Vertical Bone Height Research Articles

TRANSCRESTAL MAXILLARY SINUS FLOOR ELEVATION USING THE BALLOON TECHNIQUE WITH SIMULTANEOUS IMPLANT PLACEMENT

INTRODUCTION: Rehabilitation of the maxilla using implants is frequently problematic because of the pneumatization of the maxillarysinus into the alveolar ridge. When only a few millimeters of augmentation are needed in conjunction with simultaneous implant placement,an indirect sinus lift is effective. This study describes transcrestal sinus lift using the sinus balloon technique and DASK (Dentium AdvancedSinus Kit) drills for implant placement in patients with an atrophic maxillary posterior area with synthetic bone graft, to evaluate the boneheight achieved and the implant success rate.OBJECTIVES: To evaluate clinically and radiographically the simultaneous implant placement and grafting with synthetic bone graft afterSchneiderian membrane elevation using the maxillary sinus balloon technique and DASK drills.MATERIALS AND METHODS A total of 13 patients with missing posterior maxillary teeth (premolars or molars) and with limited boneheight below the floor of the maxillary sinus received an implant and grafting with synthetic bone graft after maxillary sinus lifting using amaxillary sinus balloon technique and DASK drills.RESULTS: Cone beam computerized tomography 6 months postoperatively showed statistically significant increase in bone height anddensity. The mean preoperative vertical bone height value was (5.97 ± 1.17 mm), while the mean 6 months postoperative vertical bone heightvalue was (10.45 ± 1.56 mm). The mean preoperative implant bone density value was (349.6 ± 1265.9 HU), while the mean postoperativeimplant bone density was (771.1 ± 239.1 HU).CONCLUSIONS: Sinus balloon and DASK drills are an acceptable tool for indirect sinus lifting with simultaneous implant placement.KEYWORDS: Transcrestal approach, sinus balloon technique, DASK drills, implants.

EVALUATION OF ALVEOLAR OSTEOTOMY FOR CORRECTION OF VERTICAL BONE RESORPTION IN ANTERIOR MANDIBULAR RIDGE USING A MIXTURE OF TWO GRAFTED MATERIALS

INTRODUCTION: Extensive loss of alveolar bone and teeth in the anterior mandible presents a complex problem for reconstruction. Alveolar osteotomy technique with the use of mixture of hydroxy apatite and beta-tricalcium phosphate together with injectable PRF is one of the reliable methods to restore vertical ridge deficiencies. OBJECTIVES: : Evaluate vertical ridge augmentation using sandwich osteotomy technique in anterior atrophic mandible and the use of hydroxy apatite, beta-tri-calcium phosphate mixed with injectable PRF as a grafting material. MATERIALS AND METHODS: This study was conducted clinically on 8 patients indicated for vertical ridge augmentation by sandwich technique osteotomy and fixation of the osteomatized segment by micro-plates and screws, and the placement of Ha- BTCP mixed with I-PRF as interpositional graft material. Patients were evaluated clinically and radiographically by using panoramic radiograph and cone beam computed tomography (CBCT). RESULTS: In this study no severe pain was recorded postoperatively. No signs of inflammation or swelling were observed in almost all of the patients along the follow up period. Vertical bone height gain of the residual ridge was satisfactory and prepared the ridge to receive final prosthesis successfully. CONCLUSIONS Sandwich osteotomy technique with Ha- BTCP mixed with I-prf is a reliable method to restore vertical ridge deficiencies in anterior mandible.

