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Purpose: To evaluate whether grafting with additional anorganic bovine bone to augment horizontally the buccal plate (internal and external grafting [IEG]) at single post-extractive implants preserves the alveolar ridge, improving aesthetics, better than internal socket grafting alone (ISGA). Material and methods: A total of 78 patients, treated in four Italian private practices, requiring a single immediate post-extractive implant, having at least 1 mm of implant-to-buccal bone gap after implant insertion and a preserved buccal bone, had the residual bone-to-implant gap filled with anorganic bovine bone. Thirty-nine randomly allocated patients received additional buccal horizontal augmentation of about 2 mm thickness with the same bone substitute (IEG group) covered with collagen resorbable membranes. Implants were submerged for 4 months before being loaded with provisional acrylic crowns. Definitive crowns were delivered after 6 months. Outcome measures were crown/implant failures, complications and aesthetics recorded by blinded assessors 6 months after initial loading, at delivery of definitive crowns. Results: Six months after initial loading, 8 patients dropped out, did not complete the treatment or were treated twice and therefore had to be excluded (4 from each group). There were no statistically significant differences for implant failures and complications between the two groups. Two implants failed in the IEG group versus 1 in the ISGA group. Four complications occurred, 2 in each group. The mean implant aesthetic score (IAS) was 7.8 at ISGA sites and 8.0 at IEG sites. There were no statistically significant differences between the two groups (P = 0.492; difference 0.2 mm; 95% CI -0.769, 0.369) for IAS score. There were no statistically significant differences in the outcomes between the centres. Conclusions: The use of adjunctive anorganic bovine bone placed buccally at preserved buccal sites of immediate post-extractive implants may not improve the aesthetic outcome, however additional research is needed to confirm or reject these preliminary findings. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this case series is to propose an approach to help maintain autogenous bone grafts. This is done by applying a collagen membrane (CM) and anorganic bovine bone (ABBM) at the time of implant surgery, rather than at the time of ridge augmentation, to avoid volume loss after implants are inserted. Materials and Methods: Ten patients with severe horizontal bone atrophy were consecutively enrolled in this study. A staged approach was chosen for implant placement following horizontal ridge augmentation. A block graft was harvested from the retromolar area and secured to the recipient site with fixation screws; contour overbuilding was avoided. The width of the ridge was measured before and after horizontal augmentation. After 4 months of healing, implants were inserted, the augmented site was relined with ABBM, and CM was applied to prevent bone volume loss. Another 4 months later, at the time of abutment placement, cone beam computed tomography was performed to quantify the end result. Results: The mean horizontal ridge width prior to treatment was 2.1 ± 0.5 mm. Mean postsurgical crest width was 6.9 ± 0.5 mm. After the 4-month healing period, the mean alveolar crest width was 6.6 ± 0.6 mm. At the time of abutment connection, the mean width of the regenerated ridge, as measured on three-dimensional cone beam images, was 7.7 ± 0.8 mm. Conclusions: Minimal bone loss occurred in unprotected autogenous bone grafts with respect to alveolar bone contour (0.25 ± 0.29 mm). After the implants were inserted, no further remodeling/resorption occurred with sites treated by ABBM and CM relining; moreover, an additional increase in alveolar crest width was evident. The nonresorbable ABBM osseointegrated clinically and radiologically, preventing bone loss prior to implant loading. This layer appeared to maintain the regenerated crest volume. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to evaluate the feasibility of application of thermoplastic poly-Llactic acid (PLLA) membranes for guided bone regeneration in rabbit parietal bone. Materials and Methods: PLLA membranes with a molecular weight of 100,000 (PLLA-100,000) and a molecular weight of 380,000 (PLLA-380,000) were dissolved in chloroform to prepare concentrations of 8% by weight and 4% by weight, respectively. The compression strength, temperature, and time to prepare each formulation were measured. Moreover, the pH was noted and cytotoxicity of the membrane was determined by monotetrazolium assay. In vivo experiments were performed to measure the volume of newly formed bone tissue in hematoxylin and eosin-stained tissue sections 4 and 12 weeks after implantation. Results: The membrane prepared from PLLA-380,000 showed excellent thermoplasticity at 75°C to 80°C and the compressive strength was equal to that of titanium mesh, in contrast to that of PLLA-100,000 and poly(lactic acid-co-glycolic acid). There was a significant change in the pH of an aqueous solution in which the PLLA-380,000 membrane was placed, but there was no cytotoxic activity. The membrane made of PLLA-380,000 induced new bone formation in a dome shape without any membrane deformation. Conclusion: Thermoplastic PLLA membrane shows promise for guided bone regeneration in vertical bone augmentation [ABSTRACT FROM AUTHOR]

Purpose: To compare bone augmentation on pure titanium-machined surfaces and surfaces that have been modified by microarc oxidation (MAO) using titanium caps. Materials and Methods: Twenty caps were manufactured from rods of commercially pure titanium. The control group (CG) consisted of 10 titanium caps with machined inner walls. The test group (TG) consisted of 10 titanium caps that were modified by MAO in an electrolyte solution containing calcium phosphate ions. The two types of titanium caps were fixed on the calvaria of 10 New Zealand rabbits. Each rabbit received two different caps. Although each cap was unfilled, the marrow and blood from the wound of the rabbit skulls could penetrate into the caps. After 4 weeks, the rabbits were sacrificed, and the skulls were removed for observation. The zenith of new bone was measured directly after the caps were removed from the skulls; subsequently, the bone volume was calculated by microcomputed tomography. Results: Little bone augmentation could be observed in the CG caps, and the new bone height of the CG group was inconspicuous. In contrast, the new bone extended along the inner walls of the TG caps. The mean height of new bone of the TG group was 2.3 ± 0.28 mm. The mean volume of new bone in the TG group was 18.63 ± 3.80 mm3. Conclusions: New bone formation in a titanium cap surface modified by MAO was greater than that of a nonmodified cap. A titanium cap allowed new bone formation on the MAO surface to be observed and is a promising device for bone augmentation. Additionally, this finding suggests that observation through a titanium cap is a feasible method for biomaterial testing in hard tissue. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of long implants (10–16 mm) inserted in maxillary sinuses augmented according to a lateral approach versus short (8 mm) implants placed in crestally augmented sinuses, early loaded after 45 days. Materials and methods: Forty partially or fully edentulous patients having 3 to 6 mm of residual crestal height and at least 4 mm in thickness below the maxillary sinuses were randomised according to a parallel group design to receive either one to three 10 to 16 mm-long hydroxyapatite-coated implants (20 patients) after lateral sinus lifting with 50% an organic bovine (Bio-Oss) and 50% autogenous bone, or 8 mm implants (20 patients) after crestal sinus lifting with autogenous bone. Implants were submerged and left healing for 45 days before loading the implants. Within 1 week after abutment connection, implants were loaded with screw-retained full acrylic provisional prostheses. Definitive metal-ceramic prostheses were provisionally cemented 45 days after abutment connection. Outcome measures were prosthesis and implant failures, any complications, and radiographic periimplant marginal bone level changes. In addition, the stability of individual implants was assessed with Osstell and Periotest at abutment connection (baseline), and at 1 and 5 years after loading by blinded outcome assessors. All patients were followed up to 5 years after loading.Results: One patient dropped out (death) from the longer implant group. One implant failed in the short implant group versus 5 implants in 3 patients of the longer implant group. The difference was not statistically significant. Four complications occurred in 4 patients of the short implant group versus 8 complications in 7 patients of the long implant group, the difference being not statistically significantly different. However, the 2 major postoperative complications occurred in the longer implant group: 1 abscess, and 1 sinusitis that led to the complete failure of the treatment in 2 patients (4 implants lost). A total of 0.72 mm of peri-implant marginal bone was lost after 5 years at long implants and 0.41 mm at short implants, the difference between the two groups was statistically significant (P = 0.028). Osstell values increased and Periotest decreased over time and there were no differences between groups at any time points. Conclusions: In atrophic maxillary sinuses with a residual bone height of 3 to 6 mm, 8 mm short implants placed in a simultaneously crestally lifted sinus might be a preferable choice than a 1-stage lateral sinus lift for placing longer implants since they appear to be associated with less morbidity. If these implants are placed with an insertion torque >35 Ncm and are joined together under the same prosthesis, they can be early loaded at 6 weeks. Conflict-of-interest statement: This study was completely self-supported and no contribution from any commercial party was received, including support in the form of free materials. [ABSTRACT FROM AUTHOR]

