Placement Of Endosseous Implants Research Articles

Reconstruction of the Shallow Vestibule Edentulous Mandible With Simultaneous Split Thickness Skin Graft Vestibuloplasty and Mandibular Endosseous Implants for Implant-Supported Overdentures

To evaluate the long-term outcome of simultaneous split thickness skin graft (STSG) vestibuloplasty and endosseous implant placement for implant-supported overdentures in patients with shallow mandibular vestibules. This was a retrospective evaluation of 13 consecutive white male patients who underwent simultaneous mandibular vestibuloplasty with STSG combined with placement of 2 to 4 mandibular endosseous implants for construction of an implant-supported mandibular overdenture with a minimum of 2-year follow-up. Patients' charts were evaluated for implant survival and prosthetic success. Thirteen male patients at an average age of 60.4 years who had undergone simultaneous STSG mandibular vestibuloplasty and endosseous implant placement in the anterior mandible, were followed for an average of 43 months and were retrospectively evaluated. A total of 40 implants (average of 3 implants per patient) were placed in the anterior mandible in preparation for an implant-supported overdenture placement. There were no complications in graft or recipient sites, implant placement, or overdenture construction. The endosseous dental implant integration rate was 97.5% and the prosthetic success rate was 100%. Simultaneous STSG mandibular vestibuloplasty for vestibular lengthening and placement of mandibular endosseous implants in preparation for mandibular implant-supported overdentures is a reliable method in patients with shallow mandibular vestibules.

The Use of Laser Technology (Er;Cr:YSGG) and Stereolithography to Aid in the Placement of a Subperiosteal Implant: Case Study

The use of laser technology has helped this clinician to provide treatment with less postoperative pain and increased healing. The subperiosteal implant is a modality that has been used for several decades, although its popularity has declined in favor of endosseous dental implants. In some instances, however, it remains the treatment of choice, specifically in the atrophic mandible (where placement of endosseous implants is not possible) or when placement would increase the chances of jaw fracture. This article reports the case of a patient rehabilitated using a simplified surgical protocol involving laser surgery and stereolithography.

Clinical and Histomorphometric Evaluation of Staged Approach Using Bone Augmentation and Autogenous Masticatory Mucosal Graft With Endosseous Implant Placement: A Case Report

Various materials have been used to prevent or minimize ridge collapse after tooth extraction in an attempt to improve implant placement. However, there is no report evaluating the effect the additional autogenous masticatory mucosal graft (free gingival graft [FGG]) on the maturation of the grafted area. A patient who presented with a missing area with prior bone-augmentation procedure was treated with FGG. The additional procedure of FGG performed well as a soft tissue barrier for frenal pull, and the underlying bone showed good healing maturity with a high percentage of new bone formation.

Particulate Inlay Nasal Graft With Immediate Dental Implant Placement in a Patient With Repaired Alveolar Cleft: Case Report

Primary bone grafts in congenital cleft alveolus do not always provide sufficient bulk or height of bone for ideal placement of endosseous implants. Thus, maxillary sinus or nasal floor elevation and inlay bone grafts in previously grafted areas are not exceptions in the daily routine. This case report stresses the need of a detailed treatment plan and careful surgical management of nasal floor elevation with particulate autogenous bone graft to successfully provide the patient with osseointegrated prostheses.

O.185 Functional outcomes in oral reconstructions with ALT

The anterior maxillary osteoplasty restores adequate bone to the edentulous Class IV ridge prior to placement of endosseous implants. The aim of this retrospective study was to compare the long-term survival of implants placed into the particulate bone of an anterior alveolar osteoplasty to those placed into a ‘block’ onlay bone graft. Of 85 patients with Class IV ‘knife-edge’ alveolar ridges, 50 received interpositional particulate bone via an alveolar osteoplasty and 35 received an onlay cortico-cancellous graft. A total of 386 implants were placed as a secondary procedure and followed postoperatively (mean 6 years; 39 failures). There was improved cumulative survival of implants placed into the particulate bone of an osteoplasty compared to the block bone of an onlay graft. Implants supporting a fixed superstructure had a longer cumulative survival than those supporting a removable appliance. There was no statistical difference between implants placed into male and female bone, or between those in edentulous and partially dentate jaws. Within a partially dentate jaw there was a statistically significant increase in cumulative survival for implants within osteoplasty inlay bone compared to onlay bone grafts. Anterior osteoplasty is the surgical treatment of choice for augmentation of the resorbed Class IV alveolar ridge prior to placement of osseo-integrated implants.

