Residual Alveolar Bone Research Articles

The impact of antiplatelet and anticoagulant medications on early implant failure following sinus floor augmentation: A retrospective cohort analysis.

The effect of antiplatelet and anticoagulant medications on the outcomes of sinus floor augmentation remains unclear. This retrospective cohort study analyzed data from electronic medical records of consecutive patients undergoing sinus floor augmentation at a single medical center. Patients were categorized into three categories: patients under antiplatelet medications, patients under anticoagulation medications, and healthy individuals. Data collected included tobacco smoking, residual alveolar bone height, timing of implant placement, materials used, vertical bone gain, early implant failure (EIF), and complications such as Schneiderian membrane perforation and postoperative bleeding. Multivariable analysis was performed to assess risk factors for EIF. Statistical significance was considered below 5%. Among 110 patients with 305 implants, EIF occurred in 10% of patients and 4.65% of implants. No significant difference in postoperative bleeding or EIF was found between study groups. Univariate and multivariable analyses highlighted tobacco smoking (odds ratio [OR] = 7.92), lower residual alveolar ridge height (OR = 0.81), and staged implant placement (OR = 4.64) as significant EIF risk factors in this cohort. Anticoagulant and antiplatelet therapies do not significantly elevate the risk of EIF or postoperative bleeding following sinus floor augmentation. Tobacco smoking, residual alveolar ridge height and staged sinus floor augmentation were risk factors for EIF in patients using antiplatelet or anticoagulation medications undergoing sinus floor augmentation.

Fabrication and in vitro biological performance of a double-layered nanoparticles-microarc oxidation composite coating on titanium for dental implant application

Sufficient residual alveolar bone volume plays an important role in the success rate and service life of dental implants. However, alveolar bone deficiency is a common clinical phenomenon, and the alveolar bone would be further absorbed by peri-implant infection. Therefore, it is highly desirable to promote peri-implant alveolar bone regeneration and inhibit alveolar bone resorption when the alveolar bone mass is insufficient. For this purpose, a pH-sensitive double-layered nanoparticles-microarc oxidation (MAO) composite coating was fabricated on titanium for dental implant application in this study. The pH-sensitive double-layered nanoparticles were prepared by a poly(L-lactic acid) inner layer and a chitosan outer shell, containing stromal-cell derived factor-1, recombinant human bone morphogenetic protein 2 and osteoprotegerin. The composite coating was fabricated on MAO coating by cross-linking the pH-sensitive double-layered nanoparticles with gelatin. The surface morphology of the composite coating showed that the pH-sensitive double-layered nanoparticles were well distributed and tightly cross-linked in the pores of MAO coating. The composite coating could sustain release the three drugs for more than 30 days. With decreasing pH, the release of osteoprotegerin from the composite coating increased (p < 0.05). In vitro biological studies suggested that the composite coating exhibited no cytotoxicity, and can recruit bone marrow-derived mesenchymal stem cells (BMSCs), promote BMSC differentiation into osteoblasts, and inhibit osteoclast generation. Moreover, with decreasing pH, the inhibitory effect on osteoclast generation was enhanced (p < 0.05). It can be concluded that the fabricated composite coating, which can promote bone regeneration and inhibit bone resorption, has the potential to be applied on the surface of dental implant, especially when the residual alveolar bone is in poor condition.

Cone-beam CT evaluation of post-extraction alveolar bone changes at the maxillary incisor sites in an East Asian population: A cross-sectional study

ObjectiveUnderstanding the characteristics of alveolar bone resorption in an East Asian population after maxillary incisor extraction and providing a reference for implant treatment plans. Study designCone-beam computerized tomography (CBCT) data of 125 East Asian patients with unilateral extraction of maxillary incisors for 3 months were collected. The alveolar bone width and height in the extraction sites were measured and compared with the corresponding contralateral sites. ResultsThe differences in alveolar bone width between the extraction site and contralateral site were as follows: 4.11 mm, 2.68 mm, and 2.09 mm (3 mm, 5 mm, 7 mm apical from CEJ of the contralateral tooth). Data are expressed as the median. The horizontal resorption ratio of alveolar bone was 49.94 %, 31.5 %, and 24.46 %. The difference in alveolar bone height was 0.78 mm. The vertical resorption ratio was 7.78 %. The resorption did not differ significantly between sexes and was not significantly affected by tooth positions. ConclusionsIn the studied East Asian population, significant horizontal and vertical alveolar bone resorption occurs after natural healing of maxillary incisor extraction for 3 months. The closer to the alveolar ridge crest, the more significant the horizontal resorption, resulting in an “inverted triangle” shape residual alveolar bone.