In tissue engineering and regenerative medicine mesenchymal stem cells (MSC) are widely used to replace and restore the function of dysfunctional or missing tissue. Recent studies have shown significant enhancements of the in vivo healing process following dentofacial bone augmentation procedures employing stem cell-loaded xenografts. We conducted experimental and numerical investigations in perfusion flow bioreactor-xenograft-systems to identify flow conditions as well as bioreactor design features that allow for homogeneous MSC-distribution in Geistlich Bio- Oss Block xenografts. Pressure gradient - velocity characteristics and flow distributions were investigated experimentally and numerically for two bioreactor designs at steady-state flow conditions with Reynolds numbers (Re) ranging from 0.01 ≤ Re ≤ 0.32. Distilled water at 20°C with a dynamic viscosity of 1.002 mPa∙s and a density of 998 kg/m3 was used. The geometry of the xenograft utilized in three-dimensional computational fluid dynamics (CFD) simulation was obtained by means of micro-computed tomography (μCT) at an isotropic spatial resolution of 9.5 μm. The permeability values calculated from the experimental data are in good accordance with the numerical results. The investigations showed that the increase of the inflow- and outflow-area diameter, as well as the decrease of the volumetric flow rate, result in a decreasing heterogeneity of the flow distribution within the xenograft. The calculated wall shear stress rates in the three-dimensional (3D) scaffold range from 1∙10-12Pa ≤ τ ≤ 0.2 Pa. Experimentally validated CFD simulations introduced in this study provide an applicable tool to assess optimal flow conditions for homogeneous MSC distribution in bioreactor-xenograft-systems.

Objective The aim of the present study was to evaluate the clinical outcomes of implant⁃supported pros⁃ theses for oral function rehabilitation in patients with ectodermal dysplasia. Methods Thirteen patients were included in the present study. After bone augmentation, zygomatic implants (ZIs) or regular implants (RIs) were placed, fabrica⁃ tion of dental prostheses were applied, and psychological and oral education was carried out. Implant survival rates, pa⁃ tient satisfaction and other related evaluation indicators were assessed. Results The ilium was chosen for autogenic bone grafts in two patients. The fibula was used in two other patients and the mandibular ramus in one other patient. One patient was treated through alveolar distraction osteogenesis of the mandible. Guided bone regeneration was applied in seven other patients. Bone graft resorption in the maxilla was observed in one patient; bone augmentation of the man⁃ dible was successful in all patients, and no obvious bone resorption was observed. One hundred and eighteen implants were placed, among which 22 were ZIs, and 96 were RIs. Five RIs failed and were removed. The survival rate for ZIs was 100%, and the survival rate for RIs was 94.79%, in a follow up after 3 years. All patients were satisfied with the res⁃ toration of their oral function. More than 50% of the patients exhibited self⁃confidence. Conclusion Oral function can be restored in edentulous ectodermal dysplasia patients using bone augmentation and implant⁃supported prostheses, and patient self ⁃confidence can be enhanced. However, the resorption of grafted bone in the anterior region of the maxilla cannot be ignored.

Background and Objectives: Preliminary studies emphasize the similar performance of autogenous bone blocks (AUBBs) and allogeneic bone blocks (ALBBs) in pre-implant surgery; however, most of these studies include limited subjects or hold a low level of evidence. The purpose of this review is to test the hypothesis of indifferent implant survival rates (ISRs) in AUBB and ALBB and determine the impact of various material-, surgery- and patient-related confounders and predictors. Materials and Methods: The national library of medicine (MEDLINE), Excerpta Medica database (EMBASE) and Cochrane Central Register of Controlled Trials (CENTRAL) were screened for studies reporting the ISRs of implants placed in AUBB and ALBB with ≥10 participants followed for ≥12 months from January 1995 to November 2021. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was assessed via several scoring tools, dependent on the study design. Means of sub-entities were presented as violin plots. Results: An electronic data search resulted in the identification of 9233 articles, of which 100 were included in the quantitative analysis. No significant difference (p = 0.54) was found between the ISR of AUBB (96.23 ± 5.27%; range: 75% to 100%; 2195 subjects, 6861 implants) and that of ALBB (97.66 ± 2.68%; range: 90.1% to 100%; 1202 subjects, 3434 implants). The ISR in AUBB was increased in blocks from intraoral as compared to extraoral donor sites (p = 0.0003), partially edentulous as compared to totally edentulous (p = 0.0002), as well as in patients younger than 45 as compared to those older (p = 0.044), cortical as compared to cortico-cancellous blocks (p = 0.005) and in delayed implantations within three months as compared to immediate implantations (p = 0.018). The ISR of ALBB was significantly increased in processed as compared to fresh-frozen ALBB (p = 0.004), but also in horizontal as compared to vertical augmentations (p = 0.009). Conclusions: The present findings widely emphasize the feasibility of achieving similar ISRs with AUBB and ALBB applied for pre-implant bone grafting. ISRs were negatively affected in sub-entities linked to more extensive augmentation procedures such as bone donor site and dentition status. The inclusion and pooling of literature with a low level of evidence, the absence of randomized controlled clinical trials (RCTs) comparing AUBB and ALBB and the limited count of comparative studies with short follow-ups increases the risk of bias and complicates data interpretation. Consequently, further long-term comparative studies are needed.

The sources of iliac crest bone grafts are limited. Alternatives are evaluated due to the progress in biomaterial sciences. Synthetical hydroxyapatite (HA), ß-tricalcium phosphate (ß-TCP) or biphasic compounds, or even a mélange of HA and ß-TCP will replace bovine ceramics. The goal is maintenance of replica-based-bone formation (RBBF) for bone augmentation. 2 female and 2 male patients between 41 and 73 years with 5 sinus elevations were evaluated. Sinus elevations with lateral fenestration, trapezoidal-muco-periosteal flaps and filling with micro-chambered beads (1.5 mm) was performed. A porcine-collagenous membrane and the refixated flap covered the defect. A biopsy program over 20 months was confirm confirm the maintenance of the newly formed bone. A fast bone formation was pronounced. The biopsies revealed mature lamellar bone and full osseointegration of the ß-TCP implant. The biopsy after 20 months showed compact bone with osseointegration of minor rests of the ceramic implant. The defect revealed a mature bone stock already after 5 weeks. The introduction of the replica-based-bone formation (RBBF) around micro-chambered beads will change the paradigm of bone augmentation. The next step of the ongoing study has to redefine the interval for implant insertion. The clinical approach confirms the breakthrough to primary mature lamellar bone formation and will permit reduction of placement time for a dental implant. [ABSTRACT FROM AUTHOR]