Cone-beam computed tomography versus orthopantomography in sinus lift procedures: Two-dimensional versus three-dimensional imaging

Context: The present study was undertaken to do a comparative evaluation of the role of cone-beam computed tomography (CBCT) imaging and orthopantomography (OPG) for preoperative implant planning in combination with sinus grafting procedures to assess sinus anatomy and morphology and the existing bone height in three-dimensions (3D). Aim: The aim of the present study was to assess sinus anatomy and morphology and the existing bone height in all the 3D. Materials and Methods: Pre- and postoperative assessment of maxillary sinuses was done in 17 patients who underwent implant therapy in combination with sinus augmentation procedures using CBCT and OPG. These patients were subjected to orthopantomographs and CBCT imaging both preoperatively and postoperatively. CBCT imaging helped decide the type of sinus augmentation procedure best suited for the patients as per the individual needs and depending on the residual alveolar bone height, timing of implant placement, sinus morphology, anticipation of complication, and comparative analysis between pre- and postprocedural gain in vertical alveolar bone height and increase in bone density. Statistical Analysis Used: The results were tabulated and statistically analyzed using paired and unpaired t-tests. Results: In the majority of cases, there was a concordance between the treatment types based on pre- and postoperative CBCT scans. The assessment of sinus morphology revealed a significantly higher detection rate of aberrations in the form of sinus mucosal hypertrophy and septae on CBCT which were imperceptible on routine radiographs. The most appealing result was that vertical alveolar bone height could be measured precisely, and there was a significant increase in surgical confidence and a significantly better prediction of complications when using CBCT imaging. Conclusions: A preoperative planning based on CBCT imaging seems to improve sinus diagnostics and helps execute a better treatment plan. Furthermore, it is a good tool for the comparison of vertical alveolar bone height pre- and postoperatively following sinus augmentation procedures using various graft materials.

Correlation of Mandibular Incisor Inclination to Marginal Bone Levels and Cortical Bone Thickness in Different Skeletal Patterns: A Retrospective, Cone Beam Computed Tomography Study

Introduction: Biologic factors, such as the cortical bone thickness and supporting bone as well as biomechanical factors, such as proclined teeth are closely interrelated. These factors often determine the potential deleterious effects of orthodontic treatment, such as gingival recession, dehiscence, fenestration, and external root resorption. The alveolar bone thickness and bone levels vary in different facial patterns and here in this study, we are finding if there is any correlation of these to tooth inclinations. Aims and objectives: To assess the influence of mandibular incisor inclination on cortical bone thickness and alveolar bone levels in different skeletal patterns. Materials and methods: Thirty cone beam computed tomography (CBCT) scans and lateral cephalograms of pretreatment patients were analyzed with different skeletal patterns (10 each) for their alveolar bone height, alveolar bone thickness, and cortical bone thickness at mid root level and mandibular incisor inclination. Inclination and thickness were compared among the three groups and were correlated. Results: Although there are wide variations, cortical bone thickness at mid root level in vertical, horizontal, and average growth pattern lingually and labially were 2.3 ± 0.29 mm, 2.4 ± 0.42, 2.2 ± 0.39, and 0.69 ± 0.12, 0.65 ± 0.23, and 0.59 ± 0.37 respectively, and these values were not statistically significant. The vertical alveolar bone height did not hold any significance in our study. The incisor–mandibular plane angle (IMPA) for evaluating growth patterns was found to be significant. Clinical significance: The inclination of the mandibular incisors is an important diagnostic consideration and has to be kept in mind during treatment planning. Excessive proclination of the incisors can lead to dehiscence, fenestration, as well as recession. Therefore, it becomes important to know the thickness of the bone as well as the marginal bone level to help us to use appropriate biomechanics. Conclusion: The mandibular incisor inclination and growth pattern of the patient appear to have no significant impact on the alveolar bone levels and cortical bone thickness. However, studies with a larger sample size and with high-dose CBCT are warranted.

Osteotome-Mediated Sinus Floor Elevation With or Without a Grafting Material: A Systematic Review and Meta-analysis of Long-term Studies (≥5-Years).

