Transition from failing dentition to full-arch fixed implant-supported prosthesis with a staged approach using removable partial dentures: a case series.

The present retrospective case series is aimed at evaluating a staged approach using a removable partial denture (RPD) as an interim prosthesis in treatment to correct a failing dentition until such time as a full-arch fixed implant-supported prosthesis may be inserted. Eight patients, who had undergone maxillary full-arch rehabilitation with dental implants due to poor prognosis of their dentitions, were analyzed. All treatment included initial periodontal therapy and a strategic order of extraction of hopeless teeth. An RPD supported by selected teeth rehabilitated the compromised arch during implant osseointegration. These remaining teeth were extracted prior to definitive prosthesis delivery. Advantages and drawbacks of this technique were also recorded for the cases presented. Among the advantages provided by the staged approach are simplicity of fabrication, low cost, and ease of insertion. Additionally, RPD tooth support prevented contact between the interim prosthesis and healing abutments, promoting implant osseointegration. The main drawbacks were interference with speech and limited esthetic results. Implant survival rate was 100% within a follow-up of at least 1 year. The use of RPDs as interim prostheses allowed for the accomplishment of the analyzed rehabilitation treatments. It is a simple treatment alternative for patients with a low smile line.

Correction of buccal dehiscence at the time of implant placement without barrier membranes: a retrospective cone beam computed tomographic study.

PURPOSE: To assess the clinical and tomographic findings of a grafting approach without barrier membranes to treat peri-implant buccal bone dehiscences at the time of implant placement. MATERIALS AND METHODS: This retrospective study was conducted on all patients who needed implant placement with buccal bone grafting and were treated consecutively between March 2007 and June 2010. Two different implant systems were used (PSI, Globtek; XiVE Plus, Dentsply/Friadent). All sites had thick soft tissue (> 2 mm). All bone dehiscences were completely grafted with biphasic calcium phosphate and covered only by a soft tissue flap. Cone beam computed tomographic images were used to assess vertical buccal bone loss by measuring the distance between the implant platform and the first buccal bone contact with the implant body. Statistical analysis (Mann-Whitney test) was carried out to compare the outcomes from the two different implant systems analyzed. RESULTS: Forty-one subjects (18 men, 23 women; mean age 57.3 ± 10.4 years) were selected and received 60 implants (52 delayed and 8 immediate placement). Mean follow-up was 26 months (range, 18 to 39 months). All 8 immediate implants and 33 of the 52 delayed implants presented buccal bone loss from 0 to 0.5 mm. Only two delayed sites presented buccal bone loss over 2 mm. No significant differences were seen between the implant systems. The study implant cumulative success rate was 100% (mean follow-up, 26 months). CONCLUSION: Predictable outcomes can be obtained by grafting buccal bone dehiscence areas without barrier membranes in sites with a minimum soft tissue thickness greater than 2 mm.

Effectiveness of piezoelectric surgery in preparing the lateral window for maxillary sinus augmentation in patients with sinus anatomical variations: a case series.

PURPOSE: The present article sought to evaluate the effectiveness of a piezoelectric surgical unit for maxillary sinus augmentation surgeries in avoiding perforation of the sinus membrane and other possible procedural complications in patients with anatomical variations of the sinus. MATERIALS AND METHODS: Twenty-five patients presenting sinus anatomical variations, who were indicated for a total of 40 sinus grafting procedures performed by the lateral window approach with a piezoelectric device, were analyzed. After 6 months of healing, implants were placed. Information collected included clinical and computed tomographic information on anatomical variations in the sinus bone walls, in the size of the sinus, and in the thickness of the sinus membrane. Occurrence of sinus membrane perforation and computed tomographic measurements of the amount of bone height gained with the grafting procedures were also recorded. RESULTS: Only two patients presented a small perforation (less than 5 mm in diameter) of the sinus membrane, which occurred only after osteotomies of the lateral windows and did not compromise the surgical outcome. No implants were lost during a mean follow-up period of 19 months. CONCLUSION: The use of piezoelectric surgery allowed for the accomplishment of all rehabilitation treatments within the follow-up period of this study.

Cone beam computed tomographic evaluation of a maxillary alveolar ridge reconstruction with iliac crest graft and implants.

The present article discusses an atrophic maxilla reconstruction with iliac crest bone block and particulate grafts and dental implants. Onlay block grafts were used to restore bone volume of the anterior maxilla, whereas bilateral sinus floor augmentation was performed using a particulate graft. Ten months after the grafting surgery, 9 dental implants were placed to rehabilitate the case. Results of a 7-year follow-up were obtained clinically and by cone beam computed tomographic images.

Nontraumatic bone expansion for immediate dental implant placement: an analysis of 21 cases.

Ridge bone resorption is a common event that occurs in tooth loss areas and that can happen in different degrees. The harvesting of autogenous bone can significantly increase treatment time and costs, and poses some risks, including postoperative pain, or possibly nerve or arterial injury. The aim of this article is to demonstrate and analyze the use of bone expansion in order to circumvent problems related to bone harvesting. This is done with screws, followed by immediate implant placement. Twenty-one cases are used to define management solutions for this type of technique to enable the later implant rehabilitation of sites affected by poor bone width.

Tratamento de deiscência com exposição óssea peri-implantar na mandíbula / Treatment of dehiscence and peri-implant bone exposure in the lower jaw: a case report

A deiscência é uma das possíveis complicações pós-operatórias. Trata-se da abertura espontânea de suturas, que pode vir concomitantemente a eventos como a exposição óssea. Sabe-se que ela pode ser tratada por métodos específicos ou pela simples remoção do material necrótico presente e abundante irrigação com solução fisiológica, permitindo assim condições para a regeneração tecidual. No caso clínico presente, houve a oportunidade de realizar a estimulação da reparação tecidual através de focos de sangramentos provocados, associado ao tratamento convencional da deiscência em região peri-implantar da mandíbula. E após um acompanhamento de cerca de três meses foram apresentados resultados satisfatórios que culminaram com a confecção de uma nova prótese reabilitando o paciente. Este relato de caso mostra que existem diversas maneiras para tratar a deiscência e obter sucesso e ressalta a importância do acompanhamento freqüente do paciente.