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The aim of this human cadaver study was to assess the accuracy of zygomatic/pterygoid implant placement using custom-made bone-supported laser sintered titanium templates. For this purpose, pre-surgical planning was done on computed tomography scans of each cadaver. Surgical guides were printed using direct metal laser sintering technology. Four zygomatic and two pterygoid implants were inserted in each case using the guided protocol and related tools. Post-operative computed tomography (CT) scans were obtained to evaluate deviations between the planned and inserted implants. Accuracy was measured by overlaying the real position in the post-operative CT on the virtual presurgical placement of the implant in a CT image. Descriptive and bivariate analyses of the data were performed. As a result, a total of 40 zygomatic and 20 pterygoid implants were inserted in 10 cadavers. The mean deviations between the planned and the placed zygomatic and pterygoid implants were respectively (mean ± SD): 1.69° ± 1.12° and 4.15° ± 3.53° for angular deviation. Linear distance deviations: 0.93 mm ± 1.23 mm and 1.35 mm ± 1.45 mm at platform depth, 1.35 mm ± 0.78 mm and 1.81 mm ± 1.47 mm at apical plane, 1.07 mm ± 1.47 mm and 1.22 mm ± 1.44 mm for apical depth. In conclusion, the surgical guide system showed accuracy for all the variables studied and allowed acceptable and accurate implant placement regardless of the case complexity.

The objective of this clinical study was to assess the outcomes of autologous tooth structure in alveolar ridge preservation procedures. Extraction sites were grafted with autologous tooth structure prepared from the extracted teeth, and histologic samples were obtained at varying intervals to allow observation of bone-healing dynamics over time. Grafted areas were occupied by dentin particles that had begun to connect via bridges of woven bone at 3 months posthealing, and vital bone was in direct contact with residual particles with no inflammatory infiltrate. Further clinical investigation is warranted on the comparative effectiveness of autologous tooth structure against established bone-substitute biomaterials.

Purpose To evaluate the effectiveness and predictability of a novel biomechanical, minimally invasive bone instrumentation technique that enhances bone density through compaction grafting, called osseous densification, and allows for transcrestal sinus membrane elevation and augmentation with simultaneous implant placement. Materials and methods Patients who were consecutively treated with the bone densification and transcrestal sinus augmentation technique and were followed up in three treatment centers between May 2012 and September 2017 were included in this retrospective study. The summary statistics are presented as means for continuous variables and percentages for categorical variables. Results In total, 222 patients with 261 implants were included in the final clinical analysis. The included follow-up period ranged from 6 to 64 months with a mean of 35 months. The subsinus residual bone height at baseline was 5.4 mm (SD: 1.9). Following the sinus augmentation, a significant vertical increase of 7 mm (SD: 2.49) was observed. No sinus membrane perforations and no late implant failures were observed from 6 up to 64 months follow-up, yielding a cumulative implant survival rate of 97%. Conclusion This osseous densification technique for maxillary implant site preparation with transcrestal sinus augmentation and simultaneous implant placement led to favorable clinical outcomes with up to 64 months of follow-up.

Introduction: Patients with an edentulous posterior maxillary segment frequently lack adequate bone mass to support dental implants. Implant placement into the posterior maxillary ridge can be complicated by limited quantity and poor quality of bone. Sinus lift and bone grafting result in bone regeneration as well as an increase in bone volume and hence help stabilize implants. The challenge of bone deficiency of this segment has been traditionally addressed by two approaches: 1) lateral maxillary window (hinge osteotomy) and 2) the crestal approach via osteotome technique.Case Presentation: A 70-year-old female patient presented needing a full maxillary rehabilitation. The osteotome-closed approach was used on the right side, which was grafted with nanocrystalline calcium sulfate (nCS) bone graft. The lateral window sinus elevation approach was used on the left side, which was grafted with nCS in combination with platelet-rich fibrin. Implants were placed simultaneously. Computed tomography scans showed ...

Purpose: The aim of this paper is to present a large-scale long-term follow-up of dental implants placed simultaneously with nasal floor augmentation using osteoconductive bovine bone substitutes. Materials and Methods: Patients who received dental implants combined with nasal floor elevation in three dental centers between 2006 and 2012 were included in this report. Preoperative available bone height was measured on computed tomographic scans. Implant parameters as well as implant survival rates were recorded. The cohort consisted of long-term follow-up of this previously reported cohort, combined with a cohort of newly treated patients. Results: Overall, 67 patients were included in this study. Cigarette smoking was reported by 16 patients. Two hundred three implants were inserted in combination with nasal floor elevation. No nasal mucosa perforations were observed. The mean follow-up periods were 65.93 ± 13.2 months (range, 33 to 86 months) for the original cohort and 23.14 ± 9.4 months (range, 7 to 44 months) for the newly treated patients. The available bone height prior to bone augmentation was 8.89 ± 1.1 mm (range, 5 to 11.2 mm) and a mean of 3.65 ± 0.9 mm (range, 1.1 to 7 mm) of additional height was achieved with nasal floor elevation. During the follow-up period, no implants were lost, resulting in a 100% survival rate. Conclusion: Nasal floor augmentation, as shown in this report, might serve as a reliable method for reconstruction of the anterior atrophic maxilla when residual height is insufficient.

Introduction: The use of bone grafts to replace the lost bone in extraction sockets is commonplace today. This helps to maintain the height and width of the bone for eventual placement of dental implants.Case Presentation: A 41-year-old female patient presented to a private clinic with a hopeless tooth #31. Atraumatic extraction was performed. The socket was cleaned. Infected, inflamed tissue, as well as remnants of periodontal ligament, were removed. The site was thoroughly irrigated and decorticated. Particles of nanocrystalline calcium sulfate (nCS) were mixed with saline to form a putty. nCS putty was then lightly condensed in the extraction socket with a plastic instrument and a plugger. The site was closed with a barrier membrane. Radiographs were taken before and after the surgery. The patient was followed regularly. Four months after grafting the socket, two dental implants were placed in the healed socket. A small core of the bone from the grafted socket was obtained before implant placement and ...