To test the hypothesis of no difference in the long-term treatment outcome after osteotome-mediated sinus floor elevation with or without a grafting material. A MEDLINE/PubMed, Cochrane Library, and EMBASE search in combination with a hand-search of relevant journals was conducted, including human studies published in English from January 1, 1986 to December 1, 2017. One comparative and 7 noncomparative studies fulfilled the inclusion criteria. Survival of suprastructures had never been compared within the same study. Meta-analysis demonstrated an overall estimated patient-based implant survival of 94%. Gain in vertical alveolar bone height was similar with the 2 treatment modalities. Noncomparative studies demonstrated high long-term survival rate of suprastructures and implants with the 2 treatment modalities, as well as limited periimplant marginal bone loss. High long-term implant survival was demonstrated after osteotome-mediated sinus floor elevation with or without a grafting material. However, long-term randomized controlled trials comparing the 2 treatment modalities are sparse. Hence, conclusions drawn from this systematic review should be interpreted with caution.

Short, parallel-walled, conical-connection implants for a broad range of indications in the maxilla and mandible: Retrospective multicenter study with up to 33 months of follow-up.

To evaluate the survival and complication rate of 7-mm short, parallel-walled, conical-connection implants in daily practice. This multicenter retrospective study included 219 consecutive patients who received 323 implants. Indication was limited vertical bone height preventing placement of implants longer than 7 mm. Placement and loading protocols were determined on a case-by-case basis and included placement in fresh extraction sockets and healed sites, and loading was either immediate, early, or delayed. Patients were followed for up to 33 months. Outcome measures were implant survival rate and any biologic or technical complications. In total, eight implants in seven patients failed, accounting for the survival rate of 97.3% at implant level and 96.4% at patient level. The mean time to failure was 7.5 months and 10.2 months at the implant and patient level, respectively. The majority of patients (67.1%) received one implant and the placement was predominantly in healed sites (82.7%). Immediate loading was done for 21.4% of implants placed in the extraction site and for 21.3% of implants placed in healed sites. In most of the cases (71.8%) implants were placed in the premolar or molar position in the mandible. No complications were reported. These results suggest that in cases of limited vertical bone height, the short, parallel-walled, conical-connection implant can successfully support different prosthesis types in a wide variety of indications and loading protocols.

Direct Maxillary Sinus Floor Augmentation for Simultaneous Dental Implant Placement.

Aim:The present study was done to evaluate the efficacy of platelet-rich fibrin (PRF) with bovine bone graft (Bio-Oss™) in direct sinus augmentation for simultaneously dental implant placement.Materials and Methods:The study included 14 patients who fulfill the inclusion criteria, among them 10 were male and 4 were female with PRF with Bio-Oss™. For each patient, bone level was assessed preoperatively and postoperatively after 1, 6, and 12 months with a panoramic X-ray and radiovisiography to evaluate the vertical bone height from the shoulder of the implant to the most apical end.Results:The outcome of the sinus lift and the implants placed was evaluated periodically at 1, 6, and 12 months postoperatively. All the patients underwent two-stage procedures. At the end of 20th week, implants were exposed; radiological parameters were assessed again for implant integration, and prosthetic rehabilitation was started after 2 weeks and it was completed by the end of 24 weeks (6 months postoperatively). Twelve months postoperatively, the endosinus bone gain noted was 7 mm, which indicated the use of PRF with bovine bone graft as a reliable filling material during simultaneous sinus lift and implantation.Conclusion:PRF with bone graft (Bio-Oss) is used as an augmentation material after direct maxillary sinus lift, and the resulting bone formation was adequate for placement of dental implant.

Is Bone Morphogenetic Protein-2 as Effective as Alveolar Distraction Osteogenesis for Vertical Bone Regeneration?

