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Introduction: Open extruded fractures of the talus occur in 2% of talar fractures. These fractures are challenging for surgeons due to complications such as infection, nonunion, and arthritis. The most common treatment method is talus reimplantation and osteosynthesis. Case report: A 19-year-old presented with an open extruded fracture of the talus, classified as Hawkins II, following a fall from a height. Emergency surgery involved wound debridement, talus reimplantation, osteosynthesis with modified external fixation for dynamic ankle joint fixation (Mitkovic-type), and two Kirschner wires. Fragments were repositioned under C-Arm fluoroscopy. The patient received a 14-day antibiotic regimen (Cephalosporins, Aminoglycoside, Metronidazole) and thromboembolic prophylaxis for 35 days. After 6 weeks we allowed movements in the ankle joint with physical therapy. Gradual weight-bearing was allowed after 8 weeks. The osteosynthetic material was removed after 18 weeks, with full weight-bearing achieved after 6 months. Radiographic follow-up was conducted up to 24 months postoperatively, showing excellent healing with minimal dorsiflexion restriction. Conclusions: Treating this injury is a significant challenge. External fixation can be a viable method for managing open luxation fractures of the talus.

The emotional intelligence (EI) is a significant concept that affects the management processes and employees in organisations. The psychologists and managers worldwide have also accepted the concept by applying different emotional intelligence models in their working practice. The paper emphasises the importance of measuring emotional intelligence in contemporary management and analyses the application of the Wong-Law Emotional Intelligence Scale (WLEIS) in companies in the Republic of Serbia. The WLEIS model is a 16-item self-report measure of emotional intelligence based on the revised Mayer and Salovey (MEIS) model with four branches (assessment of own emotions, assessment of others' emotions, use of emotions and regulation of emotions). The survey presented in this manuscript included top and middle managers (N=128) and tested their emotional intelligence abilities. The aim of this study was to apply the Wong-Law Emotional Intelligence Scale within the managers in companies in the Rebublic of Serbia, and to determine the difference between the genders and management levels. The research findings have demonstrated that the managers in tested companies had moderately high scores in the scale. However, the highest scores were registered for the variables of Others-Emotion Appraisal and the research was further oriented towards the analysis of this aspect of emotional intelligence by gender and management levels.

The explosion that caused by blasting is accompanied by the release of a large amount of energy. That energy can be used for rock mass destruction. At the same time, one part of that energy is utilized for rock destruction while the second one gets lost in the rock mass in the form of seismic wave. Regarding that, blasting effects can be divided into two categories such as: useful work and useless work. Useful work is manifested in form of crushing and milling of the rock material in the limited zone around explosive matter and is defined as brisant effect of explosion. Useless work is a phenomenon known as seismic effect of explosion. Useless work is associated with the elastic displacement i.e., the oscillation of the rock mass particles in a very large space around the place of explosion and is felt as a shock. Oscillation velocity of the induced rock mass is most often taken as the parameter for the evaluation the seismic effect of blasting. It is considering that the oscillation velocity best relates and describes the danger of shocks and damages which can be caused, so the appropriate standards for the shock protection are based on the data related to the oscillation velocity. In many countries, regulations that control the shock level caused by blasting activities have been adopted. For our country, these regulations have not yet been adopted, so we used the regulations of other countries to solve these problems. In this paper, criterion of the Institute of Physics of the Earth, Russian Academy of Sciences, criterion according to the Russian standards for mining objects, criterion according to the German standards DIN and criterion according to the USA standards are presented.

PURPOSE: The aims of the current study were to: (1) evaluate the results of vertical guided bone regeneration (GBR) with particulate autogenous bone grafts, (2) determine clinically and radiographically the success and survival rates of 82 implants placed in such surgical sites after prosthetic loading for 12 to 72 months, and (3) compare defects that were treated simultaneously with sinus augmentation and vertical GBR to other areas of the jaw treated with vertical GBR only. MATERIALS AND METHODS: Eighty-two implants were inserted in 35 patients with 36 three-dimensional vertical bone defects. The patients were divided into three groups: single missing teeth (group A), multiple missing teeth (group B), and vertical defects in the posterior maxilla only (group C). All group C subjects were treated simultaneously with sinus and vertical augmentations. All patients were treated with vertical ridge augmentation utilizing titanium-reinforced polytetrafluoroethylene (e-PTFE) membranes and particulated autografts. After removal of the e-PTFE membrane, all sites received a collagen membrane. RESULTS: At membrane removal, mean vertical augmentation was 5.5 mm (+/-2.29 mm). Mean combined crestal remodeling was 1.01 mm (+/-0.57 mm) at 12 months, which remained stable through the 6-year follow-up period. There were no statistically significant differences between the three groups in mean marginal bone remodeling. One defect had a bone graft complication (2.78%, 95% CI: 0.00%, 8.15%). The overall implant survival rate was 100% with a cumulative success rate of 94.7%. CONCLUSIONS: (1) Vertical augmentation with e-PTFE membranes and particulated autografts is a safe and predictable treatment; (2) success and survival rates of implants placed in vertically augmented bone with the GBR technique appear similar to implants placed in native bone under loading conditions; (3) success and failure rates of implants placed into bone regenerated simultaneously with sinus and vertical augmentation techniques compare favorably to those requiring only vertical augmentation. [ABSTRACT FROM AUTHOR]

IIntroduction: Fractures of the lower leg are frequent fractures of long bones that are of great importance in traumatology. The role of external fixation (SF) as a type of surgical treatment is significant and widely applied. There are 3 methods of using SF to treat tibial fractures: SF as primary and definitive treatment, SF combined with internal fixation, and conversion of SF to internal fixation. Objective: To show the possibilities of SF as a definitive way of treating lower leg fractures. Methods: In our paper, we analyzed 254 lower leg fractures treated with SF according to Mitković M20, which were treated at the Department of Orthopedics and Traumatology of CHC Kosovska Mitrovica. This series included 172 men or 68% of the total number of patients, and 83 or 32% women. Results: The average age of patients treated with this method is between the third and fourth decades of life. Falling on the leg with twisting of the table or the entire lower part of the leg is the most common type and cause of injuries in 69%. A closed lower leg fracture was diagnosed in 220 patients (A AO 59.%, B AO 26% and C AO 15%). Adequate position of the bone fragments was achieved by the closed reposition method in 190 (%), the average healing time was 18.4 weeks. In 93% of patients, we achieved bone union. Conclusion: The simple placement technique, the simplicity of the instrumentation, the wide range of indications where SF can be used, have led to the fact that it is a type of surgical treatment of great importance for lower leg fractures in small areas.

Buildings were recognized as large energy consumers, and they represent great potential for energy savings through the implementation of a wide range of measures for improving of energy efficiency. Through numerous directives and procedures that have been adopted over the past 30 years, the building sector is committed to the use of renewable energy sources. Among the solutions to the global energy problem, as well as the problem of excessive emissions of greenhouse gases, primarily CO2, which directly affect global warming, the use of solar energy is one of the most acceptable environmental solutions. In the recent years, a new aspect of the application of solar systems in the construction sector has been developed - their integration into the building envelope. This paper presents an overview of the latest research related to solar thermal systems integrated into the building envelope. The current status in the field of technology of solar thermal systems integrated into the building envelope is presented in paper. Different types of these systems that can be integrated into the building envelope are described, and their basic performance is presented. Possible applications of solar thermal collectors in different parts of the building envelope (facade, roof, overhangs, balcony) are also described and presented. By applying these systems, it is possible to significantly influence to the reduction of energy consumption in the building sector, as well as environmental pollution by reducing CO2 emissions.

