Maxillary Ridge Research Articles

Trans-sinus Implant using TTPHIL-ALL-TILT ®Technique as Alternative to Sinus Lifts: A Technical Description and Case Series

Background: Severe atrophy of maxillary ridge and extended maxillary sinus pneumatisation limits the treatment options available for rehabilitating patients with teeth missing in posterior maxilla. Sinus lifts followed by bone grafting has become the norm for rehabilitating such patients. But, sinus lift procedures can be cumbersome, time-consuming and uneconomical, especially if patients are in need of immediate function. Objective: This case series describes a unique combination of placing trans- sinus implants using TTPHIL-ALL-TILT ® technique for treating patients with atrophied posterior maxilla. Methods: Three different clinical situations have been described where trans-sinus placement of implants using TTPHIL-ALL-TILT ® technique was done for managing atrophied posterior maxilla. first case was that of a single tooth missing in the posterior maxilla, the second of multiple posterior tooth missing (distal extension, partially edentulous condition) and the third being that of a completely edentulous maxilla. The implants were placed in a flapless tilted manner along with double bi-cortical engagement through the maxillary sinus. Results and Discussion: Following prosthetic rehabilitation, clinical reviews were performed after 6 months. In all cases, implant stability was manually checked and no pathological symptoms or signs were recovered at any follow-up visit. Conclusion: Trans-sinus implant using TTPHIL-ALL-TILT ® technique prove to be good choice to rehabilitate these three clinical scenarios. All three patients were extremely satisfied with the treatment outcome. This could very well become a convenient treat alternative to sinus lift procedures.

Prosthetic Rehabilitation of Parkinson’s Disease Patient with Flabby Ridge Using Modified Window Technique: A Case Report

A flabby alveolar ridge is a mobile soft tissue seen superficially affecting either maxillary or mandibular alveolar ridge. It commonly develops when alveolar bone gets replaced by hyperplastic soft tissue. It is particularly seen in maxillary anterior region of long term denture wearers. Inadequate support stability and retention of complete denture are the problems encountered in these patients. Tremors caused by Parkinsonrsquos disease can make prolonged dental treatment challenging. Various methods are used for managing flabby alveolar ridges which include surgical technique special impression procedures equalized distribution of occlusal forces and implant placement. Special impression technique that involves window technique for flabby ridge has multiple challenges. This case report discusses the use of modified window technique for managing maxillary ridge with flabby area from canine to canine in a Parkinsonrsquos disease patient. This impression technique aids in recording the impressions of the flabby ridges with minimal displacement thus enhancing retention stability and support of the denture.

Indirect Sinus Lift in Maxillary Posterior Region using BAOSFE Technique

Implant placement in edentulous posterior maxilla along the maxillary sinuses poses difficulties following tooth extraction due to ridge resorption and pneumatization of sinuses resulting in inadequate vertical bone height. The maxillary sinus lying close to the posterior maxillary edentulous ridge can be augmented by various methods such as lateral window sinus floor elevation, crestal approach, and grafting procedures. Summers introduced the less invasive approach for the sinus floor elevation known as osteotome sinus floor elevation technique in which the vertical bone height was attained by retaining and relocating existing bone using different graded osteotomes. He further modified this technique by addition of bone graft to the osteotomy site before sinus elevation known as bone added osteotome mediated sinus floor elevation (BAOSFE). This case report shows placement of implant in atrophic maxillary region using BAOSFE technique.

An in vivo study to assess and compare the angular, linear, and depth deviation as well as the difference in bone density of implants placed using computer-aided design/computer-aided manufacturing fabricated three-dimensional guides versus the implants placed using bone pen kit in maxillary and mandibular ridges.

