Placement Of Endosseous Dental Implants Research Articles

A comparison of preoperative soft tissue contour versus bone accuracy as a predictor of quality of life outcomes in osseous free flap jaw reconstruction using occlusal-based virtual surgical planning

ObjectivesOcclusal based virtual surgical planning (VSP) prioritises placement of endosseous dental implants, over replicating native bone contour. This may compromise facial aesthetics. This study aims to compare function and health-related quality of life (HRQOL) following maxillomandibular reconstruction according to ability to replicate preoperative soft-tissue contour and virtual plan. Materials and methodsPatients who had undergone occlusal based VSP osseous free flap reconstruction of the maxilla or mandible, with high-resolution pre- and postoperative facial computerised tomography imaging, and completion of FACE-Q questionnaire were retrospectively identified. Accuracy of reconstruction compared to preoperative soft tissue contour and virtual plan, was measured using 3DSlicer® and CloudCompare® in three dimensions. Random effects modelling determined associations between bony and soft tissue accuracy and HRQOL/functional domains. ResultsTwenty-two patients met the inclusion criteria. For mandibular and maxillary reconstructions, better soft tissue accuracy was associated with improved appearance (p = 0.048) and appearance distress (p = 0.034). For mandibular reconstructions, better soft tissue accuracy was associated with improved smile (p=0.039) and smile distress (p=0.031). For maxillary reconstructions, better bony accuracy was associated with improved appearance (p=0.023) and drooling distress (p=0.001). Unexpectedly, better bony accuracy was associated with worse eating and drinking (p=0.015), oral competence (p=0.005) and eating distress (p=0.013) in mandibular reconstructions. ConclusionWhilst soft tissue accuracy was associated with better functional and HRQOL outcomes, bone accuracy was associated with worse oral function/distress in mandibular reconstruction. These results need validation but should be considered when performing occlusal-based VSP, which prioritises dental rehabilitation over replicating facial bony contour.

Lateral Window Maxillary Sinus Augmentation – Complications and Management

Introduction: The sinus lift procedure is the most predictable surgical intervention for enhancing bone quality and quantity in the posterior maxilla prior to the placement of endosseous dental implants. However, despite careful planning and precise surgical technique, several complications can arise. These include - haemorrhage, membrane perforation, infection, wound dehiscence, post operative pain, implant failure/ loss, graft loss, hematoma, barrier membrane exposure, oroantral fistula and sinusitis. Aim: The purpose of this report was to address the most common complications associated with the sinus lift procedure and discuss how to avoid and manage them when they occur. Methodology: A total of 140 articles from peer reviewed journals published in English from January 1986 to January 2023 were collected from a search performed using MEDLINE and PubMed. The keywords utilized were “dental implant”, “sinus augmentation”, “sinus complication”, “membrane perforation”, “bleeding – sinus augmentation”. Twenty-nine of the 140 articles satisfied the inclusion criteria and were utilized in this article. Results: Sinus membrane perforation is the most prevalent complication of maxillary sinus augmentation procedures, ranging from 11-60%. An incidence of 28% perforation rate is found. Bleeding was reported with an incidence of 2% of the sinus procedures performed. The use of piezoelectric devices as well as other measures play an important role in ensuring the stopping of bleeding. Conclusion: Proper planning and management of these complications will minimize the negative effects on therapy and allow for a successful implant result when placed in augmented maxillary sinuses.

Histologic Assessment of Peri-implant Tissues Around Endosseous Dental Implants Placed Along with Intentionally Retained Root Fragment in Animal Models: A Systematic Review.

To evaluate whether the placement of endosseous dental implants along with intentionally retained root fragments enhances peri-implant histologic characteristics and outcomes in healthy animal models. Two review authors independently performed electronic literature searches across the PubMed/MEDLINE, LILACS, EBSCOhost, and Science Direct databases by using different keywords and Medical Subject Headings terms to identify relevant articles. Only preclinical animal trials evaluating the histology of peri-implant tissues around endosseous dental implants placed along with intentionally retained root fragments were included in the review. The risk of bias assessment was investigated using the Systematic Review Centre for Laboratory animal Experimentation (SYRCLE) tool, and the reporting quality of each trial was evaluated using the Animal Research: Reporting in Vivo Experiments guidelines. Seven preclinical trials including a total of 33 animals and 155 endosseous dental implants were eligible for the analysis. One trial reported the histologic assessment of peri-implant tissues around endosseous dental implants with ankylotic root fragments, whereas the other six studies used nonankylotic root fragments. The effects of the length of retained root fragments on peri-implant tissues were reported in two trials that showed contrasting results. The effects of the width of retained root fragments were assessed in two trials reporting that a remaining thickness < 2 mm and buccal bone thickness > 3 mm favors alveolar bone preservation over a period of 12 weeks. Although the mean quality assessment score for all preclinical trials was moderately high, the summary for the risk of bias presented a high risk. Limited data and short-term preclinical evidence showed optimal peri-implant histologic findings of endosseous dental implants placed along with intentionally retained root fragments. However, further preclinical histologic evaluation with homogenous populations and long-term controlled clinical studies are needed to substantiate its applicability in clinical situations.