Introduction/Objective. Epidemiological research shows that we have a dramatic increase in the number of people with hip fractures, especially those over 65 years of age. The objectives of this study are to assess the association between preoperative comorbidity and the risk of postoperative complications and mortality and postoperative worsening of comorbid conditions and their relationship to mortality within one year of hip fracture surgery. Methods. In this retrospective study, from January 2018 until January 2020, 64 patients with hip fractures were operated on at the Department of Orthopedic Surgery in Kosovska Mitrovica. We monitored the number of comorbidities and their significance on the preoperative risk and the course of concomitant diseases in the postoperative period and one-year mortality after surgery, in patients with hip fractures. Results. We collected data on patients from the moment of admission to discharge from the hospital accompanied by medical histories, and after discharge after follow-up examinations, six months and one year from discharge. Of the total number of subjects, 23 (35.9%) had one or two comorbidities, most often of cardiac and neurological nature, in 25 patients (39.1%) we had three concomitant diseases, and in 11 (17.2%) four and more comorbidities. The mean age of the patients was 72.51 years (69–92 years). Conclusion. Approximately 45–60% of men and women who suffer a hip fracture have three or more comorbid states. In older people with hip fractures, the presence of three or more comorbidities is the strongest preoperative risk factor.

Treatment of humerus fractures is divided into operative and non-operative treatment Fractures of the diaphysis of the humerus heal well. Surgeons today have many opportunities to treat them. The decision on the type of treatment to be applied depends on the location of the fracture, the existence of associated injuries, the age and the general condition of the patient. Non-operative treatment is most often applied, although there are fractures in which surgical intervention is necessary in order to perform healing and prevent complications. Non-operative treatment of fractures of the diaphysis of the humerus gives good results, with little angulation and minimal or no shortening of the arm. Adequate repositioning, appropriate plaster immobilization and regular X-rays heal the fracture within the allotted time. Disciplined early physical therapy in terms of circular movements prevents shoulder contracture and allows later physical therapy to last significantly shorter. Non-operative treatment lasts from 7-11,5 weeks.

Introduction. At the very beginning of the Corona virus epidemic there was not enough data on whether hemodialysis patients have a higher risk for Corona virus infection and which factors may affect the severity of clinical picture. Objective. The aim of the study was to determine the significance of the Modified Early Warning Assessment (MEWS) score for the assessment of coronavirus disease exacerbation. Methods. The research was conducted in COVID dialysis, as a retrospective, descriptive-analytical study, at the University Clinical Center Kragujevac, Serbia, which was organized ad-hoc for treatment of SARS-Cov-2 infection positive patients, which are transfered from Center for Hemodialysis "Ćuprija". They were evaluated routine laboratory findings, demographic and gender structure, arterial blood pressure, presence of comorbidities and residual diuresis, duration of dialysis, radiological evaluation of lungs, determination of MEWS score were the parameters that were monitored. The results were monitored on admission and and in the end of treatment. Results. A statistically significant difference was registered in serum lactate dehydrogenase concentration (486 ± 107.62 vs. 423.7 ± 92.4 U/L); p = 0.022 and absolute monocyte count (0.46 ± 0.15 vs. 0.67 ± 0.34 x 103; p = 0.008). The significant increase in MEWS score was also found (b = 0.017; p = 0.030). There was a positive correlation between increase of MEWS score and age (b = 0.027; p = 0.002) and arterial hypertension as a concomitant comorbidity (b = 0.700; p = 0.033). Conclusion. In the observed period, there was a significant increase in the degree of MEWS score of dialysis patients who had SARS-Cov-2 infection.

Introduction. This paper aimed to present a hybrid approach as a less invasive and acceptable treatment. Case outline. Because of respiratory failure, the patient was deemed at high risk for open repair. Standard thoracic endovascular aortic repair (TEVAR) was unfeasible, so the patient underwent the hybrid procedure – partial aortic arch debranching at the first stage, followed by visceral debranching and endovascular exclusion of thoracic aortic aneurysm as a final procedure. The postoperative course was uneventful and the patient was discharged 10 days after TEVAR and visceral debranching. Conclusion. Staged hybrid procedure with combined debranching of the aortic arch and visceral arteries is feasible and should be considered as an alternative treatment option in patients with high-risk for open repair. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175008]

Objective: In the available literature data, there is not much information about problems of patients with end stage kidney disease in relation to oral health. Our objective was to show the importance of oral diseases for patients on hemodialysis. Data sources: In this review article, the sources of data are review articles and scientific articles in the English language published in MEDLINE database. The choice of studies was based on keywords: Chronic kidney disease, Hemodialysis, Oral health, Periodontal diseases. Results: It is assumed that almost 90% patients with chronic kidney disease manifest some symptoms of oral disease. Therefore, it is important to determine the impact of periodontal disease on the progression of kidney failure in these individuals, to evaluate inflammatory parameters in this patient population, to assess the degree of bone loss and periodontal disease index, to determine the presence of bacterial strains, paradontopathy of gingival fluid and antibody titers, to examine correlations of proinflammatory cytokines in the gingival sulcus and serum, as well as to determine the relationship between periodontal tissue and inflammatory mediators. Periodontal diseases can increase the possibility of developing chronic kidney disease by 1.5 to 2 times. These oral diseases include gingival hyperplasia, periodontitis, xerostomia, unpleasant breath, changes in the oral mucosa, malignancies, oral infections, dental abnormalities and bone lesions. Conclusion: This requires serious cooperation between nephrologists and dentists to make proper communication possible, in order to provide quality dental care for this growing patient population in accordance with new treatment strategies.

A proper assessment of the stability leads to proactive decision making for the method of construction, the shape and size of the cross-section of the facility and the adequate support. The stability is directly dependent on the physical, mechanical and technical characteristics of the rock mass. The traditional assessment-based approach and the classification of stability of underground facilities is based on both experience and experiments with previously constructed facilities. To ease the process for the early phase of design, there was a need for the development of a mathematical model for assessment of the stability. Ambiguity in mining engineering, directs the development of the model using a fuzzy logic system and fuzzy "if-then" rules. The model was developed based on very scarce input data that is most often the only data available during the design stage. Fuzzy model results have shown, through the random selection of input data in the model, that in 70% of cases, there is high numerical congruence with the traditional method for determination of coefficient of stability S; and in 90% of cases, there is also congruence in accordance with the traditional approach to the classification of underground facilities based on the stability assessment.

To conserve threatened farmland species requires an estimate of the representation of their habitats within protected areas, especially in countries with inadequate mechanisms for protecting and managing habitats outside of protected areas. We conducted a gap analysis to evaluate the conservation status of suitable habitats for two threatened farmland bird species - corncrake (Crex crex) and lesser grey shrike (Lanius minor) - within the networks of national protected areas (NPAs) and important bird areas (IBAs) in Serbia. We determined the distribution of suitable habitats using MaxEnt based on climate, topography and land-cover variables. We found that the proportion of suitable habitats within the NPAs is very low (12.31% and 2.04% for the corncrake and lesser grey shrike, respectively), although it is significantly higher for both species within IBAs (25.86% and 9.91%, respectively). Upland farmland habitats (preferred by corncrake) are better represented within both networks (especially IBAs) than lowland habitats (preferred by lesser grey shrike). Our spatially explicit distribution models identify suitable habitats within and beyond the NPAs and IBAs that require monitoring and appropriate conservation measures. The low representation of suitable habitats within these networks is an obstacle to the conservation of both species and other farmland birds in Serbia. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. OI 173002: Conservation strategy for protected and strictly protected hoverflies (Insecta: Diptera: Syrphidae) species in Serbia - Case study]

