Inlay autograft of intra-membranous bone for lateral alveolar ridge augmentation: a new surgical technique.

This study describes a new surgical technique for harvesting intra-membranous bone from the mandibular symphyseal region and using it as an inlay graft. The surgical technique of turning a complex-shaped defect into a defect of defined size by contour preparation and insertion of an appropriate inlay graft was used in 31 patients. At 4 months, 15 patients (48%) showed negligible graft resorption of 0.33 mm. At 5-8 months the resorption rate in the remaining 16 patients was around 1.22 mm. All in all, a significant positive correlation was found between bone resorption and time (r = 0.574; P < 0.001). All patients received an implant after the fixation screw was removed. A conservative interpretation of the results suggests that, on account of the flush fit and the early revascularization of the graft, implants may and should, in fact, be inserted earlier in order to prevent graft resorption.

Dental CT evaluation of mandibular first premolar root configurations and canal variations.

OBJECTIVES: Routine dental CT scans were used to describe mandibular first premolar root configurations and canal variations. STUDY DESIGN: One hundred twenty dental CT examinations were evaluated for mandibular first premolar root configurations and canal variations regarding shape of root and root canal, incidence of multiple canals, and level of bifurcation. RESULTS: A total of 17 teeth in 12 patients showed mesial invagination of the root of the mandibular first premolar. One root displayed 3 canals with 3 apical foramina. In 2 teeth, a single canal divided into 2 canals, but merged into 1 apical foramen. One root showing 2 root canals finally divided into 2 roots near the apex. Thirteen roots had 2 canals and 2 apical foramina. The distance from the cementoenamel junction to the level of bifurcation was between 4 and 13 mm (mean, 7.4 mm). CONCLUSION: The occurrence of incidentally found mandibular first premolar root variations should be an important component of dental CT reports.

Short epithetic implants for orthodontic anchorage in the paramedian region of the palate. A clinical study.

Orthodontic movement of teeth often requires maximum anchorage, so that additional resistance must be added to teeth to avoid reaction to reciprocal forces. Thus, use of endosseous implants may be a valuable alternative for ensuring stable intraoral anchorage. This study was designed to evaluate the efficacy of short epithetic implants for orthodontic anchorage in the paramedian region of the palate. Twenty-one patients (15 female, 6 male; mean age 25.8+/-9.9 yrs, min 12.7, max. 48.1) were included in this study. Following adequate preoperative planning, an implant system with reduced length, which had already been used for anchorage of epitheses, was placed in the paramedian region avoiding the anterior palatine suture. After a mean period of 4 months with unloaded healing, the implants were subjected to direct or indirect orthodontic loading. Despite varying bone quality and varying vertical bone volume in this region, adequate primary stability was achieved for all of the implants. No implant was lost during the healing period. Three out of the 21 implants placed were considered as failures. Two implants loosened shortly after the start of orthodontic loading. One of these was lost at a later stage due to peri-implant inflammation, while the other one was left in place during the 9-month follow-up period because no inflammation developed and this implant is still indirectly included in the orthodontic treatment. Another implant loosening was observed after 8.5 months following direct loading with 8 N. This implant was also lost due to peri-implant inflammation. The time-related survival probability was 84.8% after 22.9 months. As yet, 4 implants have been removed due to completion of orthodontic treatment. The results of this study indicate that short epithetic implants are suitable to achieve maximum anchorage in the paramedian region of the hard palate in orthodontic treatment.

Multidimensional osteodistraction for correction of implant malposition in edentulous segments.

