Augmented Area Research Articles

Maxillary Sinus Floor Augmentation Using Low-Crystalline Carbonate Apatite Granules With Simultaneous Implant Installation: First-in-Human Clinical Trial

Carbonate apatite (CO3Ap), an inorganic component of human bone, can be fabricated inchemically pure form from calcium carbonate block via a dissolution-precipitation reaction. A first-in-human clinical trial was conducted in which low-crystalline CO3Ap granules were evaluated for safety and efficacy in sinus floor augmentation and simultaneous implant installation. Procedures were performed in 8 patients (9 implants) with 2 granule sizes: small (300 to 600μm) and medium (600 to 1,000μm).Panoramic radiographic assessment was performed immediately after augmentation, 7±2months after augmentation, 6±2months after prosthetic loading, and 12±2months after prosthetic loading. Postoperative healing was uniformly uneventful, with no abnormal bleeding, pain, or swelling, and all implants achieved successful osseointegration. The mean residual maxillary molar bone height was 5.2±0.8mm preoperatively and increased to 14.0±1.9mm after augmentation. Implants 9.0 to 11.5mm in length were placed. The post-augmentation height decreased to 12.4±1.3mm at 7±2months; after prosthetic loading, it decreased to 11.9±0.8mm at 6±2months and 11.7±0.6mm at 12±2months. No abnormal bone resorption of the augmented areas was observed, and bone height supporting the implants was maintained. The overall implant survival rate was 100%, with no implant failures or complications during the first year. Low-crystalline CO3Ap granules were useful and safe for sinus floor augmentation and simultaneous implant installation, providing a promising bone substitute for dental implant surgery.

Leukocytic toll-like receptor 2 knockout protects against diabetes-induced cardiac dysfunction

Diabetic cardiomyopathy is characterized by the deterioration of the myocardial function. Emerging evidences have indicated that leukocytic toll-like receptor 2 (TLR2) played an important role in the development of diabetic cardiomyopathy. Our study aimed to investigate whether TLR2 knockout (KO) exerted a cardioprotective effect in vivo. The establishment of diabetes model was set up in mice via intraperitoneal injection of streptozotocin (STZ). Results demonstrated that blocking of TLR2 significantly suppressed the enhanced left ventricular end-diastolic dimension (LVEDD), left ventricular end systolic diameter (LVESD) and the reduced the heart rate in diabetic cardiomyopathy mice. The decreased resting cell length, PS, TPS and + dL/dt while increased TR90 and - dL/dt caused by diabetic cardiomyopathy were remarkably inhibited by TLR2 KO. Besides that, the alleviated ΔFFI (360/380), decreased SERCA2a and p-NFATc3 expressions, extended Ca2+ decay time and elevated Calcineurin A induced by diabetic cardiomyopathy were vastly repressed by TLR2 KO in cardiocytes. Moreover, TLR2 gene silence could ameliorate oxidative stress-induced apoptosis, evidences were the up-regulated superoxide generation and Bax/Bcl-2 expression while restrained GSH/GSSG ratio caused by diabetic cardiomyopathy were tremendously repressed in TLR2 KO mice. Furthermore, blocking of TLR2 remarkably attenuated the augmented fibrosis areas of heart tissues in mice with diabetic cardiomyopathy. The result of the enhanced α-SMA and collagenⅠ caused by diabetic cardiomyopathy were suppressed in heart tissues of TLR2 KO mice further validate it. All in all, our study demonstrated that diabetes-induced cardiac dysfunction could be attenuated by TLR2 KO.

Cone Beam CT-Based Preoperative Volumetric Estimation of Bone Graft Required for Lateral Window Sinus Augmentation, Compared with Intraoperative Findings: A Pilot Study.