Clinical Evaluation of Endosseous Implants in Radiated Fibula Bone Grafts

Purpose: Fibula free flap reconstruction with following placement of endosseous implants became a gold standard of reconstruction after mandible resection. Many patients had radiation to the area and there is little available data in the literature about the success of osteointegration in the irradiated fibula. The goal of this study is to evaluate implant success in radiated fibula flaps and mandibles after oral cancer resection.

Clinical and Histologic Assessment of Lateral Alveolar Ridge Augmentation Using a Synthetic Long‐Term Bioabsorbable Membrane and an Allograft

Guided bone regeneration (GBR) is a widely used procedure for augmenting alveolar ridge width prior to placement of endosseous implants. Various graft materials and barrier membranes (non-resorbable and bioabsorbable) have been used in GBR. The aim of this study was to assess the performance of a new bioabsorbable, synthetic polyglycolic acid/trimethylene carbonate (PGA/TMC) barrier membrane with an increased absorption time in conjunction with a combination of assayed demineralized bone matrix and cortical cancellous chips uniformly dispersed in a thermoplastic biologic carrier. At 72 potential implant sites in 38 subjects, ridge width at the crest and 4 mm apical to the crest was measured before and 6 months after a GBR procedure using the long-term (LT) PGA/TMC membrane and an allograft in a thermoplastic carrier. Before placement of endosseous implants, 48 biopsy specimens were obtained from the augmentation sites and analyzed histomorphometrically. The GBR procedure increased the mean ridge width at the crest from 2.4 to 5.2 mm. This 216% change from baseline was significant (P <0.001). The mean width 4 mm apical to the crest increased from 4.4 to 7.5 mm, a significant (P <0.001) 174% change. The histomorphometric analysis showed that the biopsy specimens consisted, on average, of 57% bone (36% graft material and 21% new bone) and 43% soft tissue and space. Our findings suggest that the LT PGA/TMC barrier membrane, used in conjunction with an allograft, provides lateral alveolar ridge augmentation comparable to that achieved with other materials without the necessity for bone-graft harvesting or a second procedure to remove the barrier membrane.

Ten years of experience with the anterior maxillary and mandibular osteoplasty (class IV ridges): a retrospective analysis of implant survival rates

The anterior maxillary osteoplasty restores adequate bone to the edentulous Class IV ridge prior to placement of endosseous implants. The aim of this retrospective study was to compare the long-term survival of implants placed into the particulate bone of an anterior alveolar osteoplasty to those placed into a ‘block’ onlay bone graft. Of 85 patients with Class IV ‘knife-edge’ alveolar ridges, 50 received interpositional particulate bone via an alveolar osteoplasty and 35 received an onlay cortico-cancellous graft. A total of 386 implants were placed as a secondary procedure and followed postoperatively (mean 6 years; 39 failures). There was improved cumulative survival of implants placed into the particulate bone of an osteoplasty compared to the block bone of an onlay graft. Implants supporting a fixed superstructure had a longer cumulative survival than those supporting a removable appliance. There was no statistical difference between implants placed into male and female bone, or between those in edentulous and partially dentate jaws. Within a partially dentate jaw there was a statistically significant increase in cumulative survival for implants within osteoplasty inlay bone compared to onlay bone grafts. Anterior osteoplasty is the surgical treatment of choice for augmentation of the resorbed Class IV alveolar ridge prior to placement of osseo-integrated implants.

