Maxillary Posterior Area Research Articles

Histologic and clinical evaluation for maxillary sinus augmentation using macroporous biphasic calcium phosphate in human

This study evaluated both the clinical and histological aspects of bone formation in maxillary sinus augmentation using MBCP as the bone-grafting material. MBCP was used as a primary bone substitute for maxillary sinus augmentation. Fifty-two patients were selected after a medical and dental examination, and were divided into the following three groups: those augmented with MBCP only; MBCP combined with irradiated cancellous bone; and MBCP combined with intraoral autogenous bone. After a healing period (average 6.78 months after surgery), bone cores were harvested for a histological evaluation and the implant fixtures were installed. These bone cores were evaluated via light microscope and implants were followed up for at least six months after loading. Four to ten months after surgery, new vital bone surrounding the MBCP particles was observed in 18 bone biopsies. Two out of the 130 implants installed were explanted due to a failure of osseointegration before the prosthetic procedure. All the remaining implants were functioning for 6 to 27 months (average 12.96 months). The cumulative survival rate of the implants was 98.46%. These results show that MBCP can be used as a grafting material for sinus floor augmentation, whether combined with other bone graft materials or not, and lead to a predictable prognosis for dental implants in the posterior maxillary area where there is insufficient vertical height for fixture installation.

Sinus augmentation using human mesenchymal stem cells loaded into a β-tricalcium phosphate/hydroxyapatite scaffold

Implant placement in the posterior maxilla may often be contraindicated because of insufficient bone volume and presence of the maxillary sinus. In these situations, sinus floor augmentation frequently has been proposed as the best treatment. This clinical study was based on the hypothesis that the clinical effectiveness of adult mesenchymal stem cells (MSCs) loaded to the biphasic scaffold. In this report, the clinical and radiographic results are presented on 6 consecutively treated patients using MSCs in combination with biphasic hydroxyl apatite/ beta-tricalcium phosphate (HA/TCP) for sinus elevation. All the patients in the study had less than 3 mm initial bone height in the posterior maxillary area (IBH). MSCs were cultured and expanded from bone marrow aspirate for each patient. Three months after sinus elevation, radiographic evaluation was performed for the patients and the secondary bone height was measured (SBH(1)). In the second stage surgery, 30 implants were placed. Trephine bur was used as a pilot drill and a core biopsy was obtained from each implant site. Prosthetic rehabilitation of the patients was performed after 4 months. Secondary bone height was measured 9 months after implant placement (SBH(2)). Of 30 implants, 28 (93%) were considered clinically successful. Two implants were removed due to mobility at the time of surgical exposure. Histologic evaluation of the biopsy specimens revealed numerous areas of osteoid and bone formation HA/TCP, with no evidence of inflammatory cell infiltrate. Mean bone regenerate was 41.34%. Clinically, no complications were observed, and all implants were considered clinically osseointegrated after 4 months. Mean bone height was measured 3 and 12 months after sinus grafting (mean of SBH(1)= 12.08 mm and mean of SBH(2)= 10.08 mm). These clinical and histological findings suggest that sinus grafting with HA/TCP in combination with MSCs provide a viable therapeutic alternative for implant placement. The findings suggest that the addition of MSCs to bone derivative/substitute materials may enhance bone formation in the maxillary sinus area. Of course more studies with the control groups are needed for the evaluation of this method as a clinical solution for the patients.

Proximal Tibial Bone Harvesting Under Local Anesthesia Without Intravenous Sedation in the Dental Office: A Case Report

Maxillary sinus enlargement often occurs in the maxillary posterior edentulous area and reduces the available bone height for implantation. Therefore, maxillary sinus lift and bone graft procedures are necessary to provide sufficient available bone. Autogenous bone grafting is the best base for implant osseointegration. Recently, tibial bone has been recognized as an alternative extraoral donor site. We present a case in which we used a proximal tibia bone graft for maxillary sinus augmentation under local anesthesia without sedation in the dental office. During a 4-year postoperative follow-up, gait was not disturbed and the scar on the donor site remained unremarkable.

A modified free gingival graft technique for the treatment of oro-antral sinus track: A case report

Purpose: Surgical intervention into the maxillary posterior area can lead to inadvertent communication with the maxillary sinus. Spontaneous healing of 1 to 2 mm openings can occur. However, in patients with larger oro-antral communications and those with a history of sinus disease, surgical closure is often indicated. Materials and Methods: In this case, a modified free gingival graft technique was used. The oro-antral sinus track after extraction was about 2×4 mm. But the patient had a history of Caldwell-Luc operation. Immediately after extraction, a modified free gingival graft was used for the closure of oro-antral sinus track. Result: A modified free gingival graft technique was successfully used for the closure of oro-antral sinus track. With this technique, esthetic results including similar colors, textures were achieved. Conclusion: It is thought that this technique is very useful in the closure of oro-antral sinus track. (J Korean Acad Periodontol 2008;38:109-114)

