with SMT < 0.8 mm were time following tooth extraction and nasal septum deviation. Despite the limitations of this study, these preoperative evaluations may be of utmost importance for safely conducting maxillary sinus floor augmentation.

Abstract Background We performed maxillary sinus floor augmentation using the crestal approach and beta-tricalcium phosphate (β-TCP) and a long-term evaluation using cone-beam computed tomography (CBCT). Methods Twenty-three patients (30 implants) underwent sinus floor augmentation using the osteotome technique. Subjects underwent CBCT imaging before surgery, immediately after surgery, and at follow-up (≥ 3 years after surgery). We measured the changes in height of the augmented sinus floor (SL), the augmented bone above apex of the implant (BH), and the implant length that projected into the sinus (IL). Results The mean SL decreased from 6.54 ± 1.51 (immediately after surgery) to 3.11 ± 1.35 mm (follow-up). The mean BH decreased from 3.17 ± 0.97 to − 0.25 ± 1.19 mm; the maxillary sinus floor in many implants was near the apex at follow-up. The SL at follow-up showed a strong correlation with the IL (p = 0.0057). Conclusions Osteotome sinus floor elevation with beta-tricalcium phosphate was clinically effective. Cone-beam computed tomography analysis revealed that ≥ 3 years after surgery, the maxillary sinus floor was near the apex of the implant.

Abstract Background Previous studies have shown that porous composite blocks containing uncalcined hydroxyapatite (u-HA; 70 wt%) with a scaffold of poly-DL-lactide (PDLLA, 30 wt%) are biodegradable, encourage appropriate bone formation, and are suitable for use as a bone substitute in vertical ridge augmentation. The present study aimed to accelerate osteogenesis in vertical ridge formation by adding types 1 and 3 collagen to the u-HA/PDLLA blocks and assessing the effect. Material and methods The bone substitute in the present study comprised porous composite blocks of u-HA (70 wt%) with a PDLLA (27–29 wt%) scaffold and enriched with types 1 and 3 collagen (1.7 ~ 3.4 wt%). The control blocks were composed of u-HA (70 wt%) and PDLLA (30 wt%). The materials were formed into 8-mm diameter, 2-mm high discs and implanted onto the cranial bones of six rabbits. The animals were sacrificed 4 weeks after implantation, and histological and histomorphometrical analyses were performed to quantitatively evaluate newly formed bone. Results New bone formation occurred with both block types, showing direct contact with the original bone. Mean ± standard deviation bone formation was significantly greater in the experimental blocks (25.6% ± 4.8%) than in the control blocks (17.0% ± 4.7%). Conclusions Histological and histomorphometrical observations indicated that new bone was formed with both block types. The u-HA/PDLLA block with types 1 and 3 collagen is a more promising candidate for vertical ridge augmentation than the u-HA/PDLLA alone block.

In guided bone regeneration (GBR), a barrier membrane is applied to provide a space for bone regeneration to promote cell adhesion, cell proliferation, and bone regeneration by inducing cell migration to the surface of the bone-deficient site. We prepared a non-woven absorbable membrane for GBR comprised of a copolymer of L-lactic acid and glycolic acid (PLLGA) using the dry spinning method. A thin and dense membrane comprising unsintered hydroxyapatite (uHA) and poly-L-lactic acid (PLLA) was used for comparison. Osteoblast TMS-12 cells were seeded onto the membranes, and cell adhesion and proliferation rates were examined. Calcification levels were quantified by Alizarin Red S staining after cell culture in calcification induction medium. Osteoblastic gene expression was examined by RT-PCR. Cell adhesion and proliferation rates and calcification on PLLGA membranes were significantly higher than those on uHA/PLLA membranes. PLLGA membranes upregulated osteogenic gene expression compared to on uHA/PLLA membranes. Non-woven PLLGA membranes may be useful in GBR for promoting bone formation and maturation [ABSTRACT FROM AUTHOR]