Results of Maxillary Sinus Lift and Maxillary Sinus Floor Elevation with Osteotome for Endosseous Implant Placement

Results of Maxillary Sinus Lift and Maxillary Sinus Floor Elevation with Osteotome for Endosseous Implant Placement

The Challenge of Implant Therapy in the Posterior Maxilla: Providing a Rationale for the Use of Short Implants

Rehabilitating patients with a resorbed maxilla presents several challenges when the desired treatment plan involves the placement of endosseous implants. Correct diagnosis requires knowledge on jaw healing patterns, systemic effects, and the impact of bone quality changes on implant success rates. Appropriate treatment planning requires an in-depth understanding of the materials and methods available to the contemporary implant surgeon. The clinician must be able to persist on evidence-based techniques and adhere to those proven methods. Successful surgical placement requires correct use of the available armamentarium and acceptance of the limitations that implant dentistry still presents. Especially challenging is the implant treatment of maxillary molars due to the plethora of complicating factors such as limited bone availability, interarch space challenges, sinus problems, etc. These are just a few of the factors that may lead us to placement of short implants in these sites. An extensive review of the literature that is available for short implants (implants < 10 mm in length) indicates that although they are commonly used in areas of the mouth under increased stress (posterior region), their success rates mimic those of longer implants when careful case selection criteria have been used. The available studies and case-series offer a valid rationale for placement of short implants so long as one understands the limitations, indications, risk factors, and limited studies that actually follow-up success rates of short implants for over 5 years. This review of the literature will provide the reader an in-depth view of the evidence in using short implants as an alternative treatment modality for the maxillary molar region.

Poster 166: Esthetic and Functional Reconstruction Using Implants in a Patient With Alveolar Clefts

Statement of the ProblemA residual alveolar cleft represents an obstacle for rehabilitation of a dental arch. As a solution, implants with an autogenous bone graft have been suggested for dental reconstruction in alveolar clefts patients. Insufficient interdental alveolar bone height and aesthetic issues seem to be limiting factors in the clinical use of this procedure. This report suggested that superior results can be obtained for esthetic and functional reconstruction using implants with alveolar clefts.Materials and MethodsThe patient was born with a congenital bilateral complete cleft and palate. A closure of the left cleft lip was completed at 4 months of age, the right was completed at 8 months, and the palatal cleft was closed at 1 year 9 months. The patient underwent right alveolar bone grafting at the age of 22 years and left alveolar bone grafting at 23 years. After bony bridge formation became a base, the patient underwent veneer grafting after 6 months to insert implants. The implants were inserted with bone grafting after 3 months.Method of Data AnalysisFindings after surgery demonstrated well maintained interdental bony height and width in the premaxilla. The results indicated that osseointegrated implants combined with bone grafting are more reliable than conventional procedures for occlusal reconstruction in patients with alveolar cleft.ResultsFor general treatment of alveolar cleft, we obtained superior results in respect esthetics and configuration. The results here suggested that the placement of implants can be successfully carried out in grafted alveolar clefts.ConclusionPlacement of endosseous implants in grafted alveolar clefts. Statement of the ProblemA residual alveolar cleft represents an obstacle for rehabilitation of a dental arch. As a solution, implants with an autogenous bone graft have been suggested for dental reconstruction in alveolar clefts patients. Insufficient interdental alveolar bone height and aesthetic issues seem to be limiting factors in the clinical use of this procedure. This report suggested that superior results can be obtained for esthetic and functional reconstruction using implants with alveolar clefts. A residual alveolar cleft represents an obstacle for rehabilitation of a dental arch. As a solution, implants with an autogenous bone graft have been suggested for dental reconstruction in alveolar clefts patients. Insufficient interdental alveolar bone height and aesthetic issues seem to be limiting factors in the clinical use of this procedure. This report suggested that superior results can be obtained for esthetic and functional reconstruction using implants with alveolar clefts. Materials and MethodsThe patient was born with a congenital bilateral complete cleft and palate. A closure of the left cleft lip was completed at 4 months of age, the right was completed at 8 months, and the palatal cleft was closed at 1 year 9 months. The patient underwent right alveolar bone grafting at the age of 22 years and left alveolar bone grafting at 23 years. After bony bridge formation became a base, the patient underwent veneer grafting after 6 months to insert implants. The implants were inserted with bone grafting after 3 months. The patient was born with a congenital bilateral complete cleft and palate. A closure of the left cleft lip was completed at 4 months of age, the right was completed at 8 months, and the palatal cleft was closed at 1 year 9 months. The patient underwent right alveolar bone grafting at the age of 22 years and left alveolar bone grafting at 23 years. After bony bridge formation became a base, the patient underwent veneer grafting after 6 months to insert implants. The implants were inserted with bone grafting after 3 months. Method of Data AnalysisFindings after surgery demonstrated well maintained interdental bony height and width in the premaxilla. The results indicated that osseointegrated implants combined with bone grafting are more reliable than conventional procedures for occlusal reconstruction in patients with alveolar cleft. Findings after surgery demonstrated well maintained interdental bony height and width in the premaxilla. The results indicated that osseointegrated implants combined with bone grafting are more reliable than conventional procedures for occlusal reconstruction in patients with alveolar cleft. ResultsFor general treatment of alveolar cleft, we obtained superior results in respect esthetics and configuration. The results here suggested that the placement of implants can be successfully carried out in grafted alveolar clefts. For general treatment of alveolar cleft, we obtained superior results in respect esthetics and configuration. The results here suggested that the placement of implants can be successfully carried out in grafted alveolar clefts. ConclusionPlacement of endosseous implants in grafted alveolar clefts. Placement of endosseous implants in grafted alveolar clefts.

