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Purpose: To review and compare the available literature on bone regeneration using titanium mesh and map the current evidence on bone gain outcomes and complications while comparing this scaffold with collagen membranes., Materials and Methods: A comprehensive electronic and manual search was performed to identify randomised and non-randomised prospective controlled clinical trials that involved the use of titanium mesh in at least one arm, with outcomes including complications and vertical and/or horizontal bone gain. The focused questions were defined as follows: What are the outcomes of using titanium mesh in ridge augmentation compared to other types of barrier membrane, and what is the complication rate (membrane exposure and infection) when titanium mesh is used in these procedures?, Results: A total of 22 articles were included in the qualitative analysis. Overall, the studies that measured bone gain resulted in 3.36 mm vertical (196 subjects; 95% confidence interval 2.44 to 4.64 mm, range 1.4 to 5.7 mm) and 3.26 mm horizontal augmentation (81 subjects; 95% confidence interval 2.93 to 3.63 mm, range 2.6 to 3.7 mm), with variability among studies. The most commonly noted complication was mesh exposure, regardless of the type of mesh used, and the second most common was graft failure. The overall pooled complications rate reported in clinical trials was 10.8%. The meta-analysis comparing titanium mesh and collagen membranes, controlling for the type of bone regeneration (staged or simultaneous with implant placement), failed to show a significant difference in horizontal bone gain between the two techniques., Conclusions: Within the limitations of the present study and acknowledging the heterogeneity among the articles included, titanium mesh can serve as a feasible protective scaffold for bone regeneration with a relatively acceptable complication rate and in defects requiring around 4 mm 3D reconstruction. Data on patient-reported outcomes were scarce., Conflict-Of-Interest Statement: None of the authors have any financial interests, either directly or indirectly, in the products or information mentioned in the present article.

Postextraction bone grafting and implant placement help preserve alveolar bone volume. Collagen wound dressings and soft tissue graft substitutes may help protect extraction socket bone grafts and provide better gingival contours. This randomized, controlled, multicenter, and double-blinded study was conducted to compare a control (wound dressing) and a test (soft tissue graft) substitute in nearly intact extraction sockets. Both test and control sockets were grafted with a xenogeneic bone graft. Graft containment, extraction socket soft tissue gap closure, gingival contour, and gingival thickness were examined over 16 weeks, at which time implants were placed. Healing was uneventful for both groups, and there was no significant difference (P < .05) between the times required to close the extraction socket soft tissue gap (~80% of sites closed by 8 weeks). Bone grafts were covered and contained longer in the test group (~4 weeks vs ~2 weeks), with less contour disruption out to 4 weeks; however, at implant placement, soft tissue contours in both groups were comparable, and soft tissue thicknesses were not significantly different.

The aim of the present study was to generate an international and multidisciplinary consensus on the clinical management of implant protrusion into the maxillary sinuses and nasal fossae. A total of 31 experts participated, 23 of whom were experts in implantology (periodontologists, maxillofacial surgeons and implantologists), 6 were otolaryngologists and 2 were radiologists. All the participants were informed of the current scientific knowledge on the topic based on a systematic search of the literature. A list of statements was created and divided into three surveys: one for all participants, one for implant providers and radiologists and one for otolaryngologists and radiologists. A consensus was reached on 15 out of 17 statements. According to the participants, osseointegrated implants protruding radiographically into the maxillary sinus or nasal fossae require as much monitoring and maintenance as implants fully covered by bone. In the event of symptoms of sinusitis, collaboration between implant providers and otolaryngologists is required. Implant removal should be considered only after pharmacological and surgical management of sinusitis have failed.

Vertical bone augmentation (VBA) procedures for dental implant placement are biologically and technically challenging. Systematic reviews and meta-analyses of studies on VBA have failed to identify clinical procedures that provide superior results for treatment of the vertical ridge deficiencies. A decision tree was developed to guide clinicians on selecting treatment options based on reported vertical bone gains (< 5 mm, 5 to 8 mm, > 8 mm). The choice of a particular augmentation technique will also depend on other factors, including the size and morphology of the defect, location, and clinician or patient preferences. Surgeons should consider the advantages and disadvantages of each option for the clinical situation and select an approach with low complications, low cost, and the highest likelihood of success.