The safety of maxillary sinus floor elevation and the accuracy of implant placement using dynamic navigation.

To date, it remains a challenge to conduct maxillary sinus floor elevation (MSFE) owing to heterogeneity of anatomical structures and limited operative visibility of the maxillary sinus. The aim of this study is to investigate the safety of MSFE and the accuracy of implant placement using dynamic navigation. Forty-two implants were placed in thirty-five patients requiring implantation in posterior maxilla with dynamic navigation. They were assigned to either lateral window sinus floor elevation (LWSFE) group (n = 22) or transcrestal sinus floor elevation (TSFE) group (n = 20) according to the residual alveolar bone height (RBH). Platform deviation, apex deviation and angular deviation between actual and planned implant placement were measured in precision evaluation software. Three deviations of two groups were compared via SPSS 22.0 software. Neither accidental bleeding nor perforation of Schneiderian membrane occurred in any patients. The actual window position of LWSFE was consistent with the preoperative design. There were no significant differences in platform, apex and angular deviations between the two groups (P > 0.05). In this study the dynamic navigation harvested clinically acceptable safety of MSFE and accuracy for implant placement in posterior maxillary region. The dynamic navigation would provide the clinician with assistance in achieving precise preoperative planning and reducing complications in surgical procedures. The granular bone grafts used in the LWSFE did not significantly affection on the accuracy of the simultaneous implant placement under the guidance of dynamic navigation.

Risk factors, Consequences and Treatment Alternatives of Schneiderian Membrane Perforation: Case Report and Review of the Literature

Maxillary sinuses are the greatest sinus cavities in the human cranium and they are the closest to the oral cavity. Thus, perforation of the Schneiderian membrane is a common complication that may be encountered during various oral surgery procedures in the molar and premolar regions of the maxilla such as teeth extractions, implant placement or sinus augmentation procedures. Membrane perforations lead to oroantral communications, which may later turn into oroantral fistulas. Moreover, these perforations may cause infections, loss of graft or implant if encountered during sinus augmentation procedures. The purpose of this review was to determine the risk factors associated with this complication and present the various treatment alternatives used to manage this type of complication. In the literature, the selected surgical technique, the thickness of the sinus membrane, the quality and quantity of the residual alveolar bone, the anatomy of the area and patients’ habits such as smoking were reported as points to be considered. A case of Schneiderian membrane perforation during implant placement and successful management of the complication was also presented.

Sufficiency of residual alveolar bone in terms of regions, age and gender in patients who underwent CBCT evaluation

Background: Alveolar bone resorption may complicate dental implantation of the edentulous area. The quantity of residual bone depends on the region, and it is uncertain which region may present more difficulties before implantation. In this study, the alveolar bones of patients who had cone beam computed tomography (CBCT) before dental implantation were examined, and residual bone was evaluated based on age, gender, and the location of the missing tooth. Methods: In this observational study, the patients with CBCT were divided into two age groups: 18 to 35 and 36 and older. Also, the edentulous regions were divided into incisor, premolar, and molar regions. Radiographic measurements were performed with a cross-sectional aspect in the single-tooth deficiency regions of the patients; bone height and width measurements were made. Results: This study included 164 CBCT scans from individuals (99 females and 65 males). There was no statistically significant difference between the bone heights and between bone widths at the 1st, 3rd, 5th, and 7th mm according to age or gender (P&gt;0.05). Bone height in the incisor tooth region (ITR) and bone width at the 1st, 3rd, 5th, and 7th mm in the molar tooth region (MTR) were significantly larger (P&lt;0.01). Conclusion: This study revealed that the bone width at the 1st mm of the ITR was insufficient for dental implant placement and that horizontal bone augmentation was needed.