Introduction: Obesity is a growing health problem in economically developed countries. Abdominal fat is distributed in two large compartments: visceral fat is localized in the abdominal cavity (around the abdominal organs) and subcutaneous fat (between the skin and muscle layers of the abdominal wall). Ultrasonography is the most appropriate imaging method for estimating the amount of visceral and subcutaneous abdominal fat in obese patients. Aim: The aim is to assess the correlation between the amount of visceral and subcutaneous abdominal adipose tissue, estimated by ultrasound in obese individuals, and biochemical indicators of their glycolipid status. Material and Methods: Retrospective study included 183 adult obese patients (131 women and 52 men, mean age 42.6 ± 12.2, mean weight 123.4 ± 26.7 kg, mean BMI 43.5 ± 7.6kg/m2), in whom diameters of visceral (dVAFT) and subcutaneous abdominal fat (dSCAFT) were measured by ultrasonography. Following anthropometric parameters, height, weight, waist circumference (WC) and hip cimrcumference (HC) were also measured. Also, biochemical analysis of the concentration of glucose, insulin, HbA1c, triglycerides and cholesterol (parameters of the glycolipid status) was done. Correlation among these parameters was tested using Pearson's test of linear correlation (r). Results: Positive correlation was found between the dVAFT and all analyzed biochemical parameters of the glycolipid status (p < 0.001). The exceptions were total cholesterol (p = 0.158), negative correlation between the dSCAFT and concentrations of serum glucose, HbA1c and triglycerides (p < 0.01), dVAFT/dSCAFT index most strongly positively correlated with the glucose concentration (r = 0.534), HbA1c (r = 0.456) and triglyceride levels (r = 0.443). WC and WC/HC index significantly correlated with the concentration of all biochemical parameters of glycolipid status, except total cholesterol, but less strongly than dVAFT and dVAFT/dSCAFT index. Conclusion: Visceral and subcutaneous abdominal fat diameters were measured by ultrasound, and especially dVAFT/dSCAFT index, express stronger correlation with the biochemical parameters of glycolipid status, than the anthropometric parameters, in adult obese people.

Background: Oxidative stress represents tissue damage caused by reactive forms of oxygen and nitrogen due to the inability of antioxidant mechanisms to reduce reactive forms into more stable ones. The aim of the study was to evaluate the influence of surgical trauma on nitric oxide (NO) and nitrotyrosine (NT) values in patients undergoing conventional and laparoscopic cholecystectomy. Methods: A prospective study included sixty patients from the Department of Emergency Surgery, Clinical Centre of Serbia who were operated for gallstone related chronic cholecystitis. All the patients enrolled in the study underwent cholecystectomy; the first group was operated conventionally (30 patients - control group), while the second group was operated laparoscopically (30 patients - treatment group). Results: There were no statistically significant differences in the values of NO and its postoperative changes in both groups, the conventionally operated group (p= 0.943) and the laparoscopically operated group (p= 0.393). We found an increase in NT values 24 hours postoperatively (p= 0.000) in the conventionally operated patients, while in the group operated laparoscopically we didn't find statistically significant changes in the values of NT (conventionally operated group (p=0.943) and laparoscopically operated group (p=0.393)). Conclusions: In our study, we found a significant increase in NT values 24 hours postoperatively in conventionally operated patients i.e. the control group, vs. the treatment group. Further randomized studies are needed for a better understanding of the impact of surgical trauma on oxidative stress response.

Background/Aim. Age-related cataract is a common disease among senior population. Vitamin C is the most effective reducing hydrosoluble antioxidant causing reduction in the levels of free radicals in crystaline lens. The aim of this study was to evaluate the age-related change of vitamin C (L-ascorbic acid) level in the aqueous humor of patients with senile cataract. Methods. This prospective study included 74 patients, divided into 3 age groups, with age-related cataract, underwent routine phaco cataract surgery with intraocular lens implantation. Aqueous humor was aspirated from 74 eyes at the beginning of phacoemulsification. The levels of vitamin C (L-ascorbic acid) in aqueous humor were determined with high-performance liquid chromatography (HPLC). Results. The average age of patients included in the study was 65 ± 9.85 years (54-87 years). The level of vitamin C in aqueous humor was 152.78 ± 7.0125 μg/mL in the group A (50-59 years), 134.15 ± 5.1569 μg/mL in the group B (60-69 years) and 106.51 ± 5.44 μg/mL in the group C (over 70 years). Conclusion. The amount of vitamin C in aqueous humor of patients with age-related cataract is decreasing with age. There was a statistically significant change (p < 0.001) of vitamin C aqueous concentration in the patients of different age. This decrease could play a role in susceptibility to cataract formation in older population.

Background/Aim. Within diabetic retinopathy (DR), diabetic macular edema (DME) is one of the leading causes of the loss of visual acuity. The aim of this study was to determine the efficacy of the intravitreal vascular endothelial growth factor (VEGF) inhibitor application alone or combined with macular focal/grid lasephotocoagulation compared with laser treatment alone. Methods. This prospective randomized clinical trial included 72 patients (120 treated eyes) with varying degrees of DR and DME. The DME treatment included intravitreal VEGF inhibitor bevacizumab (Avastin®) application, with and without laser treatment. Bevacizumab (1.25 mg/0.05 mL) was administered intravitreally in 4-6-week intervals. Laser is applied 4-6 weeks after last dose of the drug as a part of combined treatment, or as the primary treatment. Results. The mean reduction in central macular thickness (CMT) for the eyes (n = 31) treated with bevacizumab alone was 162.23 μm, for the eyes (n = 53) treated with combined treatment the mean reduction in CMT was 124.24 μm, both statistically significant at p < 0.001. Laser macular photocolagulation as a part of combined treatment (in 53 eyes) significantly contributed to the CMT reduction, based on the paired t-test results (366.28 vs 323.0 μm at p < 0.05). In our study, the mean visual acuity improvement of 0.161 logMAR was achieved in the group of eyes treated with bevacizumab alone, and 0.093 logMAR in the group with combined treatment, both statistically significant at p < 0.05. The effect of laser photocolagulation alone on visual acuity and CMT was not statistically significant. Conclusion. Treatment with bevacizumab alone or within combined treatment is more effective in treating DME than conventional macular laser treatment alone, both anatomically and functionally.

Background: Cawood-Howell class IV atrophies, also known as "knife-edge" ridges, represent a serious horizontal defect, making the placement of regular implants challenging., Aim: To clinically and radiographically evaluate bone regeneration of severe horizontal bone defects with 3 years of follow-up., Materials and Methods: This study was designed as a single cohort, prospective clinical trial. Patients having horizontal bone width of 4 mm or less in the posterior mandible or maxilla were treated with resorbable collagen membranes and a 1:1 mixture of anorganic bovine bone (ABB) and autogenous bone. Implants were inserted and loaded 7 months later. Outcomes were implant and prosthetic survival rates, any biological and prosthetic complications, horizontal and volumetric bone dimensional changes measured on cone beam computer tomography (CBCT), peri-implant marginal bone level (MBL) changes measured on periapical radiographs, plaque index (PI), and bleeding on probing (BOP)., Results: Eighteen patients received 55 implants. No patient dropped-out. No implant and prosthetic failures and no complications were recorded. Super imposition of pre and 7-month postoperative CBCT scans revealed an average horizontal bone gain of 5.03 ± 2.15 mm (95% CI: 4.13-5.92 mm). After 3 years, mean MBL was 1.15 ± 0.28 mm (95% CI 0.84-1.22 mm). The PI was 11.6%, and BOP was 5.2%., Conclusion: Within the limitations of the present study, high implant survival rate and high average bone augmentation seem to validate the use of collagen resorbable membranes with a 1:1 mixture of particulate ABB and autogenous bone for the reconstruction of Cawood-Howell class IV alveolar ridge atrophies., (© 2019 Wiley Periodicals, Inc.)