Purpose: The aim of this retrospective study was to determine if penicillin allergy and/or clindamycin therapy may contribute to a higher incidence of postsurgical infections after bone augmentation., Materials and Methods: This retrospective study analyzed patients between 2014 and 2019 who received bone augmentation procedures (socket grafting [SG]; ridge augmentation [RA]) prior to placement of dental implants. All the grafting procedures were performed under preoperative and postoperative oral antibiotic coverage with either amoxicillin or clindamycin for patients who reported penicillin allergy. Infections associated with the bone augmentation procedures were recorded., Results: In this study, 1,814 patients received 2,961 bone augmentation procedures (2,530 SG, 431 RA). In the 2,530 SG procedures, 270 (10.7%) were associated with a penicillin allergy. Infections occurred in 91 of the 2,530 SG sites (3.6%). However, the infection rate was 10.7% (29 SG sites) for clindamycin and only 2.7% (62 SG sites) for amoxicillin (P < .02). In the 431 RA procedures, 71 (16.5%) were associated with a penicillin allergy. Overall infections occurred in 31 of the 431 sites (7.2%). However, the infection rate was 22.5% (16 RA sites) for clindamycin and only 4.2% for amoxicillin (15 RA sites; P < .01). Penicillin-allergic patients taking clindamycin demonstrated a higher risk of infection with a risk ratio of 6.9 (95% CI) and 4.5 (95% CI) compared with nonallergic patients taking amoxicillin for RA and SG, respectively., Conclusion: Penicillin allergy and the use of clindamycin following SG and RA procedures was associated with a higher rate of infection and may be a risk factor for bone augmentation complications.

Vertical bone augmentation techniques are more invasive than other procedures, and success rates often vary according to the surgical expertise of the clinician. As a result, there has been a trend over time towards minimally invasive treatment options in implant dentistry. This article discusses a "graft less" treatment philosophy that emphasizes the use of less-demanding augmentation techniques for the purpose of placing shorter implants in atrophic posterior sites, avoiding more complicated procedures for implant placement. In the posterior maxilla and mandible, the use of short implants (< 8.0 mm) can reduce the need for vertical bone grafting. Patients often prefer this strategy over more complex procedures that can cause complications, increase morbidity, and require longer treatment times with higher costs. When inadequate available bone is present for implant placement, planned bone augmentation procedures may be performed for the purpose of placing shorter implants; these procedures are less demanding, less invasive, and more predictable, allowing long-term outcomes for the implant-supported restoration.

Purpose: Because of limitations of the absorbable collagen sponge (ACS), recombinant bone morphogenetic protein (rhBMP-2) requires a scaffolding device for ridge augmentation., Materials and Methods: Twenty-one patients were treated with 37 allogeneic block grafts and rhBMP-2/ACS. Cone-beam computed tomography (CBCT) was used to measure the ridge at 2 points preoperatively, postoperatively, and after graft healing. Dental implants were placed after 6 months of healing., Results: The CBCT scan measurements revealed variable graft resorption at 2.0 mm and 5.0 mm above the crest (point A: 0%-33.82%; point B: 0%-31.51%). The graft resorption at point A averaged 14.7 ± 11.59% and at point B averaged 6.67 ± 8.25%. There was no statistically significant difference between these 2 points. All 37 bone blocks were found well incorporated. The range of horizontal augmentation gain at the crest (point A) was 2.8 mm to 7.7 mm (average horizontal gain 4.61 ± 0.82 mm). Sixty dental implants were inserted into the blocks in all planned sites. One implant failed during prosthetic treatment for an implant survival of 98.3%. Follow-up at 3 to 34 months found no additional failures., Conclusion: This case series suggests that allogeneic bone blocks may be a suitable replacement for titanium mesh as a resorbable scaffold with rhBMP-2/ACS. The growth factor may also improve allogeneic block graft incorporation.