Purpose The aim of the present report is to describe the long-term follow-up of cases treated with implant tooth-supported removable partial denture (ITSRPD) after at least 15 years. Materials and Methods The study sample comprised 20 consecutively partially edentulous patients treated with ITSRPD. Implants were placed in order to improve unfavorable removable partial denture design resulting from unfavorable teeth distribution and biomechanical considerations, esthetic, or periodontal challenges. All patients were followed up every 6 months for the first 2 years and annually thereafter for at least 15 years. Recall visits for professional cleaning and oral hygiene re-enforcement were scheduled every 3 to 6 mounts. Results A total of 42 implants were placed in 20 patients and restored with ITSRPD. All implants and prosthetic devices functioned successfully throughout the 15 years of follow-up. Three patients had gone through further implant placement several years after ITSRPD was provided, and a fixed implant-supported restoration was provided on the original and new implants. No implant failure was noted during follow-up, resulting in a rate for implant survival of 100% for the study. Marginal bone loss around implants ranged between 0 and 2 mm (mean 0.64 ± 0.6 mm). During the follow-up period, prosthetic complications were minor and included one rest rupture. All patients answered a questionnaire and were satisfied with the prosthesis. They reported good chewing ability and stability of the prosthetic devices. Conclusions ITSRPD can be used with predictable long-term results in carefully selected and well-maintained population. Patients should be advised of their role in maintenance, and a comprehensive recall system is mandatory to obtain satisfactory long-term results.

A variety of surgical techniques and materials have been developed to increase the vertical bone height in the posterior maxilla. Minimally invasive crestal approaches for the elevation of the floor of the sinus using a crestal approach have been recently reported to minimize adverse events associated with the use of the osteotome technique for indirect sinus lift. The aim of this study is to report a surgical improvisation that minimizes risks associated with sinus floor elevation using a crestal approach and simplifies the clinical procedure. The technique is based on the use of a viscoelastic calcium phosphosilicate alloplastic putty (CPS putty) bone substitute that can be delivered utilizing a unique cartridge delivery system. CPS putty not only acts as a ‘protective cushion’ thanks to its physical properties, but also provides hydraulic pressure to lift the Schneiderian membrane when used in conjunction with the cartridge system. This approach minimizes risks of benign paroxysmal positional vertigo or mechanical perforations of the Schneiderian membrane associated with the traditional osteotome technique.

I mplant-supported restoration of the maxillary anterior segment that is biologically, functionally, and esthetically acceptable following traumatic injuries in the maxillary anterior segment is always complex. Careful extraction of the fractured root, residual labial bone preservation, proper flap design, ideal positioning of the implant, appropriate softtissue contour, and the crown emergence are all important steps necessary to achieve a predictable, stable, functional, and esthetic success. However, healing of the tissues is always difficult to control and the development of new techniques and materials to improve these treatments is still necessary. The use of platelet concentrates is an interesting approach. Platelet concentrates for surgical use are widely used and continuously investigated in oral and maxillofacial surgery. The objective is to gather platelet growth factors and to inject them on a surgical site to stimulate the healing process. A significant percentage of the literature is focused on the platelet-rich plasma (PRP) families. PRP is a liquid platelet suspension often activated into a platelet-rich gel (like fibrin glues). Another technology called leukocyteand platelet-rich fibrin (L-PRF) allows for the preparation of strong fibrin membranes enriched with cells (activated platelets, leukocytes, circulating cells) and platelet growth factors. This autologous healing biomaterial is free of additives (no anticoagulant during blood harvest, no chemicals for activation), simple, inexpensive, and quick to prepare (15 minutes for all steps). This technique is specifically adapted to the practical needs in daily implant dentistry. Several articles have reported the use of these L-PRF membranes for the stimulation of bone and 1 Private practice, Turin, Italy. 2 Private practice, Ra’anana, Israel. 3 Clarion Research Group, Clarion, Penn. Department of Restorative Dentistry, State University of New York at Buffalo, Buffalo, NY. 4 LoB5 Unit, Research Center for Biomineralization Disorders, School of Dentistry, Chonnam National University, Gwangju, South Korea. Department of Stomatology, Oral Surgery, and Dental and MaxilloFacial Radiology, School of Dental Medicine, University of Geneva, Geneva, Switzerland. * Corresponding author, e-mail: LoB5@mac.com DOI: 10.1563/AAID-JOI-D-12-CL.3802

Objectives: The aim of the present study was to report on the survival of dental implants placed in conjunction with nasal floor elevation. Methods: A retrospective cohort of 32 consecutive patients from two private practices was evaluated. All patients presented with alveolar bone height deficiency in the anterior region, which was not sufficient to place a dental implant according to a computed tomography (CT) scan preformed prior to implantation. Elevation and augmentation of the nasal mucosa was performed simultaneously with dental implant placement. Data collection included demographic information, as well as records of the pre-operative available bone height, implant dimensions, bone addition following nasal floor augmentation, and survival of the implants at last follow-up. Results: Overall, 32 patients received 100 implants that were performed in conjunction with nasal floor elevation. The average pre-operative available bone height according to a CT scan that was preformed prior to implantation was 9.1 1 0.9 mm and ranged from 7.3 to 11.2 mm. Bone addition following nasal floor augmentation was 3.4 1 0.9 mm and ranged between1.1 and 5.7 mm. The mean follow-up time was 27.8 1 12.4 months, and during that follow-up period, no implant failure was recorded, resulting in 100% implant survival. Conclusion: Nasal floor elevation might serve as a predictable procedure, which allows implant placement in areas with significant atrophy together with increased implant stability due to the bicortical support.