Comparison of implant survival rate by sinus lifting technique in implantation with sinus lift

Purpose: The purpose of this study was comparison of survival rate of implant as two sinus elevation techniques and when window opening procedure had done it was comparison of survival rate of implant between the procedure of implantation after 6 month of sinus elevation to allow healing period and that of implantation with sinus elevation simultaneously. Material and Methods: All 79 of patients treated at DanKook University Dental Hospital Dept. of Periodontics for 164 implantation of maxillary posterior edentulous area with sinus elevation. Sinus elevation technique was divided of the technique : Osteotome technique and window opening technique. Result: 14 implants among 96 implants was failed implants of using osteotome for sinus elevation whereas one implant of 68 implants was failed of using window opening technique. Conclusion: Window opening technique had higher survival rate than osteotome technique. In case of window opening, there was no significant difference of immediate implantation and delayed implantation. (J Korean Acad Periodontol 2008;38:445-452)

Internal Sinus Manipulation (ISM) Procedure: A Technical Report

The sinus augmentation procedure has facilitated dental implant treatment in the posterior maxilla where there is insufficient bone for implant placement. A modified Caldwell-Luc, lateral window technique can be applied in most cases needing sinus augmentation in order to create a larger bone volume. However, treatment morbidity can be a concern, especially in the form of postoperative swelling due to surgical trauma. Vertical augmentation using osteotomes has also been selected as a choice of treatment due to less invasive surgery and less postoperative trauma. Although the osteotome technique enables the surgeon to raise the sinus membrane internally through an implant osteotomy site, the quantity and predictability of bone augmentation can be limiting due to the elasticity of the Schneiderian sinus membrane, difficulty of the membrane to separate from the floor as well as the inability to have direct tactile access to "peel" the membrane off of the floor. The objective of this report is to present a new, minimally invasive sinus augmentation technique, called the Internal Sinus Manipulation (ISM) procedure, which has been developed to facilitate sinus floor augmentation while reducing treatment morbidity and yet have direct tactile access to raise the membrane off of the sinus floor. Access to the Schneiderian sinus membrane is achieved without perforation of the membrane through a conventional osteotomy drilling procedure alone or combined with osteotome technique, followed by reflection of the membrane utilizing special ISM instrumentation and bone graft procedure laterally and vertically through the osteotomy site. A planned implant is then placed. The Internal Sinus Manipulation procedure can be used as an alternative treatment modality for sinus augmentation as compared to the external lateral window technique while reducing postoperative morbidity for the patients who need implant treatment in posterior maxillary areas.

Evaluation of clinical results on osteotome sinus floor elevation and dental implant placement (122 cases report)

To evaluate the clinical results of osteotome sinus floor elevation technique in the posterior maxillary region. A total of 122 patients underwent osteotome sinus floor elevation from July 1998 to July 2004. Forty-eight cases were male and 74 were female. The mean age was 46.5 years (between 20 and 69). A total of 157 implants were placed and restored. The mean follow-up time was 29.7 months (between 14 and 84 months). Clinical examination and radiographs were conducted. All the patients with 8 - 11 mm height of residual bone in the posterior maxilla underwent sinus floor elevation and implant placement using osteotome without any bone grafts simultaneously. The elevation height was 2 - 5 mm. Healing abutments were connected at the same time of implant placement with insertion torque over 0.25 N.m and the final prostheses were restored after 3 - 4 months. Implants were submerged if the insertion torque was less than 0.25 N.m. Second-stage operation was conducted 3 - 4 months later and the implants were restored afterwards. Sinus membrane perforation was observed in 12 cases, no sinus complication was observed during the follow-up. All of the 157 implants gained osteointegration and were restored. No implant lost was observed during the follow-up. All the patients were satisfied with the final prostheses. Osteotome sinus floor elevation without any bone graft was a predictable and safe technique. It could be used in the maxillary posterior area implant placement with residual bone volume of 8 - 11 mm.