This study examined multidimensional osteodistraction as a treatment method for correction of implant malposition and as an alternative to augmentation procedures. The prosthetically unfavourable implant positions were due to growth-related implant malposition (in the context of treatment of young patients with oligodontia) or primary bone-driven implant insertions. The radiographical and clinical findings obtained with this osteodistraction technique are presented and discussed. A tooth-supported osteodistractor for multidimensional distraction with custom-fabricated distraction abutments was used for treatment of 8 patients with a total of 9 maxillary and mandibular edentulous segments including single-tooth gaps. All patients underwent an osteotomy at a minimum distance of 1 mm from the implant surface. Following primary wound healing, distraction was carried out by 1 mm in vertical direction and 0.5 mm in the demanded transverse direction daily until the prosthetically optimized position was achieved. During and after the 12-week retention phase, the patients were evaluated clinically and radiographically. Multidimensional osteodistraction was carried out successfully in all 8 patients. The distraction distances were 3 to 11 mm in vertical direction and a maximum of 5 mm in buccolingual/buccopalatal direction. The malpositioned implants were brought into a prosthetically optimized position in all cases. The results of this study show that this multidimensional osteodistraction technique allows both augmentation of edentulous segments with a clearly compromised implant host site and correction of unfavourable implant positions.

Lethal photosensitization for decontamination of implant surfaces in the treatment of peri-implantitis.

Peri-implantitis is considered to be a multifactorial process involving bacterial contamination of the implant surface. A previous study demonstrated that a combination of toluidine blue O (100 microgram/ml) and irradiation with a diode soft laser with a wavelength of 905 nm results in an elimination of Porphyromonas gingivalis (P. gingivalis), Prevotella intermedia (P. intermedia), and Actinobacillus actinomycetemcomitans (A. actinomycetemcomitans) on different implant surfaces (machined, plasma-flame-sprayed, etched, hydroxyapatite-coated). The aim of this study was to examine the laser effect in vivo. In 15 patients with IMZ implants who showed clinical and radiographic signs of peri-implantitis, toluidine blue O was applied to the implant surface for 1 min and the surface was then irradiated with a diode soft laser with a wavelength of 690 nm for 60 s. Bacterial samples were taken before and after application of the dye and after lasing. The cultures were evaluated semiquantitatively for A. actinomycetemcomitans, P. gingivalis, and P. intermedia. It was found that the combined treatment reduced the bacterial counts by 2 log steps on average. The application of TBO and laser resulted in a significant reduction (P<0.0001) of the initial values in all 3 groups of bacteria. Complete elimination of bacteria was not achieved.

Alternative to the median region of the palate for placement of an orthodontic implant.

Tooth-borne anchorage may be one of the greatest limitations of modern orthodontic treatment, because teeth move in response to forces. Previous investigators have placed temporary implants in the median-sagittal palate in order to establish maximum anchorage. This area, however, may be characterized by relatively low vertical bone support. The aim of this study was therefore to find an alternative palatal implant site which offers a higher amount of bone support. This study comprised 22 patients wishing for maximum anchorage underwent presurgical diagnostic evaluation by means of low-dose dental CT. The measuring results regarding vertical bone volume and the position of the neighbouring tooth roots were used as the basis for further treatment. The statistical data analysis indicated an area suitable for implant placement in the group of patients examined. This area was located 6 to 9 mm posterior to the incisive foramen and 3 to 6 mm paramedian, under avoidance of the mid-palatal suture. The patients showed such a great range of variation in vertical bone volume that a preoperative diagnostic evaluation also seems to be recommendable when very short implants are used in order to avoid perforations of the lower nasal duct.

Use of crestal bone for augmentation of extremely knife-edged alveolar ridges prior to implant placement: report of 3 cases.

A technique is presented for interforaminal lateral augmentation of mandibles with adequate bone height, but extremely knife-edged mandibular alveolar ridges (Class IV of Cawood and Howell's classification of residual ridges), in which the crestal portion of the knife-edged ridge is used as grafting material. Following an osteotomy and rotation of the grafts by 180 degrees, the grafts were fixed to the residual ridge below the osteotomy line by means of miniscrews. All grafts showed only mild resorption after a healing period of 3 months, and it was possible to place 4 implants in the now sufficiently wide host region.

Dental vertical root fractures: value of CT in detection.