Featured Application: The aim of lateral sinus floor elevation (LSFE) is to increase the residual alveolar bone volume at the posterior maxillary area for implant-supported restoration. However, due to the restricted surgical access, mainly to the anterior sinus wall, this procedure becomes more challenging and difficult to perform in cases where adjacent proximal vital teeth are present. The present study proves that through a strict surgical protocol and careful tissue management, LSFE is a predictable and safe procedure presenting no risk of vitality loss and periapical pathology for adjacent vital teeth. The aim of the present study was to evaluate the pulpal and periapical status of vital teeth within the area of a lateral sinus floor elevation (LSFE). The files of patients treated by LSFE between 2009 and 2015 were retrospectively evaluated. The radiographic bone measurements and the periapical status of the teeth adjacent to the LSFE area were evaluated preoperatively and 6 months following the surgery by CBCT. The pulpal status of the adjacent teeth was clinically evaluated using thermal pulp vitality testing. Vital teeth within the sinus floor elevation area were the main inclusion criteria for this study. A total of 158 LSFE procedures were evaluated; 18 cases fulfilled the inclusion criteria, and 20 adjacent teeth were vital. There were no cases of periapical pathology or loss of pulp vitality. There was a statistically significant difference in the ridge height between the baseline and 6 months postoperatively and in the distance from the apex to the sinus floor between pre- and 6 months postoperatively (p < 0.01).The pulpal and periapical status of vital teeth was not affected following LSFE. [ABSTRACT FROM AUTHOR]

Background: Calvarial bone grafts are successful in the reconstruction of the severely atrophied maxilla as a pre‐implant procedure. However, not much is known about graft incorporation at the microscopic level. Purpose: This study aimed to assess calvarial bone conversion 4 months after being grafted in the edentulous maxillary bone. Materials and methods: In 13 patients (age:65.3 ± 8.7 years) the atrophic maxilla was reconstructed with autologous calvarial bone. Biopsies were taken from fresh calvarial bone grafts and from the reconstructed maxillae after 4 months of healing. Micro‐CT, histomorphometric, and histological analysis were performed. From three patients biopsies were obtained after 9, 11, or 45 months. Results: The micro‐CT analysis revealed that in the maxilla the calvarial bone was well preserved even after 45 months. Histology showed progressive incorporation of grafted bone within a maxillary bone. Osteoid and osteocytes were present in all biopsies indicating new bone formation and vital bone. Histomorphometrically, the percentage of grafted bone volume over total volume decreased from 79.8% (IQR78.7‐83.3) in fresh calvarial grafts to 59.3% (IQR44.8‐64.6) in healed grafts. The biopsies were taken after 9, 11, and 45 months showed similar values. Conclusions: Calvarial bone grafts result in stable and viable bone, good incorporation into native maxillary bone, and a minor decrease in bone volume after healing. Consequently, they provide a solid base for implant placement in severely atrophied edentulous maxillary bone. [ABSTRACT FROM AUTHOR]

Addition of alveolar bone to implant treatment is a common practice to obtain the function and aesthetics expected in areas of inadequate bone. Bone augmentation is a surgical procedure to correct the shape and size of the alveolar bone in preparation for receiving or maintaining a dental prosthesis. Correction of bone deficiencies will not only allow ideal implant placement in terms of angulation and size, but also allow correction of soft tissue deficiencies to improve overall esthetics. Several bone augmentation techniques for correcting inadequate bone conditions include interpositional grafts, onlay block bone grafting, ridge split / ridge expansion, guided bone regeneration and osteogenesis distraction. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to retrospectively assess bone volumes, healed ridge topography and possibility to plan prosthetically guided implants (PGI) at least 6 months after extraction or exfoliation of first molars as a consequence of terminal periodontitis (EEFMP). Materials and Methods: 45 subjects with stage III‐IV periodontitis providing 74 extraction sites (maxillary = 51 and mandibular = 23) were included. The degree of residual periodontal support on each root was assessed by combining periodontal and radiographic data. Digital planning of PGI with 4.8/4.1 mm diameter, 8 mm long, root‐form dental implant and need for bone augmentation (BA) were performed using CBCT with a radiographic stent. Possibility of standard implant placement (STANDARD) and need for simultaneous or staged BA were assessed. Results: Planning PGI placement was possible in all cases. For a 4.8 mm diameter implant, STANDARD was possible in 37.8% of the sites, 33.8% required BA at the time of implant placement, and 28.4% required staged BA before PGI. The use of 4.1 mm rather than 4.8 mm diameter implant allowed STANDARD in an additional 8.1% of cases that originally required simultaneous BA/osteotome sinus floor elevation (OSFE). The level of periodontal bone loss did not predict the complexity of implant placement, but significant differences were observed comparing maxillary with mandibular sites. Conclusion: PGI planning at sites with first molar loss due to terminal periodontitis is possible but poses great challenge to rehabilitation, often requiring advanced augmentation procedures and sinus augmentation. [ABSTRACT FROM AUTHOR]

Even though conventionally prepared octacalcium phosphate and collagen composite (OCP/Col) has exhibited excellent bone regeneration and has recently been commercialized for treating bone defects, reproducible appositional bone formation with OCP/Col has never been achieved. The present study investigated whether appositional bone formation could be achieved by altering the density of OCP/Col and applying liquid nitrogen during the preparation of OCP/Col. The prepared OCP/Col disks had eight variations and were divided into categories according to four different type of densities (1.0, 1.3, 1.7, and 2.0) of OCP/Col and two different pre‐freezing conditions of gas phase (G group: −80°C) and liquid phase (L group: −196°C). These disks were implanted into subperiosteal pockets in rodent calvaria, five samples per each eight variations. Radiomorphometric analysis was conducted at 4 and 12 weeks after implantation, and histological analysis was conducted at 12 weeks after implantation. OCP/Col samples in the L group tended to retain their height and shape and had enhanced appositional bone formation, whereas OCP/Col samples in the G group tended to lose their height and shape and had limited appositional bone formation. The appositional bone formation increased along with growing density of OCP/Col, and L2.0 demonstrated higher appositional bone formation than other samples. These results suggest that the pre‐freezing conditions and densities of OCP/Col affect the appositional bone formation. [ABSTRACT FROM AUTHOR]

Periodontitis involves destruction of the periodontal ligament and supporting structures. It ranges from a simple inflammation of gums to major damage resulting in loss of bone. Multiple conditions like trauma, periodontal disease, reconstructive surgery, ageing, osteoporosis and neoplastic pathology, have a common characteristic feature being loss of bone and tissue. The regenerative procedures that are currently practiced aim to regenerate the lost tissue via means of grafting, placement of membranes and many more, but have been accompanied with a set of limitations and major disadvantage being graft rejection. Periodontal regeneration still endures to be a partially unsolved algorithm. In dentistry, a new arena of development is being exploited to set a new approach for regeneration that is Nanotechnology. This branch involves tissue engineering which aims to regenerate the lost tissues via manufacturing scaffolds which transport signaling cells and molecules. These scaffolds possess magnificent physical as well as chemical properties and biomimetic features that act as a substitute of the highest standard offering innumerable benefits for promoting cell growth and tissue regeneration via tissue engineering.Nanomaterials because of their refined physiochemical characteristics and biomimetic attributes serve as a scope worthy substitute that offers several advancements for stimulation of cell growth and tissue regeneration. This review provides an insight to basic information about nanotechnology, the various nano particles having application in periodontal regeneration, the advanced regenerative procedures fabricated on the principles of nanotechnology, their applications, the clinical studies highlighting the achievements so far, supremacy over the conventional method and limitations. [ABSTRACT FROM AUTHOR]

