Comparison of 0.12% Chlorhexidine and a New Bone Bioactive Liquid, BBL, in Mouthwash for Oral Wound Healing: A Randomized, Double Blind Clinical Human Trial.

Following surgery, healing within the oral cavity occurs in a hostile environment, and proper oral care and hygiene are required to accelerate recovery. The aim of the current study is to investigate and compare the bioreactivity characteristics of mouthwashes based on either chlorhexidine (CHX) or a novel bone bioactive liquid (BBL) in terms of oral healing within seven days application post-surgery. A randomized, double blind clinical trial was conducted in 81 patients, wherein the mouthwashes were applied twice a day for a period of 7 days. The visual analog scale (VAS) protocol was applied to determine pain index scores. Early wound healing index (EHI) score was determined for evaluating oral cavity healing progress. No adverse effects were observed using the mouthwashes, but CHX application resulted in stained teeth. Applications of both CHX and BBL were sufficient to reduce pain over a period of 7 days. However, the BBL group demonstrated a statistically significant reduction in VAS scores starting on day 4. The EHI scores were significantly higher in the BBL group compared with the CHX group, independent of tooth location. No differences in either VAS or EHI scores due to gender were observed. Compared with the commercially available CHX mouthwash, application of the BBL mouthwash reduced pain and accelerated oral cavity healing to a greater extent, suggesting it effectively improves the oral cavity microenvironment at the wound site in mediating soft tissue regeneration.

Chemically Defined Conditions Mediate an Efficient Induction of Dental Pulp Pluripotent-Like Stem Cells into Hepatocyte-Like Cells.

Liver diseases are major causes of morbidity and mortality. Dental pulp pluripotent-like stem cells (DPPSCs) are of a considerable promise in tissue engineering and regenerative medicine as a new source of tissue-specific cells; therefore, this study is aimed at demonstrating their ability to generate functional hepatocyte-like cells in vitro. Cells were differentiated on a collagen scaffold in serum-free media supplemented with growth factors and cytokines to recapitulate liver development. At day 5, the differentiated DPPSC cells expressed the endodermal markers FOXA1 and FOXA2. Then, the cells were derived into the hepatic lineage generating hepatocyte-like cells. In addition to the associated morphological changes, the cells expressed the hepatic genes HNF6 and AFP. The terminally differentiated hepatocyte-like cells expressed the liver functional proteins albumin and CYP3A4. In this study, we report an efficient serum-free protocol to differentiate DPPSCs into functional hepatocyte-like cells. Our approach promotes the use of DPPSCs as a new source of adult stem cells for prospective use in liver regenerative medicine.

Histologic and Histomorphometric Evaluation of a New Bioactive Liquid BBL on Implant Surface: A Preclinical Study in Foxhound Dogs.

BACKGROUND: Bioactive chemical surface modifications improve the wettability and osseointegration properties of titanium implants in both animals and humans. The objective of this animal study was to investigate and compare the bioreactivity characteristics of titanium implants (BLT) pre-treated with a novel bone bioactive liquid (BBL) and the commercially available BLT-SLA active. METHODS: Forty BLT-SLA titanium implants were placed in in four foxhound dogs. Animals were divided into two groups (n = 20): test (BLT-SLA pre-treated with BBL) and control (BLT-SLA active) implants. The implants were inserted in the post extraction sockets. After 8 and 12 weeks, the animals were sacrificed, and mandibles were extracted, containing the implants and the surrounding soft and hard tissues. Bone-to-implant contact (BIC), inter-thread bone area percentage (ITBA), soft tissue, and crestal bone loss were evaluated by histology and histomorphometry. RESULTS: All animals were healthy with no implant loss or inflammation symptoms. All implants were clinically and histologically osseo-integrated. Relative to control groups, test implants demonstrated a significant 1.5- and 1.7-fold increase in BIC and ITBA values, respectively, at both assessment intervals. Crestal bone loss was also significantly reduced in the test group, as compared with controls, at week 8 in both the buccal crests (0.47 ± 0.32 vs 0.98 ± 0.51 mm, p < 0.05) and lingual crests (0.39* ± 0.3 vs. 0.89 ± 0.41 mm, p < 0.05). At week 12, a pronounced crestal bone loss improvement was observed in the test group (buccal, 0.41 ± 0.29 mm and lingual, 0.54 ± 0.23 mm). Tissue thickness showed comparable values at both the buccal and lingual regions and was significantly improved in the studied groups (0.82-0.92 mm vs. 33-48 mm in the control group). CONCLUSIONS: Relative to the commercially available BLT-SLA active implants, BLT-SLA pre-treated with BBL showed improved histological and histomorphometric characteristics indicating a reduced titanium surface roughness and improved wettability, promoting healing and soft and hard tissue regeneration at the implant site.

