Bone Augmentation Procedures Research Articles

Fresh-Frozen Bone Allografts in Maxillary Alveolar Augmentation: Analysis of Complications, Adverse Outcomes, and Implant Survival.

Success of any bone augmentation procedure is dependent on several factors. Because complications occur in some cases, the aims of this study are to analyze adverse events associated with placement of fresh-frozen bone allografts (FFBAs) during alveolar ridge augmentation and to assess 1-year survival of dental implants placed in reconstructed sites. Fifty-eight consecutive patients (15 males and 43 females, aged 38 to 76 years; mean age: 58 ± 9.2 years) requiring maxillary bone reconstruction prior to implant placement were enrolled in this study. A total of 268 implants was subsequently placed in sites reconstructed with FFBAs. There were 22 posterior grafted sites, 19 anterior, and 17 full-arch sites. After a 4- to 6-month integration period, all patients received an implant-supported fixed prostheses. Complications occurring during treatment and the 12-month follow-up period were recorded and evaluated. Thirteen of 58 (22.41%) patients experienced some kind of complication in the receptor site. Infection occurred in six (10.34%) individuals, dehiscence in five (8.62%), and mucosal perforation in seven (12.07%). Adverse outcomes categorized as partial and total graft loss occurred in four (6.90%) and three (5.17%) patients, respectively. Implant failure rate was 16 (5.97%) of the 268 fixtures placed in 12 (20.70%) of 58 patients. Infection and suture dehiscence are significantly correlated with graft loss in a maxillary FFBA augmentation. Patients with full-arch grafting reconstructions lost significantly more implants. Early diagnosis and prompt management of adverse events seem to be of great importance in prevention of total graft loss.

Anterior Shoulder Instability in the Military Athlete.

Context:Given its young, predominately male demographics and intense physical demands, the US military remains an ideal cohort for the study of anterior shoulder instability.Evidence Acquisition:A literature search of PubMed, MEDLINE, and the Cochrane Database was performed to identify all peer-reviewed publications from 1950 to 2016 from US military orthopaedic surgeons focusing on the management of anterior shoulder instability.Study Design:Clinical review.Level of Evidence:Level 4.Results:The incidence of anterior shoulder instability events in the military occurs at an order of magnitude greater than in civilian populations, with rates as high as 3% per year among high-risk groups. With more than 90% risk of a Bankart lesion and high risk for instability recurrence, the military has advocated for early intervention of first-time shoulder instability while documenting up to 76% relative risk reduction versus nonoperative treatment. Preoperative evaluation with advanced radiographic imaging should be used to evaluate for attritional bone loss or “off-track” engaging defects to guide comprehensive surgical management. With complex recurrent shoulder instability and/or cases of clinically significant osseous lesions, potential options such as remplissage, anterior open capsular procedures, or bone augmentation procedures may be preferentially considered.Conclusion:Careful risk stratification, clinical evaluation, and selective surgical management for at-risk military patients with anterior shoulder instability can optimize the recurrence risk and functional outcome in this population.

Periodontally accelerated osteogenic orthodontics

This case report demonstrates an orthodontic method that offers short treatment time and the ability to simultaneously reshape and increase the buccolingual thickness of the supporting alveolar bone. A 23-year-old female with Angle’s Class I moderately to severely crowded malocclusion with periodontal pocket with 31 and reduced thickness of the buccal cortical plate of lower anteriors, requested shortened orthodontic treatment time. This surgery technique included buccal full-thickness flaps, selective partial decortication of the cortical plates, concomitant bone grafting/augmentation, and primary flap closure. Following the surgery, orthodontic adjustments were made approximately every 2 weeks. From bracketing to debracketing, the case was completed in approximately 7 months and 3 weeks. Posttreatment evaluation of patient revealed good results. Preexisting thin labial bony cortical plate with lower anteriors was covered. This finding suggests credence to the incorporation of the bone augmentation procedure into the corticotomy surgery because this made it possible to complete the orthodontic treatment with a more intact periodontium. The rapid expansive tooth movements with no significant apical root resorption may be attributed to the osteoclastic or catabolic phase of the regional acceleratory phenomenon.