PURPOSE: To determine the value of computed tomography (CT) in the diagnosis of dental vertical root fractures relative to the value of conventional dental radiography. MATERIALS AND METHODS: Thirty-seven patients with 42 teeth in which vertical root fracture was clinically suspected underwent dental radiography and axial CT. Two radiologists evaluated the images independently and by consensus for a fracture line. The results were compared with intraoperative findings. RESULTS: Twenty-eight of the 42 teeth were proved intraoperatively to be fractured. The sensitivity and specificity averaged for the two reviewers in the assessment of vertical fractures were 23% and 70%, respectively, with dental radiography and 100% and 100%, respectively, with CT. Consensus reading showed sensitivities of 25% for dental radiography and 75% for CT. Eight (reviewer A) or nine (reviewer B) false-negative CT findings were encountered in cases in which metallic artifacts obscured parts of the root and in cases in which the root was very small in diameter. Interobserver agreement was 95% for dental radiography and 93% for CT. CONCLUSION: CT is superior to dental radiography in the detection of dental vertical root fractures.

Experimental study of the damping behaviour of IMZ implants.

Measurements of the damping behaviour of dental implants with the Periotest device are considered to be an objective means to assess the mobility of implants. The effects of the position of an implant in the maxilla or mandible, the period of time passing between the measurements and implant placement and the height at which the Periotest measurements are performed on the damping behaviour of implants have been discussed controversially. This experimental study examined the influence of the use of different measuring devices, the measuring height and the embedding depth on the damping behaviour of IMZ implants. The implants were embedded in resin at different depths and damping measurements were carried out at different measuring heights. It was found that the values rose with an increasing measuring height and a decreasing embedding depth. Analysis of variance was used to assess the influence of the embedding depth and revealed that the embedding depth had a significant impact on the measuring values at each measuring height, above 6 mm. Moreover, it was found that the higher the measuring height, the higher the measured values and the greater the differences between the values obtained at the individual depths. The different measuring devices had no influence on the measuring results (P = 0.79). The results of this study suggest that a longitudinal follow-up of the peri-implant residual bone height around individual implants is possible. Single measuring values by themselves do not allow any conclusions about the prognosis of an implant. The assessment of the peri-implant bone height through Periotest measurements is conceivable only when a table of damping values taking into account the physical length of the implant, the embedding depth and the measuring height for the examined implant system is available. In cylindrical implants, the head of the available prefabricated measuring post can be recommended as a constant measuring point for further studies, especially when the results are to be compared with those obtained by other study groups.

[Conventional dental radiography and future prospectives]. / Konventionelle Dentalradiologie und Zukunftsperspektiven.

Until recently, conventional dental radiology was performed by dentists and orofacial surgeons. Due to the rapid development of radiological technique, the demand of radiological advice is increasing. The radiologists see more and more dental patients in their daily routine. The aim of this article is to give an overview on established dental radiology and a glimpse into the future. Conventional dental radiology and digital radiography are presently in use. Intraoral technique comprises dental films, bite-wing views and occlusal radiographs. Panoramic views and cephalometric radiographs are done with extraoral technique. Digital radiography lacks all processes in behalf of film development. It leads to dose reduction and enables image manipulation.

Treatment of patients with extreme maxillary atrophy using sinus floor augmentation and implants: preliminary results.

Twenty consecutive patients with extreme maxillary atrophy underwent bilateral sinus floor augmentation, either with autogenous bone from the iliac crest or with a combination of autogenous bone and hydroxyapatite. One patient was treated using autogenous bone from the chin region. After a period of three to eight months, three to four implants were placed in each posterior maxilla. Only 10 out of 155 inserted implants were located in the anterior non-augmented maxilla. During the observation period of one to six years, four implants (one of them located in the anterior maxilla) had to be removed prior to prosthetic treatment. Another three implants were lost during the follow up period. This corresponds to a Kaplan-Meier survival probability of 95.4% after 70 months. No statistically significant difference in implant success was observed between women and men (P=0.16). All prosthetic suprastructures are still in function despite these implant losses. Mean peri-implant bone resorption was 1.34 mm with no statistically significant difference between implants placed more mesially and those placed more distally in the augmented area, though a trend could be observed (P=0.058) for a more pronounced bone resorption around implants placed in the premolar region. When a mean mesial and distal bone resorption of >2 mm was considered in the calculation of the success prognosis, the survival probability dropped to 74.7% after 70 months.