The aim of this study was to assess the clinical effectiveness of alveolar distraction osteogenesis (ADO) versus recombinant human bone morphogenetic protein-2 (rh-BMP-2) for vertical ridge augmentation. Few data have been published on vertical bone regeneration using rh-BMP-2. The authors implemented a retrospective cohort study and enrolled a sample composed of patients with deficient alveolar vertical bone height. The primary predictor variable was vertical augmentation with BMP-2 and a titanium mesh or ADO. The primary outcome variable was gain in vertical bone height (millimeters) measured using computed tomography. The secondary outcome variable was postoperative complications, namely need for further grafting before or simultaneous with implant placement, soft tissue dehiscence, paresthesia, infection, implant failure, and pain. Other outcomes included implant stability at time of placement and follow-up (implant stability quotient by resonance frequency analysis), surgical time (minutes), and total treatment time until implant placement (weeks). Other study variables included location of reconstruction (maxilla or mandible). Appropriate bivariate statistics were computed and statistical significance was set a P value less than .05. The retrospective review yielded 21 patients in the BMP group and 19 in the ADO group. For the BMP-2 group, the average vertical bone gain was 2.96±1.8mm overall (maxilla, mean 3.6±3.1mm; mandible, mean 2.32±1.8mm). For the ADO group, this gain was 4±1.69mm overall (maxilla, mean 2.8±1.94mm; mandible, mean 5.2±4.67mm). For complications, group BMP showed a statistically minor tendency for more postoperative problems, such as wound dehiscence. For implant survival, group BMP showed a 92.2% survival rate versus 96.3% in group ADO at 3 to 45months after delivery of the prosthesis (average, 22months). The 2 techniques showed similar values in absolute vertical bone gain. Group ADO showed a slightly better outcome in outright vertical regenerative potential, albeit with a more frequent need for regrafting before and simultaneous with implant placement. Group BMP showed a lesser need for regrafting, despite having a higher postoperative complication rate.

The Sinus Membrane-Maxillary Lateral Wall Complex: Histologic Description and Clinical Implications for Maxillary Sinus Floor Elevation.

Maxillary sinus floor elevation has been documented as a safe and predictable procedure for gaining vertical bone height in the atrophic posterior maxillae. Conversely, there is a lack of basic research on the characteristics of the union between the sinus membrane (SM) and the bone. Clinical implications of an impaired union in healthy or pathologic membranes remain unknown. The objective of this study was to present a comprehensive histologic and morphologic description of the sinus membrane-lateral bone wall complex. In 14 fresh cadaver heads, 28 lateral wall sinus augmentation procedures were performed to obtain SM samples. Samples were assessed using hematoxylin-eosin, Masson trichrome, and toluidine blue staining and immunofluorescence and immunohistochemistry procedures. Specimens were coded and studied by a trained examiner using an optical microscope at ×4, ×10, ×40, and ×100 objectives. Thickness and inflammation status were assessed in these samples. Overall SM thickness of the samples was 0.40 ± 0.12 mm and was positively correlated to the inflammatory condition of the membranes. Such low values are the consequence of limited inflammation. Most of the fibers and cells in the deeper layers of the SM ran in a horizontal direction, oriented parallel to the underlying bone wall. In the immunohistochemistry study, 3 out of 7 samples showed a certain degree of nestin expression, suggesting osteogenic potential in spite of the elderly specimens. Large variations in thickness across the SM were found. These were noted to be partially correlated to the SM inflammatory status. The vast majority of the fibers were oriented parallel to the maxillary lateral wall, and only a few isolated areas showed a stronger perpendicular attachment. This might indicate the surpassing importance of the SM inflammatory status, operator skill, and other anatomical factors over the sinus membrane-maxillary lateral wall complex interface. Moreover, about half of the SM investigated were positive for nestin, indicating their osteogenic potential.

Novel expandable short dental implants in situations with reduced vertical bone height\u2014technical note and first results

PurposeShort implants often have the disadvantage of reduced primary stability. The present study was conducted to evaluate the feasibility and safety of a new expandable short dental implant system intended to increase primary stability.MethodsAs a “proof of concept”, a prospective clinical cohort study was designed to investigate intraoperative handling, primary and secondary implant stability (resonance frequency analysis), crestal bone changes, implant survival and implant success, of an innovative short expandable screw implant. From 2014 until 2015, 9 patients (7–9-mm vertical bone height) with 30 implants (length 5–7 mm, diameter 3.75–4.1 mm) were recruited consecutively.ResultsAll 30 implants in the 9 patients (age 44 to 80 years) could be inserted and expanded without intraoperative problems. Over the 3-year follow-up period, the implant success rate was 28/30 (93.3%). The mean implant stability quotients (ISQ) were as follows: primary stability, 69.7 ± 10.3 ISQ units, and secondary stability, 69.8 ± 10.2 ISQ units (p = 0.780), both without significant differences between the maxilla and mandible (p ≥ 0.780). The mean crestal bone changes after loading were (each measured from the baseline) as follows: in the first year, 1.0 ± 0.9 mm in the maxilla and 0.7 ± 0.4 mm in the mandible, and in the second year, 1.3 ± 0.8 mm and 1.0 ± 0.7 mm, respectively.ConclusionsCompared to other prospective studies, in this indication, the success rate is acceptable. Implant stability shows high initial and secondary stability values. The system might present an extension of functional rehabilitation to the group of elderly patients with limited vertical bone height. Further long-term investigations should directly compare this compressive implant with standard short implants.