The aim is to assess and compare angular, linear, and depth deviation and difference in bone density of dental implants placed using computer aided design/computer aided manufacturing (CAD/CAM) fabricated surgical guides versus implants placed using Bone Pen Kit. Till now, no original research exists in the search engines such as Pubmed, Google Scholar, Science Direct, and Research Gate on this kit. In vivo- Randomised control trial. Twenty clinical cases were selected and split into two distinct groups. Group 1 involved the placement of 10 implants using CAD/CAM fabricated three dimensional guides and Group 2 involved the placement of 10 implants using Bone Pen Kit. Four deviation parameters were evaluated, which included: (a) Angular deviation, (b) Linear deviation at implant platform, (c) Linear deviation at implant apex, and (d) Depth deviation and difference in bone density before and after implant placement was also evaluated. SPSS software version 23 was utilized for the analysis of the data. The comparison was made using the Whitney test, and Wilcoxon signed rank test. When comparing angular deviation, the results indicated a statistically significant difference with a P < 0.05. The values observed for angular and linear deviation in Group 2 were significantly greater than those in Group 1. No statistically significant difference in depth and linear deviation was found at the implant platform among the two groups. Bone density before and after implant placement was significantly higher in Group 1. (1) Angular and linear deviation at the apex in Group 2 exhibited higher values in comparison to Group 1, (2) No difference in depth and linear deviation at the implant platform was found among the two groups, and (3) There was no difference in change in bone density among two groups.

Comparative evaluation of dental implants in posterior maxilla placed using unicortical and bicortical anchorage-A split-mouth prospective study.

The use of dental implants has become a very predictive method of rehabilitation for patients with partial or complete edentulism. It is more challenging to treat the posterior quadrants of the maxillary ridges using dental implants due to their anatomical and physiological characteristics. So to overcome the limitations of other techniques, short implants were introduced recently as a new approach to simplify implant placement in compromised alveolar bone and to prevent possible damage to vital structures. This study aims to compare the clinical outcomes of dental implants placed using the osteotomized sinus floor elevation (OSFE) technique side engaging the bony floor of the maxillary sinus (bicortical anchorage) on one side and the conventional technique by split mouth on the other side. This study included 15 patients. Study participants had dental implants placed on both sides of the mouth at the same time, so one side was implanted according to the test method, while the other side used the control method. Randomization determined which side would be implanted. The OSFE technique provides greater stability to the implant via bicortical anchorage than conventional techniques, which only provide unicortical anchorage.

Evaluation of the effect of direct sinus lift surgery on maxillary sinus volume by Mimics software.

Sinus lift surgery allows sufficient volume of bone to be created in the posterior part of the maxilla. The aim of this study was to investigate the changes in maxillary sinus volume after a sinus lift and the rate of increase in ridge height at the site of the graft. Eleven patients were chosen for sinus lift from among those who were referred to the radiology department for implant placement in the posterior region of the maxilla and whose bone height at the posterior of the maxilla was less than 4 mm on the cone-beam computed tomography (CBCT) image. The sinus volume was measured after importing the CBCT file in DICOM format into Mimics software. After determining the sinus volume, the patients underwent sinus lift surgery, and the amount of material used during the surgery was measured. After the time required to repair the area, the CBCT image was taken again. Then, the changes in the volume of the maxillary sinus and the increase in the height of the maxillary ridge at the surgical site were calculated. Then, the second stage of the surgery was performed to place the implant at the implant site. For an average of 1.40 cm3 of material, the rate of increase in ridge height was 10.52 mm, and the average change in sinus volume was 1.19 cm3. CBCT images and Mimics software have many applications in examining and predicting parameters before and after sinus lift surgery.

Effect of implant diameter and cantilever length on the marginal bone height changes and stability of implants supporting screw retained prostheses: A randomized double blinded control trial.

This randomized controlled trial aimed to evaluate the effect of implants' two different diameters and cantilever lengths on the marginal bone loss and stability of mplants supporting maxillary prostheses. Ninety-six implants were placed in sixteen completely edentulous maxillary ridges. Patients were randomly divided into two groups: Group A, implants were placed with a cantilever to anterior-posterior AP spread length (CL:AP) at a ratio of 1:3; Group B, implants were placed with a CL:AP at a ratio of 1:2. Patients were further divided into four sub-groups: Groups A1, A2, B1, and B2. Groups A1 and B1 received small diameter implants while Groups A2 and B2 received standard diameter implants. Bone height and stability measurements around each implant were performed at 0, 4, 8 and 24 months after definitive prostheses delivery. Statistical analysis of the mean implant stability and height values revealed an insignificant difference between Group A1 and Group A2 at all the different time intervals while significantly higher values in Group B1 in comparison with Group B2. Results also showed significantly higher values in Group A1 in comparison with Group B1 and an insignificant difference between Group A2 and Group B2 at all the different time intervals. It can be concluded that the use of small diameter implants placed with a CL:AP at a ratio of 1:3 provided predictable results and that the 1:2 CL:AP significantly induced more critical bone loss in the small diameter implants group, which can significantly reduce long term success and survival of implants.