Surgical and prosthetic rehabilitation of siblings with Witkop tooth and nail syndrome using zygomatic implants: a familial case series of 3 patients with up to 15-year follow-up.

Witkop tooth and nail syndrome is a rare, autosomal dominant type of ectodermal dysplasia that can have significant effects on dentition, including hypoplastic and malformed dentition and significantly atrophic maxillas. Endosseous implants have become one possible solution to replace missing teeth, although their use in areas where bone is sparse becomes challenging. Due to the severe atrophy of the maxillary alveolus, extensive preprosthetic surgeries including orthognathic surgery, extensive bone grafting, and sinus floor augmentations have been recommended prior to placement of endosseous dental implants. Although this treatment has shown favorable outcomes, it requires multiple surgical procedures, contributing to a prolonged treatment course and increased morbidity. An alternative treatment of atrophic maxillas in patients with ectodermal dysplasia includes the use of zygomatic implants. This familial case series discusses 3 siblings, all previously diagnosed with Witkop Syndrome, who underwent comprehensive preprosthetic surgery and prosthetic rehabilitation using zygomatic implants with a follow-up period up to 15years.

ImplantsP-36666236-303Quantitative evaluation of zygomatic buttress, ramus and symphysis onlay grafts in ridge augmentation

<h3>Background</h3> Placement of endosseous dental implants requires adequate bone width for prosthetic support. In severe deficiency of bone width, implant placement is challenging. This study evaluates onlay grafts from zygomatic buttress, ramus and symphysis in ridge augmentation prior to implant placement. <h3>Method</h3> A comparative study comprising of 30 patients with maxillary and mandibular edentulous width of less than 3mm radiographically were selected. Patients were randomly divided into 3 groups- Group A (Zygomatic buttress), Group B (Ramus), Group C (Symphysis). They were evaluated in terms of pain, interincisal opening (IIO), postoperative complications, patient satisfaction score and width of the newly formed bone using CBCT immediate postoperative and then at 1 month, 3 months and 6 months. <h3>Findings</h3> All patients demonstrated an average bone width increase of 4.75mm. There was no significant difference in postop pain, and interincisal opening on later follow-up, at 1 month, 3 months and 6 months. However, the immediate postoperative IIO was less and swelling was more in Group B followed by Group C and Group A. The average increase in bone width was 4.4, 5.2 and 4.7mm for Group A, B and C respectively at 6 months. Grafts resorption was seen in two cases in Group A. <h3>Conclusion</h3> Ramal graft provides more bone volume compared to zygomatic buttress and symphysis. Symphysis graft leaves an aesthetic defect at the donor site. Therefore, ramal grafts may be considered the ideal intraoral bone grafts for implant surgery.

An ethical perspective to using bone grafts in dentistry

An ethical perspective to using bone grafts in dentistry

Tracking Tag Stabilization With a Small-Diameter Implant in an Edentulous Mandible to Assist Dynamically Navigated Surgery: A Case Report

This report describes the use of a temporary dental implant to secure a radiographic fiducial marker and patient-tracking tag to an edentulous mandible for dynamically guided implant placement into a fibula microvascular free flap. A small-diameter dental implant was placed into the anterior mandible to secure a radiographic fiducial marker followed by a patient tag. The patient tag allowed for tracking of the patient's mandible during placement of endosseous dental implants. Four endosseous dental implants were successfully placed into the edentulous fibula free flap mandibular reconstruction. Dynamic navigation using a small-diameter implant to secure radiographic fiducial markers and patient tags provides a novel technique to place implants into an edentulous microvascular free flap with minimal incision and reflection of soft tissue.

Trigeminal nerve injuries in oral and maxillofacial surgery: a literature review

Objective: Trigeminal nerve injury is an uncommon complication of outpatient oral surgery and dental procedures such as removal of impacted teeth, placement of endosseous dental implants, and even injection of local anesthesia. In the field of oral and maxillofacial surgery, the two most commonly injured branches of the trigeminal nerve are the inferior alveolar and lingual nerves. Fortunately, most nerve injuries will undergo spontaneous recovery, with only a small percentage of cases resulting in permanent sensory deficits.