Introduction:The presence of an atrophic maxilla creates a serious challenge in cases of implant placement, while maxillary sinus pneumatization further complicates the surgery. This pilot study was performed to investigate the validity of two techniques used to estimate the volumes of bone graft material required in cases that included lateral window sinus augmentation.Materials and Methods:Cone beam computed tomography was used for preoperative volumetric analysis of the maxillary sinus. The analysis was performed using the manual measurement of sinus dimensions, as well as automated measurements via the segmentation technique. The estimated volumes of required bone graft material were compared with actual intraoperative findings in cases requiring lateral window sinus augmentation. For this pilot study, only 5 patients were selected to be included.Results:To achieve 80% power and confidence interval of 95%, the sample size should be 35 patients. The correlation coefficient between the segmented volume and mm3 used was – 0.5332, whereas the coefficient between the manual volume and mm3 used was – 0.6784. Consequently, both results indicate that the two methods have a moderate negative correlation with the mm3 used.Conclusion:Performing a similar study with an increased number of patients, according to the calculated sample size, increases the possibility of revealing higher correlation between the methods used to analyze the partial volume of the sinus cavity. The estimated sinus volume of the area of augmentation, obtained by using either manual or segmentation techniques, could be considered as a maximum estimate for the required amount of graft material. Furthermore, the segmentation technique may be valuable in preoperative planning of sinus augmentation, as it reveals the topographic shape and morphology of the sinus.

3D-printed polycaprolactone scaffold mixed with β-tricalcium phosphate as a bone regenerative material in rabbit calvarial defects.

Defect-specific bone regeneration using 3-dimensional (3D) printing of block bone has been developed. Polycaprolactone (PCL) is biocompatible polymer that can be used as 3D scaffold. The aim of this study is to assess the biocompatibility and osteogenic efficacy of 3D printed PCL scaffold and to evaluate the effectiveness of β-tricalcium phosphate (β-TCP) addition in PCL scaffold. In this work, four circular defects (diameter: 8 mm) in rabbit calvarium were randomly assigned to (1) negative control (control), (2) PCL block (PCL), (3) PCL mixed with 10 wt% β-TCP (PCL/β-TCP), and (4) PCL/β-TCP plus collagen membrane (PCL/β-TCP + M). Animals were euthanized at 2 (n = 5) and 8 weeks (n = 5). Results indicated that in micro-CT, PCL/β-TCP + M showed the highest total augmented volume and new bone volume at 8 weeks, but there was no significant difference among four groups. Histomorphometrically, PCL, PCL/β-TCP, and PCL/β-TCP + M showed the significantly higher total augmented area compared to the control. PCL/β-TCP + M showed the highest new bone area but not statistically higher than the control. New bone formation deep inside the scaffold was observed only in β-TCP added scaffold. PCL showed high biocompatibility with great volume maintenance. Addition of β-TCP to PCL seemed to increase hydrophilicity and osteoconductivity. Developments in 3D-printed PCL material are expected. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1254-1263, 2019.

Clinical Success of Dental Implants Placed in Posterior Mandible Augmented With Interpositional Block Graft: 3-Year Results From a Prospective Cohort Clinical Study

The purpose of the present cohort study was to investigate the 3-year efficacy and clinical performance of implant-supported rehabilitations in posterior mandibles augmented with the sandwich osteotomy technique. Twenty-three partially edentulous patients who developed atrophy of the posterior mandible (residual ridge height, 3 to 7mm) were treated (32 surgical sites) with vertical bone augmentation using interpositional equine cancellous bone blocks and porcine corticocancellous bone particulate. All implants were placed 4months after augmentation and were loaded with fixed dental prostheses. One side per patient was selected and followed for 3years, and the patient was the unit of analysis. Linear radiographic vertical bone gain and peri-implant marginal bone loss were assessed; secondary outcomes-complication rates after surgery, prosthesis and implant failure rates, width of keratinized mucosa, and patient satisfaction-were evaluated. All patients reported postoperative paresthesia that resolved over a period of 2months after the augmentation procedure. The mean vertical bone gain was 5.6mm after 4months. Ninety-one dental implants were positioned into the augmented areas. The global 3-year survival rate was 95.5%. The mean peri-implant marginal bone loss around implants was 1.06±0.37mm 3years after loading, whereas the width of keratinized mucosa had an overall increase of 0.39±0.36mm. The results of the present 3-year study suggested high success rates for implants placed in areas augmented with the osteotomy sandwich technique. This surgical approach could be helpful in the presence of a low residual vertical height in the posterior mandible before implant placement.