Reconstruction and rehabilitation of atrophic partial edentulous maxillary ridge: Complications and stability

Reconstruction and rehabilitation of atrophic partial edentulous maxillary ridge: Complications and stability

Maxillary Ridge Split with Simultaneous Implant Placement – A Case Report

Inadequate alveolar ridge width often poses difficulty in implant placement. Such ridges require a combination of techniques in placing implants. One such technique is the ridge split technique which helps the expansion of the ridge with or without greenstick fracture of cortical plates. Before placing implants the width of the alveolar ridge can be effectively restored utilising the modified ridge splitting approach employing autologous bone grafts. This case report describes the ridge splitting and placement of a dental implant in the left maxillary central region followed by guided bone regeneration. Ridge expansion was done in relation to 21 and osteotomy was prepared to the desired depth. After proper treatment planning implant measuring 3.5 mm in diameter and 11.5 mm in length was placed. Four months later final cementation was done with PFM crown. The ridge split technique with the immediate implant placement resulted in minimal resorption of alveolar bone along with maximum expansion of the bone. The sequential surgical and restorative techniques were combined into one successful protocol whose steps are well elaborated in this case report.

A simplified clinical approach towards renovated esthetics using flangless denture: A case report

In edentulous patient, restoring labial fullness is a delicate technique. To achieve our clinical aim, proper communication between the dentist and the laboratory technician is required. In some completely edentulous cases, the prominent enlarged labial flange of a complete denture contributes to poor facial aesthetics. To solve this problem, the complete denture was adjusted and a gum-fit or flangless denture was prescribed. This case reports presents a simple, cost-effective, conservative and non-surgical option for fabricating dentures in a patient with a large maxillary ridge in order to improve the patient's facial aesthetics.

Axial and Nonaxial Retention Forces of Different Designs of Milled Bar Attachments for Maxillary Implant Overdentures: An In Vitro Study.

To compare the axial and nonaxial retention forces of different milled bar attachment designs for maxillary implant overdentures. Four implants were placed in the canine and second premolar areas of an edentulous maxillary ridge model and connected to a cobalt-chromium milled bar either with or without Locator attachments. According to the type of bar and overlying housing, the following groups (n = 10 each) were investigated: group 1 (MWM) = milled bar without attachments and metal housing; group 2 (MWP) = milled bar without attachments and PEEK housing; group 3 (MAM) = milled bar with Locator attachments and metal housing; and group 4 (MAP) = milled bar with Locator attachments and PEEK housing. Axial and nonaxial (anterior, posterior, and lateral) retention forces were measured both at baseline and after wear simulation, then compared between groups and dislodging directions. MAM showed the highest axial (53.20 ± 2.28 N) and nonaxial (anterior [33.80 ± 1.48 N], posterior [37.60 ± 2.07 N], and lateral [34.40 ± 1.67 N]) retention forces at baseline, followed by MAP, then MWM, and MWP (P < .001). MAP showed the highest axial (42.80 ± 2.28 N) and nonaxial (anterior [24.00 ± 1.58 N], posterior [29.40 ± 2.07 N], and lateral [27.80 ± 1.64 N]) retention forces after wear simulation, followed by MAM, then MWP, and finally MWM (P < .001). MAM showed the highest axial (25.25 ± 2.45 N) and nonaxial (anterior [28.29 ± 4.03 N], posterior [24.40 ± 3.25 N], and lateral [25.55 ± 1.65 N]) retention loss, followed by MWM, then MAP, and finally MWP (P < .001). For all groups, the highest retention forces were noted with axial dislodging, followed by posterior dislodging, then lateral dislodging, and finally vertical dislodging (P < .001). Milled bars with PEEK housings and Locator attachments for maxillary implant overdentures were associated with the highest axial and nonaxial retention forces after wear simulation, while milled bars with metal housing and no attachments showed the lowest forces. Milled bars with metal housing and attachments showed the highest retention loss, while milled bars with PEEK housing with no attachments showed retention gain.