In vivo immunohistochemical investigation of the effect of the topical application of growth hormone on the osseointegration of cpTi implant

Background: Dental implants are a suitable option for the replacement of some or all missing teeth. The successful insertion of a biocompatible material into living tissue with little to no evidence of rejection has revolutionized medicine and dentistry. An increase in bone response was observed with local administration of growth hormone around dental implants. Growth hormone may act as a bone stimulant in the placement of endosseous dental implants and enhances osseointegration. The aim of the study was to evaluate immunohistochemically the effect of the topical application of growth hormone on the osseointegration of cpTi implant. Materials and Methods: Eighty titanium screw implants were inserted in the tibia of the forty adult rabbits. Growth hormone was applied on experimental implants. Immunohistochemical tests were performed on the implants of both control and experimental groups for (3 days1, 2, and 6 weeks) healing intervals. Results: Titanium implants coated with growth hormone revealed an early bone formation, minerlization and maturation in comparison to control. Immunohistochemical findings revealed positive expression for VEGF in experimental implant in comparison to control one. Conclusion: Topical application of growth hormone may act as a bone stimulant in the placement of endosseous dental implants and enhances osseointegration.

The role of implant dentistry in the specialty of endodontics

The routine incorporation of the placement of endosseous dental implants into the armamentaria of endodontists is currently limited, but it is on the rise. A need exists for endodontists to address the increased patient interest in implant‐supported restorations. This can be accomplished concomitantly with educating patients about the predictability of various treatment options. Based on the experience that endodontists have in the diagnosis of complex endodontic problems, treating teeth with multiple clinical problems such as resorption, infractions, vertical root fractures, and evaluating the outcomes of various treatment procedures, they are uniquely qualified to discuss objectively with patients the risks and benefits related to treatment options that include endodontics and replacement with dental implants. By incorporating implant dentistry in the endodontic clinical practice, or at least becoming highly knowledgeable about the discipline of implant dentistry, the endodontist will be in a position to provide patients with valuable and practical information and services.

A comparison of masticatory efficiency in conventional dentures, implant retained or supported overdentures and implant supported fixed prostheses: A literature review

Patients wearing conventional removable dentures often complain particularly about the instability of the mandibular denture. Due to instability of mandibular dentures, there is an increase in the severity of mandibular atrophy. Furthermore, denture instability leads to a feeling of insecurity, inefficient mastication, and overall dissatisfaction with the prosthesis. Placement of endosseous dental implants to retain and support mandibular overdentures or fixed complete dentures have been developed and studied as a method for solving the problem of instability associated with conventional dentures. Implant-retained dentures have many advantages compared to conventional removable dentures. Occasionally, anatomical or financial limitations may prohibit the patient to use of a fixed implant-retained prosthesis. In these cases, a removable implant-retained denture with a limited number of implants may be the possible choice. The aim of this article is to review the literature to compare implant-retained or supported dentures versus conventional dentures in terms of masticatory efficiency, stability, and patient satisfaction.

Osseointegrated supported prosthesis - Surgical techniques for hard and soft tissue grafting

Several techniques have been developed to improve the bone volume for the placement of dental implants in an effort to shorten the length of treatment, avoid a second surgical appointment, reduce the use of additional surgical sites, reduce challenges to the patient and decrease patient morbidity. This article will review these surgical procedures for both hard and soft tissue grafting in the placement of endosseous dental implants.

Mandibular Ridge Splitting and Gradual Bone Expansion Technique for Immediate Placement of Implant in the Posterior Thin Region: A Clinical Report

Introduction: Narrow alveolar ridges especially in posterior mandibular remains a serious challenge for successful placement of endosseous implants. Case Presentation: This case report addresses surgical procedures for widening the atrophic ridge by means of splitting the crest of an edentulous ridge as thin as 2.5 mm and gradual expansion in the posterior mandibular ridge, then simultaneous placement of dental implants within the split ridge. A significant increase was achieved in the bone dimension, which enabled the placement of endosseous dental implants successfully. Discussion: This segmental ridge-split procedure with gradual bone expansion provides a quicker method wherein an atrophic ridge can be predictably expanded and eliminating the need for a second surgical site. This technique also shows that immediate implantation in split ridge of mandible can be performed.