11th International Dental Congress on Modern Pain Control The Essential Role of Dental Anesthesiology in the 21st Century Safe and Comfortable Dentistry 4th–7th October, 2006

11th International Dental Congress on Modern Pain Control The Essential Role of Dental Anesthesiology in the 21st Century Safe and Comfortable Dentistry 4th–7th October, 2006

Immediate Placement of Dental Implants Into Debrided Infected Dentoalveolar Sockets

To describe a protocol for the immediate placement of endosseous implants into debrided infected dentoalveolar sockets. A total of 30 implants were immediately placed into debrided infected sites in 20 patients. The pathology at the receptacle dentoalveolar sockets varied, and included subacute periodontal infection, perio-endo infection, chronic periodontal infection, chronic periapical lesion, and a periodontal cyst. The immediate placement protocol emphasized the meticulous debridement of the infected tissues in combination with peripheral ostectomy of the alveoli. Guided bone regeneration was accomplished to support bony healing of alveolar defects surrounding the implantation site. Pre- and postsurgical antibiotic therapy was administered. All implants but 1 were osseointegrated and functional when followed up after 12 to 72 months. One implant was mobile after its immediate restoration and was removed. Complications were related to the use of guided bone regeneration. Deficiency of the attached gingiva was noted in 1 case. The treatment approach is illustrated in 2 anterior maxilla cases with 3-year follow-up. Successful immediate implantation in debrided infected alveoli depends on the complete removal of all contaminated tissue and the controlled regeneration of the alveolar defect. With this proposed clinical approach, experienced clinicians may consider immediate implants as a viable treatment option in patients presenting with dentoalveolar infections.

Alveolar Zygomatic Buttress: A New Donor Site for Limited Preimplant Augmentation Procedures

Augmentation of anterior maxillary alveolar bone defects before placement of endosseous implants still poses a clinical challenge. Previous traumatic loss of upper anterior teeth is often concomitant with significant bone loss. The aim of augmentation is to reconstitute as far as possible the original hard tissue contour. This is a prerequisite for later optimal positioning of the dental implants in accordance with prosthodontic and functional principles. This article describes a new method for the reconstruction of small anterior maxillary alveolar bone defects using donor bone from the zygomatic buttress region. This region provides harvested bone with a natural convex shape, which is ideally suited for the anterior alveolar process region. Later fibrous tissue transplantation to provide more anterior projection to the anterior dental area is also avoided. Bone harvesting was done with the piezoelectric device, which avoids trauma to the mucosal membrane of the maxillary sinus.