Background and Purpose: Frequently, the posterior maxilla lacks sufficient bone mass to support dental implants. This multiphysician registry assessed the feasibility and safety of minimally invasive antral membrane balloon elevation (MIAMBE), followed by bone augmentation and implant fixation. Materials and Methods: One hundred twelve consecutive patients were referred for MIAMBE. Following pre-procedural assessment and informed consent, patients underwent alveolar crest exposure, and 3 mm osteotomy followed by MIAMBE. Platelet-rich fibrin and bone substitutes were injected under the antral membrane; implant placement and primary closure were executed at the same sitting. Implant loading was carried out 6 to 9 months later. Results: One hundred nine (97.3%) patients successfully concluded the initial procedure. Three patients had membrane tear requiring procedure abortion. One case of infection was documented at 4 weeks. Procedure time was 58 ± 23 minutes. Incremental bone height consistently exceeded 10 mm, and implant survival of 95% was observed at 6 to 9 months. Conclusion: MIAMBE can be applied to all patients in need of posterior maxilla bone augmentation with high procedural success, low complication rate, and satisfactory bone augmentation and implant survival. As it is minimally invasive and associated with minimal discomfort, MIAMBE should be an alternative to the currently employed methods of maxillary bone augmentation.

Numerous studies demonstrate successful immediate loading of dental implants. The purpose of this study was to evaluate the long-term survival of single-tooth implants immediately placed in fresh extraction sites at the anterior maxilla with immediate infraocclusion-provisional restorations and nonfunctional immediately loading.A total of 24 implants were placed in 16 patients. The fixed provisional restorations were connected to a prefabricated plastic abutment. Occlusal contacts were avoided. Follow-up starting at implantation day ranged from 24 to 72 months with a mean of 40.7 months.One implant failed 1 month after placement due to the unscrewing of a temporary abutment that resulted in implant overload. Overall implant survival rate resulted in 95.8%. The mean marginal bone loss increased by 0.9 +/- 1.1 mm. starting from implant placement.Within the limits of this study, the data indicate that nonfunctional immediate loading of single-tooth implants placed in fresh extraction sites in the anterior maxilla can result in successful implant integration and stable peri-implant conditions up to 6 years.

The aim of this paper is to present a technique for segmental dento-alveolar intrusive osteotomy in a posterior maxilla with lack of inter-arch distance for prosthetic rehabilitation combined with sinus floor elevation.A full thickness flap is elevated exposing the lateral wall of the maxillary sinus. A lateral window is opened and the Schneiderian membrane elevated. Segmental dento-alveolar osteotomy is performed. After complete detachment of the segment, it is adapted and fixed to the new position using the pre-prepared guide, making sure not to damage or perforate the Schneiderian membrane.Four cases of segmental dento-alveolar intrusive osteotomy in a posterior maxilla combined with sinus floor elevation were performed utilizing the above-mentioned technique. All surgeries went according to plan, and healing was uneventful except for swelling and pain that lasted for 10-14 days post- operatively. The opposing dentition was later treated by implant placement. The average follow-up time for those cases was 5.4 months. Vitality test four months after surgery was positive.The presented technique for segmental dento-alveolar intrusive osteotomy combined with sinus floor elevation can serve as a viable treatment option in the posterior maxilla with lack of inter-arch distance due to severe overeruption.

The aim of this report was to suggest an alternative approach to avoid impacted canine extraction by utilizing computer-guided implant placement for providing an implant adjacent to the impacted canine without contact to the impacted tooth. In cases when the adjacent area is available for implant placement, a computerized three-dimensional (3D) planning system can be used to place implants in a way that avoids the impacted canine. Tilted implants could be used to achieve the proper support for implant-supported fixed dentures without damaging the impacted teeth. Following careful 3D planning, a computer-derived surgical stent is used to guide the surgical placement of the implants in the proper place. Since the position of the implants is known prior to the surgical procedure, a prefabricated provisional restoration is delivered immediately at the end of the surgery. Following a waiting period of 6 months, the implant-supported definitive restoration is fabricated using the same technique and delivered to the patient, making sure that proper maintenance and oral home care hygiene are feasible. This suggested treatment modality, when suitable, could provide a relatively short treatment time, a less invasive procedure, and fewer potential complications compared to the extraction of an impacted canine, massive bone grafting, and implant placement. Also, it might be assumed that the use of the native bone, as suggested here, rather than an augmented bone could lead to better long-term results.

The use of autologous platelet-rich plasma (PRP) as a source for growth factors in bone grafting is a relatively new and promising technique. Early controlled studies indicate that combining PRP with autologous bone grafts significantly enhances the rate of bone formation and maturation. The study consisted of 105 patients who required sinus augmentation with crestal bone height of less than 5 mm in the posterior maxilla. All patients received a composite bone graft that consisted of 30% to 40% autogenous bone harvested from the lateral wall of the maxilla zygomatic-maxillary buttress and the tuberosity and 60% to 70% xenograft. A total of 50 mL of blood was obtained from each patient before the surgical treatment for preparation of 10 mL of PRP. The graft-PRP mixture was activated by human thrombin. All sinus augmentations were carried out simultaneously with dental implants. At 6 months postoperatively, implants were exposed showing no clinical evidence of crestal bone loss around the implants both clinically and radiographically. All implants were clinically osseointegrated and loaded with fixed porcelain fused to metal prosthesis. The use of PRP in augmenting the severely atrophic posterior maxilla has obvious clinical benefits in terms of reducing the healing period of bone maturation, better graft handling, and accelerated soft tissue healing.

The aim of the present study was to present results of single molar area rehabilitated by 2 narrow diameter dental implants.A retrospective cohort of 33 consecutive patients from 2 private practices between the years 2008 and 2009 had been evaluated. Patients who had a first molar single replaced by 2 narrow diameter implants (3 mm wide) were included in this case series. Patients' demographics, site and implant characteristics, and time of follow-up were recorded from the medical files.Overall, 33 patients received 66 implants replacing 33 missing first molars. Patients' age ranged from 23 to 76 years with an average of 49.2 ± 12.7 years. Most of the implants were used to replace a mandibular molar (76%) and 16 were used to replace 8 maxillary molars. In 2 patients, immediate implantation was performed. The mean distance between the adjacent teeth was 12.1 ± 1.0 mm. Follow-up time ranged from 10 to 18 months (average, 12.2 ± 1.9 months). All implants survived the follow-up time. One implant presented with 1 mm of bone loss at 12-month follow-up.Replacing a single missing molar with 2 narrow diameter dental implants might serve as a viable treatment option providing good and predictable long-term results.