Potential adverse events of endosseous dental implants penetrating the maxillary sinus: Long‐term clinical evaluation

The aim of this study was to evaluate the nature and incidence of long-term maxillary sinus adverse events related to endosseous implant placement with protrusion into the maxillary sinus. Retrospective cohort study. All patients who underwent placement of endosseous dental implants with clinical evidence of implant penetration into the maxillary sinus with membrane perforation were included in this study. Only patients with a minimum follow-up of 5 years after implant placement were included in this study. Maxillary sinus assessment was both clinical and radiological. Eighty-three implants with sinus membrane perforation in 70 patients met the study's inclusion criteria. Mean age was 65.96 years ± 14.23. Twelve patients had more than one implant penetrating the maxillary sinus, and seven of them had bilateral sinus perforation. Estimated implant penetration was ≤ 3 mm in all cases. The average clinical and radiological follow-up was 9.98 years ± 3.74 (range 60-243 months). At the follow-up appointments, there were no clinical or radiological signs of sinusitis in any patient. This long-term study, spreading over a period of up to 20 years, indicates that no sinus complication was observed following implant penetration into the maxillary sinus. Furthermore, absence of occurrence of such complications is related to the maintenance of successful osseointegration. A contrario, and in the presence of an acute or chronic maxillary sinusitis, the differential diagnosis must always consider other potential odontogenic and nonodontogenic etiologies.

The sequential treatment of extensive mandibular ameloblastoma

Ameloblastoma is the most frequent odontogenic tumor of the jaw. If not treated, ameloblastoma can gain an enormous size and cause severe facial disfigurement and functional impairment. Here we report two patients afflicted with extensive mandibular ameloblastoma (sized in 23 cm × 18 cm × 17 cm and 15 cm × 12 cm × 10 cm, respectively). Both the patients received the same sequential treatment including radical tumor resection, simultaneous reconstruction with fibula free flap graft, vertical distraction osteogenesis on the fibula graft, placement of endosseous dental implants, and final pros-thodontic rehabilitation. It took about 15 months to finish the entire course of treatment. And after the four-year follow-up, neither soft tissue related, nor hard tissue related problems were observed. Satisfactory facial symmetry, chewing and speech functions of the patients were restored. So this sequential treatment for extensive mandibular ameloblastoma can obtain an excellent effect by the shortest time and the lowest economical cost. Furthermore, the series also can be used to reconstruct giant mandibular defects caused by different reasons.

Iliac Crest Flap for Mandibular Reconstruction After Advanced Stage Mandibular Ameloblastoma Resection

Ablative surgeries for neoplastic processes of the oral cavity, traumas, infections/inflammations, osteoradionecrosis, and congenital deformities are the most common causes of large mandibular defects. Ameloblastoma is a locally aggressive tumor that, if not treated, can gain an enormous size and cause severe facial disfigurement and functional impairment. Although the smaller lesions of ameloblastoma in the mandible are treated by conservative approaches such as marsupialization, enucleation, and curettage combined with liquid nitrogen spray cryosurgery, larger lesions require radical surgical ablation procedures resulting in large tissue defects. A large mandibular defect has deleterious effects on a person's life, with a significant loss in the quality of life unless it is reconstructed successfully. The aim of present case series report is to show the results of the multidisciplinary treatment of patients with advanced stage ameloblastoma, including tumor resection, simultaneous reconstruction with iliac crest flap, followed by placement of endosseous dental implants, and finally the prosthodontic rehabilitation.

Localized ridge augmentation using autogenous block bone graft followed by dental implant placement

The placement of endosseous dental implants is often hampered by unfavourable anatomy of the alveolar bone. Most frequently patients lose their teeth due to alveolar bone loss, tooth extraction; trauma and long term use of removable appliances tend to lose the bone making it difficult for the placement of implant in an optimal prosthetic position. The loss of width of the residual alveolar ridge necessitated measures which could refurbish the lost dimensions. Here we report the successful management of such a condition wherein placement of implant was made possible by placement of autogenous bone block graft obtained from the mandibular symphysis region and predictable osseointegration thus achieved.

Fibula Free Flap With Endosseous Implants for Reconstructing a Resected Mandible in Bisphosphonate Osteonecrosis

Bisphosphonates are a class of drugs with several uses. Primarily, they are used to treat bone metastases, multiple myeloma, Paget's disease, and osteoporosis. However, the use of bisphosphonates can lead to osteonecrosis of the jaws. Here, we present our experience treating this widely discussed disease. We describe a patient who underwent surgical reconstruction of the mandible with a fibula free flap after total mandibulectomy, performed to treat osteonecrosis induced by the use of intravenous bisphosphonates complicated by a mandibular fracture. Endosseous implants were inserted simultaneously to optimize the length and outcome of surgery. Osteonecrosis of the jaws is a treatment challenge, and several approaches have been suggested. In this patient, the use of a fibula free flap to reconstruct the mandible was a winning strategy. The patient is now free from disease, and the esthetic results were optimal. With the simultaneous placement of endosseous dental implants, the functional outcome was optimal, with no significant complications or recurrence.