Effects of saliva contamination on osseointegration during dental implant surgery in augmented areas

Effects of saliva contamination on osseointegration during dental implant surgery in augmented areas

Guided bone regeneration using beta-tricalcium phosphate with and without fibronectin-An experimental study in rats.

This histomorphometric study compared bone regeneration potential of beta-tricalcium phosphate with fibronectin (β-TCP-Fn) in critical-sized calvarial defects (CSDs) in rats to assess whether fibronectin (Fn) improved new bone formation. Critical-sized calvarial defects were created in 30 adult male Sprague Dawley rats, which were divided into four groups according to the time of euthanasia (6 or 8weeks of healing) and type of filling (β-TCP-Fn/6weeks, β-TCP/6weeks, β-TCP-Fn/8weeks and β-TCP/8weeks). The primary variables related to new bone formation were augmented area (AA) and gained tissue (GT; sum of mineralized bone matrix [MBM] and bone substitute [BS]). Secondary variables were the diameter of the defect, MBM, non-mineralized tissue (NMT) and BS. A total of 29 rats and 58 histological samples were evaluated, 28 (48.3%) samples obtained at 6weeks and 30 (51.7%) at 8weeks, homogeneously distributed between right and left sides. Thirteen (22.4%) were treated with β-TCP-Fn, 16 (27.6%) with β-TCP and 29 (50%) were controls. At 8weeks, histomorphometric analysis showed significant differences in AA using β-TCP and β-TCP-Fn versus controls (p=0.001 and p=0.005, respectively). Bone turnover expressed as % within the target area was slightly higher but not statistically significant in the β-TCP-Fn than in β-TCP (MBM) at 6weeks versus 8weeks (p=0.067 and p=0.335, respectively). Finally, the total GT area in mm2 was higher using β-TCP-Fn as compared to β-TCP (p=0.044). β-TCP-Fn was slightly but non-significantly more effective than β-TCP without Fn for improving the volume of regenerated bone in CSDs of rats, possibly allowing a more efficient bone remodelling process. This effect however should continue being investigated.

Vertical Bone Augmentation Using Ring Technique with Three Different Materials in the Sheep Mandible Bone.

The purpose of this study was to examine the volumetric alterations and osseointegration properties in the augmented area of the ring technique using different types of bone graft material in sheep mandible bone. Three different materials (columnar forms, 7-mm diameter, 3-mm height) were stabilized using dental implants with a turned surface in the mandible bone of Finnish Dorset cross-bred sheep: group A, autogenous bone; group B, bovine bone; group C, biphasic bone substitute. Animals were euthanized after 5 weeks (N = 6). Three-dimensional image data by digital oral scanner were taken at the surgery and sacrifice, and the volume alteration of the material was calculated. The bone samples were fixed in formalin and dehydrated in ethanol. Resin-embedded samples were subjected to non-decalcified ground sectioning, and histologic and histomorphometric analysis (bone and material area alteration, bone-to-implant contact [BIC]) were done. In three-dimensional (3D) image analysis, group A showed a statistically higher percentage of remaining materials compared with groups B and C. The histologic observation showed no new bone formations around the implants in all groups, especially at the maxillary site of the implant in the augmented area. In histomorphometric analysis, group A showed a statistically higher percentage of bone area (BA) compared with groups B and C; however, in all groups, bone-to-implant contact (BIC) showed low values, and there were no statistical differences between groups. The results of this study suggested that the autogenous bone maintained bone volume around the dental implant using the ring technique, and the impact of surface properties was of some importance; osseointegration with the turned surface in the augmented area showed low BIC values in all groups.