Objective: Maxillary sinus augmentation is used when performing implant treatment in the maxillary molar region with inadequate bone height. Posterior superior alveolar artery (PSAA) is the branch of the maxillary artery that supplies the lateral sinus wall and sinus membrane. When performing an osteotomy via lateral approach, however, damage to the PSAA can occur, because it runs inside the lateral wall of the maxillary sinus, causing hemorrhage and hampering surgery. The objective of the present study was to compare the defect patterns with the distances from the alveolar crest and sinus floor to the PSAA. Method and Materials: 280 lateral regions in 235 patients with at least three missing consecutive posterior teeth were measured. Measurement locations were the 1st premolar (P1), the 2nd premolar (P2), the 1st molar (M1), and the 2nd molar (M2). Results: The detection rate was 29% to 59%, and the longest diameter was between 1.1 mm and 1.3 mm. The average distances between the PSAA and the alveolar crest were 24.1 mm, 21.3 mm, 15.4 mm, and 15.3 mm (P1-M2), with statistically significant differences in all locations except M1 and M2. The average distances between the PSAA and the maxillary sinus floor were 10.4 mm, 10.4 mm, 9.0 mm, and 8.5 mm (P1-M2), with no significant differences. There were no significant differences between different defect patterns in the distance between the PSAA and either the alveolar crest or the maxillary sinus floor. PSAA detection rate and the longest diameter were related to the spatial resolution of the computed tomography (CT) scan. Conclusion: Although the distance between the PSAA and the alveolar crest was significantly shorter in the molar region than in the premolar region, it did not affect the defect pattern. [ABSTRACT FROM AUTHOR]

The effectiveness of a previously developed unsintered hydroxyapatite (uHA) and poly(L-lactic acid) (PLLA) hydrophilic membrane as a resorbable barrier for guided bone regeneration (GBR) was evaluated. Critical-size 8-mm diameter bone defects were surgically generated in the parietal bones of 24 12-week-old male Wistar rats, which were then divided into three groups in which either a uHA/PLLA or a collagen membrane or no membrane (control) was placed onto the bone defect. Following sacrifice of the animals 2 or 4 weeks after surgery, bone defects were examined using microcomputed tomography and histological analysis. Bone mineral density, bone mineral content, and relative bone growth area values 2 or 4 weeks after surgery were highest in the uHA/PLLA group. Four weeks after surgery, the relative bone growth area in the uHA/PLLA group was larger than that in the collagen group. The resorbable uHA/PLLA membrane is thus potentially effective for GBR. [ABSTRACT FROM AUTHOR]

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Background: The long-term stability of maxillary sinus floor augmentation with β-TCP remains largely unknown. We report the long-term assessment of volumetric changes in maxillary sinus floor augmentation with β-TCP by cone-beam computed tomography (CBCT). Methods: The subjects included 30 patients who underwent maxillary sinus floor augmentation using β-TCP and 58 implant placement for unilateral maxillary defect, simultaneously. Volumetric changes in β-TCP and the height of peri-implant bone were analyzed by CBCT. Results: In all patients, the mean volume of the grafted bone decreased from immediately after implant placement to 6 months after implant placement (75.6 % reduction rate); it decreased further at 2.5 years after implant placement (54.9 % reduction rate). The mean of the height from the implant tip to the maxillary sinus floor was 2.00 ± 1.51 mm, 0.73 ± 1.33 mm, and −0.72 ± 1.11 mm immediately, 6 months, and 2.5 years after implant placement, respectively. The implant tip protruded beyond the maxillary sinus floor in approximately 70 % of the implants (41/58 implants) at 2.5 years after surgery. During the observation period, the implant survival rate was 100 %. Conclusions: The radiographic analysis by CBCT is considerably more advanced than previous radiographic examinations. Although maxillary sinus pneumatization continues to progress ≥1 year after maxillary sinus floor augmentation with β-TCP, it stabilizes 3 years after surgery. [ABSTRACT FROM AUTHOR]

A case study describing an aesthetical reconstruction of an anterior tooth in an alveolar cleft site is presented. Topics covered include the importance of host bone volume and gingival thickness in aesthetical reconstructions, factors that influence implant survival in an alveolar cleft, and the clinical history of the patient. The necessity of bone grafting using only bone substitute is cited.

Objectives: This study investigated the biological reaction to porous poly-DL-lactic acid (PDLLA) scaffolds with holes for soft tissue augmentation., Materials and Methods: The control group was porous PDLLA with a diameter of 5.0 mm and a height of 2.0 mm. For the 2 test groups, 7 holes were drilled from the upper to the lower base of the scaffolds; the holes had diameters of 0.5 and 1.0 mm. A scaffold was placed in the periosteum of the cranium. The height and molecular weight (Mw) of the scaffolds were measured at 4 and 8 weeks. Hematoxylin and eosin staining was used to measure the connective tissue and blood vessel areas., Results: All groups had similar scaffold heights, but the Mw decreased significantly over time. There were significant differences in the connective tissue and blood vessel areas among the control, 0.5-mm, and 1.0-mm groups at the same time point. The soft tissue was increased by drilling holes in the scaffolds., Conclusion: Porous poly-DL-lactic acid (PDLLA) contributed favorable prognosis for soft tissue. A wider hole was associated with increased connective tissue and blood vessel areas. The scaffold height and Mw were not impacted by size of the holes.