Dental implants placed in expanded narrow edentulous ridges with the Extension Crest® device

This study has been designed to evaluate the capability of a new surgical device (Extension Crest) to widen narrow edentulous alveolar ridges and to allow a correct placement of endosseous implants in horizontally atrophied sites. Forty-five patients, 20 males and 25 females, aged 20-66 years, affected by edentulism associated to horizontal resorption of the ridges, were treated by means of a sagittal osteotomy and expansion of the ridge with a new surgical device (Extension Crest) to obtain a wider bony base for ideal implant placement. In the same procedure in 33 patients, and 1 week afterwards in 12 patients, 110 endosseous titanium implants (ITI TE) were placed. Three to four months later, the patients were rehabilitated with implant-supported prostheses. The success rate of the expansion technique was 97.8%. A total of 110 implants were inserted in the expanded ridges. The mean follow-up after the start of prosthetic loading was 20.4 months. Three implants were removed before the start of prosthetic loading, because of non-integration, while no other implants failed after the completion of the prosthetic rehabilitation. Three implants, although integrated and in function, did not fulfill success criteria: cumulative success and survival rates at the end of the observation period were 95.4% and 97.3%, respectively. Within the limits of this study, this technique appeared to be reliable and simple, with reduction of morbidity and times of dental rehabilitation as compared with other techniques such as autogenous bone grafts and guided bone regeneration. Survival and success rates of implants placed in the treated areas are consistent with those placed in native bone.

Effects of the placement of endosseous implants in vascularized bone grafts on bone union in beagle dogs

Recently, reconstructive surgery with revascularized osteocutaneous flaps has been used to restore function in patients with bone defects caused by surgery for oral cancer. However, few basic studies have addressed problems such as the union of bone segments after osteotomy, the effects of dental implant placement on blood flow, and bone formation at the bone:implant interface in grafted bone. Nine adult beagle dogs were divided into three groups of three dogs each. Each group received osteotomized vascularized tibial grafts, osteotomized tibial grafts with implants (implants placed in contralateral limbs as control), or simple (non-vascularized) tibial grafts. The development of bone around the implants was studied by histological examination, contact micro-radiography (CMR), and fluorescent bone labeling. In the dogs receiving osteotomized vascularized tibial grafts, bone bridging was confirmed at both the medial and distal junctions of the bone segments after 4 weeks. Additional newly formed bone was observed after 8 weeks, and bone union at the surface of the segments was completed after 12 weeks. In contrast, bone formation was clearly delayed in dogs receiving simple (non-vascularized) tibial grafts. Histologically, no difference in bone union was evident between limbs with dental implants in tibial bone and control limbs without implants, suggesting that implant placement does not negatively affect revascularization. Fluorescent bone labeling technique confirmed high vascularity of the vascularized tibial bone grafts but not of the simple (non-vascularized) tibial bone grafts early after the procedure. Our results suggest that osseointegration occurred around dental implants placed at the same time as reconstruction with osteotomized vascularized bone grafts in this animal model.

An 8‐Year Retrospective Study: 1,100 Patients Receiving 1,557 Implants Using the Minimally Invasive Hydraulic Sinus Condensing Technique

For many clinicians, inadequate alveolar bone height and anatomical features of the maxillary sinus complicate sinus lift procedures and placement of endosseous implants. We present a new internal crestal approach that addresses these issues. Sinus burs and condensers of increasing width are used in conjunction with pliable atraumatic bone grafting mixture and hydraulic pressure from a surgical handpiece. The risk of a membrane perforation is minimized when the surgeon's tactile skill is administered in a two-stage process to first loosen and then graft bone particulate under the Schneiderian membrane. Threaded implants can then be placed in the same visit and secured via primary closure. A retrospective investigation of 1,100 cases showed that eight implants failed and 14 required longer healing periods in patients with alveolar ridge heights varying between <1 to 5 mm. Our experience suggests that hydraulic sinus condensing is a predictable and minimally invasive alternative for prosthetic rehabilitation of maxillary anterior and posterior regions in the presence of anatomical restrictions to implant placement.