Aims: The scope of this study was to analyze the influence of clinically feasible implant diameter and length on the stress transmitted to the peri-implant bone in the case of a resorbed and bone augmented mandible through finite element analysis. Settings and Design: The study was carried out in silico. Subjects and Methods: Resorbed and bone-augmented 3D models were derived from in vivo cone-beam computed tomography scans of the same patient. Corresponding implant systems were modeled with the diameter ranging from 3.3 to 6 mm and length ranging from 5 to 13 mm, and masticatory loads were applied on the abutment surface. Statistical Analysis Used: None. Results: In the bone augmented ridge, maximum stress values in the peri-implant region drastically decreased only when using implants of a diameter of 5 mm and 6 mm. Implants up to 4 mm in diameter led to comparable stress values with the ones obtained in the resorbed ridge, when using the larger implants. The increase of length reduced stress in the resorbed mandible, whereas in the bone augmented model, it led to small variations only in implants up to 4 mm in diameter. Conclusions: It was concluded that bone augmentation provides the optimal framework for clinicians to use larger implants, which, in turn, reduces stress in the peri-implant region. Diameter and length play an equally important role in decreasing stress. Implant dimensions should be carefully considered with ridge geometry. [ABSTRACT FROM AUTHOR]

Maxillofacial trauma that occurs in a traffic accident often results in not only missing teeth but also sever bone defects, with bone augmentation including possible reconstruction of occlusion needed for treatment. This case report describes bone augmentation treatment for a patient with severe bone injuries because of a traffic accident, in which titanium mesh and an iliac bone (autogenous particulate cancellous bone and marrow: PCBM) graft were utilized. A 33-year-old male was involved in a traffic accident and referred to visited Kyushu Dental University Hospital 2 months later. Computerized tomographic scanning showed a maxillary and mandibular anterior alveolar bone defects. Mandibular surgery was performed under general anesthesia, and a reconstructive plate was used for fixation with titanium mesh as well as PCBM graft. For the alveolar bone defect in the maxillary anterior region, bone augmentation using titanium mesh was also performed. At 6 months after the operation, the plate and titanium mesh were removed, then 5 implants were successfully placed and remained intact for more than 5 years. Additionally, the esthetic and functional results successfully matched the expectations of the patients. [ABSTRACT FROM AUTHOR]

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BACKGROUND: Chitosan exhibits good physiochemical properties and biocompatibility, but it has poor biological activity of osseointegration. Therefore, it needs to combine with other materials for bone repair. OBJECTIVE: Calcined bone/chitosan composite was prepared and its physiochemical properties and biocompatibility were analysed. METHODS: Calcined bone/chitosan composite was prepared at a mass ratio of 1 : 2, 1 : 1, 2 : 1 respectively by solution blending method. The physicochemical properties of three composite materials were characterized．Passage 5mouse L929 fibroblasts were treated with the leaching solution of three composite materials. The cytotoxicily of three composite materials was detected by the CCK-8 test. RESULTS AND CONCLUSION: (1) X-ray diffraction and Fourier Transform Infrared Spectroscopy showed that the essential components of three composite materials were hydroxyapatite and β-tricalcium phosphate.The characteristic diffraction peaks of hydroxyapatlte/β-tricalcium phosphate increased with the increase of the proportion of calcined bone. (2) Scanning electron microscopy showed that calcined bone particles were evenly dispersed in chitosan medium. (3) With the increase of the proportion of calcined bone, the compressive strength of the composite decreased gradually. (4) After 7 days of culture, the cells in the leaching solution of three composite materials grew well without obvious change in morphology. By the ninth day, the relative proliferation rate of the cells in the leaching solution of three composite materials was over90%. Cytotoxicily was grade 1, which meets the safely standard of biomateriaIs. (5) These results Suggest that the calcined bone/chitosan composite has good structural characteristics, physciochemical properties and suitable compressive strength and is safe and non-toxic. [ABSTRACT FROM AUTHOR]

Background: It is not well-known which pre-implantological procedures are preferred by maxillofacial (MFS) and oral surgeons (OS) for the narrow atrophic alveolar ridge under practice based conditions and, if different training paths in surgery lead to other pre-implantological techniques being preferred. This study aims to identify which procedures are preferred by the respective specialists in which indication. Methods: A questionnaire was sent to a total of 300 MFS and OS in southern Germany. The questionnaire examined pre-implantological procedures (bone block, bone grafting material and/or particulate autogenous bone, titanium mesh, bone split, resection) in the edentulous severely atrophic mandible and in the severely atrophic single-tooth gap. Kendall's Tau-b test was used for statistical analyses. Results: One hundred seventeen participants returned the questionnaire. 68 (58%) were OS and 49 (42%) were MFS. In the edentulous mandible, bone substitute material and resection were most preferred by both specialists. Bone blocks were statistically significantly more frequently associated with MFS and bone substitute materials with OS. Bone split was more frequently used in the atrophic single tooth gap than in the edentulous mandible. OS preferred bone blocks in the single tooth gap more often than in the edentulous mandible. MFS and OS preferred resection in the edentulous mandible significantly more frequently than in the single tooth gap. Conclusions: MFS in general prefer more invasive pre-implantological therapies with the same initial diagnosis than OS, which seems to be attributed to different training paths. [ABSTRACT FROM AUTHOR]

Zygomatic bone is one of the facial bones, which forms the prominence of the cheek. It helps in formation of walls of bony orbit, temporal, and infratemporal fossa. Nowadays, the importance of this bone is highlighted in several clinical conditions. In dental implants, when there is no adequate bone volume permitting their anchorage, zygomatic implants are long screw-shaped implants developed as a partial or complete alternative to bone augmentation procedures for the severely atrophic maxilla.1 The potential main advantages of zygomatic implants could be that bone grafting may not be needed and a fixed prosthesis could be fitted sooner.Cone Beam Computerized (CBCT) of 30 patients (15 males and 15 females) above 40 years of age who underwent radiological evaluation for implant placement in posterior atrophic maxilla were selected as the study participants with edentulism for more than 1 year. The inclusion criteria of the study was partially edentulous or completely edentulous patients with maxillary atrophied posterior region. The exclusion criteria was tumours, trauma and those with systemic complications. Informed consent was obtained from the patients before radiograph. In the study population, 39.2% were males and 60.7% were females. In relation to CBCT variation of zygomatic bone length among males. Most prevalent (30%) zygomatic bone length is observed to be 40mm females. Most prevalent (50%) zygomatic bone length is observed to be 43mm among males. Most prevalent (50%) zygomatic bone width is observed to be 4.5mm to among Females. Most prevalent (30%) zygomatic bone width is observed to be 5 mm among males. Within the limits of the study it was found that the majority of male population 30% has zygomatic bone length 40mm and in Female population 50% has 43 mm. Most prevalent (50%) zygomatic bone width is observed to be 4.5 mm and 5mm in females (30%). [ABSTRACT FROM AUTHOR]