Maxillary Sinus Floor Augmentation: a Review of Selected Treatment Modalities.

ABSTRACTObjectivesThe objective of the present study is to present the current best evidence for enhancement of the vertical alveolar bone height and oral rehabilitation of the atrophic posterior maxilla with dental implants and propose some evidence-based treatment guidelines.Material and MethodsA comprehensive review of the English literature including MEDLINE (PubMed), Embase and Cochrane Library search was conducted assessing the final implant treatment outcome after oral rehabilitation of the atrophic posterior maxilla with dental implants. No year of publication restriction was applied. The clinical, radiological and histomorphometric outcome as well as complications are presented after maxillary sinus floor augmentation applying the lateral window technique with a graft material, maxillary sinus membrane elevation without a graft material and osteotome-mediated sinus floor elevation with or without the use of a graft material.ResultsHigh implant survival rate and new bone formation was reported with the three treatment modalities. Perforation of the Schneiderian membrane was the most common complication, but the final implant treatment outcome was not influenced by a Schneiderian membrane perforation.ConclusionsThe different surgical techniques for enhancement of the vertical alveolar bone height in the posterior part of the maxilla revealed high implant survival with a low incidence of complications. However, the indication for the various surgical techniques is not strictly equivalent and the treatment choice should be based on a careful evaluation of the individual case. Moreover, further high evidence-based and well reported long-term studies are needed before one treatment modality might be considered superior to another.

Long-term stable vertical bone regeneration after sinus floor elevation and simultaneous implant placement with and without grafting.

Less invasive surgical approaches to regenerate bone intra-sinus and allow long-term functional implant stability are needed. To evaluate long-term vertical bone regeneration after sinus floor elevation and simultaneous implant placement with and without bone grafting. Vertical bone gains (VBG) post-sinus elevation, with and without grafting, were evaluated in thirty individuals presenting an average residual bone height (RBH) of 4.2 mm using a standardized digital technique. Measurements were taken preoperatively, and at an average of 64.6 months follow-up. Clinically, peri-implant tissues were assessed for pocket formation and presence of inflammation to evaluate established success criteria. Overall, RBH averaged 4.2 ± 1.1 mm (range: 1.8-5.8) and VBG 7.7 ± 1.6 mm (range: 6.0-12.9). Mean difference of 7.6 mm between vertical bone heights (VBH) at augmented implants sites and initial RBH, 11.8 versus 4.2 mm, (P < .0001, CI95%: 6.9-8.2) was statistically significant. RBH averaged 4.5 ± 0.8 mm and 3.8 ± 1.2 (P = .07) and VBG 6.8 ± 0.5 and 8.5 ± 1.9 mm (P = .003, CI95%: 0.6-2.7), for nongrafted and grafted individuals, respectively. The grafting group received an average graft volume of 0.35 ± 0.1 cc (range: 0.25-0.5) per implant site. Long-term follow-ups average 64.6 months (range: 36-144) and all implants met the success criteria. VBG ≥ 7 mm were 7.3 times more likely to develop on grafted sites (OR = 7.3, P = 0.02, CI95%: 1.2-46.2). None to negligible amounts of grafting material are required to regenerate substantial amounts of autogenous bone into atrophic sinus cavities after simultaneous implant placement. The regenerated VBH seems stable for functional implant stability long-term. Implant success rates were 100% at an average of 64.6 months.