Purpose: To present the medium-term results of one-stage guided bone regeneration (GBR) using autologous bone and anorganic bovine bone, placed in layers, in association with resorbable collagen membranes, for the reconstruction of horizontal bony defects., Materials and Methods: This study was designed as an uncontrolled prospective study. Partially edentulous patients, having less than 6.0 mm and more than 4.0 mm of residual horizontal bone width were selected and consecutively treated with simultaneously implant installation and bone regeneration by using 2.0 mm of autologous bone and 2.0 mm of anorganic bovine bone that was placed in layers and then covered with a resorbable collagen membrane. Outcome measures were: implant and prosthesis failures, any complications, peri-implant marginal bone level changes, probing pocket depth (PPD) and bleeding on probing (BOP)., Results: In total, 45 consecutive patients (20 male, 25 female) with a mean age of 52.1 years each received at least one GBR procedure, with contemporary placement of 63 implants. At the 3-year follow-up examination, no patient had dropped out and no deviation from the original protocol had occurred. No implant or prosthesis failed. In six patients (13.3%) the collagen membrane was slightly exposed 1 to 2 weeks after bone reconstruction. Four of these patients were moderate smokers. Post-hoc analysis using Fisher's exact test found significant association (P = 0.0139) between a smoking habit and early membrane exposure. Mean marginal bone loss experienced between initial loading and 30 months afterwards was 0.60 ± 0.20 mm (95% CI 0.54 - 0.66). The mean BOP values measured at the definitive restoration delivery were 1.23 ± 0.93, while 2 years later they were 1.17 ± 0.78. The difference was not statistically significant (-0.06 ± 0.76; P = 0.569). The mean PPD values measured at the definitive restoration delivery were 2.62 ± 0.59 mm, while 2 years later they were 2.60 ± 0.54 mm. The difference was not statistically significant (-0.03 ± 0.62; P = 0.765)., Conclusions: Within the limitations of the present study, the use of a 2.0 mm layer of particulated autologous bone on the implant threads, and a 2.0 mm layer of anorganic bovine to cover the resorbed ridge, in combination with the resorbable collagen membrane, seems to be a viable treatment option for the reconstruction of horizontal bony defects., Competing Interests: This study was not supported by any company, and there are no conflicts of interest.

Aim: To clinically and radiographically evaluate bone regeneration of severe horizontal bone defects., Materials and Methods: This study was designed as a single cohort, prospective clinical trial. Partially or fully edentulous patients, having less then 4 mm of residual horizontal bone width were selected and consecutively treated with resorbable collagen membranes and a 1:1 mixture of particulated anorganic bovine bone and autogenous bone, 7 months before implant placement. Tapered body implants were inserted and loaded 3 to 6 months later with a screw retained crown or bridge. Outcomes were: implant survival rate, any biological and prosthetic complications, horizontal alveolar bone dimensional changes measured on cone beam computed tomography (CBCT) taken at baseline and at implant insertion, peri-implant marginal bone level changes measured on periapical radiographs, plaque index (PI), and bleeding on probing index (BoP)., Results: Eighteen consecutive patients (11 females, 7 males) with a mean age of 56.8 years (range 24-78) and 22 treated sites received 55 regular platform implants. No patient dropped-out and no implants failed during the entire follow-up, resulting in a cumulative implant survival rate of 100%. No prosthetic or biological complications were recorded. Supraimposition of pre- and 7-month post-operative CBCT scans revealed an average horizontal bone gain of 5.03 ± 2.15 mm (95% CI: 4.13-5.92 mm). One year after final prosthesis delivery, mean marginal bone loss was 1.03 ± 0.21 mm (95% CI 0.83-1.17 mm). PI was 11.1% and BoP was 5.6%., Conclusion: Within the limitation of the present study, high implant survival rate and high average bone augmentation seem to validate the use of collagen resorbable membranes with a 1:1 mixture of particulated anorganic bovine bone and autogenous bone, for the reconstruction of severe horizontal ridge defects., (© 2016 Wiley Periodicals, Inc.)

Purpose: To compare the outcome of implants inserted in maxillary sinuses augmented with anorganic bovine bone (ABB) grafts vs mixed 50% ABB and 50% autologous bone graft, using a lateral window approach., Materials and Methods: This study was designed as a randomised controlled trial of parallel groups. Patients in need of an implant-supported prosthesis in a maxillary posterior area with a residual alveolar bone height no greater than 4 mm (range 0-4 mm) were recruited for lateral sinus grafting. Patients were randomly allocated to receive 50% ABB and 50% autogenous bone (group A) or 100% ABB (group B). After 7 months, tapered implants were inserted with an insertion torque between 20 and 45 Ncm. After 3 months, implants were loaded with screw-retained temporary crowns. Definitive crowns were delivered 3 months later. Outcome measures were implant survival, complications, radiographic marginal bone-level changes, probing pocket depths (PPD) and bleeding on probing (BOP). Clinical data were collected at definitive prosthesis delivery, 1 and 2 years after loading., Results: Thirty-two consecutive patients were treated with 32 sinus lift procedures (16 group A, 16 group B). A total of 46 implants were installed. No patient dropped out. No crown/implant failed by the end of the study. Three complications (one sinus membrane perforation and two chipping of the ceramic) were observed in three patients in group A, vs none in group B (RR 0.81; 95% CI 0.64 - 1.03 mm; P = 0.225). At the 2-year after final loading follow-up, the mean marginal bone loss was 1.18 ± 0.50 mm (95% CI 0.95 - 1.45 mm) in group A and 1.28 ± 0.48 mm (95% CI 0.97 - 1.43 mm) in group B, with no statistically significant differences between the two groups (difference 0.11 ± 0.22 mm; 95% CI -0.06 - 0.16 mm; P = 0.586). At the same follow-up, the mean PPD value was 2.70 ± 0.39 for group A and 2.54 ± 0.66 for group B, with no statistically significant difference between groups (difference 0.17 ± 0.39 mm; 95% CI 0.06 - 0.32 mm; P = 0.456), while the mean BOP value was 1.21 ± 0.79 for group A and 1.28 ± 0.68 for group B, (difference: 0.06 ± 0.49 mm; 95% CI -0.23 - 0.25 mm; P = 0.297)., Conclusions: Within the limitations of this study, the present data seem to confirm the hypothesis that the clinical outcome of implants inserted in sinuses grafted with ABB vs implants inserted in sinuses grafted with mixed 50% ABB and 50% autologous bone are comparable. Conflict-of-interest statement: This study was not supported by any company. All the authors declare no conflict of interest.