The Effect of Commercially Available Endodontic Cements and Biomaterials on Osteogenic Differentiation of Dental Pulp Pluripotent-Like Stem Cells.

The aim of this study is to compare the osteogenic differentiation capacity of the dental pulp pluripotent-like stem cells (DPPSCs) using conditional media pretreated with ProRoot-MTA, Biodentine (BD) or the newly manufactured pure Portland cement Med-PZ (MZ). DPPSCs, isolated from human third molars, are the most relevant cell model to draw conclusions about the role of biomaterials on dental tissue regeneration. Cytotoxicity, alkaline phosphatase (ALP) activity, and calcium deposition analysis were evaluated at different differentiation time points. Gene expression of key osteogenic markers (RUNX2, Collagen I and Osteocalcin) was determined by qRT-PCR analysis. The osteogenic capacity of cells cultured in conditioned media prepared from MZ or MTA cements was comparable. BD conditioned media supported cell proliferation but failed to induce osteogenesis. Relative to controls and other cements, high osteogenic gene expression was observed in cultures pre-treated with the novel endodontic cement MZ. In conclusion, the in vitro behavior of a MZ- endodontic cement was evaluated, showing similar enhanced cell proliferation compared to other commercially available cements but with an enhanced osteogenic capacity with prospective potential as a novel cement for endodontic treatments.

Anquiloglosia y problemas de succión, tratamiento multidisciplinar: terapia miofuncional orofacial, sesiones de lactancia materna y frenotomía / Ankyloglossia and breastfeeding problems, multidisciplinary management: Orofacial myofunctional therapy, breastfeeding sessions and frenotomy

Introducción. La limitación de la movilidad lingual en neonatos puede ocasionar problemas en la lactancia, entre ellos: dolor-grietas-mastitis en la madre, mal progreso de peso del neonato y duración excesivamente larga de las tomas. El objetivo de este trabajo es evaluar la efectividad de los tratamientos realizados en los pacientes con anquiloglosia y trastornos de succión. Material y métodos. Estudio descriptivo preliminar de la efectividad del circuito establecido entre los servicios de Cirugía Oral y Maxilofacial, Logopedia y Rehabilitación Orofacial y Lactancia Materna para el tratamiento de los pacientes que acuden con problemas de lactancia materna y se les diagnostica anquiloglosia. Resultados. Se trató a 61 pacientes de edades entre 0 y 6meses con anquiloglosia asociada a problemas clínicos relacionados con la lactancia: 20 niñas (32.8%) y 41 niños (67.2%). Se establecieron 3 grupos según el tratamiento realizado: grupo1 (n=6) únicamente las sesiones de lactancia materna (SLM), grupo2 (n=19) terapia miofuncional (TMF) y asesoramiento en SLM, y grupo3 (n=36) frenotomía y siguieron TMF y asesoramiento de SLM. La anquiloglosia tipoiii es el frenillo lingual más frecuente (57.4%). En el total de la muestra se observaron mejorías en los parámetros que valoran la efectividad y el confort de la lactancia materna. Conclusiones. Mejorar la succión es posible; se recomienda estimular la succión con terapia miofuncional antes y después de la frenotomía, y también en aquellos casos en los que no será necesaria la cirugía (AU)

Introduction. The limitation of lingual mobility in newborns can cause problems in lactation. Among these problems are, soreness, cracked nipples or mastitis in the mother, poor weight gain of the newborn, and an excessively prolonged period of time in each breastfeed. The aim of this study is evaluate the effectiveness of the treatment received by the newborns with breastfeeding problems and ankyloglossia. Material and methods. A preliminary study of the effectiveness of the circuit established between the Oral and Maxillofacial Surgery, Speech Therapy and Orofacial Rehabilitation and the Breastfeeding Department to treat patients that attended the hospital with breastfeeding problems and were diagnosed with ankyloglossia. Results. A total of 61 patients with ages between 0 and 6 months had ankyloglossia were seen due to clinical problems related to breastfeeding. Of these, 20 (32.8%) were girls and 41 (67.2%) were boys. Three groups were established in accordance with the treatment carried out: group1 (n=6) solely from the Breastfeeding Sessions (BFS), group2 (n=19) Myofunctional Therapy (MFT) and BFS, and group3 (n=36) Frenotomy, followed by MFT and BFS. Ankyloglossia type3 was the most frequent lingual frenulum (57.4%). From the total sample, improvements were observed in the parameters that assessed the effectiveness and comfort of breastfeeding. Conclusions. Improving breastfeeding is possible, and in some cases, surgery should not be necessary. If surgery is required, it is recommended to stimulate suction before and after the frenotomy with myofunctional therapy (AU)

Implant-supported fixed prostheses in a Patient with Osteogenesis Imperfecta: A 4-year follow-up.