Periodontal regenerations and bone augmentations are common procedures practiced on a daily basis worldwide. This had led to the introduction of a wide number of barrier membranes, all aiming at regenerating a sufficient amount of bone while being safe, cost effective and easy to handle. Membranes have different characteristics that may influence their clinical properties and the result obtained. The article aims at presenting an overview of the different barrier membranes commonly used in the oral surgery field, while shedding light on the new advances in the third generation membranes. [ABSTRACT FROM AUTHOR]

No previously published studies have reported on the placement and restoration of dental implants in a patient diagnosed with sarcoidosis. Patients with sarcoidosis may develop periodontitis as a manifestation of systemic disease and are therefore at increased risk of tooth loss. These patients are likely to want fixed dental prostheses, which may need to be supported by dental implants. The case presented is that of a 31-year-old female patient presenting with a missing maxillary central incisor and a sarcoidal process affecting the anterior maxilla, which had severely compromised the periodontium of the adjacent lateral incisor. The patient was successfully rehabilitated with an implant-retained prosthesis following a staged horizontal and vertical bone augmentation procedure. At the 4-year review, the implant restoration performed well with stable peri-implant bone levels. We conclude that dental implant rehabilitation in patients with sarcoidosis may be a predictable treatment option, depending on disease stability and concurrent systemic therapy, but these patients will require additional maintenance because of the possibility of an increased risk of peri-implantitis. The effects of sarcoidosis and its management on the success of dental implants are discussed to aid treatment planning for such patients. [ABSTRACT FROM AUTHOR]

To evaluate the clinical efficacy of concentrated growth factors (CGFs) combined with mineralized collagen (MC) in guided bone regeneration (GBR). A retrospective study involving 29 patients treated with GBR technique, which was performed either CGF and MC complexes or MC alone. Implants were inserted simultaneously and cone-beam computed tomography was taken immediately, at 3 and 6 months postoperation. Questionnaires were completed by all patients so as to evaluate the main symptoms and daily activities during the first week after surgery. The outcomes of the two groups were statistically compared. All implants healed uneventfully. Patients in both groups suffered from different levels of discomfort for the reason of swelling, pain and chewing impairment on 1–2 days. Meanwhile, swelling of the Trial group was weaker than the Control group. When compared with the Control group, pain levels in Trial group were more rapidly reduced and patients took fewer analgesics from Day 3. Furthermore, the reconstitution mean value of the graft was thicker at 3 and 6 months in Trial group. CGFs complex with MC were beneficial to relieve the clinical symptoms, promote the peri-implant bone regeneration and shorten the healing time. [ABSTRACT FROM AUTHOR]

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Background: Limited studies focused on the bone profile maintenance at the alveolar ridge crest applying horizontal bone augmentation. Purpose A novel approach named as "in‐situ bone ring technique" was introduced to be compared with tent‐pole technique to evaluate their horizontal bone gain, resorption, and postoperative perception. Materials and methods: A total of 30 patients were included in this retrospective cohort study. All patients required horizontal bone augmentation at anterior site. Accordingly, quantitative and qualitative analyses were conduct radiographically and histologically between in‐situ bone ring (ring group) and tent‐pole technique (tent group). Moreover, the visual analog scale (VAS) was introduced to assess the patients' perception toward both treatments. Results: Cone‐beam computed tomography results showed great significant difference regarding horizontal bone width at 0 mm and 3 mm from alveolar ridge crest between two groups (P <.05). On the basis of histological outcomes, delightful bony fusion was shown 6‐month postoperatively in ring group. The VAS ratings for pain and swelling reflected similar results between two groups. Conclusions: In‐situ bone ring technique evidently increased and maintained horizontal bone mass at the alveolar ridge crest compared to tent‐pole technique, which might be favorable for implant rehabilitation in anterior area. Meanwhile, no further discomfort was caused according to VAS scoring between two groups. [ABSTRACT FROM AUTHOR]

Background: Multiple approaches for fixation of distal radius fractures exist; nonetheless, there is no consensus on the optimal treatment for these injuries. Although using volar locking plates has become increasingly common as a surgical intervention, the usefulness of bone augmentation remains debatable. Therefore, this study aimed to evaluate the necessity of bone augmentation for distal radius fractures fixed with a volar locking plate.Methods: This retrospective study enrolled patients with a single distal radius fracture treated with a volar locking plate between January 2014 and December 2016. Overall, 105 fractures were included and divided into two groups (non-bone augmentation: group 1, n = 88; bone augmentation: group 2, n = 17). Images were reviewed, and dorsal cortex collapse, volar tilting, and radial height and inclination were measured immediately after surgery and at the 6-month follow-up.Results: Both groups exhibited significant differences in dorsal collapse (p < 0.001 and p = 0.001, respectively) and radial height shortening (p < 0.001 and p = 0.039, respectively); volar tilting and radial inclination did not differ significantly. There was no difference in the degree of dorsal collapse (p = 0.715) and radial height shortening (p = 0.651) between the two groups. Of the 105 fractures, 54 were identified as comminuted type according to the AO classification (A3, C2, and C3), and similar radiographic outcomes were noted.Conclusions: Volar locking plates for the treatment of distal radius fractures with or without bone augmentation do not affect the radiographic outcomes. In comminuted fractures, additional bone augmentation is unnecessary if intraoperative anatomical reduction and fixation are performed when possible. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this retrospective study was to determine clinical benefits of ridge preservation in terms of surgical invasiveness of implant placement compared to natural healing in the maxilla. Materials & Methods: This study included 178 patients with 206 implants placed at ridge‐preserved sites and 493 patients with 656 implants placed at naturally healed sites in maxillary anterior and posterior regions. Patient‐ and implant‐related data were collected from electronic dental records including additional augmentation procedures performed before or during implant placement and surgical complications. Cumulative survival rate was assessed using Kaplan–Meier method. The annual peri‐implant marginal bone loss between the two groups was compared using the Mann–Whitney U test. Results: The follow‐up period was 24.4 ± 18.1 months (mean ± standard deviation) for ridge‐preserved sites and 45.7 ± 29.6 months for naturally healed sites. Sinus augmentation was performed at similar frequencies in the two groups, but lateral approach was applied significantly more at naturally healed sites (37.2%) than ridge‐preserved sites (8.3%, p ≤.001). There was no intergroup difference in the cumulative survival rate or annual peri‐implant marginal bone loss. Conclusion: Ridge preservation can be clinically beneficial for minimizing the invasiveness of implant surgery by simplifying the procedure when sinus augmentation is expected in the maxilla. [ABSTRACT FROM AUTHOR]

Objectives: To assess clinical, radiographic and aesthetic outcomes, and satisfaction of patients treated with single implant restorations in the maxillary aesthetic region 5 years after final restoration. Material and methods: Sixty patients (29 male/31 female, mean age 37 years) with a missing anterior tooth in the maxilla (39 central incisors/10 lateral incisors/5 cuspids/6 first premolars) received a bone‐level implant with conical connection. In 29 patients, a bone augmentation procedure was necessary before implant placement (autogenous bone grafts mixed with spongiosa granules). All implants (12 with 3.3 mm diameter/ 48 with 4.1 mm diameter) were loaded after 3 months of submerged healing. The restoration consisted of an individually designed full‐ zirconia abutment veneered with porcelain. Follow‐up with clinical and radiographic assessment was conducted until 60 months after the final restoration. Aesthetic outcome of the restoration was determined with the Pink Esthetic Score–White Esthetic Score (PES‐WES). Patient satisfaction was assessed with a VAS scale and satisfaction questionnaire. Results: Fifty patients completed the 5‐year follow‐up. Implant survival was 100%, restoration survival 98%. Mean bone‐level change was −0.13 ± 0.66 mm with a median (IQR) pocket probing depth of 2.75 [2.25; 3.25]. The mean PES and WES scores were 6.6 ± 1.7 and 7.8 ± 1.5, respectively. Patient satisfaction was high (92.1 ± 7.8 on 100 mm VAS scale). There were no differences between patients with or without a bone augmentation procedure. Conclusion: Bone‐level implants with a conical connection are a reliable treatment option in single‐tooth replacements in the maxillary aesthetic zone. [ABSTRACT FROM AUTHOR]