Evaluation of Alveolar Bones in the Context of Orthodontic Single-Tooth Space Closure: A Retrospective Cone Beam Computed Tomography-Based Analysis

In the literature, there are no studies evaluating alveolar bone width in areas with a single missing tooth in terms of orthodontic tooth movement. This study was meant to determine whether residual alveolar bone width in edentulous crests is a risk factor for orthodontic tooth movement. The aim of this study was to evaluate the change in the residual alveolar bone width in the edentulous region compared to the alveolar bone width on the symmetrical toothed side using CBCT in individuals with a single missing tooth in whom orthodontic tooth movement was planned. This retrospective radiographic study was performed using CBCT images that were taken before orthodontic treatment for the evaluation of the edentulous area between January 2010 and January 2022. Individuals without any systemic disease aged 18 years or older whose edentulous area was restricted to one tooth were included in this study. Bone measurements were made on cross-sectional CBCT images. Of the 265 individuals participating in this study, 129 were male and 136 were female, with a mean age of 32.67 ± 6.50 years. The distribution of 265 edentulous regions (caused by 265 tooth extractions) was as follows: 23 were in the incisor region, 54 were in the premolar region, and 188 were in the molar region. The molar region had the highest bone width among the edentulous regions (p &lt; 0.01). Bone widths were smaller in the edentulous crests for all regions (p &lt; 0.01). In this study, it was determined that the bone width in the areas with a single missing tooth was insufficient, and this is a risk factor for orthodontic treatment.

Finite element analysis of the angle range in trans-inferior alveolar nerve implantation at the mandibular second molar

BackgroundTrans- inferior alveolar nerve (IAN) implantation technique was wildly used while the potential appropriate angle range in which the residual alveolar bone can bear the stress without absorption are currently unclear. This study aimed to evaluate the stress distribution pattern of the interface between bone and implant by finite element analysis (FEA) to determine the appropriate range of the implant tilt angle.MethodsCone beam computed tomography (CBCT) images of 120 patients with missing mandibular second molars and vertical bone height < 9 mm in the edentulous area were selected. The distances from the mandibular nerve canal to the buccal cortex, the lingual cortex and the alveolar ridge crest were measured by using a combination of software. The angular ranges of the buccal-lingual inclination of simulated trans-IAN implants were measured and three-dimensional finite element models were constructed in the mandibular second molar area according to the differences of the inclination angles. A vertical load (200N) was then applied to analyze the biomechanical conditions of the implant-bone interface during median occlusion.ResultsThe distance at the second molar from the nerve canal to the buccal cortex, lingual cortex and alveolar crest were 6.861 ± 1.194 mm, 2.843 ± 0.933 mm and 7.944 ± 0.77 mm. Trans-IAN implantation was feasible in 73.33% of patients. The minimum angle and maximum angles of the buccal-lingual inclination of the simulated implant were 19.135 ± 6.721° and 39.282 ± 6.581°. When a vertical static load of 200N was applied, the tensile stress in cortical bone gradually increased with the increase of the implant tilt angle. When the inclination angle reached 30°, the tensile stress (105.9 MPa) exceeded the yield strength (104 MPa) of cortical bone. Compared with the conventional implants, the stress peak value of the vertical ultra-short implant in cortical bone was greater than the stress peak value of the conventional implants at 10°(79.81 MPa) and 20°(82.83 MPa) and was smaller than the stress of the implant at 30°(105.9 MPa) and 40°(107.8 MPa). Therefore, when the bone mass allows, conventional-length implants should be selected whenever possible, and an operative range of the trans-IAN implantation in the mandibular second molar could be retained with an inclination angle of < 30°.ConclusionsThe mandibular nerve canal at the mandibular second molar was obviously biased to the lingual side, which ensured sufficient bone mass at the buccal side. In most patients with severe mandibular atrophy, it was possible to maintain a safe distance from the nerve canal with conventional-length implants via the trans-IAN implantation technique.

Morphometric Assessment of Alveolar Antral Artery Using Medical Computed Tomography.

This study aimed to investigate the prevalence, diameter, and position of the alveolar antral artery (AAA) in paranasal sinus computed tomography (CT) images and to correlate the location of the AAA with tooth position, the presence of teeth, and residual alveolar bone height (ABH). A retrospective study was conducted at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, from November 2016 to October 2021. CT images of 100 maxillary sinuses from 50 patients managed for modified endoscopic sinus surgery and sinus lifting by a single surgeon were selected and obtained from the Infinitt picture archiving and communication system radiology system (Infinitt Healthcare Co., Seoul, Korea). The location of the AAA in the lateral wall of the maxillary sinus was evaluated in correlation with the area of the first and second molars (M1 and M2), the presence of teeth, and the residual ABH. In this study, we found that the intraosseous type is the most common type of AAA. Furthermore, the location and distance of the AAA are significantly affected by tooth position, an edentulous state in the case of the first molar, and residual ABH. Pre-evaluation of the diameter, position, and distance to the AAA using CT images is essential to help prevent hemorrhage. The existence and wide range of the AAA distances based on the tooth position, edentulous state, and residual ABH should be considered even if CT imaging cannot locate the AAA.