The aim of this retrospective study was to evaluate the primary stability of implants placed in significantly pneumatized maxillary sinuses with minimum residual bone height. Seventeen patients who had been treated with simultaneous implant placement in sites with

Transition from a hopeless dentition to a fixed-implant-supported full-arch reconstruction can be difficult for patients if wearing a transitional removable denture is involved. In addition, an increased risk for trauma to bone augmentation areas and to the implant-bone interface exists when using a removable transitional complete denture during the implant healing period; such risk can compromise implant success or increase crestal bone loss around implants before the final restoration. This article describes a treatment approach that allows replacement of the hopeless dentition with an osseointegrated fixed prosthesis, without rendering the patient totally edentulous before the delivery of the final implant-supported prosthesis. A staged approach using a few hopeless teeth to support a provisional fixed restoration during the healing process can help avoid discomfort and improve implants' outcome. A treatment plan for a maxillary arch reconstruction is used to illustrate the staged approach protocol. This protocol addresses patients' psychologic need to remain dentate during partial or full-mouth rehabilitation, while providing good esthetics and function during restoration of a dental arch.

Maxillary sinus augmentation surgery is frequently employed to provide adequate vertical bony dimensions in posterior maxillary sites. When significant gain in bone height is sought for, an invasive lateral-window approach is routinely used to achieve sinus floor elevation. The minimally invasive antral membrane elevation technique was initially conceived as a surgical improvisation that has been shown to lead to up to, or exceeding, 10 mm of bone height, while enhancing the safety profile of the transalveolar sinus augmentation technique. This approach is based on the use of hydraulic pressure that is applied to the schneiderian membrane via a saline-inflatable balloon. Even though this technique has been shown to be a safe and efficacious treatment modality, the need for specialized equipment, training, and corresponding costs may hinder its widespread application. The purpose of this clinical paper is to introduce a simplified approach to the minimally invasive antral membrane elevation technique. The simplified minimally invasive antral membrane elevation technique is based on the application of hydraulic pressure by a viscous bone graft that acts as an incompressible fluid. The specific clinical steps of this technique will be demonstrated to illustrate how grafting of the maxillary sinus is achieved simultaneously with the atraumatic elevation of the schneiderian membrane, thus resulting in even less operative time. This simplified technique may make the minimally invasive antral membrane elevation technique more accessible to implant surgeons as it eliminates the need for purchase of specialized equipment and aids in further decrease of intra-operative time accomplished with the original technique.

The aim of the present case series was to evaluate a simplified minimally invasive transalveolar sinus elevation technique utilizing calcium phosphosilicate (CPS) putty for hydraulic sinus membrane elevation. The simplified minimally invasive antral membrane elevation technique is based on the application of hydraulic pressure via a viscous bone graft that acts as an incompressible fluid. In this retrospective study, 21 patients (mean age: 48.5 ± 12 years) consecutively treated with the simplified minimally invasive transalveolar sinus elevation technique were evaluated. 28 tapered implants were placed in posterior maxillary sites with less than 6 mm of residual bone height as determined radiographically on cone beam volumetric tomographs. No sinus membrane perforations were noted and none of the patients complained of symptoms of sinusitis post-operatively (0%). The mean gain in bone height post-operatively was 10.31 ± 2.46 mm (p0.001). All implants successfully integrated (100% success rate) and were loaded with cement-retained prostheses. The proposed technique is a simple, efficacious, minimally invasive approach for sinus elevation that can be recommended for sites with at least 3 mm of residual height.

Background: Dental implant placement associated with sinus floor augmentation in a severely atrophic maxilla can be performed in a 1- or 2-stage surgical procedure, depending on the height of the residual alveolar bone. A minimum of 4 to 5 mm is recommended for a 1-stage procedure. Methods: This clinical study describes the use of hydroxyapatite (HA) bone cement to stabilize HAcoated cylindrical implants placed simultaneously during sinus augmentation in 10 patients where insufficient bone volume did not allow primary implant stability. A total of 26 HA-coated dental implants were inserted in 10 grafted sinuses of 10 patients. Results: None of the cases presented any difficulty in achieving initial stabilization and parallelism. No clinical complications of the sinuses were evident. Prior to exposure, radiographic evaluation revealed the implants embedded in a densely homogeneous radiopaque mass. At second-stage surgery, there was no clinical evidence of crestal bone loss around the implants. All implants were clinically osseointegrated. All patients received fixed implant-supported prostheses. Mean follow-up was 18 months (range 12 to 24 months). Conclusions: According to this preliminary study, the hydroxyapatite bone cement appears to hold great promise as a grafting alloplastic material for sinus floor augmentations. Its main advantage is its ability to provide initial stability required for osseointegration and proper implant location and parallelism. Further clinical and histological studies are required before it can be recommended for routine use in sinus lift procedures. J Periodontol 2000;71:1187-1194.

Background Treatment of asymptomatic impacted maxillary canines in adults is inevitable when primary canine becomes lost through extraction or exfoliation or when the impacted tooth becomes symptomatic. Treatment alternatives include an orthodontic procedure to bring the unerupted tooth to the dental arch or prosthetic replacement of the missing tooth. The authors describe an alternative treatment that involves immediate placement of implants into extraction sockets of the teeth. Case Description A patient with bilateral palatally impacted upper canines chose to have the unerupted teeth removed and replaced with implants and crowns. Two hydroxyapatite cylindrical implants were inserted through the alveolar ridge into the extraction sites. The unfilled areas in the extraction sites, around the dental implants, were packed and covered with demineralized freeze-dried bone allograft in conjunction with a collagen membrane barrier. Six months after implantation, computed tomography revealed complete osseous fill of the extraction defects and no bone loss around the implants. The implants were uncovered, and porcelain-fused-to-metal restorations were fabricated and placed. Clinical Implications This treatment modality avoids the need for conventional preparation of teeth as part of prosthetic reconstruction or prolonged orthodontic treatment aimed at bringing the impacted canine to the dental arch. Combining the implantation with bone augmentation preserved the alveolar bone and shortened the treatment period.

