Treatment of Postextraction Sites With Allograft-Stabilized Dental Implants: A Clinical Case Series.

PURPOSE: Additional grafting procedures for the treatment of extremely atrophic jaws may be demanding, expensive, and sometimes require long time and multiple surgical sessions, which may reduce patient's acceptance and quality of life. This study evaluated the outcomes of 10 patients with extensive alveolar bone defects in the posterior jaws, treated in a single surgical session with grafting and implants. MATERIALS AND METHODS: Ten consecutive patients were treated within 3 months of extraction. After ridge exposure, implants were positioned in 4-wall defects without contact with pristine bone, and mineralized particulate allograft packed around to stabilize them. Sites were covered with resorbable membranes and soft tissues were sutured tension-free. Five months later, implants were restored in centric occlusion. RESULTS: At uncovering, newly formed bone filled all defects and all implants resisted at 30 Ncm of reverse torque. No complication was recorded throughout the study; survival rate was 100% for both implants and grafts. After 24 months of follow-up, mean periimplant bone level change was 0.15 ± 0.53 mm and mean bone gain at the defect site was 11.62 ± 1.04 mm. CONCLUSION: Rehabilitation of wide postextraction defects may achieve successful outcomes using allograft and a special implant design, even in the absence of optimal primary stability.

Radiographic analysis of a transalveolar sinus-lift technique: a multipractice retrospective study with a mean follow-up of 5 years.

BACKGROUND: Various sinus-lift techniques have been described in the literature. The aim of this retrospective study is to evaluate the efficacy of a transalveolar sinus-lift technique in terms of implant survival, marginal bone loss, and complications. METHODS: A total of 538 patient records were examined, and after applying exclusion and inclusion criteria, a sample of patients was included with a mean follow-up of 5 years. Implants with a smooth or tapered surface were considered. Therefore, only sinus lifts with inorganic bovine bone matrix or demineralized bone matrix were included, and 1,536 periapical radiographs were analyzed. Outcome measures were implant success, implant failure (peri-implantitis and loss of osseointegration), marginal bone resorption, and biologic complications (membrane perforations, sinusitis, and intraoperative and/or postoperative hemorrhage). Periapical radiographs were evaluated before surgery, post-surgery, and after 6 months and 1, 3, and 5 years. We analyzed the residual crestal bone height under the sinus, the amount (mm) of height increase after surgery, and values of implant marginal bone resorption for considered follow-ups. RESULTS: Two hundred eighty-two (282) patients were excluded. Therefore, 256 patients treated with the transalveolar sinus-lift technique were included. A total of 376 dental implants and 323 sinus lifts were analyzed. The overall rates of implant success and failure were 94.9% and 5.1%, respectively. The mean bone loss around implants was 1.98 mm (mean follow-up of 5 years). Patients treated with inorganic bovine bone matrix showed a better implant success rate (P = 0.03) than did patients treated with demineralized human matrix. Three Schneiderian membrane perforations occurred in the 323 sinus lifts. In these cases, the surgeon performed another surgical operation after 3 months. Postoperative complications were peri-implantitis (six cases) and osseointegration losses (13 cases). CONCLUSIONS: The transalveolar sinus-lift technique was a safe, minimally invasive technique with an implant success rate comparable to traditional implantology. The implant success rate was positively affected by the low-resorption graft material, and a low bone-resorption rate around implants was found.

Crestal sinus lift with sequential drills and simultaneous implant placement in sites with <5 mm of native bone: a multicenter retrospective study.

PURPOSE: The aim of this multicenter retrospective clinical study was to evaluate the survival rate of implants placed in the posterior maxilla with a residual bone height of <5 mm. MATERIALS AND METHODS: One hundred seventeen patients, recruited from 6 different centers, had 134 implants placed below the maxillary sinus. The patient population consisted of 52 men and 65 women ranging in age from 39 to 78 years (mean age, 53.2 years). Sinus lift procedures were performed following a crestal approach using a specific sequence of drills (Cosci's technique). All implants were submerged. Periapical radiographs were obtained with a paralleling technique and were digitized. The pattern of bone remodeling was subsequently evaluated. RESULTS: The average (±SD) follow-up time was 48.2 months (±29.30 months; range, 24 to 120 months). Of the original 134 implants placed, 5 implants (3.7%) failed. The implant survival rate was 96.3%. The average residual bone height was 3.46 mm (±0.91 mm) at baseline. The average height of the alveolar crest in the treated implant sites was 9.94 ± 2.29 mm. The radiographic bone gain was 6.48 ± 2.38 mm. CONCLUSION: The investigation suggests that this crestal drill approach can be a successful sinus lifting procedure in a severe atrophic maxilla with <5 mm of crestal bone height.

Effectiveness of prophylactic antibiotics at placement of dental implants: a pragmatic multicentre placebo-controlled randomised clinical trial.

PURPOSE: To evaluate the efficacy of prophylactic antibiotics for dental implant placement. MATERIALS AND METHODS: Thirteen dentists working in private practices agreed to participate in this trial, each centre providing 50 patients. One hour prior to implant placement, patients were randomised to take orally 2 g amoxicillin or identical placebo tablets. Patients needing bone augmentation at implant placement were not included. Outcome measures were prosthesis and implant failures, adverse events and post-operative complications. Patients were seen 1 week, 2 weeks and 4 months post-operatively. RESULTS: Two centres did not deliver any data, two centres did not manage to include the agreed quota of patients and three patients had to be excluded. Two-hundred and fifty-two patients were evaluated in the antibiotic group and 254 in the placebo group, and none dropped out at 4 months. Four prostheses and seven implants (in five patients) failed in the antibiotics group versus 10 prostheses and 13 implants (in 12 patients) in the placebo group. Eleven complications were reported in the antibiotic group versus 13 (in 12 patients) in the placebo group. No side effects were reported. There were no statistically significant differences for prosthesis failures, implant losses and complications. Patients receiving immediate post-extractive implants had an increased failure risk compared with patients receiving delayed implants (9% versus 2%). CONCLUSIONS: No statistically significant differences were observed, although trends clearly favoured the antibiotic group. Immediate post-extractive implants were more likely to fail.

Efficacy of prophylactic antibiotics for dental implants: a multicentre placebo-controlled randomised clinical trial.

PURPOSE: To evaluate the efficacy of prophylactic antibiotics for dental implant placement. MATERIALS AND METHODS: Twelve Italian private practices agreed to participate in this trial, each centre providing 30 patients. One hour prior to implant placement, patients were randomised, for consumption orally of 2 g amoxicillin or identical placebo tablets. Patients needing bone augmentation procedures were not included. Outcome measures were prosthesis and implant failures, adverse events and post-operative biological complications. Patients were seen 1 week, 2 weeks and 4 months post-operatively. RESULTS: One centre did not deliver any data and 14 patients had to be excluded from the trial for various reasons. One hundred and fifty-eight patients were evaluated in each group and none dropped out at 4 months. Two prostheses and two implants failed in the antibiotics group, compared with four prostheses and nine implants in the placebo group. There were no statistically significant differences for prosthesis failures, implant losses, complications and side effects. CONCLUSIONS: No statistically significant differences were observed. However, four times more patients in the placebo group experienced implant failures than in the antibiotic group, and this requires further investigation.