Octacalcium phosphate and its collagen composite have been recognized as bone substitute materials possessing osteoconductivity and biodegradation properties. We evaluated the effectiveness of octacalcium phosphate and its collagen composite used for bone augmentation in major oral and maxillofacial surgeries in a clinical trial. Octacalcium phosphate and its collagen composite were used in cases of sinus floor elevation in 1- and 2-stage, socket preservation, cyst, and alveolar cleft procedures. A total of 60 patients were evaluated for effectiveness after the implantation of octacalcium phosphate and its collagen composite. Although sinus floor elevation in 1-stage, cyst, and alveolar cleft cases met the criteria for the judgment of success, sinus floor elevation in 2-stage and socket preservation groups did not meet the criteria in the initial evaluation. However, an additional evaluation for reconfirmation revealed the effectiveness of octacalcium phosphate and its collagen composite in those groups, and all evaluation results ultimately indicated the success of this clinical trial. Therefore, this clinical trial suggested that application of octacalcium phosphate and its collagen composite for oral and maxillofacial surgery was safe and effective and that octacalcium phosphate and its collagen composite could be a bone substitute candidate instead of autologous bone. [ABSTRACT FROM AUTHOR]

Octacalcium phosphate and its collagen composite have been recognized as bone substitute materials possessing osteoconductivity and biodegradation properties. We evaluated the effectiveness of octacalcium phosphate and its collagen composite used for bone augmentation in major oral and maxillofacial surgeries in a clinical trial. Octacalcium phosphate and its collagen composite were used in cases of sinus floor elevation in 1- and 2-stage, socket preservation, cyst, and alveolar cleft procedures. A total of 60 patients were evaluated for effectiveness after the implantation of octacalcium phosphate and its collagen composite. Although sinus floor elevation in 1-stage, cyst, and alveolar cleft cases met the criteria for the judgment of success, sinus floor elevation in 2-stage and socket preservation groups did not meet the criteria in the initial evaluation. However, an additional evaluation for reconfirmation revealed the effectiveness of octacalcium phosphate and its collagen composite in those groups, and all evaluation results ultimately indicated the success of this clinical trial. Therefore, this clinical trial suggested that application of octacalcium phosphate and its collagen composite for oral and maxillofacial surgery was safe and effective and that octacalcium phosphate and its collagen composite could be a bone substitute candidate instead of autologous bone. [ABSTRACT FROM AUTHOR]

The scope of our study was to analyze the impact of implant prosthetic rehabilitation, in bilateral terminal partial edentulism with mandibular bone atrophy, and potential benefits of mandibular bone augmentation through finite element analysis. A 3D mandible model was made using patient-derived cone-beam computed tomography (CBCT) images, presenting a bilateral terminal edentation and mandibular atrophy. A virtual simulation of bone augmentation was then made. Implant-supported restorations were modeled for each edentulous area. Forces corresponding to the pterygoid and the masseter muscles, as well as mastication conditions for each quadrant, were applied. The resorbed mandible presented high values of strain and stress. A considerable variation between strain values among the two implant sites in each quadrant was found. In the augmented model, values of strain and stress showed a uniformization in both quadrants. Virtually increasing bone mass in the resorbed areas of the mandible showed that enabling larger implants drastically reduces strain and stress values in the implant sites. Also, although ridge height difference between the two quadrants was kept even after bone augmentation, there is a uniformization of the strain values between the two implant sites in each of the augmented mandible quadrants. [ABSTRACT FROM AUTHOR]

Objective: This study compared and evaluated the clinical and radiographic results of guided bone regeneration using platelet-rich fibrin (PRF) and collagen membrane as barrier membrane in immediately placed implants with severe buccal bone defect (with respect to marginal bone level, implant stability quotient [ISQ]), and histological analysis of new bone formation. Materials and Methods: Sixteen implants were placed in patients requiring immediate implant placement and having a buccal wall defect and randomly divided into two groups one receiving PRF membranes and other collagen membrane. The sites were grafted with bone-substitute material in both the groups. After 4 months, at the time of second-stage surgery, implant stability is measured by Osstell Mentor, crestal bone level on mesial and distal sides of implant by digital intraoral periapical, buccal defect clinically by probe and histological analysis of biopsied bone. Results: The results were insignificant and comparable in both the groups when comparison was made between the groups. The mean buccal defect, mean values of average ISQ, crestal bone level in both the groups at baseline and after 4 months were compared. No significant difference between both the groups was found after 4 months. Bone quality seemed to be equal in both groups after histological analysis. Within the limits of the study, both the groups had shown similar results in all criteria. Conclusion: Within the limitation of the study, it can be concluded that both the treatment modalities are successful in terms of buccal defect reduction, stability, and increase in crestal bone level. [ABSTRACT FROM AUTHOR]

Purpose: The present study was conducted to evaluate the amount of bone height gain, density values, and implant stability after maxillary sinus floor elevation using graftless tenting technique or the use of Hydroxyapatite Nanoparticles bone substitute for augmentation with simultaneous implant placement. Materials and Methods: A total of 20 sinuses with a residual alveolar bone height ranging from 4‐6 mm were divided into two groups and underwent sinus augmentation using nano hydroxyapatite bone substitute material and the graftless tenting technique with simultaneous implant placement. Computed tomography CT scans and ISQ measurements were conducted to evaluate bone quality, quantity, and implant stability. Results: Radiographic analysis revealed that the mean bone height gain of the nano group was (7.0 ± 0.8 mm) compared to (5.0 ± 1.5 mm) in the tent group, which was statistically significant (P =.002) being higher in the nano group. The mean bone density value of the nano group was (548 ± 25 HU) compared to (420 ± 23 HU) in the tent group, which was statistically significant (P <.001) being higher in the nano group. The mean ISQ value after 6 months in the nano group was (78 ± 5) compared to (77 ± 5) in the tent group, which was statistically nonsignificant (P =.901). Conclusion: Nano hydroxyapatite bone graft offered superior results in terms of the bone height gain and the relative bone density as compared to graftless tenting technique. However, both techniques showed accepted results regarding implant stability. [ABSTRACT FROM AUTHOR]

Aim: The aim of this systematic review was to critically evaluate the currently existing clinical evidence on the efficacy of autogenous teeth (AT) for the reconstruction of alveolar ridge deficiencies. Materials and methods: A search protocol was developed to answer the focused question: "In patients exhibiting alveolar ridge deficiencies and being in need of an implant retained restoration, what is the efficacy of reconstructive procedures employing AT on changes in ridge dimensions compared with control measures?" Uncontrolled studies were also included to assess the overall efficacy of AT for specific procedures. Results: A total of six studies (one randomized, one non-randomized controlled, two observational, one controlled case series, one retrospective) were identified. Two studies used AT for staged lateral augmentation, whereas four studies used AT as a demineralized dentin matrix (AutoBT) for the simultaneous grafting of dehiscence-type defects, vertical augmentation of post-extraction sockets, and lateral/transcrestal sinus floor elevation. The reported clinical outcomes following the application of either AT or AutoBT were within the range of those data noted in the respective control groups. Adverse events were commonly not observed. Conclusions: The available limited studies involved relatively small patient samples and short follow-up periods but pointed to the potential of AT to serve as an alternative material for the reconstruction of alveolar ridge deficiencies. Clinical relevance: AT appear to be effective in reconstructing alveolar ridge deficiencies. [ABSTRACT FROM AUTHOR]