The purpose of this paper is to present radiological findings of a short-term (8 to 10 months) computerized tomography (CT) follow-up study on 1-stage maxillary sinus lift cases. Pre- and postoperative dental CT scans of 21 patients (24 sinuses) after sinus lift procedures were compared. CT scans were used to assess newly formed bone and its interface with the implants, condition of the sinus membrane, evidence of buccal window cortication, and presence of any sinus pathology. Of the 57 implants placed, 28 had bone fully covering the implant on all sides which did not extend above the apical portion; 20 had bone fully covering the implant which did extend above the apex; and 9 exhibited incomplete bone coverage. All implants supported a fixed ceramo-metal prosthesis, and no implant failures were recorded after 3 years of follow-up. There was evidence of cortication of the buccal window in 10 sinuses; in the 14 remaining sinuses, bone consolidation on the buccal aspect was evident, but no evidence of cortication was seen. All sinuses healed without complications or clinical signs of sinusitis. In 11 sinuses, no changes in membrane thickness were noted. Membrane thickness decreased postoperatively in 12 sinuses, and in one, there was evidence of membrane thickening. Bone cortication in the anterior wall window may serve as an indicator for the remodeling status of the entire graft. Postoperative findings showed a significant improvement in overall membrane thickness. No clinical symptoms of sinusitis were evident, indicating that sinus lift procedures can be considered safe and do not predispose the sinus to acute or chronic sinusitis.

Dental implant placement associated with augmentation of the sinus floor in the severely atrophic maxilla can be performed in 1- or 2-surgical stages, depending on the height of the residual alveolar bone. A minimum of 4 to 5 mm of residual alveolar bone height is recommended for a 1-stage surgical procedure. The present study describes a 1-stage procedure in cases where the residual alveolar bone height in the posterior maxilla was 1 to 2 mm. A total of 55 hydroxyapatite-coated dental implants were inserted in 20 grafted sinuses of 20 patients. No case presented any difficulty in achieving initial stabilization and parallelism. No perforation of the sinus membrane or clinical complications of the sinuses were evident. Prior to exposure, radiographic evaluation revealed bone consolidation and a close bone-implant relation. At second-stage surgery, there was no clinical evidence of crestal bone loss around the implants. All implants were clinically osseointegrated. All patients received fixed implant-supported prosthesis. The mean follow-up was 26.4 months (range 15 to 39 months). There was no implant loss after loading. The following surgical modifications are essential: a wide lateral window opening, the use of a bone mill to homogenize the bone graft, meticulous condensation, and clinical measurements to ensure implant parallelism.

The aim of the present report is to describe the long-term follow-up of cases treated with implant tooth-supported removable partial denture (ITSRPD) after at least 15 years.The study sample comprised 20 consecutively partially edentulous patients treated with ITSRPD. Implants were placed in order to improve unfavorable removable partial denture design resulting from unfavorable teeth distribution and biomechanical considerations, esthetic, or periodontal challenges. All patients were followed up every 6 months for the first 2 years and annually thereafter for at least 15 years. Recall visits for professional cleaning and oral hygiene re-enforcement were scheduled every 3 to 6 mounts.A total of 42 implants were placed in 20 patients and restored with ITSRPD. All implants and prosthetic devices functioned successfully throughout the 15 years of follow-up. Three patients had gone through further implant placement several years after ITSRPD was provided, and a fixed implant-supported restoration was provided on the original and new implants. No implant failure was noted during follow-up, resulting in a rate for implant survival of 100% for the study. Marginal bone loss around implants ranged between 0 and 2 mm (mean 0.64 ± 0.6 mm). During the follow-up period, prosthetic complications were minor and included one rest rupture. All patients answered a questionnaire and were satisfied with the prosthesis. They reported good chewing ability and stability of the prosthetic devices.ITSRPD can be used with predictable long-term results in carefully selected and well-maintained population. Patients should be advised of their role in maintenance, and a comprehensive recall system is mandatory to obtain satisfactory long-term results.

The aim of the present study was to evaluate the influence of implant length and diameter on implant survival.A retrospective cohort of 787 consecutive patients from 2 private practices between the years 2008 and 2011 had been evaluated. Patient demographics, site and implant characteristics, and time of follow-up were recorded from the medical files.Overall, 3043 implants were investigated. Overall survival rate was 98.7% with 39 implant failures recorded. Survival rates for narrow- (3.75 mm), regular- (3.75-5 mm), and wide- (5 mm) diameter implants were 98.2%, 98.7%, and 98.5%, respectively (P = 0.89). Survival rates of short (10 mm) and regular (10 mm and above) implants were 97% and 98.7%, respectively (P = 0.22).Implant length and diameter were not found to be significant factors affecting implant survival during the first 2 years of function in the present investigation of this specific implant system by a single manufacturer. Further long-term follow-up studies are warranted because 2-years are only interim short-term results when dealing with dental implants.

Studies have shown that tooth extraction results in loss of bone volume, which compromises dental implant placement. Prevention of site collapse at the time of extraction is recommended. In this 4-month case series, 40 patients were treated with an innovative biphasic calcium sulfate graft, demonstrating its ability to preserve or augment socket volume and resorb in the time period desired between extraction and implant placement. Some representative samples were retrieved at the time of implant placement and evaluated histologically and morphometrically for vital bone formation.

In the atrophic posterior maxilla, successful implant placement is often complicated by the lack of quality and volume of available bone. In these cases, sinus floor augmentation is recommended to gain sufficient bone around the implants. Sinus elevation can be performed by either an open lateral window approach or by a closed osteotome approach depending on available bone height. This case series demonstrates the feasibility and safety of minimally invasive antral membrane balloon elevation, followed by bone augmentation and implant fixation in 20 patients with a residual bone height of 2 to 6 mm below the sinus floor. The surgical procedure was performed using a flapless approach. At 18 months follow-up, the implant survival rate was 100%. Absence of patient morbidity and satisfactory bone augmentation with this minimally invasive procedure suggests that minimally invasive antral membrane balloon elevation should be considered as an alternative to some of the currently used methods of maxillary bone augmentation.