Tooth supported overdentures: Procedure, problems &amp; solutions

Preservation of residual alveolar bone is one of the most challenging tasks in hands of a Prosthodontist. With Preventive Prosthodontics gaining popularity, all attempts are made to preserve the natural tooth structure. Overdentures have been a commonly used treatment option that helps in preservation of bone and maintains the proprioceptive sensory impulses. The treatment option has been widely exercised with implants as implant supported overdentures as well. The treatment modality has some inherent challenges and require proper deliberation and well executed treatment plan to avoid post insertion complications and ensure longevity of prosthesis. The article showcases two cases of tooth supported overdentures, some common problems, and possible solutions.

Effect of Sinus Membrane Thickness on Membrane Perforation and Bone Augmentation in Transcrestal Sinus Floor Elevation: A Retrospective Study.

Sinus membrane thickening is a common maxillary sinus disease. However, a consensus has not been reached on the effect of sinus membrane thickness on the transcrestal sinus floor elevation. This retrospective study evaluated the perforation and bone formation at transcrestal sinus floor elevation sites with different sinus membrane thicknesses. A total of 117 sites in 87 patients treated with transcrestal sinus floor elevation were included in this study. The surgical sites were divided into four groups according to the baseline sinus membrane thickness: Group A (0 to 1 mm), Group B (1 to 2 mm), Group C (2 to 4 mm), and Group D (> 4 mm). CBCT scans were taken before surgery, immediately after surgery, and 6 months after surgery. The mean baseline sinus membrane thickness was 2.16 ± 2.54 mm, and the mean residual alveolar bone height was 6.58 ± 1.85 mm. The mean endosinus new bone height was 3.76 ± 1.95 mm. The perforation rate and endosinus new bone height showed no significant difference among the groups (P > .05). The incidence rates of membrane thickening and perforation were significantly higher in smoking patients (P < .05). Membrane thickening without ostium obstruction may have little impact on transcrestal sinus floor elevation surgery in regards to perforation rate and bone formation. In addition, smoking may be a risk factor for membrane thickening, and the sinus membrane is more likely to perforate during transcrestal surgery when the patient has a history of smoking.

Sinus floor augmentation using mineralized freeze-dried bone allograft combined with recombinant human bone morphogenetic protein-2 (rhBMP-2): A long-term retrospective study

Background/purposeThe combination of recombinant human bone morphogenetic protein-2 (rhBMP-2) with a carrier material has not been extensively studied. This study aimed to evaluate the clinical, radiological, and histomorphometric outcomes of sinus floor augmentation using a 3:7 mixture of cancellous and cortical freeze-dried bone allografts (mixed AG) combined with rhBMP-2. Materials and methodsMixed AG was used for sinus floor augmentation in a total of 21 patients with a residual alveolar bone height <5 mm. Among the total 47 sites, augmentation with and without rhBMP-2 was performed in 26 and 21 sites, respectively. Radiographic parameters were assessed using cone-beam computed tomography. After a six-month healing period, core biopsies were harvested for histomorphometric analysis. ResultsThe bone gain after healing was 13.36 ± 3.9 mm and 12.07 ± 3.8 mm in the mixed AG alone and mixed AG with rhBMP-2 groups, respectively. The survival rate of implants in both groups was 100% during the follow-up period. The proportion of newly formed bone was 24.6 ± 10.2% and 39.7 ± 18.3% in the mixed AG alone and mixed AG with rhBMP-2 groups, respectively (P < 0.05). Moreover, the percentage of residual graft material was 21.0 ± 12.2% and 9.6 ± 10.0% in the mixed AG alone and mixed AG with rhBMP-2 groups, respectively (P < 0.05). ConclusionMixed AG combined with rhBMP-2 could be a suitable material for sinus floor augmentation. This combination may reduce the treatment time and improve the predictability of implant placement.