Continuous intra-sinus bone regeneration after nongrafted sinus lift with a PLLA mesh plate device and dental implant placement in an atrophic posterior maxilla: a case report.

BackgroundSinus lift is a bone augmentation procedure that improves the alveolar crest height in an atrophic posterior maxilla. However, the regenerated bone volume can vary and generally has a tendency to decrease after sinus operation. This article describes nongrafted maxillary sinus lift using a bioresorbable unsintered hydroxyapatite combined with poly l-lactide (HA/PLLA) mesh plate device and dental implant placement in an atrophic posterior maxilla, after which continuous bone gain was observed around the implant apex during a postoperative follow-up period of 3 years.Case presentationA 60-year-old healthy female was referred to our department for dental implant therapy in the right posterior maxilla. Clinical examination revealed that the maxilla was edentulous from the right first premolar to the second molar region. Radiographically, atrophy of the maxillary alveolar ridge in the same tooth site was observed. Sinus membrane elevation and simultaneous implant placement were performed through the lateral approach. HA/PLLA mesh was utilized to maintain space under the elevated sinus membrane and as a fixation device to replace the bone window. Six months later, new bone was generated in the secluded space maintained under the elevated sinus membrane. When observed 42 months after the implant insertion, bone volume around the implant apex had increased in vertical direction under the HA/PLLA mesh plate device, and there was continuous bone formation in the sinus over time.ConclusionThis nongrafted sinus lift procedure using an HA/PLLA mesh device attained predictable bone formation. Stable membrane elevation by an HA/PLLA device might induce long-term, continuous bone formation in the sinus.

Outcomes of placing short implants in the posterior mandible: a preliminary randomized controlled trial.

Short dental implants can be an alternative to bone augmentation procedures at sites of reduced alveolar bone. Most studies on short implants are retrospective or multicentre reports that lack controlled and consistent comparison between different systems. This study aimed to compare clinical and radiographic outcomes of short implants in two different systems in the posterior mandible. Twenty patients with two adjacent missing posterior teeth were recruited. Patients were assigned equally and randomly into two groups; Bicon(®) (6 or 8 mm) and Ankylos(®) (8 mm) implants. A two-stage surgical approach and singlecrowns were used for implant placement and loading. Outcomes included peri-implant clinical parameters, implant stability (Periotest values; PTVs) and peri-implant bone changes, which were assessed at baseline, 2, 6 and 12 months post-loading. No implant loss was encountered up to 12 months post-loading. No significant difference in the clinical or radiographic parameters was observed except for PTVs (p < 0.05) that was lower in Ankylos(®) implants. The use ofshort dental implants was associated with excellent 12 months clinical and radiographic outcomes.Ankylos(®) and Bicon(®) implants demonstrated similar peri-implant soft tissue and alveolar bone changes. However,Ankylos(®) implants demonstrated better implant stability at all evaluation intervals.

Controlling Bone Graft Substitute Microstructure to Improve Bone Augmentation.

Vertical bone augmentation procedures are frequently carried out to allow successful placement of dental implants in otherwise atrophic ridges and represent one of the most common bone grafting procedures currently performed. Onlay autografting is one of the most prevalent and predictable techniques to achieve this; however, there are several well documented complications and drawbacks associated with it and synthetic alternatives are being sought. Monetite is a bioresorbable dicalcium phosphate with osteoconductive and osteoinductive potential that has been previously investigated for onlay bone grafting and it is routinely made by autoclaving brushite to simultaneously sterilize and phase convert. In this study, monetite disc-shaped grafts are produced by both wet and dry heating methods which alter their physical properties such as porosity, surface area, and mechanical strength. Histological observations after 12 weeks of onlay grafting on rabbit calvaria reveal higher bone volume (38%) in autoclaved monetite grafts in comparison with the dry heated monetite grafts (26%). The vertical bone height gained is similar for both the types of monetite grafts (up to 3.2 mm). However, it is observed that the augmented bone height is greater in the lateral than the medial areas of both types of monetite grafts. It is also noted that the higher porosity of autoclaved monetite grafts increases the bioresorbability, whereas the dry heated monetite grafts having lower porosity but higher surface area resorb to a significantly lesser extent. This study provides information regarding two types of monetite onlay grafts prepared with different physical properties that can be further investigated for clinical vertical bone augmentation applications.