Synthesis of La2MoO6@MWCNTs composite catalysts as Pt-free counter electrodes for dye-sensitized solar cell

Pt-free counter electrode (CE) composed of La2MoO6 (La2O3-MoO3) was successfully synthesized by simple pyrolysis of lanthanum acetate (C6H9O6La·xH2O) and hexaammonium heptamolybdate tetrahydrate ((NH4)6Mo7O24·4H2O). Furthermore, three proportions composites catalysts of La2MoO6@MWCNTs based on La2MoO6 and multiwall carbon nanotubes (MWCNTs) were prepared and characterized as Pt-free catalyst for CE in dye-sensitized solar cells (DSSCs). The morphology and structure of La2MoO6@MWCNTs composites were determined by scanning electron microscopy, transmission electron microscope and X-ray diffraction. The electrochemical performance of La2MoO6@MWCNTs composite catalysts for CEs was determined by photocurrent-voltage measurements, cyclic voltammetry, electrochemical impedance spectroscopy, and Tafel polarization. The power conversion efficiencies of 4.68%, 4.87% and 5.06% are obtained for La2MoO6:MWCNTs with the mass ratios of 5:1, 3:1 and 1:1 towards the reduction of I3– to I– under the same conditions, respectively, which are superior to those of MWCNTs (3.94%) and La2MoO6 (1.71%) electrodes. The experimental results reveal that the presence of MWCNTs results in an augmented active catalytic surface area and enhanced charge transfer from CE to the electrolyte.

Reposition of the bone plate over the antrostomy in maxillary sinus augmentation: A histomorphometric study in rabbits.

To test if repositioning the bony plate secured with a cyanoacrylate over the antrostomy in maxillary sinus augmentation was superior to covering the antrostomy with a collagen membrane in terms of the bone augmentation area and the bone density. After the exposure of the nasal bone in eighteen rabbits, a rectangular access window was prepared with a sonic instrument, and the bony plate was removed. A bilateral sinus mucosa elevation was performed, and the space was filled with a resorbable xenograft. On the test side, the bone plate was repositioned over the antrostomy and fixed with a cyanoacrylate. On the control side, a collagen membrane was placed over the opening. Per group, six animals were sacrificed after 2, 4, and 8weeks of healing, respectively. Histological ground sections were prepared. The augmented area after elevation decreased between 2 and 8weeks from 9.4±1.8 to 4.8±2.8 mm2 at the test and from 9.5±2.6 and 5.1±1.6 mm2 at the control sites. Small amounts of new bone were seen after 2weeks in both groups (~1.6%-2.5%) forming from the bony sinus walls. New bone density increased over time in both groups reaching~10%-11% and~23%-25% after 4 and 8weeks, respectively. No statistically significant differences were found. Small residual defects were present both at the test sites in the margin of the bone plate, and at the control sites in the center of the antrostomy. The bone healing in the elevated sinus space was similar irrespective of the coverage of the antrostomy. After 8weeks, the bone plate repositioned on the antrostomy was incorporated while at the control sites the healing was still incomplete. Residual defects were still present in both groups.

A numerical modeling for the steady-state performance of a micro heat pipe using thin liquid film theory

A numerical analysis on heat and mass transfer in a micro heat pipe was performed in this work. Mass, energy, and momentum equations were applied to vapor and liquid phases under steady-state operation in the numerical model. As a result, the trends in mass flow, pressure distribution, and temperature distribution for the working fluid circulating inside the micro heat pipe were obtained for vapor and liquid, respectively. In particular, the vapor-liquid interface shape obtained with a thin liquid film through augmented Young-Laplace equation and areas for heat and mass transfer of liquid and vapor from the vapor-liquid interface thickness were predicted. These areas were applied to solution on the governing equations for vapor and liquid. The numerical model was validated by experimental results. The errors between the experimental and numerical results for the average temperature difference of the evaporator and condenser were found to be less than 1 °C. The errors for thermal resistance had maximum and minimum values of 15.2% and 3.8%, respectively.

Effect of Hypoxia-Inducible Factor 1α on Early Healing in Extraction Sockets.