[Dental magnetic resonance tomography (dental MRI) as a method for imaging maxillo-mandibular tooth retention structures]. / Dentale Magnetresonanztomographie (Dental-MRT) als Verfahren zur Darstellung des maxillo-mandibulären Zahnhalteapparates.

PURPOSE: To establish a new method for dental imaging using magnetic resonance tomography named Dental-MRT and to demonstrate its usefulness in diagnosing dentogen pathologies of the mandible and maxilla. METHODS: Seven healthy volunteers, three patients with pulpitis, two patients with dentigerous cysts, two patients after tooth transplantation, and three patients with atrophic mandibles have been evaluated. Optimized axial T1- and T2-weighted gradient echo and spin echo sequences in 2D and 3D technique have been established to perform studies of the jaws. The acquired images were reconstructed with a standard dental software package on a work-station as panorama and cross-sectional views of the mandible or maxilla. RESULTS: The entire maxillo-mandibular bone, teeth, dental pulp, and the content of the mandibular canal were well depicted. Patients with pulpitis demonstrate bone marrow edema in the periapical region. Dentigerous cysts and their relation to the surrounding structures are clearly shown. After contrast media administration marked enhancement of the dental pulp can be demonstrated. CONCLUSION: Dental-MRT promises to provide a new tool for visualization and detection of dental diseases.

Five-year results of maxillary intramobile Zylinder implants.

We retrospectively analysed the time-dependent function of 501 Intramobile Zylinder (IMZ) implants inserted between August 1983 and December 1994 to restore partially and fully edentulous maxillae. To ensure the independence of implants when calculating level of significance, we chose one implant per patient at random. This was done 500 times to obtain a representative result. The simplified success rate was 473/501 (92%) whereas the time-related survival probability was 76% after 60 months. In 31% (156/500) of the life-table calculations, implants placed in completely edentulous maxillae showed a significantly lower probability of survival than did those placed in partially edentulous patients (P mean: 0.17; SD: 0.19). Implants, that had been placed in the anterior and premolar regions of edentulous maxillae, had a survival probability of 60%, after 60 months. The survival probability of implants placed in the molar region was 100%, over the same observation period. The patient's age, sex, and the time of placement of the implant after tooth extraction had no significant influence on the implant's prognosis. The prognosis of implants inserted for partial edentulism meets the criteria proposed for a viable implant system. Our findings indicate that in complete edentulous maxillae, implants should be placed in the posterior rather than in the anterior region, even though this necessitates augmentation procedures such as sinus lift.

A minimally invasive second-stage procedure for single-tooth implants.

The natural look of dental restorations has become a universally claimed treatment objective, especially when single-tooth gaps are restored with implants. A harmonious gingival margin is crucial to achieve this goal. This article presents a new procedure for exposure of single-tooth implants that yields a favorable esthetic result in the visible maxillary regions because of the simple type of incision used. The procedure consists of two incisions: the first incision makes it possible to find out the implant position and the second incision shapes the mucous membrane according to local supply. The second incision also prevents the soft tissue from tearing after careful stretching and subsequent pressing of the supraimplant mucosa. There is minimal soft tissue traumatization, and as a result, healing time can be reduced to 1 week and an appealing esthetic result can be reached.

Complications of sinus perforations and their management in endodontics.

The intimate position of the maxillary sinus to the apices of teeth creates problems if periapical inflammation occurs. This can lead to a perforation into the sinus and cause sinusitis. Persistent and complicated situations that do not respond after nonsurgical root canal treatment demand a suitable surgical therapy. Knowledge of the specific anatomic conditions, an adequate diagnosis, and an appropriate surgical procedure facilitate success rates that are comparable with those obtained in other regions, even in unfavorable initial conditions.