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

Atrophic edentulous anterior maxilla is a challenging site for implant placement and has been successfully treated surgically by anterior maxillary osteoplasty. This procedure is associated with considerable discomfort, morbidity, and cost—and consequently reduced patient acceptance. The efficacy and safety of minimally invasive bone augmentation of the posterior maxilla has not been extended thus far to the anterior subnasal maxilla. We present 2 representative cases in which minimally invasive subnasal floor elevation was performed along with minimally invasive antral membrane balloon elevation. Both segments underwent bone grafting and implant placement during the same sitting. Minimally invasive anterior maxilla bone augmentation appears to be feasible. Designated instruments for alveolar ridge splitting and nasal mucosa elevation are likely to further enhance this initial favorable experience.

Deep bone defects are caused by the progression of periodontal disease, which breaks down bone and connective tissue that hold teeth in place. In this case, a 37-year-old male patient presented a deep bone defect with advanced periodontal disease around an upper canine. Medical-grade calcium sulfate was mixed with demineralized freeze-dried bone allograft and used to repair and regenerate the defect. Analysis of the radiographs at the 5-month time point showed the bone had completely regenerated.

Ridge deficiency is an unfortunate obstacle in the field of implant dentistry. Many techniques are available to rebuild the deficient ridge. Some of these techniques are associated with significant morbidity and often require a second surgical site. With the advent of guided bone regeneration (GBR), one may now graft the deficient ridge with decreased morbidity and without a second surgical site. The purpose of this retrospective consecutive case series from 5 private practices is to report on the outcomes of a composite material of demineralized freeze-dried allograft, mineralized cortical cancellous chips, and a biologically degradable thermoplastic carrier (Regenaform RT) when combined with a resorbable membrane for GBR of lateral ridge defects in human patients. The specific aim was to quantify clinical results through direct measurement. Data were obtained from 73 consecutively treated lateral ridge augmentations performed on 67 partial and/or completely edentate patients. Clinical data (presurgical ridge width, ridge width at implant placement, and bone density at implant placement) were obtained retrospectively from 5 private practices via an exhaustive retrospective chart review, which was pooled and averaged for analysis. The average gain in horizontal ridge width was 3.5 mm (range, 3–6 mm). The density of the bone was noted to be type 2 to 3, with type 3 being the predominant finding. This retrospective case series from 5 clinical private practices suggests that the use of a composite material of demineralized freeze-dried allograft, mineralized cortical cancellous chips, and a biologically degradable thermoplastic carrier, when covered by a resorbable collagen membrane for GBR, is an effective means of horizontal ridge augmentation.

To determine the efficacy of an alloplastic graft material, consisting of a pure-phase beta-tricalcium phosphate (beta-TCP), in the preservation of ridge volume after tooth extraction and before dental implant placement. Histomorphometric analysis was completed on a few samples to determine the percentage of vital bone over a fixed healing period.Patients requiring tooth extraction and bone regeneration before implant placement were included in this study. Measurements of alveolar width were made at the time of extraction and the time of implant placement. The extraction sites were grafted with a pure-phase beta-TCP and covered with a barrier. Approximately 6 months after surgery, the sites were reentered for implant placement. Cores were taken of the regenerated material for histologic analysis, with a trephine used as the first bur in preparation for some of the osteotomies. Implants were placed according to the manufacturers' recommendations and loaded at the appropriate time.The beta-TCP placed at the time of grafting extraction sockets was well tolerated in all sites with all of the barriers used. There were no incidences of postoperative infection or graft rejection. At the time of implant placement, much of the graft material had resorbed and been converted to vital alveolar bone. The implant recipient sites were dense and supported placement of endosseous dental implants that were fully stable. The width of the extraction sockets was preserved to 91% of the preoperative width.Extraction socket grafting with the pure-phase beta-TCP tested in this study and covered with either a resorbable collagen or dense polytetrafluoroethylene barrier is a predictable method for preserving alveolar dimensions. The graft material resorbs to a high percentage in the timeframe desired between extraction and dental implant placement, as shown clinically, radiographically, and histologically. In addition, the regenerated material in the socket has enough density to support implant placement with subsequent loading in the 4- to 6-month period used in this study.

Background: Sinus augmentation with simultaneous implant placement without bone graft material is a hotly debated technique. This technique could be improved and secured by the use of an autologous leukocyte- and platelet-rich fibrin (PRF) (Choukroun’s technique) concentrate. The objectives of this study were to assess the relevance of PRF clots and membranes as the sole filling material during a lateral sinus lift with immediate implantation using radiologic and histologic analyses in a case series. Methods: Twenty-five sinus elevations with simultaneous implantation were performed on 20 patients with Choukroun’s PRF as the sole filling biomaterial. For each patient, a presurgical exam and a 6-month postsurgical radiologic exam were performed with a panoramic x-ray and three-dimensional volumetric computed radiography (VCR) to evaluate the subsinus residual bone height and the final bone gain around the implants. In nine patients, 6 months after the sinus lift, bone biopsies were collected on the buccal wall of the alveolar ridge at the level of the osteotomy window, and evaluated by histomorphometry. Results: In this study, 41 implants from three different systems with different screw designs (Biomet 3I Nanotite, MIS Seven, Intra-Lock Ossean) were placed. All implants were inserted in residual bone height between 1.5 and 6 mm (mean – SD: 2.9 – 0.9 mm). The final bone gain was always very significant (between 7 and 13 mm [mean – SD: 10.1 – 0.9 mm]). No implant was lost. After radiologic analyses, the position of the final sinus floor was always in the continuation of the end of the implant. All biopsies showed well organized and vital bone. Conclusions: From a radiologic and histologic point of view at 6 months after surgery, the use of PRF as the sole filling material during a simultaneous sinus lift and implantation stabilized a high volume of natural regenerated bone in the subsinus cavity up to the tip of the implants. Choukroun’s PRF is a simple and inexpensive biomaterial, and its systematic use during a sinus lift seems a relevant option, particularly for the protection of the Schneiderian membrane. J Periodontol 2009;80:2056-2064.