Copyright of Implant Dentistry is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This case report describes the use of canine demineralized freeze-dried membrane allograft and cancellous bone graft material to treat an infrabony osseous defect along the lingual aspect of a left mandibular canine in a 10-year-old miniature dachshund. Postoperative examination 6 and 12 months postoperatively showed osseous integration at the infrabony defect and improvement in periodontal probing measurements. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the soft and hard tissue response to orthodontic implant site development (OISD) (ie, forced extraction), to measure the amount of tissue that was regenerated and its relationship to the amount of orthodontic vertical tooth movement, to evaluate the tissue response in teeth with different degrees of periodontal attachment loss, to understand the limits of OISD, and to evaluate the implant survival rate. Materials and Methods: A total of 32 hopeless teeth were treated with OISD, and 27 implants were placed in 13 patientsconsecutively. The level of periodontal attachment on the teeth to be extracted, amount of augmented alveolar bone, changes in soft tissue volume, and the rate of orthodontic tooth movement were recorded. Results:Mean values after OISD were as follows: orthodontic extrusive movement, 6.2 ± 1.4 mm; bone augmentation,4 ± 1.4 mm; coronal movement of the gingival margin, 3.9 ± 1.5 mm; coronal movement of the mucogingival junction, 2.1 ± 1.3 mm; keratinized gingival augmentation, 1.8 ± 1.1 mm; gingival thickness (buccolingualdimension) augmentation, 0.7 ± 0.4 mm; recession, 1.8 ± 1.2 mm; bone augmentation/orthodontic movement ratio (efficacy), 68.9% ± 17.3%; gingival augmentation/orthodontic movement ratio (efficacy), 65.2% ± 19.9%;and pocket depth reduction, 1.8 ± 0.9 mm. The implant survival rate was 96.3%. Conclusions: OISD was available treatment for these hopeless teeth to regenerate hard and soft tissues. Its efficacy was about 70% for bone regeneration and 60% for gingival augmentation. The residual attachment level on the tooth was not a limitation. OISD might be a valuable treatment option to regenerate tissues for implant site development inpatients in need of conventional orthodontic therapy. [ABSTRACT FROM AUTHOR]

Objective: Sites in which bone is reduced in quality or height create challenges in esthetic reconstruction and loading support, which leads to a higher risk of failure. The Mk IV system with a TiUnite surface was designed specifically for placement in soft bone. This paper describes postloading outcomes of 103 Mk IV implants, with a focus on bone preservation in compromised bone sites during early remodeling, stability after abutment connection, and a 3- to 7-year follow-up from implant placement. Method and Materials: A series of 103 4-mm (diameter), ≥ 10-mm (length) Mk IV implants were placed in the maxillae of 25 females and 14 males. Twenty-three patients also received staged bone grafts, and two underwent socket augmentation as well as grafts. Areas of previous infection were prepared mechanically and chemically. To ensure primary implant stability, the size of the osteotomy and the number of entries were minimized. Following a delayed loading protocol, all patients were restored with fixed partial dentures. For analysis of bone stability, the marginal levels on the mesial and distal aspects of the implants were measured at 7x magnification by a radiologist not involved in the treatment. Results: Three implants were lost, 1 implant was never loaded although it integrated, 14 implants were not available for follow-up after abutment correction, and 5 had poor-quality radiographs. The mean marginal bone loss between implant insertion and loading was 1.21 ± 0.86 mm (n = 80). The differences in bone-remodeling levels in grafted and nongrafted sites were not significant. Data are reported on 103 implants in 39 consecutive patients through abutment connection, with radiographic follow-up from 3 to 7 years postimplant placement on 27 patients. Conclusion: It is critical to ensure optimal three-dimensional orientation and minimize site preparation, particularly when placing implants in compromised bone. With bone of poor preoperative density using a customized site preparation technique, excellent short-term implant survival and long-term bone stability have been demonstrated. Further follow-up will determine whether the Mk IV implant is the optimal design for compromised bone, including associated soft tissue stability. [ABSTRACT FROM AUTHOR]

A single missing tooth in the posterior atrophic maxillary segment poses a therapeutic challenge. Open sinus lift is not often performed because of anatomical restrictions and the need for specific surgical skills. The osteotome approach has considerable efficacy and safety limitations. In many cases, the clinician elects to treat with a three-unit partial denture or discard any rehabilitation plans. Two cases in which minimal invasive antral membrane balloon elevation was performed for single-tooth replacement are presented. This procedure appears to be a relatively simple, highly effective, and safe solution for single- tooth, implant-supported restorations of the posterior atrophic maxilla. (Quintessence Int 2011;42:645-650) [ABSTRACT FROM AUTHOR]

Purpose: Since the introduction of endosseous dental implants, the treatment concepts for management of the edentulous mandible have changed drastically. Reconstructive, preprosthetic surgery has changed from surgery aimed to provide a sufficient osseous and mucosal support for a conventional denture into surgery aimed to provide a sufficient bone volume enabling placement of dental implants at the, from a prosthetic point of view, optimal position. Moreover, the currently applied implant based prosthodontic concepts for the edentulous mandible are based on prospective randomized clinical trials comparing the treatment outcome of a variety of treatment modalities. This study reviews the various treatment concepts that are currently in use to rehabilitate the extremely atrophied mandible. Materials and Methods: A comprehensive review of human studies published in the international peer-reviewed literature up to March 2010 regarding procedures related to implant treatment in the extremely atrophied edentulous mandible was made. A MEDLINE search was completed, along with a manual search, to locate relevant literature. Results: There are advantages and disadvantages that are specific to removable implantsupported overdentures and fixed implant-supported full prostheses. The choice of an overdenture or a fixed full-arch prosthesis should be made on an individual basis. Once this choice has been made, the surgical procedure and the number of implants to be placed have to be determined. Conclusion: On the basis of the best evidence currently available, a treatment concept is proposed on how to deal with the edentulous mandible in order to provide patients with a mandibular overdenture supported by endosseous implants. [ABSTRACT FROM AUTHOR]

Aim: To describe a clinical case, a rare complication, in which two mandibular incisors became discoloured following bone harvesting for pre-implant augmentation. Summary: A 57-year-old woman was referred by her general dental practitioner regarding discolouration of her mandibular right central and lateral incisors. A segmental osteotomy was performed in the vicinity of these incisors about 4 weeks previously to harvest bone, which was grafted to provide support for the placement of an implant to replace the missing maxillary right canine. Although both incisors were symptom-free, they were non-responsive to sensitivity tests. Non-surgical root canal treatment was carried out to both of these non-vital teeth, followed by intracoronal bleaching to improve their colour. Key learning points: 1. Pre-implant bone grafting procedures may risk disrupting the blood supply of teeth situated close to the harvesting site. 2. If the blood supply of teeth is compromised, this may lead to loss of vitality and tooth discolouration. 3. The length, morphology and position of the roots of teeth should be carefully evaluated using periapical radiographs, and if necessary, tomographic imaging techniques to avoid this iatrogenic sequelae. 4. The consequences of loss of vitality and tooth discolouration are managed conservatively by root canal treatment and internal bleaching. [ABSTRACT FROM AUTHOR]