Stability of Grafted Implant Placement Sites After Sinus Floor Elevation Using a Layering Technique: 10-Year Clinical and Radiographic Results.

To evaluate long-term survival rates and radiographic stability of sinus floor elevations carried out using a two-layer grafting technique. Records were analyzed for patients treated with sinus floor elevations using a modified technique. Phycogenic hydroxyapatite (Algipore, Dentsply Sirona Implants) and autogenous bone particles harvested from intraoral sites were grafted in two distinct layers after elevation of the sinus mucosae. In this approach, the basal part of the sinus floor is grafted with autogenous bone, while the cranial part is grafted with the phycogenic hydroxyapatite. In some cases, implants were placed simultaneously, such that the entire surface of each implant was covered by autogenous bone particles. A titanium membrane was used to close the sinus window, and the implants were loaded 3 months later. In two-stage approaches, the implants were inserted 3 to 4 months after the grafting and loaded after 3 additional months. Panoramic radiographs were taken after the grafting procedure, after implant insertion, after the prosthetic restoration, and then annually for 10 years. These radiographs were used to measure the height between the implant shoulders and the top of the graft. Of the 214 sinus floor elevations performed on 129 patients using the bilayering technique, 198 procedures in 118 patients were included in the study (136 one-stage and 62 two-stage). Membrane perforations during surgery occurred in 17.9% of the procedures and were sutured and sealed with fibrin glue. A total of 487 implants were placed in the grafted areas. No severe postoperative complications occurred, but three implants were lost throughout the 10-year follow-up period. A small decrease of vertical height was observed between the grafting surgery and the stage-two surgery (mean: 1.8 mm). After that, no bone height was lost over the 10 years. The layer grafting technique in combination with sinus floor elevation resulted in radiographically stable vertical bone height for 10 years. This technique enabled early placement and loading of implants in the grafted areas. The survival rate obtained with this procedure is similar to that expected for implants placed in nongrafted areas.

Two-stage reconstruction of the severely deficient alveolar ridge: bone graft followed by alveolar distraction osteogenesis

Distraction osteogenesis for the augmentation of severe alveolar bone deficiency has gained popularity during the past two decades. In cases where the vertical bone height is not sufficient to create a stable transport segment, performing alveolar distraction osteogenesis (ADO) is not possible. In these severe cases, a two-stage treatment protocol is suggested: onlay bone grafting followed by ADO. An iliac crest onlay bone graft followed by ADO was performed in 13 patients: seven in the mandible and six in the maxilla. Following ADO, endosseous implants and prosthetic restorations were placed. In all cases, the onlay bone graft resulted in inadequate height for implant placement, but allowed ADO to be performed. ADO was performed to a mean total vertical augmentation of 13.7mm. Fifty-two endosseous implants were placed. During a mean follow-up of 4.85 years, two implants failed, both during the first 6 months; the survival rate was 96.15%. In severe cases lacking the required bone for ADO, using an onlay bone graft as a first stage treatment increases the bone height thus allowing ADO to be performed. This article describes a safe and stable two-stage treatment modality for severely atrophic cases, resulting in sufficient bone for implant placement and correction of the inter-maxillary vertical relationship.

Damping ratio analysis of tooth stability under various simulated degrees of vertical alveolar bone loss and different root types