Antral septa of the maxillary sinus occurs in approximately one third of patients undergoing posterior maxillary bone augmentation and is considered a relative contraindication for lateral maxillary window (“hinge osteotomy”). We present the results of 26 consecutive cases of patients with septated maxillary sinus who underwent minimally invasive antral membrane balloon elevation (MIAMBE) followed by bone augmentation and implant fixation. After undergoing preprocedural assessment and signing an informed consent, 57 consecutive patients were referred for posterior maxillary bone augmentation. Alveolar crest exposure (via 3-mm osteotomies), MIAMBE, and bone augmentation were followed by implant placement and primary closure (executed at the same sitting). Implant loading was done 6–9 months later. Twenty-six out of 57 (45.6%) patients had significant septa (detected on computed tomography) in the designated augmentation region. Twenty-four (92%) concluded the initial procedure successfully. Two patients had membrane tear requiring procedure abortion. Mean procedure time was 48 ± 23 minutes. Incremental bone height consistently exceeded 10 mm, and implant survival of 95.2% was observed at 6–9 months. MIAMBE can be applied to patients in need of posterior maxilla bone augmentation in the presence of septated maxillary sinus with high procedural success, low complication rate, and satisfactory bone augmentation and implant survival. MIAMBE should be an alternative to the currently employed methods of maxillary bone augmentation, especially in the presence of septated maxilla.

Frequently, the posterior maxilla lacks sufficient bone mass to support dental implants. This multiphysician registry assessed the feasibility and safety of minimally invasive antral membrane balloon elevation (MIAMBE), followed by bone augmentation and implant fixation.One hundred twelve consecutive patients were referred for MIAMBE. Following pre-procedural assessment and informed consent, patients underwent alveolar crest exposure, and 3 mm osteotomy followed by MIAMBE. Platelet-rich fibrin and bone substitutes were injected under the antral membrane; implant placement and primary closure were executed at the same sitting. Implant loading was carried out 6 to 9 months later.One hundred nine (97.3%) patients successfully concluded the initial procedure. Three patients had membrane tear requiring procedure abortion. One case of infection was documented at 4 weeks. Procedure time was 58 +/- 23 minutes. Incremental bone height consistently exceeded 10 mm, and implant survival of 95% was observed at 6 to 9 months.MIAMBE can be applied to all patients in need of posterior maxilla bone augmentation with high procedural success, low complication rate, and satisfactory bone augmentation and implant survival. As it is minimally invasive and associated with minimal discomfort, MIAMBE should be an alternative to the currently employed methods of maxillary bone augmentation.

Background and objectives Analysis of tomodensitometric controls following sinus grafts clearly demonstrates a quite systematic lack of homogeneity. Sinus contamination by anaerobic bacteria seems almost unavoidable during bone graft surgery, and this problem may jeopardize the healing process. The aim of this study was to characterize in a systematic way the nonhomogeneities observed at 1, 2, or 3 months postsurgery within allogenous sinus grafts, and to assess the possible influence of a 0.5% sterile solution of metronidazole incorporated in the sinus bone graft. Materials This clinical study was conducted on 72 patients treated with single or bilateral sinus-lifts: 94 sinus elevations performed with freeze-dried bone allograft (Phoenix, TBF, Mions, France), with (test group) or without (control group) metronidazole. In the test group, each bone graft was hydrated with 2 mL of a 0.5% metronidazole solution, i.e., only 10 mg of metronidazole. All the patients went through a first presurgical computerized tomography (CT)-scan followed by a second scan performed at 1, 2, or 3 months postsurgery (which was used as the preimplant reference scan). For 11 patients, 2 postsurgical CT-scans were performed respectively at 10 days and 2 months. Using an arbitrary gray scale (Arbitrary Densitometric Unit) which functions according to the Hounsfield unit principle, the degree of radiographic homogeneity of the grafts was established. Density scattering provides some information on the homogeneity or nonhomogeneity of the bone graft. Results The 12 grafts performed without metronidazole show significant nonhomogeneities at 1, 2, or 3 months. Moreover, when a CT-scan is performed during the first postoperative days (at 10 days), the presence of air bubbles in the graft is confirmed. The tomodensitometric aspects of all grafts treated with metronidazole in this series are absolutely identical: they show a high degree of homogeneity. Sixty-three cases (76.8%) are homogeneous, and 19 cases (23.2%) are significantly homogeneous. The time at which the control scan is performed (10 days, 1, 2, or 3 months) does not seem to influence significantly the degree of homogeneity assessed. In the control group, some inflammatory events associated with facial oedema were observed in 25% of the cases. In the test group, no such event was recorded for the 82 sinus-lifts treated with metronidazole. Conclusion A possible correlation may exist between the occurrence of non homogeneities within the bone grafts and the anaerobic bacterial contamination. The local use of a very small quantity of metronidazole (equivalent to only 1/20 of a common 200 mg oral tablet) could provide more security when performing sinus-lift procedures and an improved quality of the graft. This protocol should not be considered as an antibiotherapy, but only as way to limit the initial contamination of bone graft.

The lateral window sinus elevation procedure has become a routine and highly successful preprosthetic procedure that is used to increase bone volume in the posterior maxilla for the placement of dental implants. Many surgical techniques have been proposed that provide access to the maxillary sinus through the lateral wall to allow for elevation of the sinus membrane. Among these are the multiple variations of the hinge and complete osteotomy techniques, which make use of rotary cutting instruments for the antrostomy. The most common intraoperative complication with these surgical approaches is perforation of the schneiderian membrane, with perforation rates of 14% to 56% reported in the literature. In most instances, perforation occurs either while using rotary instruments to make the window or when using hand instruments to gain initial access to begin the elevation of the membrane from the sinus walls. This article presents an alternative approach that uses a piezoelectric instrument for the sinus elevation procedure. Although new to the United States, this approach has been used successfully in Europe for many years. The membrane perforation rate in this series of 100 consecutive cases using the piezoelectric technique has been reduced from the average reported rate of 30% with rotary instrumentation to 7%. Furthermore, all perforations with the piezoelectric technique occurred during the hand instrumentation phase and not with the piezoelectric inserts.