Conflict-of-interest statement: This was an investigator initiated trial, however the trial was partially supported by Zimmer Dental, Vittorio Veneto (TV), Italy. One of the authors (Dr Cosci) who treated eight patients in this study is the inventor of the Cosci technique and was a prerequisite of the sponsor to support the trial. Purpose: To compare the effectiveness of two different techniques to lift the maxillary sinus via a crestal approach: the Summers versus the Cosci technique. Materials and methods: Fifteen partially edentulous patients missing bilaterally maxillary molars and/ or premolars having 4 to 7 mm of residual crestal height and at least 5 mm thickness below the maxillary sinuses measured on computed tomography scans were randomised to have implants placed in sinuses crestally lifted according to the Cosci or Summers technique with bone substitutes according to a split-mouth design. Implants were left to heal submerged for 6 months. Implants were loaded with acrylic provisional crowns/prostheses. Screw-retained definitive metal-ceramic prostheses were delivered 4 months after provisional loading. Outcome measures were prosthesis and implant failures, any complications, operation time, operator preference, and patient preference assessed 1 month after surgery and 1 month after delivery of the final prostheses by a blinded outcome assessor. All patients were followed up to 5 months after loading (1 year after implant placement). Results: Nineteen study implants were placed according to each technique. No patient dropped out and no implant failed. No discomfort/complications occurred at sites treated with the Cosci technique whereas 12 patients reported discomfort during the augmentation procedure at the side treated with the Summers technique, this was statistically significant, and in one of these patients a perforation of the sinus membrane occurred. Postoperatively, headache was reported by nine patients and swelling occurred in three of these patients at the Summers treated sides. Statistically significantly less time was required to place implants according to the Cosci technique (33 versus 24 minutes, on average). The two operators and 14 out of 15 patients preferred the Cosci technique. Conclusions: Both crestal sinus lift techniques were successful but the Cosci technique required less surgical time, produced less intra- and postoperative morbidity and was preferred by patients. [ABSTRACT FROM AUTHOR]

Conflict-of-interest statement: Marco Esposito, Pietro Felice and Paul Coulthard are among the authors of four of the included trials, however, they were not involved in the quality assessment of these trials. This review is based on a Cochrane systematic review entitled 'Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus' published in The Cochrane Library (see http:// www.cochrane.org/ for information). Cochrane systematic reviews are regularly updated to include new research and in response to comments and criticisms from readers. If you wish to comment on this review, please send your comments to the Cochrane website or to Marco Esposito. The Cochrane Library should be consulted for the most recent version of the review. The results of a Cochrane Review can be interpreted differently, depending on people's perspectives and circumstances. Please consider the conclusions presented carefully. They are the opinions of the review authors, and are not necessarily shared by the Cochrane Collaboration. Background: Insufficient bone volume is a common problem encountered in the rehabilitation of the edentulous posterior maxillae with implant supported prostheses. Bone volume is limited by the presence of the maxillary sinus together with loss of alveolar bone height. Sinus lift procedures increase bone volume by augmenting the sinus cavity with autogenous bone and/or commercially available biomaterials. Objectives: To test whether and when augmentation of the maxillary sinus is necessary and which are the most effective augmentation techniques for rehabilitating patients with implant-supported prostheses. Search methods: The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched. Several dental journals were hand searched. The bibliographies of review articles were checked, and personal references were searched. More than 55 implant manufacturing companies were also contacted. The last electronic search was conducted on 7th January 2010. Selection criteria: Randomised controlled trials (RCTs) of different techniques and materials for augmenting the maxillary sinus for rehabilitation with dental implants reporting the outcome of implant therapy at least to abutment connection. Data collection and analysis: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Authors were contacted for any missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and odds ratios for dichotomous outcomes with 95% confidence intervals.… [ABSTRACT FROM AUTHOR]

Purpose: To evaluate a novel surgical technique for flapless transcrestal elevation of the maxillary sinus floor via surgical templates using gel pressure. Materials and Methods: Computed tomographic scans of fresh human cadaver maxillae and three-dimensional treatment planning software were used to design surgical templates. Access to the maxillary sinus was gained by guided transcrestal osteotomies to puncture the bony sinus floor. By injection of radiopaque gel, the maxillary sinus membrane was elevated to attain a postoperative bone height of 15 mm. Results: The gel-pressure technique was performed in 10 atrophic maxillary sites with a mean residual bone height of the alveolar crest of 4.7 ± 1.6 mm. The sinus membrane was successfully elevated in all sites without causing iatrogenic perforation (mean elevation height, 10.6 ± 1.6 mm). Conclusions: The gel-pressure technique may provide a new option for minimally invasive transcrestal sinus surgery and may represent a safe method to increase bone volume in the atrophic posterior maxilla. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of 10- to 16-mm-long implants inserted in maxillary sinuses augmented according to a lateral approach technique with 50% particulated autogenous bone harvested from the oral cavity and 50% Bio-Oss, versus 8-mm-long hydroxyapatite-coated implants placed in crestally augmented sinuses with autogenous bone according to the Cosci technique. All implants were early loaded at 45 days after placement. Materials and methods: Forty partially or fully edentulous patients having 3 to 6 mm of residual crestal height and at least 4 mm thickness below the maxillary sinuses (measured on a CT scan) were randomised to receive one to three, 10- to 16-mm-long implants (20 patients) after lateral sinus lifting with 50% anorganic bovine (Bio-Oss) and 50% autogenous bone, or 8-mm-long implants (20 patients) after crestal sinus lifting with autogenous bone. Implants were submerged and left to heal for 45 days. Within 1 week of abutment connection, implants were loaded with screw-retained full acrylic provisional prostheses. Definitive metal-ceramic prostheses were provisionally cemented 45 days after abutment connection. Outcome measures were the number of prosthesis and implant failures, and any complications. In addition, the stability of individual implants was assessed with Osstell and Periotest at abutment connection (baseline) and after 1 year of loading by a blinded outcome assessor. All patients were followed up for 1 year after loading. Results: No patient dropped out. In three patients of the 8-mm implant group, primary stability could not be initially obtained. However, after immediately replacing the unstable implants with implants with a larger diameter, sufficient primary stability was obtained. One implant failed in the short implant group and five implants failed in three patients of the longer implant group. The difference was not statistically significant. There were no differences in complications between groups. However, two major post-operative complications occurred in the longer implant group: one abscess and one sinusitis, which determined the complete failure of the treatment in two patients (4 implants lost). Osstell values increased, whereas Periotest valves decreased over time, and there were no differences between groups at any time point. Conclusions: This study suggests that in atrophic maxillary sinuses with a residual height of 3 to 6 mm, it may not be necessary to perform lateral sinus lifting to place longer implants (10 to 16 mm); 8-mm short implants might be a preferable choice as the treatment appears to be associated with less morbidity. This study also suggests that it is possible to load early (at about 7 weeks) implants placed in lifted sinuses that achieved a sufficient primary stability at placement. These preliminary results must be confirmed by larger trials with follow-ups of 5 years or more to monitor the performance of short implants over time. [ABSTRACT FROM AUTHOR]