Minimally invasive maxillary sinus augmentation for single dental implant restoration: a case report

This clinical case aims to report a minimally invasive approach for maxillary sinus augmentation for first-molar replacement with a dental implant. A 61-year-old male presented to dental clinic with missing upper right first molar. Panoramic x-ray (OPG) showed insufficient posterior maxillary bone with a residual alveolar bone height&lt;4 mm. The patient underwent a minimally invasive sinus floor elevation and augmentation. Three months postoperatively, and a dental implant (⌀ 4.1×12 mm, bone level, straumann) was placed successfully. Thereafter, at 3-months post-implantation, the final restoration was accomplished. A 12-months follow-up demonstrated satisfactory clinical outcome. In conclusion, the present case-report demonstrates the advantages of the presented technique for sinus augmentation and dental implant restoration with high precision and promising result, in similar cases with a residual alveolar bone height &lt;5 mm.

Catechol-Modified and MnO2-Nanozyme-Reinforced Hydrogel with Improved Antioxidant and Antibacterial Capacity for Periodontitis Treatment.

Periodontitis is an inflammatory disease characterized by tooth loss and alveolar bone resorption. Bacteria are the original cause of periodontitis, and excess reactive oxygen species (ROS) encourage and intensify inflammation. In this study, a mussel-inspired and MnO2 NPs-reinforced adhesive hydrogel capable of alleviating periodontitis with improved antibacterial and antioxidant abilities was developed. The hydrogel was created by combining polyvinyl alcohol (PVA), 3,4-dihydroxy-d-phenylalanine (DOPA), and MnO2 nanoparticles (NPs) (named PDMO hydrogel). The hydrogel was demonstrated to be able to scavenge various free radicals (including total ROS─O2•- and OH•) and relieve the hypoxia in an inflammatory microenvironment by scavenging excess ROS and generating O2 due to its superoxide dismutase (SOD)/catalase (CAT)-like activity. Besides, under 808 nm near-infrared (NIR) light, the photothermal performance of the PDMO hydrogel displayed favorable antibacterial and antibiofilm effects toward Escherichia coli, Staphylococcus aureus, and Porphyromonas gingivalis (up to nearly 100% antibacterial rate). Furthermore, the PDMO hydrogel exhibited favorable therapeutic efficacy in alleviating gingivitis in Sprague-Dawley rats, even comparable to or better than the commercial PERIO. In addition, in the periodontitis models, the PDMO2 group showed the height of the residual alveolar bone and the smallest shadow area of low density among other groups, indicating the positive role of the PDMO2 hydrogel in bone regeneration. Finally, the biosafety of the PDMO hydrogel was comprehensively investigated, and the hydrogel was demonstrated to have good biocompatibility. Therefore, the developed PDMO hydrogel provided an effective solution to resolve biofilm recolonization and oxidative stress in periodontitis and could be a superior candidate for local drug delivery system in the clinical management of periodontitis with great potential for future clinical translation.

Risk factors contributing to early implant failure following sinus augmentation: A study of a challenging cohort.

Sinus augmentation has become a more predictable and successful procedure as the knowledge of its indications and complications increased. However, knowledge of risk factors leading to early implant failure (EIF) among challenging systemic and local conditions is insufficient. The present study aims to assess risk factors for EIF following sinus augmentation in a challenging cohort. A retrospective cohort study conducted during a period of 8 years in a tertiary referral centre providing surgical and dental health care. Implant and patient variables including age, ASA (American Society of Anesthesiology) physical status classification, smoking, residual alveolar bone, type of anaesthesia and EIF were collected. Cohort was comprised of 751 implants placed in 271 individuals. EIF rates at the implant and patient level were 6.3% and 12.5%, respectively. EIF was found to be higher among smokers (patient level: χ2 (1) = 8.74, p = .003), ASA 2 physical classification patients (patient level: χ2 (2) = 6.75, p = .03), sinuses augmented under general anaesthesia (patient level: χ2 (1)=8.97, p = .003), higher bone gain (implant level: W = 12 350, p = .004), lower residual alveolar bone height (implant level: W = 13 837, p = .001) and multiple implantations (patient level: W = 3016.5, p = 0.01). However, other variables such as age, gender, collagen membrane and implant's dimensions did not reach significance. Within the limits of the study, we can conclude that smoking, ASA 2 physical status classification, general anaesthesia, low residual alveolar bone height and numerous implants are risk factors for EIF following sinus augmentation in challenging cohorts.