Purpose: To test the hypothesis that platform switching and regular platform implants would have different outcomes in single-tooth replacement against the alternative hypothesis of no difference., Material and Methods: This study was designed as a randomised controlled split-mouth trial. Eighteen patients with bilaterally missing single premolars or molars to be restored with implant-supported single crowns, were consecutively enrolled. Implant sites were randomly assigned to be treated according to the platform switching concept (PS group), or with matching implant-abutment diameters (RP group). A total of 36 Nobel Replace Tapered Groovy implants were installed. All the implants were inserted in healed bone, with an insertion torque between 35 and 45 Ncm, according to a one-stage protocol. Both implant types were loaded with a screw-retained temporary crown 3 months after implant insertion. Definitive screw-retained single crowns were delivered 2 months later. Outcome measures were implant and prosthetic survival rates, biological and prosthetic complications, radiographic marginal bone level (MBL) changes, pocket probing depth (PPD) and bleeding on probing (BOP). Clinical data was collected at implant placement (baseline), and at 3, 9 and 36 months after loading., Results: No patients dropped out and no implant failed. No prosthetic complications were recorded. One patient experienced mucosal inflammation with positive BOP (RP group) after 3 months, three patients had bilateral peri-implant mucosal inflammation with positive BOP at 6, 24 and 30 months after loading, respectively. There were no statistically significant differences between groups for complications (3/18 versus 4/18; P = 1.0; Odds Ratio = 1.333; 95% CI: 0.3467 to 5.1272). Nine months after loading, the mean MBL was 0.93 ± 0.26 mm in the RP group and 0.84 ± 0.23 mm in the PS group, with no statistically significant differences between groups (mean difference = 0.09 mm, 95% CI: -0.22 to 0.04, P = 0.18). Three years after loading, mean MBL was 1.09 ± 0.31 mm in the RP group and 1.06 ± 0.24 mm in the PS group, with no statistically significant differences between groups (mean difference = 0.02 mm, 95% CI: -0.06 to 0.10, P = 0.70). Marginal bone level changes between 3 years and baseline were 0.72 ± 0.28 mm in the RP group and 0.71 ± 0.27 mm in the PS group, with no statistically significant differences between the groups (mean difference = -0.00 mm, 95% CI: -0.07 to 0.07, P = 0.89). Mean PPD was 2.70 ± 0.52 mm in the RP group and 2.46 ± 0.69 mm in the PS group at 36 months after loading, with no statistically significant differences between the groups (mean difference = 0.23 mm, 95% CI: -0.05 to 0.35, P = 0.43). Mean BOP was 0.83 ± 0.96 mm in the RP group and 0.89 ± 0.99 mm in the PS group at 36 months after loading, with no statistically significant differences between the groups (mean difference = 0.07 mm, 95% CI: -0.03 to 0.17, P = 0.77).
 Conclusions: The clinical and radiographic outcomes of implants restored according to the platform-switching concept versus implants restored with the matching implant-abutment diameters are comparable, 3 years after loading. Conflict of interest statement: This study was not supported by any company. All authors declare no conflict of interest.

Our aim was to compare the outcome of implants inserted in maxillary sinuses augmented with anorganic bovine bone grafts compared with those augmented with mixed 50:50 bovine and autologous bone grafts. Twenty sinuses with 1-4mm of residual crestal height below the maxillary sinuses were randomised into two groups according to a parallel group design (n=10 in each). Sinuses were grafted using a lateral approach. In one group the grafts were 50:50 anorganic bovine bone and autologous bone and in the other anorganic bovine bone alone. After 7 months, 32 implants had been inserted. Outcome measures were survival of implants, complications, marginal changes in the height of the bone, and soft tissue variables (pocket probing depth and bleeding on probing). Probabilities of less than 0.05 were accepted as significant. No patient failed to complete the trial and no implant had failed at 1 year. There were some minor complications. After 12 months, the mean (SD) marginal bone loss (mm) was 1.06 (0.61) in the 50:50 group and 1.19 (0.53) in the anorganic bovine group. The mean (SD) values for pocket probing depth (mm) and bleeding on probing (score) were 2.49 (0.38) and 1.59 (0.82) in the 50:50 group and 2.31 (0.64) and 1.36 (0.87) in the anorganic bovine group (neither difference was significant). The present data are consistent with the hypothesis that the outcome of implants inserted in sinuses grafted with either material is comparable., (Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The objective of this study was to assess implant therapy after a staged guided bone regeneration procedure in the anterior maxilla by lateralization of the nasopalatine nerve and vessel bundle. Neurosensory function following augmentative procedures and implant placement, assessed using a standardized questionnaire and clinical examination, were the primary outcome variables measured. This retrospective study included patients with a bone defect in the anterior maxilla in need of horizontal and/or vertical ridge augmentation prior to dental implant placement. The surgical sites were allowed to heal for at least 6 months before placement of dental implants. All patients received fixed implant-supported restorations and entered into a tightly scheduled maintenance program. In addition to the maintenance program, patients were recalled for a clinical examination and to fill out a questionnaire to assess any changes in the neurosensory function of the nasopalatine nerve at least 6 months after function. Twenty patients were included in the study from February 2001 to December 2010. They received a total of 51 implants after augmentation of the alveolar crest and lateralization of the nasopalatine nerve. The follow-up examination for questionnaire and neurosensory assessment was scheduled after a mean period of 4.18 years of function. None of the patients examined reported any pain, they did not have less or an altered sensation, and they did not experience a "foreign body" feeling in the area of surgery. Overall, 6 patients out of 20 (30%) showed palatal sensibility alterations of the soft tissues in the region of the maxillary canines and incisors resulting in a risk for a neurosensory change of 0.45 mucosal teeth regions per patient after ridge augmentation with lateralization of the nasopalatine nerve. Regeneration of bone defects in the anterior maxilla by horizontal and/or vertical ridge augmentation and lateralization of the nasopalatine nerve prior to dental implant placement is a predictable surgical technique. Whether or not there were clinically measurable impairments of neurosensory function, the patients did not report them or were not bothered by them.

Purpose: To compare epithelial connective tissue graft vs porcine collagen matrix for sealing postextraction sockets grafted with deproteinised bovine bone., Materials and Methods: A total of 30 patients, who needed a maxillary tooth to be extracted between their premolars and required a delayed, fixed, single implant-supported restoration, had their teeth atraumatically extracted and their sockets grafted with deproteinised bovine bone. Patients were randomised according to a parallel group design into two arms: socket sealing with epithelial connective tissue graft (group A) vs porcine collagen matrix (group B). Outcome measures were: implant success and survival rate, complications, horizontal and vertical alveolar bone dimensional changes measured on Cone Beam computed tomography (CBCT) scans at three levels localised 1, 3, and 5 mm below the most coronal aspect of the bone crest (levels A, B, and C); and between the palatal and buccal wall peaks (level D); and peri-implant marginal bone level changes measured on periapical radiographs., Results: 15 patients were randomised to group A and 15 to group B. No patients dropped out. No failed implants or complications were reported 1 year after implant placement. Five months after tooth extraction there were no statistically significant differences between the 2 groups for both horizontal and vertical alveolar bone dimensional changes. At level A the difference was 0.13 ± 0.18; 95% CI 0.04 to 0.26 mm (P = 0.34), at level B it was 0.08 ± 0.23; 95% CI -0.14 to 0.14 (P = 0.61), at level C it was 0.05 ± 0.25; 95% CI -0.01 to 0.31 mm (P = 0.55) and at level D it was 0.13 ± 0.27; 95% CI -0.02 to 0.32 mm (P = 0.67). One year after implant placement there were no statistically significant differences between the 2 groups for peri-implant marginal bone level changes (difference: 0.07 ± 0.11 mm; 95% CI -0.02 to 0.16; P = 0.41)., Conclusions: When teeth extractions were performed atraumatically and sockets were filled with deproteinised bovine bone, sealing the socket with a porcine collagen matrix or a epithelial connective tissue graft showed similar outcomes. The use of porcine collagen matrix allowed simplification of treatment because no palatal donor site was involved.