Comparison of Allogeneic Bone Plate and Guided Bone Regeneration Efficiency in Horizontally Deficient Maxillary Alveolar Ridges

(1) Background: Bone Lamina Technique and Guided Bone Regeneration (GBR) are commonly used for horizontally-deficient maxillary ridge reconstruction, although more detailed evaluation to assess the differences between such techniques is necessitated. (2) Methods: In this retrospective study, patients having a horizontal bone width of ≤4 mm in the maxilla, who were treated with Cortical Strut (CS), were collected to represent the “test group”, and those treated with GBR with no CS involvement represented the “control group”. A 1:1 mixture of autogenous bone (AB) and anorganic bovine bone (ABB) with resorbable collagen membrane was applied to both groups. Volumetric changes between groups were measured with cone-beam computed tomography (CBCT). The primary outcome represented volumetric graft resorption rate whilst the secondary outcomes represented any probable complications and implant insertion torque. (3) Results: A total of 36 patients were included in this study (36 grafted sites; 18 for CS group and 18 for GBR group). Mean bone graft volume reduction in the CS and GBR groups was 8.26 ± 1.60% and 14.36 ± 3.55%, respectively. The GBR group showed significantly more bone resorption than the CS group (p &lt; 0.001). Complications and insertion torque were similar between the groups (p &gt; 0.05). (4) Conclusions: Both CS and GBR techniques for hard-tissue augmentation provided sufficient bone graft mass volume for implant insertion, whereas CS demonstrated lower resorption rate at maxillary augmented sites, compared to GBR.

Polyetheretherketone subperiosteal implant retaining a maxillary fixed prosthesis: A case series

Statement of problemPatients needing dental rehabilitation of a complete atrophic maxilla would benefit from simplified treatment plans. PurposeThe purpose of this case series was to demonstrate the prosthetic management of 4 edentulous patients with severe maxillary ridge resorption who declined multiple stage surgery and sought a fixed prosthesis in single-stage surgery. Material and methodsThe patients were provided with completely digital computer-aided designed and computer-aided manufactured (CAD-CAM) polyetheretherketone (PEEK) maxillary subperiosteal frameworks, which were surgically placed in a 1-step procedure. The patients were followed up for 12 months and evaluated for signs of implant rejection, infection, prosthetic fracture or mobility, or implant exposure. ResultsAt the 12-month follow-up, all the implants were functionally stable with healthy soft tissue and showed no sign of prosthetic fracture, infection, or pus discharge. ConclusionsPEEK subperiosteal implants for maxillary atrophied ridges can be considered a promising treatment option within the limitations of this clinical study with low patient numbers and a short observational time.

Efficacy of platelet-rich fibrin in maxillary sinus augmentation and simultaneous implant placement in deficient maxillary ridges: A pilot comparative study

BackgroundRehabilitation with dental implants has become the most widely accepted treatment protocol for rehabilitation of lost natural teeth. Direct sinus lift is one of the most predictable procedures for augmenting the deficient posterior maxillary ridges. MethodsThe study was designed in patients with insufficient bone for implants in the maxillary posterior ridges. The test group received platelet-rich fibrin alone as filler, and the control group received a bone allograft. The residual bone height (RBH), implant mobility, and soft tissue characteristics between and within the groups were compared and analyzed. ResultsBoth the groups had considerable gain in RBH, and the intragroup analysis revealed clinical gain in bone height in both the groups, with the test group exhibiting statistically significant gain which kept on improving from 6 months with z= -3.477 and a p value of 0.001 to 9 months with z=-3.531 and a p value of 0.027. ConclusionThe results suggest that the use of platelet-rich fibrin alone improves the bone regeneration, thereby achieving predictable and stable augmentation of the sinus floor required for the success of implant therapy.