A 7-year Follow-up of 93 Immediately Loaded Titanium Dental Implants

Recently, several experimental and clinical investigations found that immediately loaded implants obtained satisfactory levels of osseointegration with high success percentages. Only a few long-term studies of immediately loaded implants have been reported in the literature. The aim of this study was a 7-year clinical and radiographic follow-up of 93 immediately loaded dental implants in human patients. Eleven patients were consecutively enrolled in this study. A total of 7 full and 9 partial edentulous arches were rehabilitated. Patients presented a completely edentulous mandible (n=6), a completely edentulous maxilla (n=1), mandibular posterior edentulous areas (n=5), or a posterior maxillary edentulous area (n=1). Patients were rehabilitated with a bar and an overdenture (n=4), a provisional prosthesis of 3 to 12 elements (n=11), or a metal-ceramic bridge of 10 elements (n=1). A total of 93 implants were inserted and loaded within a 24-hour time frame. Six implants failed in the first year after loading. No more failures were observed in the following 6 years, and all the other implants were well integrated from a clinical and radiographic point of view. The cumulative success rate at 7 years was 93.5%, and the prostheses survival rate was 98.5%. The mean marginal bone loss was 0.6 mm after the first year and 1.1 mm at the 7-year evaluation. Primary stability is one of the most important parameters in immediately loaded implants because it avoids micromotion at the bone-implant interface. Four of the 6 failures in our patients occurred in partially edentulous patients; an excessive load applied to these small bridges could be the reason for the failure. Also, the bone quality is important, for 3 of our failed implants had been inserted in D3 bone. Our clinical and radiographic results have shown that these immediately loaded implants have remained osseointegrated for a long period. Our results point to the possibility of using the immediate loading technique in selected and well-informed cases.

Histologic evaluation of a 12-year-old threaded hydroxyapatite-coated implant placed in conjunction with subantral augmentation procedure: a clinical report

This clinical report presents a histologic evaluation of a threaded hydroxyapatite-coated root-form implant retrieved from the posterior maxillary area of a patient after being in function for 12 years. The implant had been placed in conjunction with subantral augmentation. Histologically, the portion of the implant that was examined under light microscopy appeared to be integrated with the surrounding bone; 74.3% of the surface of the implant had close bone apposition at the interface. The residual graft particles were present and in close proximity to the implant surface. These observations suggest that subantral augmentation procedure performed simultaneously with the placement of a hydroxyapatite-coated implant by using hydroxyapatite as a graft material may result in osseointegration between the implant and the surrounding bone that can be maintained under long-term function.

Head and neck pain review: traditional and new perspectives.

A variety of conditions are frequently associated with the occurrence of head and neck pain. The purposes of this review are: to describe the characteristics of several musculoskeletal, neurological, and systemic conditions frequently cited as possible causes of head and neck pain and to suggest a new technique for treating head and neck pain. The characteristics of musculoskeletal conditions, such as muscle spasm, tendinitis, trigger points, and joint inflammation, and their relationship to head and neck pain are considered. The features and clinical implications of neurologic conditions, such as atypical facial pain, trigeminal and glossopharyngeal neuralgia, reflex sympathetic dystrophy, and neurogenic inflammation, are also described. The distinguishing characteristics of headaches, including cluster, tension, chronic daily, rebound, posttraumatic, and postlumbar puncture, are detailed. This review also addresses the contributions of systemic disorders, such as osteoarthritis, rheumatoid arthritis and the variants, and rheumatoid-related conditions, like dermatomyositis, temporal arteritis, Lyme's disease, and fibromyalgia, to head and neck pain. The results of a recent pilot study of the effectiveness of intraoral circulating ice water for resolving symptoms related to head and neck pain secondary to neurogenic inflammation are presented in this work. Ice water circulating through hollow metal tubes was placed intraorally for 15 minutes in the posterior maxillary area on 12 individuals with cervical pain and muscle spasm. In nine of these individuals, reduced cervical pain perception, upper trapezius electromyography signal reduction, and increased cervical range of motion was produced. Six out of 12 individuals had accompanying headache, which was reduced or eliminated in four cases. These findings suggest a strong trigemino-cervical relationship to neck pain and headache.

Periapical biopsy report: An analysis over a 10-year period

Biopsy reports of specimens from the apices of 1659 teeth physically present at the time the biopsy was performed were reviewed. The following information was recorded from each report: (a) source of specimen, (b) sex of patient, (c) age of patient, (d) location of tooth associated with lesion, and (e) diagnoses reported. Data were recorded and analyzed by chi-square analysis to note significant differences. This study found that 52% of the lesions were granulomas, 42% cysts, 2% periapical scars, and 4% other disorders. No differences were found between males and females in regard to age and location of lesions. Overall, the most common location for lesions was the maxillary anterior, followed by maxillary posterior, mandibular posterior, and finally the mandibular anterior jaw. This also was the case for all age ranges except 60 to 69 yr of age where lesions in the maxillary posterior area were most common. More granulomas were detected in all areas except in the mandibular posterior area where cysts were more common.

Posterior tooth size, body size, and diet in South African gracile Australopithecines.

AbstractA model relating relative size of the posterior teeth to diet is suggested for forest and savanna primates and Homo. Relative tooth size is calculated for the South African gracile australopithecine sample using posterior maxillary area sums and size estimates based on four limb bones. A number of limbs were shown to be non‐hominid. Comparisons show the South African gracile sample apparently adapted to a very heavily masticated diet with relative tooth size significantly greater than any living hominoid. Periodic intensive utilization of grains and roots combined with scavenged animal protein are suggested as the most likely dietary reconstruction.