The aim of the present study was to investigate the effect of hypoxia-inducible factor 1α (HIF1A) on the early healing (4 weeks) of extraction sockets exhibiting partial loss of the labial bone. Two extraction sockets of the maxillary incisors from each of six dogs were assigned to two treatment modalities: deproteinized bovine bone mineral (i) with 10% collagen (DBBM-C) soaked with HIF1A and covered by a collagen membrane (CM) (HIF group) or (ii) treated with DBBM-C only and covered by a CM (control group). Microcomputed tomography revealed some degree of collapse of the labial contour. The totally augmented volume and new bone volume did not differ significantly between two groups (P > 0.05). The histological analysis revealed that the apical area of the socket was mostly filled with newly formed bone, while there was less newly formed bone in the coronal area and incomplete cortex formation. The histomorphometric analysis revealed that the area of newly formed bone was significantly larger in the HIF group than the control group (12.16 ± 3.04 versus 9.48 ± 2.01 mm2, P < 0.05), while there was no significant intergroup difference in the total augmented area. In conclusion, even though DBBM-C soaked with HIF1A enhanced histomorphometric bone formation, this intervention did not demonstrate superiority in preventing ridge shrinkage compared to DBBM-C alone. Clinical relevance of these findings should be further studied.

Extended Maxillary Sinus Augmentation to the Apical Area of the Neighboring Teeth: Advantages and Limitations.

The extension of sinus floor augmentation beyond the edentulous area, apical to the adjacent teeth, has many therapeutic advantages, but the reliability and safety of the procedure has not been assessed in depth. The present study compares the gain of bone anterior and posterior to the edentulous area and evaluates potential advantages and limitations in the clinical setting. The maximum vertical bone height in the edentulous and extended maxillary sinus augmentation (EMSA) areas and the thickness of the sinus membrane of 65 patients were measured. Those measurements were analyzed using the t test and Pearson correlations. The average vertical bone gain was 11.98 ± 3.53 mm in the edentulous sinus area and 8.60 ± 3.89 mm in the EMSA area (P < .05). Minor perforations of the sinus membrane occurred in 4 patients. There were no postsurgical graft contaminations or periradicular changes during follow-up. EMSA is a reliable and safe procedure with a very low complication rate. This approach is effective and safe for patients who have lost part of their posterior dentition. It enables future implant placement while avoiding the need for sinus reentry and proximal teeth extraction.

Short Dental Implants (≤7mm) Versus Longer Implants in Augmented Bone Area: A Meta-Analysis of Randomized Controlled Trials.

Aim:The aim of this systematic review was to compare the survival rate and the marginal bone loss between short implants (≤7 mm) placed in the atrophic area and longer implants placed in the augmented bone area of posterior regions of maxillaries.Methods:Electronic search using three databases was performed up to May 2017 to identify Randomized Controlled Trials (RCT) assessing short implants survival with a minimal follow-up of 12 months post-loading. For the meta-analysis, a Risk Difference (RD) with the 95% Confidence Interval (CI) was used to pool the results of implant failure rate for each treatment group. For the marginal bone changes, Mean Differences (MD) with 95% CI were calculated.Results:Seven randomized controlled trials met the inclusion criteria, being included in qualitative and quantitative analyses. The RD between the short implant group and the control group was -0.02 (95% CI: -0.04 to 0.00), I2=0 and Chi2=3.14, indicating a favorable survival rate for short implant, but with no statistical significance (p=0.09).Discussion:For marginal bone loss, the mean difference was -0,13 (95%CI: -0.22 to -0.05), favoring the test group with statistical significance (p=0.002). The studies showed more heterogeneity for bone loss compared to survival rate. Short and longer implants showed similar survival rates after one year of loading, however the marginal bone loss around short implants was lower than in longer implants sites.Conclusion:Placement of implants ≤7 mm of length was found to be a predictable alternative for the rehabilitation of atrophic posterior regions, avoiding all the disadvantages intrinsic to bone augmentation procedures.