The edentulous anterior atrophic maxilla represents a challenge for the surgeon and restorative dentist. Soft- and hard-tissue augmentation procedures are often required prior to, or simultaneously with, implant placement. A well-planned treatment protocol, patient compliance, and collaboration between the treating clinicians and the laboratory are requirements in achieving predictable long-term outcomes that satisfy patient expectations. Avoiding transmucosal loading and movement of the graft during the healing phase are crucial factors in achieving lasting success. In this case report, a fixed provisional restoration supported by four immediately loaded narrow-diameter implants (NDIs) was used to enable function during healing and protect the grafted site. Two of the NDIs, along with three conventional-diameter implants, were subsequently used to support the final restoration. NDIs with diameters of less than 3 mm can achieve excellent long-term osseointegration and may be used together with conventional implants for definitive prosthodontic treatment as demonstrated by the 11-year follow-up reported in this case.

Purpose: This retrospective study evaluated the use of a composite graft of recombinant human bone morphogenetic protein-2 (rhBMP-2) and particulate mineralized bone allograft protected by a titanium mesh for vertical bone augmentation., Materials and Methods: A review of data on patients from four oral and maxillofacial surgery practices in the United States who required vertical augmentation prior to implant treatment was conducted. Vertical augmentation was accomplished with rhBMP-2 in an absorbable collagen sponge (ACS) carrier and particulate allograft. Cone beam computed tomography was used to measure vertical bone gains using this technique., Results: Sixteen vertical ridge augmentation procedures were performed in 15 patients. The maximum vertical bone gains ranged from 4.4 to 16.3 mm. The average maximum vertical bone gain was 8.53 mm. The procedure allowed implant placement in all patients. Forty implants were inserted into the grafted ridges after a minimum of 6 months of healing. All implants integrated and were used for prosthetic support., Conclusion: This study suggests that rhBMP-2/ACS and particulate mineralized bone allograft protected by a titanium mesh offers favorable vertical bone gains to allow dental implant placement.

The atrophic posterior mandible has unique challenges when implant placement is planned. The purpose of this case series was to evaluate the use of recombinant human bone morphogenetic protein 2÷acelluar collagen sponge (rhBMP-2÷ACS) and titanium mesh for augmentation of the atrophic posterior mandible prior to implant insertion. The case series included five patients with inadequate bone in the posterior mandible for implant placement. The residual ridges were augmented with rhBMP-2÷ACS and a small amount of bone substitute. Titanium mesh was used to protect the graft sites. Dental implants were inserted after 6 months of healing. Healing of the grafted ridges was uneventful. Dental implants were placed in all grafted sites without the need for further bone augmentation. All 10 implants integrated well and were restored with single crowns. The use of rhBMP-2÷ACS with titanium mesh was effective in this case series for augmentation of the atrophic posterior mandible prior to implant placement. This approach offers many advantages, including technical ease, no need for bone harvesting, decreased morbidity, and reduced surgical time.

Reconstruction of the atrophic maxilla for dental implant placement has many unique considerations. There are several methods available to augment the atrophic maxilla. Of these, autogenous bone grafting offers a well-proven predictable method for ridge augmentation and defect repair for dental implant placement. There are several advantages of using autogenous bone grafts. This article primarily focuses on the use of autogenous onlay bone grafts to reconstruct the atrophic maxilla., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Purpose: The purpose of this case series was to evaluate the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in an absorbable collagen sponge (ACS) carrier for the repair of significant bone defects following tooth removal. The surgical technique was modified because primary closure was not obtained over the grafted sockets., Materials and Methods: The present series included 10 consecutively treated patients with failed endodontically treated maxillary central incisors. Computed tomographic scans were obtained preoperatively. The extraction sockets all had > 50% buccal bone loss. The sockets were grafted with rhBMP-2/ACS and a small amount of bone substitute. Dental implants were inserted after 4 to 6 months of healing., Results: Healing of the grafted sockets was uneventful. Dental implants were placed in all grafted sites without the need for further bone augmentation. A comparison of preoperative and postgrafting computed tomographic scans found a slight loss in alveolar width at the crest of 1.07 mm. Connective tissue grafts were placed in five patients. All 10 implants integrated well and were restored with single crowns., Conclusions: The use of rhBMP-2/ACS was effective in repairing osseous defects prior to implant placement. The lack of primary closure over the graft did not appear to complicate healing or compromise bone growth. This modification simplifies the technique and may reduce postoperative morbidity caused by flap manipulation.