BackgroundThe purpose of this study was to evaluate the feasibility of using damping ratio (DR) analysis combined with resonance frequency (RF) and periotest (PTV) analyses to provide additional information about natural tooth stability under various simulated degrees of alveolar vertical bone loss and various root types.MethodsThree experimental tooth models, including upper central incisor, upper first premolar, and upper first molar were fabricated using Ti6Al4V alloy. In the tooth models, the periodontal ligament and alveolar bone were simulated using a soft lining material and gypsum, respectively. Various degrees of vertical bone loss were simulated by decreasing the surrounding bone level apically from the cementoenamel junction in 2-mm steps incrementally downward for 10 mm. A commercially available RF analyzer was used to measure the RF and DR of impulse-forced vibrations on the tooth models.ResultsThe results showed that DRs increased as alveolar vertical bone height decreased and had high coefficients of determination in the linear regression analysis. The damping ratio of the central incisor model without a simulated periodontal ligament were 11.95 ± 1.92 and 27.50 ± 0.67% respectively when their bone levels were set at 2 and 10 mm apically from the cementoenamel junction. These values significantly changed to 28.85 ± 2.54% (p = 0.000) and 51.25 ± 4.78% (p = 0.003) when the tooth model was covered with simulated periodontal ligament. Moreover, teeth with different root types showed different DR and RF patterns. Teeth with multiple roots had lower DRs than teeth with single roots.ConclusionDamping ratio analysis combined with PTV and RF analysis provides more useful information on the assessment of changes in vertical alveolar bone loss than PTV or RF analysis alone.

Preclinical Evaluation of a Crown-Splinted Custom Root-Shaped Implant.

To test whether a Maryland bridge-type splint provides adequate stability for a custom root-shaped implant to osseointegrate in a manner substantially equivalent to that of a threaded implant. Six beagle dogs were subjected to intraoral impressions and cone beam scans that were used to fabricate custom root-shaped implants (RTIs) and crowns. Premolars in the mandible (P4) and in the maxilla (P3) were extracted, and 24 RTIs were immediately placed in extraction sockets. Splint extensions of the crowns were bonded to mesial and distal teeth. Twelve mandibular molars (M2) were extracted, and threaded implants (DXI), serving as controls, were placed immediately. Animals were placed on a soft diet after surgery. Weekly intraoral photographs and radiographs were taken, and animals were sacrificed at 4 months. Fluorescent labels were injected 35, 21, and 7 days before sacrifice. Clinical implant stability and vertical pullout forces were tested, and loss of vertical bone height was measured on radiographs. Histomorphometric measurements of percent bone-to-implant contact (BIC) and mineral apposition rates were made from undecalcified sections. Three RTI splints broke or debonded, and the implants were removed. No loss of DXI implants was noted. All remaining implants were clinically stable. Mean pullout forces were 366.7 ± 182.8 N for RTI (no pullout data for the threaded DXI). Mean vertical bone loss was 0.4 ± 0.6 mm mesially and 0.2 ± 0.7 mm distally for RTI and 0.8 ± 1.1 mm mesially and 0.8 ± 1.0 mm distally for DXI, with no significant differences between groups. BIC values were 70.8% ± 12.7% for mandibular RTI, 68.3% ± 11.6% for maxillary RTI, and 78.8% ± 5.5% for DXI. Mineral apposition rates within local osteons were 1.9 ± 0.5 μm for RTI and 1.7 ± 0.3 μm for DXI; at the implant surface, they were 2.5 ± 1.2 μm for RTI and 3.3 ± 1.8 μm for DXI, with no significant differences between groups. All RTIs with intact splints exhibited clinically successful integration, similar to that of control threaded implants. The RTI may be a viable option for single-tooth replacement.

TRIPLE THERAPY FOR SOCKET SEAL SURGERY: A CASE REPORT

Socket preservation at the time of extraction is one of the most significant procedures for future prosthetic considerations and for maintenance of the health. The most important aesthetic goals of socket preservation is maintenance or enhancement of the facial and interproximal gingival contours and height of the interproximal papilla thereby maintaining health, beauty and youth. This case report illustrates the use of epithelized connective tissue graft with an amalgamation of bone graft and doxycycline in socket preservation. Apart from this, platelet rich fibrin was used as a palatal bandage at the donor site to assess the wound healing. Socket preservation performed in left upper lateral incisor region with this tunnelling approach technique provided an optimum bone fill within the socket, thereby maintaining vertical bone height and stabilizing the marginal soft tissues at the desired site. The platelet rich fibrin used as a palatal bandage at the donor site aided in better wound healing at the graft procured site. Thus this technique can be used for obtaining a good bone volume, at the recipient site and may be applied in patients with thin gingival biotype. Keywords: Socket preservation, Epithelised connective tissue graft, Bone graft, Doxycycline

Effect of Alveolar Segmental Sandwich Osteotomy on Alveolar Height: A Preliminary Study.