Poster 135: Alveolar Ridge Augmentation Utilizing Demineralized Bone Matrix Allograft

Freeze dried demineralized bone products have been used for augmentation of alveolar ridge defects for years with varying success. Defect location and barrier membrane material have been identified as variables which affect the success of a particular graft. The aim of this study was to evaluate the efficacy of a demineralized bone matrix allograft to augment various types of ridge defects for the placement of endosseous dental implants. Four hundred forty-nine ridge augmentations in 364 patients using demineralized bone matrix block impregnated with cortical chips, demineralized bone matrix paste or a combination of both were evaluated. Buccal and crestal ridge augmentations were performed in areas of insufficient alveolar bone height and width to allow an acceptable restorative position and primary stability of an endosseous dental implant. The augmentations also utilized a combination of barrier materials. The extent of buccolingual regeneration was deemed a “success” if implants of at least 4.1 mm diameter could be placed into the proposed site with at least 1 mm of facial/buccal bone thickness. Placement of a 4.1 mm diameter implant that required “patch” augmentation of a cervical dehiscence to achieve a buccal or facial bone thickness of at least 1mm was deemed a “partial success”. A “failure” occurred when a 4.1 mm diameter implant could not be placed in a desired location due to lack of osseous coverage of at least 1 mm over the implant surface. Apico-occlusal regeneration was a “success” if at least 8 mm of ridge height was achieved to provide long term support of the planned prosthesis. n/a Implants were successfully placed in 379 of 449 sites (84.4%). An additional 49 of 449 sites (10.9%) required patch grafting. Overall, 428 of 449 sites (95.3%) had implants placed with acceptable stability. This means 21/449 (4.7%) of the graft sites required additional grafting procedures prior to implant placement. A marked difference in success/partial success rate was also noted with the use of a barrier membrane (96.9%) versus no membrane (90.8%). The results of this study would suggest demineralized bone matrix is an effective material to augment alveolar bone height and width, especially in conjunction with a barrier membrane.

Bone reconstruction following implantation of rhBMP‐2 and guided bone regeneration in canine alveolar ridge defects

Alveolar ridge aberrations commonly require bone augmentation procedures for optimal placement of endosseous dental implants. The objective of this study was to evaluate local bone formation following implantation of recombinant human bone morphogenetic protein-2 (rhBMP-2) in an absorbable collagen sponge (ACS) carrier with or without provisions for guided bone regeneration (GBR) as potential treatment modalities for alveolar augmentation. Surgically induced, large, mandibular alveolar ridge saddle-type defects (2 defects/jaw quadrant) in seven young adult Hound dogs were assigned to receive rhBMP-2/ACS, rhBMP-2/ACS combined with GBR (rhBMP-2/GBR), GBR, and surgery controls. The animals were euthanized at 12 weeks post-surgery when block sections of the defect sites were collected for histologic analysis. Clinical complications included swelling for sites receiving rhBMP-2 and wound failure with exposure of the barrier device for sites receiving GBR (4/6) or rhBMP-2/GBR (3/7). The radiographic evaluation showed substantial bone fill for sites receiving rhBMP-2/ACS, rhBMP-2/GBR, and GBR. In particular, sites receiving rhBMP-2/GBR presented with seroma-like radiolucencies. The surgery control exhibited moderate bone fill. To evaluate the biologic potential of the specific protocols, sites exhibiting wound failure were excluded from the histometric analysis. Sites receiving rhBMP-2/ACS or rhBMP-2/GBR exhibited bone fill averaging 101%. Bone fill averaged 92% and 60%, respectively, for sites receiving GBR and surgery controls. Bone density ranged from 50% to 57% for sites receiving rhBMP-2/ACS, GBR, or surgery controls. Bone density for sites receiving rhBMP-2/GBR averaged 34% largely due to seroma formation encompassing 13% to 97% of the sites. rhBMP-2/ACS appears to be an effective alternative to GBR in the reconstruction of advanced alveolar ridge defects. Combining rhBMP-2/ACS with GBR appears to be of limited value due to the potential for wound failure or persistent seromas.