Reconstruction of the severely atrophic edentulous maxillae with calvarial bone grafts.

Treatment of the severely atrophic maxilla with dental implants is challenging due to the insufficient horizontal and vertical bone volume and centripetal resorption pattern of the maxilla. Bone-augmentation procedures are often necessary prior to implant placement. The objective of this study was to assess the suitability of using calvarial bone grafts to enable implant placement in severely atrophic maxillae. Seventeen patients with severe atrophic edentulous maxillae were reconstructed with autogenous calvarial bone grafts. After a 4-month healing period, the patients received a total of 134 dental implants, which were left to heal in submerged positions for 3months before prosthetic rehabilitation was performed. Patients were followed clinically and radiographically for an average observation period of 53.94months. At the intraoral recipient sites, two infections developed, causing partial loss of the respective bone grafts. Implant placement, however, was possible at all sites. No donor-site complications occurred. Two of 134 implants were lost in two patients prior to prosthetic loading. The implant survival rate was 98.51%. The implant success rate was 87.6%, and a mean marginal bone loss of 0.62mm (SD 0.77mm) was documented. Patients with severe bone atrophy of the edentulous maxilla can be successfully reconstructed with calvarial bone grafts and dental implants and show a stable clinical and radiographic situation after a mean observation period of 53months.

Four-implant overdenture fully supported by a CAD-CAM titanium bar: A single-cohort prospective 1-year preliminary study

Statement of problemIn patients with an altered skeletal maxillomandibular relationship and bone resorption, the rehabilitation of edentulous jaws by combining 4 implants, 2 straight medially and 2 tilted distally, may be preferred to avoid a bone augmentation procedure. PurposeThe purpose of this single cohort 1-year prospective study was to evaluate the clinical performance of a 4-implant overdenture fully supported by a computer-aided designed and computer-aided manufactured (CAD-CAM) titanium bar. Material and methodsThis single cohort prospective study included edentulous participants rehabilitated with a 4-implant overdenture in 1 of the 2 jaws. The outcomes were implant and prosthetic survival and success rates, any biologic and technical complications, periimplant marginal bone loss, changes in the oral health impact profile (OHIP), bleeding on probing, and the plaque index. ResultsEighteen participants received 72 implants. One year after implant placement, no implants or prosthesis had failed, and no biologic or technical complications had been observed. At the 1-year follow-up, the mean marginal bone loss was 0.29 ±0.16 mm. The OHIP summary scores demonstrated a significant improvement in oral health-related quality of life. At the 1-year follow-up, positive bleeding was found in 2 participants (11.1%) around 3 implants (4.1%). Three participants (16.6%), accounting for 5 implants (6.9%), showed a slight amount of plaque. ConclusionsA 4-implant overdenture supported by a CAD-CAM titanium bar may be a reliable option for the treatment of the edentulous mandible and maxilla over a 1-year period. Oral health-related quality of life significantly improved in all treated participants.

Complications related to bone augmentation procedures of localized defects in the alveolar ridge. A retrospective clinical study.

This retrospective clinical study aims to evaluate complications after augmentation of localized bone defects of the alveolar ridge. From standardized registrations, the following complications related to bone augmentation procedures were recorded: soft tissue dehiscence, infection, sensory disturbance, additional augmentation procedures needed, and early implant failure. A total of 223 patients (132 women, 91 men; mean age 23.5years; range 17-65years) with 331 bone defects had bone augmentation performed into which 350 implants were placed. Soft tissue dehiscence occurred in 1.7% after GBR procedures, 25.9% after staged horizontal ridge augmentation, and 18.2% after staged vertical ridge augmentation. Infections were diagnosed in 2% after GBR procedures, 12.5% after sinus floor elevation (SFE) (transcrestal technique), 5% after staged SFE, 11% after staged horizontal ridge augmentation, and 9% after staged vertical ridge augmentation. Additional augmentation procedures were needed in 2% after GBR procedures, 37% after staged horizontal ridge augmentation, and 9% after staged vertical ridge augmentation. A total of six early implant failures occurred (1.7%), four after GBR procedures (1.6%), and two (12%) after staged vertical ridge augmentation. Predictable methods exist to augment localized defects in the alveolar ridge, as documented by low complication rates and high early implant survival rates.