Patient Satisfaction with Complete Denture Constructed Using Modified Windows Impression Technique with Custom Dual Tray for hypermobile Maxillary Residual Ridge

Patient Satisfaction with Complete Denture Constructed Using Modified Windows Impression Technique with Custom Dual Tray for hypermobile Maxillary Residual Ridge

COMPARATIVE EVALUATION OF CRESTAL BONE LEVEL IN RELATION TO IMPLANTS PLACED USING CONVENTIONAL OSTEOTOMES AND BONE EXPANSION SCREWS

BACKGROUND AND OBJECTIVES: The comparison of crestal bone loss in relation to implants placed using conventional drilling osteotomy method and using bone expansion screws in maxillary region. METHODS: The crestal bone loss was measured after implant placement and after a period of six months, and the results analyzed. Equal number of male and female patients of comparable age group who opted implant treatment were selected.RESULTS AND DISCUSSION: After a period of six months of implant placement, a mean value of 1.37 mm of crestal bone loss was noticed for implants placed using conventional osteotomy method while a mean of 0.73 was noticed in relation to implants placed using expansion screws.CONCLUSION: The implants placed using bone expansion screws show less crestal bone loss compared to implants placed using conventional osteotomy method in maxillary edentulous ridge having less than ideal bone width. It infers that the bone expansion method using expansion screws is more reliable and relatively noninvasive way of implant bed preparation.

NON-HODGKIN'S LYMPHOMA VERSUS TOOTH ABSCESS: IMPORTANCE AND CHALLENGES OF A CORRECT DIAGNOSIS

A 41-year-old male patient reported pain and discomfort in the jaw for 2 months. A private dentist established the diagnosis of a tooth abscess and prescribed antibiotics for 2 weeks. On extraoral exam, slight facial asymmetry and an enlarged and firm right submandibular lymph node were noted. On intraoral exam, a lobulated, reddish, partially ulcerated, soft, and asymptomatic nodule in the maxillary ridge referring to tooth 16, measuring 2.5 cm, was observed. A differential diagnosis of lymphoma and fibrosarcoma was established, and an incisional biopsy was performed. Histopathologic examination revealed a proliferation of round and blue cells, compatible with lymphoma. The complementary immunohistochemical examination was positive for CD20 and BCL6. Dentists should consider lymphoma as a diagnostic hypothesis among lesions that grow rapidly and cause diffuse bone resorption. To avoid iatrogenesis and improper drug prescriptions, dentists should always make detailed anamnesis and complete physical examinations of patients. A 41-year-old male patient reported pain and discomfort in the jaw for 2 months. A private dentist established the diagnosis of a tooth abscess and prescribed antibiotics for 2 weeks. On extraoral exam, slight facial asymmetry and an enlarged and firm right submandibular lymph node were noted. On intraoral exam, a lobulated, reddish, partially ulcerated, soft, and asymptomatic nodule in the maxillary ridge referring to tooth 16, measuring 2.5 cm, was observed. A differential diagnosis of lymphoma and fibrosarcoma was established, and an incisional biopsy was performed. Histopathologic examination revealed a proliferation of round and blue cells, compatible with lymphoma. The complementary immunohistochemical examination was positive for CD20 and BCL6. Dentists should consider lymphoma as a diagnostic hypothesis among lesions that grow rapidly and cause diffuse bone resorption. To avoid iatrogenesis and improper drug prescriptions, dentists should always make detailed anamnesis and complete physical examinations of patients.

Hollow Denture for Completely Edentulous Maxillary Resorbed Ridges- A Case Report

Basically, complete denture success relies on the factors like stability, retention, function, support and esthetics. Mostly severely resorbed maxillary ridges are constricted and narrow and the inter-arch distance is increased due to which there is a decreased stability, support and retention. In this case the weight of the complete dentures compromises the factors further. This case report depicts a simplified technique for fabricating the lightweight hollow complete denture for balancing the factors influencing the denture and also preserves the supporting tissues and bone

A three-in-one alveolar process reconstruction protocol for maxillary molar sites with severe residual bone height deficiency: A proof-of-concept pilot study.