The International Congress of Oral Implantologists sponsored a consensus conference on the topic of Crown Height Space on June 26-27, 2004 in Las Vegas, Nevada. The panel communicated on several occasions before, during, and after the meeting, both as a group and among individuals. A consensus of one opinion was not developed for most issues. However, general guidelines emerged related to the topic. The following article is Part 2 of a summary of several of the guidelines that should be of benefit to the profession at large. (Part 1 appeared in Implant Dentistry 2005;14:312-321.).

The International Congress of Oral Implantologists sponsored a consensus conference on the topic of crown height space on June 26 and 27, 2004, in Las Vegas, Nevada. The panel communicated on several occasions before, during, and after the meeting, both as a group and among individuals. A consensus of 1 opinion was not developed for most issues. However, general guidelines emerged related to the topic. The following article is part 1 of a summary of several guidelines that should be of benefit to the profession at large.

Purpose: The purpose of this article is to describe a new technique and the anatomic sites for cutting and harvesting bone for grafting applications. A handheld instrument is described that cuts and collects thin shavings of bone from cortical surfaces., Materials and Methods: This study included 193 consecutive patients who needed bone augmentation and simultaneous implant placement in the severely atrophic posterior maxilla and in the anterior maxilla with acquired defect of alveolar bone as a result of local trauma. A total of 477 implants were placed. Clinical criteria for evaluation at time of implant exposure included stability in all directions, crestal bone resorption, and any reported pain of discomfort., Results: There were no failures of the anterior maxilla group, and no signs of bone resorption were noted at the second stage surgery or during the follow-up. During initial and late healing, there was no dehiscence of the soft tissue flaps and no membranes were exposed. Core biopsies typically showed immature, newly formed bone and, on average, 27% to 36% vital bone., Conclusion: From this research, it appears that excellent implant success rates can be achieved in grafted sinuses or ridges when a locally harvested autogenous bone graft with a ribbon geometry is used.

Immediate loading of an implant interface has been used for completely and partially edentulous patients. A biomechanical rationale to decrease the initial risk of overload is reasonable, because implant failure and overload has been well established. This article addresses methods to decrease stress to the transitional restoration. Forces may be influenced by patient factors, implant position, cantilever forces, occlusal load direction, occlusal contact intensity, and diet. The surface area of load distribution may be increased by implant size, implant design, and surface condition of the implant body. A blend of these factors affects the amount of stress to the developing implant interface and hence may affect the risk of immediate occlusal loading for implant prostheses.

Purpose: This article presents a clinical technique for immediate implant loading in the completely edentulous mandible., Materials and Methods: The protocol recommends the placement of 4 to 5 root-form implants in the anterior mandible between the mental foramina. Upon insertion the implants must have favorable primary stability. Abutments are added to the implants and the patient's lower denture is converted into an immediate load provisional fixed prosthesis., Results: The denture conversion technique has been shown to provide predictable results for immediate implant loading in the edentulous mandible. The final prosthesis is fabricated upon integration of the implants in 3 months., Conclusion: The denture conversion technique offers several advantages because it may be used with most commercially available implant systems and it incorporates conventional implant components. Guidelines for patient selection, presurgical preparation, implant surgery, prosthesis fabrication, and postoperative care are reviewed.

Ridge splitting is a useful surgical technique for preparation of the edentulous ridge for implant placement or interpositional bone grafting. This approach is limited to enhancing ridge width and is more applicable to the maxilla. The cortical plates of the residual ridge are carefully split and expanded to accommodate implant insertion or bone graft materials. A significant advantage of this technique is that it allows simultaneous implant placement rather than staging the reconstruction. This article discusses indications, limitations, patient evaluation, surgical approaches, and complications associated with ridge splitting techniques.