Pre-coating deproteinized bovine bone mineral (DBBM) with bone-conditioned medium (BCM) improves osteoblast migration, adhesion, and differentiation in vitro.

Autogenous bone grafting has remained the gold standard for bone augmentation procedures with ability to release growth factors to the surrounding microenvironment. Recent investigations have characterized these specific growth factors released by autogenous bone chips with further isolation into a "bone-conditioned medium" (BCM). The aim of the present investigation was to utilize autologous growth factors from bone chips (BCM) in combination with deproteinized bovine bone mineral (DBBM) and investigate the ability for BCM to enhance osteoblast behavior. Mouse ST2 cells were seeded on (1) DBBM particles alone or (2) DBBM + BCM. Thereafter, samples were compared for cell recruitment, adhesion, proliferation, and real-time PCR for osteoblast differentiation markers including Runx2, collagen 1 alpha 2 (COL1A2), alkaline phosphatase (ALP), and osteocalcin (OCN). Alizarin red staining was used to assess mineralization. Coating BCM on DBBM particles improved cell migration of ST2 cells and significantly enhanced a 2-fold increase in cell adhesion. While no significant increase in cell proliferation was observed, BCM significantly increased mRNA levels of COL1A2, ALP, and OCN at 3days post seeding. Furthermore, a 3-fold increase in alizarin red staining was observed on DBBM particles pre-coated with BCM. Pre-coating DBBM with BCM enhanced the osteoconductive properties of DBBM by mediating osteoblast recruitment, attachment, and differentiation towards bone-forming osteoblasts. Future animal study is necessary to further characterize the added benefit of BCM as an autogenous growth factor source for combination therapies. The application of BCM in combination with biomaterials may serve as an autogenous growth factor source for bone regeneration.

Assessment of Patients Referred to Specialty Dental Hospitals for Dental Implant Procedure: A Retrospective Cohort Analysis.

One of the most common and effective ways of replacing missing teeth is by dental implants. Both quality and quantity of bone along with the area of implant placement govern the prognosis of the implant procedure. Certain risk factors predispose the implant treatment to high failure rate. Hence, we assessed the implant patients who were referred from private practitioners to the specialty hospitals from 2010 to 2014. All the patients being referred from private clinics to the specialty dental hospital for the purpose of prosthetic rehabilitation by dental implants from June 2010 to July 2014 were included in the present study. Skilled oral and maxillofacial surgeons were appointed for performing the implant surgical procedures. Prosthetic rehabilitation was done after 6 to 8 weeks and after 10 to 14 weeks in implant cases without and with bone augmentation procedures respectively. Distribution of dental implants based on the indications, location, dimension of augmentation procedure, and complication of implants was analyzed and assessed for the level of significance. Of the patients, 712 were females, while the remaining were males. Most of the patients were in the age group of 50 to 59 years. As compared with completely edentulous patients, most of the patients required rehabilitation by a single implant. Maximum dental implants were placed in maxillary premolar region and mandibular first molar region. Over 1,000 cases in this study required rehabilitation by augmentation procedure. Partially edentulous patients are most commonly referred to specialized dental hospitals for prosthetic rehabilitation by dental implants, mostly with the purpose of implant placement. Failure rate can be minimized by following strict patient selection protocols along with following a standard surgical criterion. Following standard surgical protocols and strict treatment planning, prognosis of the dental implant procedures can be improved to a greater extent, thereby increasing its clinical success rate.