Purpose: To compare the clinical outcome of platform switching (PS) and regular platform (RP) implants in bilateral single molar replacements., Material and Methods: This study was designed as a randomised, controlled, split-mouth trial. Eighteen patients, with bilaterally missing single molars had one site randomly assigned to a PS implant or a RP implant. A total of 36 implants were bilaterally installed. Both implants were loaded with screw retained temporary crowns 3 months after implant insertion and with screw retained definitive crowns 3 months later. Outcome measures were implant/crown failure, complications, radiographic marginal bone-level changes, pocket probing depth (PPD) and bleeding on probing (BOP). Clinical data were collected at baseline 6 and 12 months after implant placement., Results: No patients dropped out and no implant failed. No prosthetic or major biological complications were observed. One year after implant placement, mean marginal bone level was 0.93 ± 0.26 mm (95% CI 0.81 to 1.05) in RP group and 0.84 ± 0.23 mm (95% CI 0.73 to 0.95) in the PS group and no statistically significant differences between the two groups were observed (P = 0.18). Mean PPD and BOP values were, 6 and 12 months after implant placement, 2.74 ± 0.49 mm (95% CI 2.51 to 2.97) and 1.28 ± 0.75 (95% CI 0.93 to 1.63) in the RP group, and 2.70 ± 0.38 mm (95% CI 2.53 to 2.88) and 1.39 ± 0.78 (95% CI 1.03 to 1.75) in the PS group respectively, with no statistical differences between groups (P = 0.81 and P = 0.16, respectively)., Conclusions: No statistically significant difference was observed between platform switched and non-platform switched implants.

Complete edentulism is a significant oral health burden associated with a reduction of overall health and quality of life. Osseointegrated implant prostheses offer a number of substantial advantages compared with conventional dentures. Traditional implant therapy, however, requires a period of at least 3 months of osseointegration to load a definitive prosthesis onto an implant. The "All-on-4" treatment concept facilitates immediate function and esthetics, along with various benefits that are associated with efficacious long-term outcomes and patient satisfaction. This article discusses considerations for All-on-4 treatment and presents methodological descriptions for the effective use of this treatment concept.

Purpose: This prospective case series evaluated the use of a new titanium-reinforced nonresorbable membrane (high-density polytetrafluoroethylene), in combination with a mixture of anorganic bovine bone-derived mineral (ABBM) and autogenous particulated bone, for vertical augmentation of deficient alveolar ridges., Materials and Methods: A mixture of ABBM and autogenous particulated bone was used for vertical ridge augmentation and covered with a new titanium-reinforced nonresorbable membrane. Ridge measurements were obtained before and after the procedure, complications were recorded, and biopsy specimens were taken for histologic examination., Results: Twenty vertical ridge augmentation procedures were carried out in 19 patients. All treated defect sites exhibited excellent bone formation, with an average bone gain of 5.45 mm (standard deviation 1.93 mm). The healing period was uneventful, and no complications were observed. Eight specimens were examined histologically; on average, autogenous or regenerated bone represented 36.6% of the specimens, ABBM 16.6%, and marrow space 46.8%. No inflammatory responses or foreign-body reactions were noted in the specimens., Conclusion: The treatment of vertically deficient alveolar ridges with guided bone regeneration using a mixture of autogenous bone and ABBM and a new titanium-reinforced nonresorbable membrane can be considered successful.

This clinical case report describes and demonstrates the successful use of purified recombinant human platelet-derived growth factor in conjunction with autogenous bone, an organic bovine bone-derived mineral, and a barrier membrane to reconstruct severe alveolar bone defects. Significant horizontal bone regeneration was achieved in the posterior maxillary region. Three implants were placed into the newly formed ridge and demonstrated stable crestal bone after 36 months of loading.

This report introduces an innovative approach for optimizing esthetics and minimizing soft tissue changes in clinical scenarios that involve extensive site preparation and submerged implants. The existing soft tissue morphology is registered at the time of implant uncovery, and an optimal peri-implant transmucosal contour is created indirectly in the lab. The customized definitive abutment is inserted during stage-two surgery and subsequently guides the peri-implant soft tissue, replicating an optimal emergence profile. The concept is demonstrated through the presentation of two clinical cases.

A new esthetic solution to restore dental implants in combination with limited interdental, facial or labial, or interocclusal space is presented. This article describes the translational application of novel-design porcelain veneers and adhesive restorative principles in the implant realm. A patient is presented who was treated with a single implant-supported restoration replacing a missing mandibular lateral incisor and partially collapsed interdental space. A screw-retained custom metal ceramic abutment was combined with a bonded porcelain restoration. This unique design was motivated by the limited restorative space and subgingival implant shoulder. It was also developed as a solution to the interference of the screw-access channel with the incisal edge, therefore providing the surgeon with more options during implant axis selection. The porcelain-to-porcelain adhesive approach was used instead of traditional principles of retention and resistance form of the abutment.

Treatment involving oral implants has established a high success rate, including implant survival on a long-term basis. The challenge facing the clinicians today is to achieve an optimal long-term aesthetic result. To address this challenge, the volume of the underlying hard and soft tissue must be restored either prior to or simultaneously with the implant placement. The learning objective of this article is to review the critical biologic and clinical criteria essential in achieving a predictable success in aesthetic enhancement of the implant site.

Background: Alveolar ridge aberrations commonly require bone augmentation procedures for optimal placement of endosseous dental implants. The objective of this study was to evaluate local bone formation following implantation of recombinant human bone morphogenetic protein-2 (rhBMP-2) in an absorbable collagen sponge (ACS) carrier with or without provisions for guided bone regeneration (GBR) as potential treatment modalities for alveolar augmentation., Methods: Surgically induced, large, mandibular alveolar ridge saddle-type defects (2 defects/jaw quadrant) in seven young adult Hound dogs were assigned to receive rhBMP-2/ACS, rhBMP-2/ACS combined with GBR (rhBMP-2/GBR), GBR, and surgery controls. The animals were euthanized at 12 weeks post-surgery when block sections of the defect sites were collected for histologic analysis., Results: Clinical complications included swelling for sites receiving rhBMP-2 and wound failure with exposure of the barrier device for sites receiving GBR (4/6) or rhBMP-2/GBR (3/7). The radiographic evaluation showed substantial bone fill for sites receiving rhBMP-2/ACS, rhBMP-2/GBR, and GBR. In particular, sites receiving rhBMP-2/GBR presented with seroma-like radiolucencies. The surgery control exhibited moderate bone fill. To evaluate the biologic potential of the specific protocols, sites exhibiting wound failure were excluded from the histometric analysis. Sites receiving rhBMP-2/ACS or rhBMP-2/GBR exhibited bone fill averaging 101%. Bone fill averaged 92% and 60%, respectively, for sites receiving GBR and surgery controls. Bone density ranged from 50% to 57% for sites receiving rhBMP-2/ACS, GBR, or surgery controls. Bone density for sites receiving rhBMP-2/GBR averaged 34% largely due to seroma formation encompassing 13% to 97% of the sites., Conclusion: rhBMP-2/ACS appears to be an effective alternative to GBR in the reconstruction of advanced alveolar ridge defects. Combining rhBMP-2/ACS with GBR appears to be of limited value due to the potential for wound failure or persistent seromas.

The field of implant dentistry has grown significantly in recent years. Balancing natural-looking esthetics with long-term function, however, remains a challenging task. The main focus of implant dentistry is on improving the survival rate, simplifying the treatment, improving the esthetic outcome, and reducing the treatment time. Developing a natural contour and anatomically dimensioned soft-tissue margin is critical to attaining an esthetic implant restoration. This article discusses the five elements to achieve natural implant esthetics: bone foundation, implant design and placement, soft-tissue profile, prosthetic tissue support, and ceramic art design.