Evidence suggests that smoking is detrimental to the survival of dental implants placed in grafted maxillary sinuses. Studies have shown that improving bone quantity and quality, using rough-surfaced implants, and practicing good oral hygiene may improve outcomes. In this prospective study, the long-term survival rates of implants placed simultaneously with sinus grafting in smokers and nonsmokers were compared.Implants with roughened surfaces were immediately placed into maxillary sinus grafts in patients with 1 to 7 mm of residual bone. A total of 2132 simultaneous implants were placed into the grafted sinuses of 226 smokers (627 implants) and 505 nonsmokers (1505 implants). A majority of the patients received a composite graft consisting of 50% autogenous bone. In both smokers and nonsmokers, approximately two thirds of the implants had microtextured surfaces; the remainder had hydroxyapatite-coated surfaces. The implants were restored and monitored during clinical follow-up for up to 9 years.Cumulative survival of implants at 9 years was 97.9%. There were no statistically significant differences in implant failure rates between smokers and nonsmokers.Implant survival was believed to depend on the following aspects of the technique used: creation of a large buccal window to allow access to a large recipient site; use of composite grafts consisting of at least 50% autogenous bone; meticulous bone condensation; placement of long implants (i.e., 15 mm); use of implants with hydroxyapatite-coated or microtextured surfaces; use of a membrane to cover the graft and implants; antibiotic use and strict oral hygiene; use of interim implants and restricted use of dentures; and adherence to a smoking cessation protocol.

Two of the major obstacles for dental implant placement to replace missing teeth are the lack of adequate bone width and interdental space. Overcoming these limitations requires bone augmentation procedures that transform the deficient ridge into a ridge that is capable of receiving conventional tooth-form implants. In the case of inadequate interdental space, orthodontic tooth movement is advocated before implantation. Using narrow-diameter mini-implants allows the clinician to overcome both of these obstacles without the need for additional grafting procedures or orthodontic tooth movement. The mini-implants are immediately loaded and restored so as to enable the patient to have satisfactory mastication and aesthetic appearance. A 5-year follow up of 32 implants demonstrates the benefit of this treatment modality.

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 posterier 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.

This investigation was conducted to obtain preliminary roughness data on a microtextured implant surface and to determine its ability to sustain a 1-stage surgical procedure and early full occlusal loading of single-tooth restorations in humans.Three-dimensional (3D) vertical scanning interferometry was conducted on samples of the test surface (MTX) and 2 control surfaces (Osseotite and sandblasted/acid-etched [SLA]). Test implants were also placed in vivo, restored with fully occluding single-tooth restorations (n = 27) after 2 months of nonsubmerged healing, and clinically monitored for 48 months of follow-up.Microtexture was relatively uniform on the test surface and more random and irregular on the control surfaces. MTX and Osseotite were similar in some roughness parameters, but the MTX surface had a greater number of micropits that were spaced closer together (Stylus Y lambda q) and with higher slope values (Stylus Y delta q). Cumulative life table results were 100% for all MTX implants placed in maxillary and mandibular jaw locations, and no discernible marginal bone changes were observed. Overall implant success was 100% after 4 years of clinical functioning.The findings of this study appear promising but should be considered preliminary, because of the limitations in the number of locations measured on each product sample and the small number of implants clinically studied.Within the scope of the present study, MTX implants exhibited a uniform micropitted surface, as well as 100% survival and 100% clinical success after nonsubmerged placement, early loading with single-tooth restorations at 2 months, and 48 months of clinical functioning. (More than 50 references.)

The healing period between implant insertion and exposure is often challenging for both the patient and the surgeon. The use of a removable dental prosthesis is not recommended for a period of several days to 2 weeks in an effort to avoid undue pressure being placed on the newly placed implants and on the surrounding soft tissues. However, patients are frequently uneasy without dentures, even for a short period of time, because their diet and appearance are compromised. A simple technique was developed to overcome these obstacles. This technique allows the surgeon to place an immediate implant-supported prosthesis, based on two transitional implants, in addition to the implants placed for final restoration. This technique is performed at the surgical stage simultaneously with the placement of the permanent implants. It requires minimal additional time, and makes use of the patient's original prosthesis as an interim removable restoration during the integration period.

Several nerve repositioning techniques have ben presented in the literature, each with limitations. This article presents a new technique involving the use of 2 osteotomies, with minimizes particularly the potential duration of sensory disruption and the risk of nerve paresthesia and inadvertent nerve transection or compression.Ten patients ranging in age from 47 to 67 years were selected for nerve lateralization utilizing the modified technique. A total of 23 cylindrical implants were placed. An average follow-up period was 29.8 months.Of the 10 patients, 4 experienced total return of sensation within 3 to 4 weeks. One patient experienced complete recovery at 6 weeks.Creating 2 osteotomies as described minimizes the chances for postoperative neuropraxia and nerve paresthesia or anesthesia.When there is moderate-to-severe bone resorption of the mandible posterior to the mental foramen, repositioning the inferior alveolar nerve using both an anterior and posterior osteotomy allows for more bone to accommodate ideal placement and greater length of implant.

Purpose One-stage implant placement in the grafted maxillary sinus has traditionally been limited to patients with at least 5 mm of residual bone to ensure complete implant stabilization. The aim of this prospective study was to determine the long-term survival rates of implants with roughened surfaces placed immediately into maxillary sinus grafts in patients with 1 to 5 mm of residual bone. Materials and Methods A total of 2,132 microtextured screw-type (n=1,374) or hydroxyapatite-coated cylinder-type (n=758) implants were immediately placed into the grafted sinuses of 731 patients. The implants were restored and monitored for up to 9 years of clinical follow-up. Results Cumulative survival at 9 years was 97.9% (n=2,091 implants); 20.4% of the implants were placed in 1 to 2 mm of residual bone. Discussion Initial implant stability and parallelism were achieved through a combination of meticulous condensation of the particulate bone graft material around the implants, the frictional interface of the roughened implant surfaces and the host tissues, and selection of an appropriate graft material. Conclusions Simultaneous implant placement into sinus floor grafts can be a predictable treatment option for patients with at least 1 to 2 mm of vertical residual bone height when careful case planning and meticulous surgical techniques are used.— Reprinted with permission of Quintessence Publishing .