Implant placement in maxillary molar sites with severe height deficiency often requires multiple surgeries, which was time-consuming, invasive, and subject to serious postoperative complications. To introduce and assess a three-in-one technique (extraction, alveolar ridge preservation [ARP], and sinus elevation) for augmenting deficiency maxillary molar alveolar ridges. Fourteen patients with severe posterior maxillary ridge height deficiency underwent extraction, sinus elevation via an intrasocket window and ARP using sticky bone and then covered with acellular dermal matrix (ADM). Primary closure was intentionally not obtained. Cone-beam computed tomography and periapical radiography were used to measure dimensional ridge changes over time. Bone biopsies were taken at implant placement 7-21 months after surgery, which proceeded without additional grafting. Peri-implant soft tissue was assessed after 8-12 months of functional loading. Maxillary molar sites (13 first molars, 1 second molar) with a mean sinus floor height of 1.73 ± 0.86 mm and mean buccal plate thickness of 1.62 ± 1.15 mm were elevated and grafted. Immediately after surgery, the mean sinus floor height was 14.03 ± 1.97 mm and the alveolar thickness at virtual implant platform level was 12.99 ± 1.88 mm. After 5-9 months healing, those measurements decreased by 2.45 ± 1.73 mm (p= 0.000) and 3.88 ± 3.95 mm (p= 0.006), respectively. Healed ridges were composed of 18.74% ± 4.34% mean vital bone and 19.08% ± 9.10% mean residual graft. After 8-12 months of functional loading, the peri-implant tissue appeared healthy, and there was a mean marginal bone loss of 0.12 ± 0.11 mm. For maxillary first molar sites with severe sinus floor height deficiency, this minimally invasive three-in-one treatment allows for uncomplicated implant placement and short-term functional stability.

Angled ball and locator attachments for immediate loaded inclined implants used to retain maxillary overdentures: A cross over study of patient satisfaction and oral health related quality of life.

The aim of this was to compare the influence of two different angulated abutment designs on patient satisfaction, oral health-related quality of life, and prosthetic aspects of implant-supported maxillary overdentures. For this cross-over study, 18 patients with completely edentulous maxillary ridges opposing implant-retained mandibular overdentures received 4 implants between the maxillary sinuses using computer-guided surgery. The anterior implants were installed at canine/lateral incisor areas and inclined 15° labially. The posterior implants were inserted just anterior to the maxillary sinuses and inclined 15o distally. Eight patients received maxillary overdentures retained by angled ball attachment (ball overdenture [BOD]) and angled locator attachment in random order. After 6months, patients indicated satisfaction with their prosthesis using a visual analog scale (VAS), and oral health impact profile (OHIP-14). Moreover, postinsertion prosthodontic maintenance and complications were recorded for both attachments. Comparisons of patient satisfaction and prosthetic complications between groups were performed using the Wilcoxon matched-pairs test and the McNemar test, respectively. Locator overdenture (LOD) recorded significantly higher scores than the BOD group regarding all the VAS questions except for ease of cleaning (p < 0.007). LOD recorded significantly higher patient satisfaction regarding the pronunciation of sounds (p=0.009), painful aching (p=0.018), feeling tense (p=0.011), unsatisfactory diet (p=0.013), irritability with people (p=0.005), and life in general (p=0.004). The most common complications were matrix activation/renewal (n=34). BOD showed a significantly higher incidence of attachment loosening (p=0.002), and teeth fracture (p=0.049) than LOD. LOD showed a significantly higher incidence of attachment wear and replacement than BOD (p <0.001). There was no difference between groups regarding soft tissue complications. Within the limitations of this study, and in terms of improved patient-centered outcomes, angled locator attachments are recommended to retain maxillary implant overdentures opposed by implant retained mandibular overdentures at it was associated with increased patient satisfaction and oral health-related quality of life than angled ball attachments. However, locator attachment was associated with more postinsertion prosthodontic maintenance than ball attachment.