Basal Implants: A New Innovation in Implant Dentistry

The conventional crestal implants (i.e. implants inserted from the top of the alveolar crest into the bone such as cylinders and blade implants) are indicated in situations where an adequate vertical bone is present. Although, crestal implants enjoy a high degree of success, their success is reduced in cases where bone augmentation procedures become part of the treatment. In addition, augmentation procedures increase the overall costs of dental implant treatment as well as the number of necessary operations. In such cases, basal implants is the viable treatment option where less vertical bone is available. This case report describes the case of basal implants placed in mandibular posterior region.

Volumetric analysis of bone substitute material performance within the human sinus cavity of former head and neck cancer patients: A prospective, randomized clinical trial

Background:In numerous animal and human studies, it could be detected that in bone augmentation procedures, material's physicochemical characteristics can influence the cellular inflammatory pattern and therefore the integration in the host tissue. Histological, histomorphometrical, and clinical analyses of the integration of the biomaterial in the surrounding tissue are well established methodologies; however, they do not make a statement on volume and density changes of the augmented biomaterial.Aims:The aim of the present study was to assess the volume and density of a xenogeneic (Bio-Oss®, BO) and a synthetic (NanoBone®, NB) bone substitute material in split-mouth sinus augmentations in former tumor patients to complete histological and histomorphometrical assessment.Methods:Immediately and 6 months after sinus augmentation computed tomography scans were recorded, bone grafts were marked, and the volume was calculated with radiologic RIS-PACS software (General Electric Healthcare, Chalfont St. Giles, Great Britain) to determine the integration and degradation behavior of both biomaterials.Results:Radiographic analysis revealed a volume reduction of the initial augmented bone substitute material (i.e. 100%) to 77.36 (±11.68) % in the BO-group, respectively, 75.82 (±22.28) % in the NB-group six months after augmentation. In both materials, the volume reduction was not significant. Bone density significantly increased in both groups.Conclusion:The presented radiological investigation presents a favorable method to obtain clinically relevant information concerning the integration and degradation behavior of bone substitute materials.

Segmental sandwich osteotomy of the posterior mandible in pre-implant surgery - A systematic review.

BackgroundThe rehabilitation of the atrophic posterior mandible with dental implants often requires bone augmentation procedures. The aim of the present study is the systematic review of the literature concerning the success rate of Segmental Sandwich Osteotomy (SSO) of the posterior mandible in pre-implant surgery.Material and MethodsSystematic review of all clinical cases and clinical studies of SSO of the posterior mandible in pre-implant surgery with a minimum follow-up of 6 months after implant loading was performed, based on specific inclusion and exclusion criteria. The search strategy involved searching the electronic databases of MEDLINE, EMBASE, COCHRANE LIBRARY, Clinical Trials (www.clinicaltrials.gov) and National Research Register (www.controlled-trials.com), supplemented by a manual search, in August 2015. In every study, the intervention characteristics and the outcome were recorded.ResultsOut of the 756 initial results, only 17 articles fulfilled the predetermined inclusion and exclusion criteria. They consisted of 9 retrospective case reports or series and 8 prospective randomized clinical trials. Overall, the studies included 174 patients. In these patients, 214 SSO augmentation procedures were performed in the posterior mandible and 444 implants were placed. The follow-up period after implant loading ranged between 8 months and 5.5 years. The success rate of SSO ranged between 90% and 100%. The implant survival during the follow-up period ranged between 90.9% and 100%.ConclusionsSegmental Sandwich Osteotomy should be considered as a well documented technique for the rehabilitation of the atrophic posterior mandible, with long-term postsurgical follow-up. The success rates are very high, as well as the survival of the dental implants placed in the augmented area. Key words:Segmental osteotomy, dental implant, mandible, inlay graft.

Alveolar Bone Dimensions of Mandibular Posterior Teeth using Cone Beam Computed Tomography: A Pilot Study