Evaluation of the Adjunctive Benefits of Platelet-Rich Plasma in Subantral Sinus Augmentation

Subantral sinus augmentation is often necessary to permit placement of endosseous implants. Recent efforts to improve wound healing have focused on autogenous sources of bioactive mediators, such as platelet-rich plasma (PRP), which offer the potential to enhance the biological activity of bone replacement grafts. The purpose of this randomized, single-blinded, controlled study was to compare bone formation after subantral maxillary sinus augmentation with freeze-dried bone allograft (FDBA) plus PRP versus FDBA plus resorbable membrane. Ten patients underwent bilateral maxillary subantral sinus augmentation, with sites within subjects randomized to receive FDBA plus PRP or FDBA plus membrane. Core biopsy specimens were obtained 4.5 to 6 months after the grafting procedure at time of implant placement. Histomorphometric analysis revealed a significantly higher percentage of vital tissue in sinuses after treatment with FDBA and PRP (78.8 +/- 8.3) than with FDBA and membrane (63.0 +/- 15.7). Moreover, the percentage of bone formation in sinuses augmented with the combination of FDBA plus PRP (33.3 +/- 11.3) was nonsignificantly (P </= 0.10) higher than in sinuses grafted with FDBA plus membrane (26.5 +/- 6.8). Residual graft particles constituted a significantly higher percentage of the regenerate in sinuses treated with FDBA plus membrane than in sinuses augmented with FDBA plus PRP (37.0 +/- 15.7) versus (21.2 +/- 8.3, respectively). When comparing the relative proportion of vital bone to residual graft particles, a significant difference also was observed between sinuses treated with FDBA and membrane compared with sinuses augmented with FDBA and PRP (0.98 +/- 0.77 versus 1.82 +/- 0.88, respectively). The results of this study suggest that the combination of FDBA and PRP enhances the rate of formation of bone compared with FDBA and membrane, when used in subantral sinus augmentation. Future research is needed to determine the clinical significance and the cost- and risk-benefit considerations of the approach.

Hemorrhaging associated with endosseous implant placement in the anterior mandible: a review of the literature.

The placement of endosseous dental implants is largely considered a safe surgical procedure. However, upper airway obstruction secondary to severe bleeding in the floor of the mouth has been occasionally reported as a rare but potentially fatal complication of implant surgery. This review presents critical hemorrhagic episodes, related to dental implantation in the anterior segments of the mandible, published to date. Massive internal bleeding in the highly vascularized region of the floor of the mouth is the result of an arterial trauma induced by instrumentation, usually through a perforation of the lingual cortical plate. Depending on the clinical situation, hemorrhage may commence immediately or with some delay after the vascular insult. The progressively expanding lingual, sublingual, submandibular, and submental hematomas have the tendency of displacing the tongue and floor of the mouth to obstruct the airway. Because the course of airway deterioration to complete occlusion may be rapid, ensuring a patent airway is of highest priority. Even though upper airway obstruction is potentially life-threatening, a secure airway was successfully established in all patients without fatal consequences. In most cases, resolution of hemorrhage required a surgical intervention for ligation of the bleeding vessels and hematoma evacuation. To reduce the probability of such a grave complication, preventive and precautionary measures to be taken before, during, and after implant placement in the anterior mandible are presented. Issues related to the level of surgical experience, fine regional arterial anatomy, radiographic and clinical evaluation of the osseous morphology, angulation and length of implants, and timing of hemorrhage onset are discussed. In addition, airway and bleeding management strategies are provided.

Rhino-sinusitis related to endosseous implants extending into the nasal cavity: A case report

Rhino-sinusitis may develop as a result of an altered airflow in the nasal cavity causing irritation of the nasal mucosa. A patient is presented who developed recurrent rhino-sinusitis complaints following placement of endosseous implants in the maxilla. Inspection of the nasal floor revealed that two implants had perforated the floor of the nasal cavity. The part of the implants protruding in the nasal cavity was surgically resected via an endonasal approach whereupon the rhino-sinusitis complaints disappeared.