Bone loss following extraction is maximum in horizontal dimension. Height is also reduced which is pronounced on the buccal aspect. Various surgical procedures are available to correct the bone volume viz. GBR, onlay bone grafting, alveolar distraction and sandwich osteotomy. Sandwich osteotomy has been found to increase the vertical alveolar bone height successfully. The objective of the study was to assess the effect of alveolar segmental sandwich osteotomy on alveolar height and crestal width. A prospective study was undertaken from December 2012 to August 2014. Seven patients with 12 implant sites with a mean age of 36years were recruited. All seven patients with 12 implant sites underwent alveolar segmental sandwich osteotomy and interpositional bone grafting. Alveolar bone height was assessed radiographically preoperatively, immediate post-op, and at 3months post-op. Alveolar bone width was assessed radiographically preoperatively and at 3months post-op. Statistical significance was inferred at p<0.05. The mean vertical augmentation at immediate post-op was 6.58mm (p=0.001). The vertical augmentation that was achieved 3months post-op was a mean of 3.75mm which was statistically significant (p=0.004). The change in alveolar height from immediate post-op to 3month post-op was a mean 1.69mm. The mean change in alveolar crestal width at 3months was a mean of -0.29mm (p=0.57). Sandwich osteotomy can be used as an alternative technique to increase alveolar bone height prior to implant placement. Moderate alveolar deficiency can be predictably corrected by this technique.

Elevación de seno VS Implante cigomático. Revisión bibliográfica y caso clínico

Implant treatment has become a predictable rehabilitation of the edentulous patient. But on many occasions, due to a great amount of resorption of the maxilla, a clinician has no choice but to rely on advanced surgical techniques. The present study is based on the absence of a clear clinical protocol on when a sinus floor elevation or zygomatic implants should be used. Therefore, a review of the literature up to the past twenty years was conducted. Results show that controversy arises in cases of patients with less than 4 mm of vertical bone height. On our patient, after evaluating bone width, height and remaining sinus size, as well as the patient’s preferences, implant treatment using zygomatic implants was undertaken. However, it should be noted that the choice of one technique or the other shall also depend on the preparation and experience of the surgeon.

Early volumetric changes after vertical augmentation of the atrophic posterior mandible with interpositional block graft versus onlay bone graft: A retrospective radiological study

PurposeThe aim of this study was to evaluate volumetric and clinical outcomes of atrophic posterior mandibles treated with inlay or onlay bone grafting techniques. Materials and methodsIn posterior mandibles, alveolar ridges were treated either with interpositional equine cancellous bone block (inlay group) or with onlay autogenous bone block (onlay group). Bone volumes at baseline and at 4 months after surgery were measured by computed tomography. ResultsA total of 20 subjects were enrolled in the present study: 10 in the inlay group and 10 in the onlay group. After surgery, atrophic posterior mandibles showed a mean vertical augmentation height of 6.0 mm in the inlay group and 7.4 mm in the onlay group. No significant differences were recorded between the two groups regarding volume loss of the grafted bone or decrease in vertical bone height of the augmented site (29% and 1.9 mm for the onlay group, and 35% and 1.7 mm for the inlay group) during healing. Two complications (1 wound dehiscence and 1 mandibular fracture) occurred postoperatively in the inlay group; on the other hand, the onlay group had three complications (wound dehiscence). A total of 80 dental implants were placed in augmented areas: 46 in the inlay group with a peri-implant marginal bone loss of 0.8 mm, and 34 in the onlay group with a peri-implant marginal bone loss of 1.3 mm (p = 0.0006). ConclusionsInlay xenogeneic grafts showed volumetric bone remodeling similar to that recorded for onlay autogenous bone. The success of the autogenous onlay blocks (82.4%) appeared to be lower than that registered for the inlay group (93.8%), but the difference was not significant.