ABSTRACTAimThe aim of this study was to analyze bone dimensions of the dentate posterior mandible using cone beam computed tomography (CBCT).ObjectivesThe objectives of this study were• To measure thickness of buccal and lingual bone walls in mandibular posterior teeth using CBCT.• To measure alveolar bone width in mandibular posterior teeth using CBCT.Materials and MethodsTen CBCT scans were included in the study (n = 65 teeth). Thicknesses of buccal and lingual walls were measured at measurement point 1 (MP1) and measurement point 2 (MP2). Alveolar width was assessed at most coronal detected alveolar bone (BW1) and at superior border of mandibular canal (BW2). Vertical distance between BW1 and BW2 was measured (H). Data were tabulated and results were statistically analyzed using unpaired t test.ResultsThe study showed that there was an increase in bone wall thickness from 1st premolar to 2nd molar for buccal and lingual alveolar plates. Lingual bone walls were thicker than buccal bone walls at MP1 and MP2 for all teeth. Bone width for premolars was considerably less than bone width of molars.ConclusionCareful preoperative analysis using CBCT is important to assess need of bone augmentation procedures. As the bone thickness and width in the molar region is more adequate, prognosis of implants placed in molar region may be better.Clinical significanceAnalysis of bone dimensions is of utmost importance for successful outcome of bone augmentation procedures in implant treatment.How to cite this articleKunte VR, Bhoosreddy AR, Bhoosreddy SA, Pandharbale AA, Shinde MR, Ahire BS. Alveolar Bone Dimensions of Mandibular Posterior Teeth using Cone Beam Computed Tomography: A Pilot Study. J Contemp Dent 2016;6(1):9-14.

The Use of Narrow Diameter Implants in the Molar Area.

Implant rehabilitations in the posterior jaw are influenced by many factors such as the condition of the remaining teeth, the force factors related to the patient, the quality of the bone, the maintenance of the hygiene, the limited bone height, the type and extent of edentulism, and the nature of the opposing arch. The gold standard is to place a regular diameter implant (>3.7 mm) or a wide one to replace every missing molar. Unfortunately, due to horizontal bone resorption, this option is not possible without lateral bone augmentation. In this situation, narrow diameter implant (NDI < 3.5 mm) could be the alternative to lateral bone augmentation procedures. This paper presents a clinical study where NDIs were used for the replacement of missing molars. They were followed up to 11 years. Special considerations were observed and many parameters were evaluated. NDI could be used to replace missing molar in case of moderate horizontal bone resorption if strict guidelines are respected. Yet, future controlled prospective clinical trials are required to admit their use as scientific evidence.

Early loading of titanium dental implants with an intra-operatively conditioned hydrophilic implant surface after 21days of healing.

The aim of the present observational medical device performance study was to test whether implants with an intra-operatively conditioned hydrophilic surface can be safely reconstructed when applying an early loading protocol after 21days in partially edentulous posterior mandibles. Partially edentulous patients with missing teeth in the posterior mandible were recruited. Immediately after implant placement, the implant position was indexed using a pickup impression technique. ISQ values were measured after 21days of healing. When ISQ values were ≥70, the implants were directly restored with provisional reconstructions in occlusal contact allowing an early loading protocol. ISQ values were repeated again at 1, 3, and 6months postloading. Clinical parameters (mPLI, mSBI, PPD, DIM, and CAL) were assessed. Standardized periapical radiographs were obtained after surgery, at implant loading and 3 and 6months later. Changes over time were analyzed for statistical significance using the nonparametric method by Brunner & Langer (SAS Proc Mixed). Fifteen partially edentulous patients with healed sites in the posterior mandible received 20 implants. All implants healed uneventfully. At 21days, all implants achieved an ISQ value of ≥70 (mean of 3 measurements) and were reconstructed at this time point with provisionals. ISQ values showed a gradual increase from baseline to 3 and 6months postloading. The assessment of clinical parameters revealed stable tissue integration. The evaluation of the radiographs showed that 3 and 6months after loading the median mesial and distal marginal bone levels had stabilized at the border between the rough surface and the 1-mm machined implant collar. Functional occlusal loading of implants with a hydrophilic, moderately rough endosseal surface 3weeks after placement appears to be a safe and predictable treatment option in healed sites in the posterior mandible without need of bone augmentation procedures.

Piezosurgery in Bone Augmentation Procedures Previous to Dental Implant Surgery: A Review of the Literature.