1853-PUB: Extrapancreatic Effects of GIP on Bone

Glucose-dependent insulinotropic polypeptide (GIP) exhibits extrapancreatic effects through the receptor for GIP (GIPR). In this study, we used Ni-Ti Closed Coil Spring (Ni-Ti) in GIPR-deficient mice (GIPRKO) and wild-type mice (WT) to investigate the effect of GIP on force-induced bone remodeling due to orthodontic tooth movement. It was investigated. Ni-Ti was attached between the maxillary bone and the maxillary left first molar (M1) of GIPRKO and WT, and mechanical load was applied by pulling the M1 in the mesial direction. Remaining amount and bone quality were measured. A histological examination of the maxilla was also performed. As a result, compared to WT, GIPRKO showed a significant increase in tooth movement distance and a significant decrease in residual alveolar bone mass. TRAP staining showed an increase in osteoclasts in GIPRKO compared to WT on the tooth moving side. We also found that GIPRKO reduced osteoblasts in the steady state and suppressed osteoblasts after tooth movement. These results suggest that GIPRK impairs bone remodeling through increased bone resorption due to mechanical load, and that GIP plays an important role in bone remodeling. Disclosure T.Yamauchi: None. S.Goto: None. K.Naruse: None. N.Nakamura: None. M.Miyabe: None. M.Ito: None. R.Hoshino: None. S.Kanada: None. T.Sekiya: None. T.Matsubara: None. K.Miyazawa: None.

Comparison between Platelet-rich Fibrin and Saline Filling after Sinus Elevation without Adjunctive Bone Graft in Dental Implants Insertion Using CBCT.

The goal of this research was to compare radiographically the outcomes of hydraulic transcrestal sinus lifting with platelet-rich fibrin (PRF) or normal saline filling on implant survival rates, negative outcomes, and variations in the height of residual alveolar ridge (HARB). There were 80 study participants included and 90 dental implants were placed. The study participants were divided into two categories: Category A and Category B. Each category consists of 40 study participants. Category A: Normal saline was placed in the maxillary sinus. Category B: PRF was placed in the maxillary sinus. Implant survival, complications, and HARB alterations were the outcome metrics. Radiographic images through Cone-beam computed tomography (CBCT) were retrieved and compared prior to surgery (T0), immediately following surgery (T1), three months later (T2), 6 months later (T3), and 12 months later (T4). There are 90 implants having an average length of 10.5 ± 0.7 mm were inserted into the posterior portion of the maxilla of 80 patients with an average HARB of 6.9 ± 1.2 mm. At T1, elevation in HARB peaked, and the sinus membrane continued to droop but steadied while observed at T3. The steady increment of areas of radiopacities was noticed below the elevated membrane of the maxillary antrum. A radiographic intrasinus bone increase of 2.9 ± 1.4 mm was caused by the PRF filling, compared to 1.8 ± 1.1 mm by the saline filling at T4 (p < 0.05). Over the course of the one-year follow-up period, all of the implants were operating normally with no major issues. Platelet-rich fibrin when used as a filling medium alone without bone graft can cause significant ascend in height of the residual alveolar bone (HRAB). The degradation of the alveolar bone under the maxillary sinus following tooth loss frequently restricts the placement of the implant in the edentulous region of posterior maxilla. Numerous sinus-lifting surgery procedures and tools have been developed to address these problems. It has been a topic of debate regarding the benefits of bone grafts placed at the apical region of the implant. The sharp protrusions of the granules of bone graft may also provide a danger of membrane puncture. Recently, it was shown that regular bone gain might occur inside the maxillary antrum without the use of any bone transplant material. Additionally, if there were substances that filled the gap between the floor of the sinus and the raised sinus membrane, then the membrane of the maxillary sinus could be raised greater and for a longer period of time during the phase of formation of new bone formation.

Prevention of Postoperative Bleeding in Anticoagulated Patients Undergoing Oral Surgery: Use of Platelet Rich Plasma