Osseointegration [direct bone-implant contact (BIC)] is a primary goal following installation of endosseous dental implants. Such bone contact provides stability for the dental implant over time. The objective of this study was to evaluate bone formation and BIC at long-term, functionally loaded, endosseous dental implants placed into bone induced by recombinant human bone morphogenetic protein-2 (rhBMP-2) in an absorbable collagen sponge (ACS) carrier. Mandibular, saddle-type, alveolar ridge defects (approximately 15 x 10 x 10 mm), two per jaw quadrant, were surgically induced in each of six young adult American fox hounds. The defects were immediately implanted with rhBMP-2/ACS. Two defects per animal additionally received a nonresorbable expanded polytetrafluoroethylene (ePTFE) membrane or a bioresorbable polyglycolide fiber membrane. Healing was allowed to progress for 3 months, when the ePTFE membrane was removed, and machined, threaded, titanium dental implants were installed into the rhBMP-2/ACS induced bone and into the adjacent resident bone. At 4 months of osseointegration, the implants were exposed to receive abutments and prosthetic treatment (two- or three-unit bridges). Some implants were removed for histologic analysis. The remainder of implants were exposed to functional loading for 12 months at which time the animals were killed for histometric analysis. One animal died prematurely due to kidney failure unrelated to the experimental protocol and was not included in the analysis. The 12-month block sections from a second animal were lost in the histological processing. Four sites receiving rhBMP-2/ACS and ePTFE or resorbable membranes experienced wound failure and membrane exposure, and subsequently exhibited limited bone formation. Defects without wound failure filled to contour with the adjacent alveolar bone. The newly formed bone exhibited features of the resident bone with a re-established cortex; however, it commonly included radiolucent areas that resolved over time. Dental implants block biopsied at 4 months exhibited limited, if any, crestal resorption, whereas those exposed to functional loading for 12 months exhibited some crestal resorption. Implants biopsied at 4 months exhibited a mean (+/- SD) BIC of 40.6 +/- 8.2% in rhBMP-2/ACS induced bone vs. 52.7 +/- 11.4% in resident bone. Dental implants exposed to 12 months of functional loading exhibited a mean BIC of 51.7 +/- 7.1% in rhBMP-2/ACS induced bone vs. 74.7 +/- 7.0% in resident bone. There were no significant differences between dental implants placed into rhBMP-2/ACS induced bone and resident bone for any parameter at any observation interval. In conclusion, rhBMP-2/ACS-induced bone allows installation, osseointegration, and long-term functional loading of machined, threaded, titanium dental implants in dogs.

A variety of potential complications associated with sinus lift surgery have been reported in the literature. However, potential alterations of voice quality following sinus elevation have so far not been mentioned or evaluated scientifically. For the majority of patients, slight changes of the voice pattern are of no importance. However, for voice professionals, whose voices have become part of their distinctive profession or trademark, minimal changes may have dramatic consequences. This specific group of patients, such as speakers, actors and singers, depend on the particular quality and timbre of their voice for their livelihood. Consequently, the purpose of this study was to assess the effects of sinus lifting on voice quality in the above patient group. In a collaborative interdisciplinary effort, the Departments of Oral Surgery and Otorhinolaryngology, Section of Phoniatrics and Logopedics, thoroughly evaluated a series of voice parameters of four patients undergoing sinus lifting pre- and postoperatively. The parameters analyzed included pitch, dynamic range, sound pressure level, percent jitter, percent shimmer and noise-to-harmonics ratio with special emphasis on formant analysis. No changes were detected in any of the commonly evaluated parameters. These were rated subjectively by patients and their friends or relatives and objectively with instrumental tools under isolated phoniatric lab conditions. In conclusion, sinus lift surgery appears to be a safe, predictable evidence-based method for regenerating the highly atrophic posterior maxilla, which does not jeopardize the individual characteristic voice pattern of high-profile patients critically dependent on their voices for their livelihood.

Background: Prosthetic-driven implant dentistry requires predictable procedures for alveolar ridge augmentation. The objective of this pilot study was to evaluate bone regeneration in mandibular, full-thickness, alveolar ridge, saddle-type defects following surgical implantation of recombinant human bone morphogenetic protein-2 (rhBMP-2) in a novel hyaluronan (HY) sponge carrier. This sponge was fabricated from auto-crosslinked HY., Methods: Alveolar ridge defects (approximately 15 x 10 x 10 mm), 2 per jaw quadrant, were surgically prepared in each of 3 young adult American fox hounds. Four defects were immediately implanted with rhBMP-2/HY. Three defects were implanted with rhBMP-2 in an absorbable collagen sponge (ACS) carrier (positive control). The rhBMP-2 solution (1.5 ml at 0.2 mg/ml) was soak-loaded onto the HY and ACS sponges. Three defects were implanted with HY sponges soak-loaded with buffer without rhBMP-2 (negative control), while 2 defects served as surgical controls. The animals were euthanized at 12 weeks postsurgery for histometric analysis., Results: Clinically, alveolar ridge defects receiving rhBMP-2/ACS exhibited a slight supracrestal expansion, while defects receiving rhBMP-2/HY were filled to contour. In contrast, the HY and surgical controls exhibited ridge collapse. rhBMP-2/HY-treated defects exhibited a dense bone quality without radiolucent regions observed in defects treated with rhBMP-2/ACS. The histometric analysis showed 100% bone fill for the rhBMP-2/ACS defects and 94%, 58%, and 65% bone fill for the rhBMP-2/HY, HY, and surgical control defects, respectively., Conclusions: The conclusions are based on data from 2 of 3 animals in the study. In one animal, no response to rhBMP-2 was observed with either carrier, and the animal may have been a non-responder of unknown nature. With this limitation, the observations herein suggest that: 1) HY supports significant bone induction by rhBMP-2; 2) the rhBMP-2-induced bone assumes qualities of the immediate resident bone; 3) HY alone exhibits no apparent osteoconductive potential; and 4) HY appears to resorb within a 12-week healing interval in the absence or presence of rhBMP-2. Thus, HY appears to be a suitable candidate carrier for rhBMP-2.

The purpose of the present study was to evaluate retrospectively, after 1 to 5 years of prosthetic loading, 123 implants consecutively inserted at the time of vertical ridge augmentation in 4 clinics. At the time of the implant surgery, 3 different techniques were used: the implants were allowed to protrude 2 to 7 mm from the bone level and a titanium reinforced expanded-polytetrafluoroethylene (e-PTFE) membrane was positioned to protect either the blood clot (Group A, 6 patients), or an allograft (Group B, 11 patients), or an autograft (Group C, 32 patients). The annual implant evaluation was carried out according to a standard protocol utilized for long term studies with endosseous implants inserted in non-regenerated bone. Only 1 implant failed immediately after the second stage surgery and after 1 month it was substituted with a new implant. All the remaining implants appeared clinically stable, no signs of radiolucency were present at the bone-implant interface, therefore, they could be defined successfully osseointegrated. The radiographic analysis showed stable bone crest levels with a mean bone loss of 1.35 mm for the Group A, of 1.87 mm for the Group B and of 1.71 for the Group C during the period of observation. Only 2 implants demonstrated an increased crestal bone loss of 3.5 mm and 4 mm respectively at the first year examination. On the base of these results, we can confirm previous long term studies on regenerated bone and we can conclude that vertically augmented bone with GBR techniques responds to implant placement like native, non-regenerated bone.

Recent investigations have demonstrated that the successful utilization of anterior implant-supported restorations in the maxilla is dependent upon the satisfaction of numerous surgical and prosthodontic criteria. Conservative treatment alternatives that use a provisionalization phase can provide clinical benefits for patients with partial edentulism by guiding tissue maturation following completion of a meticulous surgical procedure. This article demonstrates a series of prosthetic considerations that guide contemporary aesthetic restorations, and highlights the underlying surgical factors related to this treatment.