The piezosurgery has been used with increasing frequency and applicability by health professionals, especially those who deal with dental implants. The concept of piezoelectricity has emerged in the nineteenth century, but it was applied in oral surgery from 1988 by Tomaso Vercellotti. It consists of an ultrasonic device able to cut mineralized bone tissue, without injuring the adjacent soft tissue. It also has several advantages when compared to conventional techniques with drills and saws, such as the production of a precise, clean and low bleed bone cut that shows positive biological results. In dental implants surgery, it has been used for maxillary sinus lifting, removal of bone blocks, distraction osteogenesis, lateralization of the inferior alveolar nerve, split crest of alveolar ridge and even for dental implants placement. The purpose of this paper is to discuss the use of piezosurgery in bone augmentation procedures used previously to dental implants placement.

A 1‐Year Clinical and Radiographic Study on Hydrophilic Dental Implants Placed with and without Bone Augmentation Procedures

The aim of the present 1-year clinical and radiographic study was to evaluate a hydrophilic dental implant when used in everyday cases in one clinic. The purpose was also to compare augmented with nonaugmented sites. The study group consisted of 50 consecutive patients treated with 159 dental implants (Proactive, Neoss Ltd, Harrogate, UK) in both mandibles and maxillae. Ninety-two implants were placed with adjunct bone augmentation procedures, whereas 40 implants were placed in augmented maxillary sinus sites. A two-stage procedure was used for 84 implants and a one-stage procedure for 47 implants. Twenty-eight implants were immediately loaded. Implant stability was measured with resonance frequency analysis (RFA) at placement and at prosthesis delivery. The patients were scheduled for checkups after 6 and 12 months in function with clinical and radiographic examinations. Marginal bone level measurements were performed in baseline and follow-up intraoral radiographs. Two implant failures in two patients were experienced after 1 year of loading, giving a survival rate of 98.7%. One implant in nonaugmented sites and one implant in conjunction with an augmentation procedure (sinus lift), giving a survival rate of 98.5% and 98.9% for healed and augmented sites, respectively (NS). RFA measurements showed 70.2 ± 9.5 ISQ at placement and 76.5 ± 5.9 ISQ (p ≤ 0.001) after a mean healing time of 5.6 ± 1.6 months. The marginal bone loss amounted to 0.7 ± 0.7 mm after 1 year of loading. Frequency distribution showed bone gain or less than 1 mm bone loss for the majority of implants (69.3%), whereas 25.7% showed 1.1 to 2 mm, 5.0% more than 2 mm and no implants more than 3 mm of bone loss. The use of Neoss Proactive implants for prosthetic rehabilitation of consecutive patients resulted in predictable clinical and radiographic outcomes after 1 year of loading with no differences between augmented and nonaugmented sites.

A Novel Surgical Technique for Augmented Corticotomy-Assisted Orthodontics: Bone Grafting With Periosteum

To introduce grafting fixed with the periosteum (dumpling technique) as an alternative surgical technique for augmented corticotomy-assisted orthodontics in the lower anterior region and evaluate the preliminary outcomes. Eleven patients (9 women, 2 men; mean age, 21.4yr) with a thin alveolus or alveolar defect in the lower anterior region by clinical and radiographic examination underwent an augmented corticotomy using the new dumpling technique. Cone-beam computerized tomography was used to evaluate morphologic changes of the lower anterior ridge before treatment (T0) and 1week (T1) and 6months (T2) after the bone-augmentation procedure. Repeated-measures analysis of variance with Bonferroni multiple-comparison test was used to compare variables at each time point. No severe postsurgical complications occurred in any patient. The mean alveolar bone thickness of the labial plate increased from T0 to T1 (P < .001) and decreased from T1 to T2 (P < .001). However, compared with T0, there was still a significant increase in horizontal bone thickness at T2 (P < .05). The vertical alveolar bone level increased from T0 to T1 (P < .001) and was maintained from T1 to T2 (P > .05). No significant differences were found in root length of the lower anterior teeth at these 3 time points (P>.05). In this preliminary study, the dumpling technique for augmented corticotomy-assisted surgical orthodontics showed alveolar bone augmentation by increasing the vertical alveolar height and the horizontal bone thickness in the labial aspect of the anterior mandibular area. However, long-term follow-up is necessary.