Dental implants with fixed prosthodontics in oligodontia: A retrospective cohort study with a follow-up of up to 25 years

Statement of problemLong-term assessments of implant survival and treatment outcome in patients with oligodontia are lacking. PurposeThe purpose of this retrospective clinical study was to assess which factors determine a long-term implant survival and treatment outcome of up to 25 years in a cohort of patients with oligodontia. Material and methodsThe medical records of all patients with oligodontia treated with fixed implant prosthodontics between January 1991 and December 2015 in the Department of Oral and Maxillofacial Surgery at the University Medical Center Groningen, the Netherlands, were assessed. Specifically, this involved the retrieval of records on the need for and mode of bone augmentation, implant survival, and survival of and adverse events associated with the prosthodontics. The Kaplan-Meier estimator was used to analyze implant and superstructure survival. Log-rank tests were used to compare the survival of subgroups. ResultsA total of 126 patients with oligodontia were treated with dental implants. Of the 777 implants in total, 56 were lost, resulting in a 5-year cumulative survival of 95.7% (95% confidence interval [CI], 94.2% to 97.2%) and a 10-year cumulative survival of 89.2% (95% CI, 86.2% to 92.2%). The survival of implants placed in regions where bone augmentation surgery had been performed was significantly lower. The 5-year cumulative superstructure survival was 90.5% (95% CI, 87.6% to 93.5%), and the 10-year cumulative superstructure survival was 80.3% (95% CI, 75.3% to 85.3%). The performance of the screw-retained and cemented superstructures was comparable, but the survival of single crowns was significantly higher than the survival of fixed partial dentures (P<.001). ConclusionsImplant treatment is a predictable treatment option for patients with oligodontia with a favorable long-term outcome. Survival of implants in augmented areas is lower.

Histological Changes in Alveolar Bone After Onlay Augmentation Using the Casing Method.

Numerous studies on alveolar bone augmentation have been reported. However, it remains challenging to obtain favorable new bone, especially for onlay bone augmentation. For successful onlay bone augmentation, it is necessary to use a graft material with high bone-forming activity and wound stabilization. We performed onlay bone augmentation on the buccal surface of mandibular alveolar bone in dogs, using a polyethylene terephthalate (PET) case (Casing method). The aim of this study was to histologically examine the feasibility of Casing method for external onlay bone augmentation. Beagle dogs were selected for this study. At 12weeks after tooth extraction, a PET case was placed on the buccal surface of mandibular alveolar bone and filled with a mixture of hydroxyapatite and β-tricalcium phosphate (β-TCP) particles (volume ratio 1:1) impregnated with crushed autogenous bone (superfine bone powder) suspended in plasma. At 4, 8, and 16weeks after bone graft, nondecalcified sections were histologically examined. At 4weeks, new bone formation on the particle surfaces was observed on the original bone side of the PET case. At 16weeks, bone formation was observed in almost all areas inside the case. The percentage of the augmented area (including new bone and particles surrounded by new bone; was significantly greater at 16weeks (85.7%±6.0%) than at 4weeks (10.5%±4.8%) or 8weeks (69.6%±15.6%). The results of this study suggest that onlay bone augmentation using the Casing method has considerable potential to yield histologically favorable new bone formation. Anat Rec, 301:1148-1158, 2018. © 2018 Wiley Periodicals, Inc.

Lateral bone augmentation in narrow posterior mandibles, description of a novel approach, and analysis of results.

Combination of particulate grafts and collagen membranes is widely used for augmentation of bony defects for implant placement. Fixation of the barrier membrane may avoid complications due to unfavorable mechanical properties and poor stability leading to collapse of the augmented area. To evaluate a new simplified method for resorbable collagen membrane fixation in lateral bone augmentation procedures in narrow posterior mandibles. This retrospective study analyzed 16 procedures performed in 15 patients who followed lateral ridge augmentation procedures before implant placement in the posterior mandible. A particulate mineralized bone allograft was covered with a cross-linked resorbable collagen barrier membrane, which was fixated with a single, nonresorbable pin. Complications were registered and results analyzed on pre and post op measurements on computerized tomographic scans. Descriptive statistical analysis and ANOVA with repeated measures were performed. No complications were recorded. Average bone gain was 3.3 mm at implant platform level and 4.29 mm at 3 mm apically, both, statistically significant. All sites had sufficient bone width allowing implant placement. Thirty-three implants placed in the augmented areas, integrated and survived for over a 2-year follow-up. The simplified membrane fixation procedure enables large horizontal bone gain with minimal complications while allowing adequate implant placement.