With the increased use of osseointegrated implants and with many implants functioning for long periods of time, the soft tissue barrier around implants has become more important. This paper reviews the soft tissue response around implants under healthy and diseased conditions and presents the etiology of peri-implant tissue breakdown. Diagnostic techniques such as probing pocket depth, radiographic evidence, and microbial sampling have been analyzed and modified from the periodontal field and used during the maintenance phase of the dental implant. The long-term goal of implant maintenance is to prevent or to arrest the progression of disease, and to achieve a maintainable implant site. Recent reports indicate that peri-implant tissues can be treated with either non-surgical or surgical techniques.

Reconstructive procedures are able to provide improved aesthetics for implant patients who present with anatomical limitations (e.g., vertical or horizontal tissue loss) in the anterior maxilla. Aesthetic results, however, are directly related to the ability of the treatment team to reconstruct the lost bone and soft tissue, place the implant into its proper tridimensional position in the patient's arch, and use precise restorative techniques. This article presents comprehensive treatment steps for the utilization of single-unit and multiple-unit implant-supported restorations in the anterior maxilla.

The use of the mandibular symphysis for harvesting intraoral autografts in implant reconstruction cases is based on the ample supply of donor material, the proximity to the recipient site, and the ease of access to the tissue. This article discusses the technique of successful bone harvesting from the mandibular symphysis. As with other harvesting techniques, morbidity can occur. This report demonstrates a low morbidity rate and presents guidelines to help accomplish this.

This study investigated the effect on vertical bone regeneration of the addition of demineralized freeze-dried bone allograft or autogenous bone chips to a membrane technique. Twenty partially edentulous patients with vertical jawbone deficiencies were selected for this study. The patients were divided into two groups of 10 individuals. The 10 patients of Group A received 26 Brånemark implants in 10 surgical sites. The 10 patients of Group B received 32 implants in 12 surgical sites. Fifty-two out of 58 implants (22 in Group A and 30 in Group B) extended 1.5 to 7.5 mm superior to the bone crest. Titanium-reinforced expanded polytetrafluoroethylene membranes were used to cover the implants and, before complete membrane fixation, demineralized freeze-dried bone allograft particles were condensed under the membrane in Group A, and autogenous bone chips were used in Group B. At the reentry after 7 to 11 months the membranes were removed and a small biopsy was collected from 11 sites comprehending the miniscrews. The clinical measurements from Group A demonstrated a mean vertical bone gain of 3.1 mm (SD = 0.9 mm, range 1 to 5 mm) with a mean percentage of bone gain of 124% (SD = 46.6%). The measurements from Group B showed a mean vertical bone gain of 5.02 mm (SD = 2.3 mm, range 1 to 8.5 mm) with a mean percentage of bone gain of 95% (SD = 26.8%). Histomorphometric analysis of the present study clearly demonstrated a direct correlation between the density of the pre-existing bone and the density of the regenerated bone. The mean percentage of new bone-titanium contact was from 39.1% to 63.2%, depending on the quality of the pre-existing bone. Both the clinical and histologic results indicate a beneficial effect of the addition of demineralized freeze-dried bone allograft or autogenous bone particles to vertical ridge augmentation procedures in humans.

Treatment involving oral implants has established a high success rate, including implant survival on a long-term basis. The challenge facing the clinicians today is to achieve an optimal long-term aesthetic result. To address this challenge, the volume of the underlying hard and soft tissue must be restored either prior to or simultaneously with the implant placement. The learning objective of this article is to review the critical biologic and clinical criteria essential in achieving a predictable success in aesthetic enhancement of the implant site. The article discusses the five phases of ridge reconstruction, utilization of bone grafts (with or without membranes), and the use of membranes alone. Soft tissue management and augmentation in aesthetic and nonaesthetic regions are differentiated and presented. Surgical complications are recognized as a clinical reality, and exposure of the membranes is evaluated and discussed. Four cases are used to describe and illustrate the clinical procedure.

Advances in bone reconstructive techniques, including the potential of barrier membrane usage for osteogenesis, have increased the indications for implant placement. This review discusses the critical biologic and clinical criteria involved in achieving a predictable success with barrier membranes. Experimental and clinical findings have shown that the type of adjunctive grafting material used, healing time of the membrane site, type and size of bone defect, and membrane exposure all influence the end result. Small bony defects like implant fenestrations and intact extraction sites seem not to depend on the application of membranes to regenerate bone membranes. Large bone grafts used for ridge reconstruction purposes might benefit from membranes, because they reduce the inevitable resorption of bone grafts when used alone. New developments in material and tissue engineering have introduced the use of resorbable membranes, xenografts, and osteoinductive proteins, such as recombinant human bone morphogenic protein, that are likely to play a role in the treatment of localized ridge deficiencies.

Advances in bone reconstructive techniques have increased the indications for implant placement in sites previously thought to be unsuitable. This clinical study evaluated a new surgical technique for the treatment of a variety of localized bone defects in four patients utilizing a titanium-reinforced membrane. The membrane material was developed to maintain a large protected space between the membrane and the bone surface without the need for a supportive device. Healing was uneventful in all sites, and the membranes were retrieved after 6 to 12 months. No residual defects were noted, resulting in an average change of implant exposure of 8.2 +/- 2.3 mm for sites with buccal dehiscences and from 5 to 6 mm ridge enlargement in localized bone defects. The quality of the regenerated tissue under the titanium-reinforced membrane appeared as bone structure with a superficial fibrous layer. This fibrous layer was more pronounced in sites treated with a membrane alone but was more than compensated by the quantity of new bone under the soft tissue. The results demonstrated that the use of a reinforced membrane appears to be a viable alternative for the clinical treatment of non-space-maintaining implant/bone defects. Further clinical and experimental investigations are recommended.

To test the osteopromotive activity in large non-spacemaking alveolar bone sites, a total of 20 titanium dental implants were placed superior to a previously modified mandibular alveolar process in five adult beagle dogs. The supracrestal implant position resulted in a mean buccal dehiscence of 5.1 +/- 1.03 mm and a mean supracrestal bone deficit of 2.69 +/- 0.45 mm. Three treatment groups were randomly assigned: group I, ten implants treated with a titanium-reinforced expanded polytetrafluoroethylene (ePTFE) membrane (TR); group II, six implants treated with a standard ePTFE membrane (ST); and group III, four implants that received no membrane (control). Before mucoperiosteal flap closure, the bone surface was perforated and peripheral blood was injected around the implants and underneath the membranes. Clinical evaluation of submerged implant sites showed evidence of complete regeneration of the peri-implant bone defects in groups I and II, minimal bone formation in control group III, and a widening of the ridge in group I. Corresponding histologic examination of undecalcified sections demonstrated large amounts of newly formed bone beneath both types of membranes with a superficial layer of loose connective tissue. Mean gain of supracrestal regenerated bone amounted to 1.82 +/- 1.04 mm (TR group), 1.90 +/- 0.30 mm (ST group), and 0.53 +/- 1.34 mm (control group). Mean bone regeneration at the buccal dehiscences was 3.33 +/- 1.44 mm (TR group), 2.46 +/- 0.51 mm (ST group), and 2.76 +/- 0.84 mm (control group). The TR membranes showed evidence of increased alveolar bone width compared to ST membranes and control sites. These results suggest that supracrestal bone regeneration can successfully be enhanced by a submerged membrane technique in the dog model and that the titanium-reinforced membranes were able to maintain a large, protected space for blood clot stabilization without the addition of bone grafts and produced a larger bone quantity when compared to standard membranes.