Introduction: Anticoagulant therapy is essential for patients with various medical conditions. The use of anticoagulant medications is associated with a prolonged bleeding time. Platelet-rich plasma (PRP) contains a high concentration of platelets. PRP has been used to improve bone and soft tissue regeneration and lessen postoperative complications. Study design: It is a randomized controlled study conducted at DOW International Dental College, Karachi for the duration of six months from August 2022 to January 2023. Material and Methods: The study was done on 40 patients who visited tertiary care unit for duration of six months. There were 6 patients that belonged to the age group 40-50 years. 19 and 15 patients were in the age group 55-60 years and 60-65 years respectively. There were 14 males and 26 females included in our study. There were 72 extractions performed on these patients. Results: It was found that there were 4 patients who reported about hemorrhagic complications. There were two women that had hemorrhage linked to poor placement of platelet gel. One patient reported about hemorrhage related to severe formation of coagulum. Mild bleeding was observed in 13 patients. Conclusion: In conclusion the results of our trial suggest that PRP is a successful anticoagulant therapy that can be used for preventing any post-operative hemorrhagic complication among patients going through dental surgery, as PRP is easy to use, it has low cost and a good placement into residual alveolar bone, therefore it has better outcomes among patients. Keywords: postoperative bleeding, anticoagulant therapy and Platelet-rich plasma.

Application of Implant Healing Abutment Supporting Vertical Bone Augments in the Posterior Mandibular Area.

To address the problem of insufficient bone mass in the implant area, we focused on the vertical increment of the posterior mandibular area to increase bone mass with the aid of a healing abutment. Data of patients with insufficient vertical bone height in the posterior mandibular area were collected, and vertical increment of alveolar bone operations was performed with the aid of a healing abutment. Preoperative residual alveolar bone height, immediate postoperative alveolar bone height, and 6-month postoperative alveolar bone height were recorded, with peri-implant soft tissue results 6 months after surgery using the modified plaque index and sulcus bleeding index. Twelve patients, aged 42-73 years, with an average age of 55.91 ± 11.58 years, received vertical bone augmentation in the posterior mandibular region supported by implant healing abutments. Fifteen SLA TSIII OSSTEM implants were utilized in the 12 patients; one patient failed in vertical bone augmentation at one site (H0 = 0 mm). The vertical bone augmentation effect of two patients at two sites was 0 mm < H0 < 1 mm, and the vertical bone augmentation effect of 12 sites in nine patients was H0 ≥ 1 mm. The implant success rate was 93.3%, and the mean vertical bone gain was 2.91 mm. Peri-implant soft tissue parameters are as follows: mean modified plaque index, 1.92; mean modified sulcus bleeding index, 1.21; and mean probing depth, 3.18. No clinically observable complications occurred. Bone augmentation supported by the implant healing abutment showed the characteristics of "platform transfer", with good formation of the implant-bone interface. The bone augmentation surgery was completed at the same time as the implant placement, which reduced the pain of multiple operations and shortened waiting times. We provide a novel idea to solve the problem of insufficient vertical bone height in the posterior mandibular region.

Using Platelet-Rich Fibrin in Combination With Allograft Bone Particles Can Induce Bone Formation in Maxillary Sinus Augmentation

Sinus pneumatization secondary to posterior maxillary tooth extraction can hinder proper implant installation. Maxillary sinus floor augmentation is a surgical procedure that has been proposed to overcome this issue. The aim of this study was to evaluate and compare the histomorphometric outcomes of sinus floor elevation using allograft bone particles with or without platelet-rich fibrin (PRF). This randomized clinical trial included patients scheduled for maxillary sinus floor elevation in the Implant Department of Mashhad Dental School. Healthy adults with an edentulous maxilla and residual alveolar bone height of 3mm or less were eligible to participate and were randomly allocated to intervention (A) or control (B) groups. Bone biopsies were obtained 6months postoperatively. The predictor variable was using a PRF membrane for maxillary sinus augmentation. In group A, sinus floor elevation was performed using PRF combined with bone allografts, while in group B only allograft particles were used. The primary outcome variables were the recorded postoperative histologic parameters, as in the area of newly formed bone, new bone marrow, and residual graft particles (μm2). The secondary outcome variables were the radiographically measured postoperative bone height and width at the graft site. Age and sex. Independent sample t-test was employed to compare the postoperative histomorphometric parameters between groups A and B. P value ≤ .05 was considered statistically significant. A total of 20 patients (10 per group) completed the study. The mean rate of new bone formation was 43.25±5.22% in group A and 38.25±7.01% in group B. This difference was statistically insignificant (P=.087). The mean amount of newly formed bone marrow was significantly more in group A compared to group B (6.81±2.19% vs 10.23±4.49%; P=.044). The average amount of remaining particles was also significantly less in group A patients (9.35±3.43% vs 13.18±3.67%; P=.027). Incorporating PRF as an adjunctive grafting material results in fewer residual particles of allograft and in more bone marrow formation and may serve as a treatment option for developing the atrophic posterior maxilla.