Osteointegration of dental implants in augmented bone after bone flap rotation

The article presents clinical case of a patient with partial secondary absence of teeth and maxillary defect because of vertical alveolar bone atrophy. Vertical alveolar ridge augmentation by osseous flap rotation and xenogenous bone block with 10% collagen was performed. Eight months later 4 dental implants with modified surface were placed in the augmentation area. After 3 months 3 implants showed no signs of osteointegration and were removed. Three week later the patient was admitted to ENT department because of maxillary sinusitis symptoms.

Peri-implant Tissues and Patient Satisfaction After Treatment of Vertically Augmented Atrophic Posterior Mandibles with Intraoral Onlay Block Bone Grafts: A Retrospective 3-Year Case Series Follow-up Study.

To evaluate the peri-implant soft and hard tissues of dental implants placed in vertically regenerated posterior mandibles with intraoral onlay block bone grafts and patient satisfaction at 3-year follow-up. A retrospective study of patients with dental implants placed in posterior mandibular sites vertically augmented with intraoral onlay block bone grafts was carried out between 2005 and 2009 at the University of Valencia. The outcomes assessed at the 3-year follow-up visit were the peri-implant soft tissues (Plaque Index and Bleeding Index, probing depth, keratinized mucosa width, and recession), implant survival and success rates, marginal bone loss, and patient satisfaction. Sixteen patients with 36 implants were included. The mean Plaque Index and Bleeding Index scores were ≤ 0.4. The mean band of facial keratinized mucosa was ≥ 3 mm in 52.7% of implants; 38.8% of the implants showed facial recession. The mean midfacial recession was -0.31 ± 0.75 mm. Implant survival reached 100%, while the success rate was 85%, and the mean marginal bone loss was 1 ± 1.03 mm (range: 0.1 to 5.3). Good quality of life (9.19 ± 0.40) was reported for all patients, and the overall general satisfaction score was 8.07 ± 1.04 (mucosa esthetics: 7.71 ± 1.45; prosthesis esthetics: 8.42 ± 0.6; chewing: 8.68 ± 0.94; ease of cleaning: 8.01 ± 1.03). Considering the limitations of the study, implants in vertically augmented posterior mandibular areas with intraoral onlay block bone grafts showed good soft tissue levels and high patient satisfaction. No implants were lost at 3 years postloading, though one-fifth of the patients showed a statistically significant marginal bone loss.

The Use of Cortical Bone Wedges from the Mandibular Ramus “Wedge Technique”: For 3-Dimensional Bone Augmentation of the Atrophic Ridges. Technique Presentation and Report of Case Series

Purpose: Autogenous bone was still considered as the gold standard in bone augmentations prior to implants insertion at the atrophic ridges. However if large bone grafts are needed to augment multiple edentulous atrophic segments, extraoral donor sites may be mandatory. The aim of this report is to introduce the Fares Wedge Technique, as a new bone augmentation method that can augment multiple edentulous ridges with intraoral cortical bone grafts. Methods: This report includes patients with moderate to severe ridge atrophy in different regions of the both jaws who were treated over 6-years period (2009-215) with wedge Technique (WT). Patients received panorex immediately after the surgery, and they were examined clinically and radiographically (periapical) every 2 weeks. At 4 months, computed tomography was performed to evaluate the bone gain. Reentry was performed after 4 to 5 months to evaluate the new bone volume and quality and to insert implants. At this stage specimens for histologic examination were also obtained. Results: 39 augmentation sites in 22 patients (15 women, 7 men: mean age 47 years) were followed 12 to 52 months. The healing process was uneventful, with minimal morbidity. The success rate was 95%, and the bone gain average was 3 - 6 mm vertically and 3 - 9 mm horizontally. In two patients the graft was partially exposed and treated with shaving and rounding the exposed wedges, but the augmentations were saved. In one case the majority of the bone graft was lost. At 38 sites the patients had successfully received 114 implants. Conclusions: wedge technique can augment multiple segments of atrophic ridges with small amount of autogenic graft. The bone volume that achieved was satisfying, especially that the majority of the augmented areas were at posterior mandibular defects.