Cortical bone grafts harvested from the posterior mandible offer several advantages for bone augmentation prior to implant placement. These grafts maintain their dense quality and exhibit minimal resorption upon incorporation. Considerable amounts of bone can be harvested from this area for use as an onlay graft. In addition, the ramus area has some inherent advantages over other donor sites. This article describes the indications and surgical technique for harvesting bone from the ramus region.

Problems with crestal bone resorption and bone adaptation to dental implants in compromised and weak bone present clinical challenges due to insufficient bone volume. Mathematical models have shown that a new, square-thread, dental implant design increases functional surface area and reduces shear loading at the implant interface. The aim of this investigation was to evaluate the ability of bone to grow between the threads of the new implant and its general biocompatibility in a canine model. Test implants were placed in the mandibles of four beagle dogs after posterior partial edentulism. Three months after implantation, the animals received independent fixed partial dentures, were followed for an additional 6 months, and then euthanized for histological analyses. Analyses revealed that bone grew between the threads and closely apposed the new implant design. Histological observations also revealed that the inferior aspect of the test implant threads were apposed by more bone than the coronal aspect, suggesting a biological advantage for the compressive load transfer mechanism of the new implant design. The results of this study revealed that the new implant design became osseointegrated with bone growing between the threads of the device.

This article describes the fabrication of a surgical template for planning and performing the harvest and placement of autologous bone grafts for the reconstruction of alveolar defects before implant placement. A diagnostic cast is altered to replicate the anticipated bone anatomy. The ideal bony contours for implant placement are then created on the cast to form the template. This template may then be used for treatment-planning donor sites for the harvest of corticocancellous bone grafts. The template is sterilized and used by the surgeon in procuring and placing the bone graft. This template allows communication of the prosthetic requirements of the ridge augmentation, as well as ensuring adequate volume and proper positioning of the block graft for eventual implant placement.

This interim report presents the data from a prospective study of BioHorizons, a bone quality-based implant system, with four implant designs. The surgical survival of 975 implants was 99.4%, with the survival 100% for D4 bone. Three critical phases of crestal bone loss have been identified: bone remodeling from stage I to stage II surgery; stage II uncovery to prosthesis delivery (transition period); and prosthesis delivery up to the first year of loading (early loading bone loss). The stage I to stage II uncovery crestal bone remodeling resulted in a mean vertical bone loss of 0.21 mm to 0.36 mm (SD = 0.90 mm), dependent on whether the implant became exposed in the oral cavity during osseous healing. No statistically significant difference was found among the four implant designs, diameter, bone density, or location. The stage II to prosthesis delivery mean vertical bone loss ranged from 0.12 mm to 0.20 mm. One hundred three consecutive patients (partially and totally edentulous) were restored, with 360 implants and 105 prostheses in function for a period of 12 to 26 months. No early loading implant failure occurred, and all patients with implants are in satisfactory to optimum health according to the Misch Implant Quality Scale. The mean early loading bone loss was 0.29 mm (SD = 0.99 mm). Past clinical reports in the literature indicate most failures or crestal bone loss occur by the first year of loading. This study suggests the bone quality based dental implant design minimizes overall implant failure and crestal bone loss, regardless of bone density.

The contour of the residual ridge is reduced within 1 year by approximately 25% in width after the extraction of a natural tooth. The augmentation of a tooth socket after an extraction decreases the loss of available bone width for an endosteal implant. Grafting at the same time as the extraction has benefits from both a patient and doctor perspective. However, primary closure is more difficult, and may require the facial keratinized gingiva to be undermined and approximated on the crest of the ridge, or the use of membranes, which are exposed during the soft tissue healing. The modified socket seal surgery uses a technique described by Landsberg and couples his procedure with autologous bone harvested from the maxillary tuberosity. As a result, the tooth extraction socket may be augmented with autologous bone and connective tissue with a simplified approach at the same time as the extraction of a tooth.