Osteogenesis Imperfecta (OI) is a rare autosomal dominant connective tissue disorder in wich, the bone quality and density is affected. OI includes some metabolic disorders and have a wide range of clinical presentations. In Osteogenesis Imperfecta bone has a very low density and it is a disorder currently treated with bisphosphonates. Quality and quantity of bone is important for establishment of osseointegration in dental implants. There are few reported cases in the literature. This is a case report of a 61 year-old man with grade IV OI, rehabilitated with implant-supported fixed prostheses in the posterior right and left mandible, whithout bone grafts. At the 4-year follow-up, clinical and imaging study showed no evidence of pathology in the peri-implant tissues. The final outcome is a correct occlusion and masticatory function. This case shows that dental implants may be a treatment option in this patients, however there is still quite limited scientific evidence. Key words:Osteogenesis imperfecta, osteoporotic bone, dental implants, bone fragility, bisphosphonates, drilling technique.

Management of Ankyloglossia and Breastfeeding Difficulties in the Newborn: Breastfeeding Sessions, Myofunctional Therapy, and Frenotomy.

The problems of suction in newborns give rise to multiple consequences for both the mother and the newborn. The objective of this paper is to present a case of ankyloglossia ("tongue-tie") and the suction problems that were treated by a multidisciplinary team. The subject is a 17-day-old male patient, with ankyloglossia and suction problems during breastfeeding (pain in the breastfeeding mother, poor weight gain, and long breastfeeds). The patient followed the circuit established in our centre between the services of Oral and Maxillofacial Surgery and Breastfeeding and Speech Therapy and Orofacial Rehabilitation (CELERE). The evolution following the breastfeeding sessions, the myofunctional stimulation, and the lingual frenotomy was very favourable, thereby solving the suction problems that the newborn presented. All our patients receive breastfeeding sessions and myofunctional therapy as treatment. We know that a frenotomy is not always necessary and we believe that the stimulation of sucking before and after the surgical intervention is important in order to improve the final result.

Multidisciplinary management of ankyloglossia in childhood. Treatment of 101 cases. A protocol

BACKGROUND: Partial ankyloglossia is a limitation which restricts the possibility of protrusion and elevation of the tip of the tongue due to the shortness of either the lingual frenulum or the genioglossus muscles or both. The principal objective of this paper is to present our protocol of action for the treatment of ankyloglossia. The specific objectives are to study patients with ankyloglossia treated by the Service of Maxillofacial Surgery and the Service of Speech Therapy of our pediatric Hospital, describe the diagnostic procedures, the pre-surgical intervention, the surgical technique undertaken and the post-surgical rehabilitation taking into account the level of collaboration of the patients, and finally, describe the surgical complications and the referral of patients. MATERIAL AND METHODS: This is a descriptive study of healthy patients, without any diagnosis of syndrome, ranging between 4 and 14 years that have been surgically treated and rehabilitated post-surgery within a period of 2 years. RESULTS: 101 frenectomies and lingual plasties have been performed and patients have been treated following the protocol of action that we hereby present. After the surgical intervention, the degree of ankyloglossia has been improved, considering correction in 29 (28%) of the patients (95% CI: 20%, 38%), reaching, with the post-surgical orofacial rehabilitation, a correction of 97 (96%) of the participants (95% CI: 90%, 98%). CONCLUSIONS: The chosen surgical technique for moderate-severe ankyloglossia in our centre is the frenectomy and lingual plasty. The myofunctional training begins one week before the surgical intervention so that the patients learn the exercises without pain

Multidisciplinary management of ankyloglossia in childhood. Treatment of 101 cases. A protocol.

BACKGROUND: Partial ankyloglossia is a limitation which restricts the possibility of protrusion and elevation of the tip of the tongue due to the shortness of either the lingual frenulum or the genioglossus muscles or both. The principal objective of this paper is to present our protocol of action for the treatment of ankyloglossia. The specific objectives are to study patients with ankyloglossia treated by the Service of Maxillofacial Surgery and the Service of Speech Therapy of our pediatric Hospital, describe the diagnostic procedures, the pre-surgical intervention, the surgical technique undertaken and the post-surgical rehabilitation taking into account the level of collaboration of the patients, and finally, describe the surgical complications and the referral of patients. MATERIAL AND METHODS: This is a descriptive study of healthy patients, without any diagnosis of syndrome, ranging between 4 and 14 years that have been surgically treated and rehabilitated post-surgery within a period of 2 years. RESULTS: 101 frenectomies and lingual plasties have been performed and patients have been treated following the protocol of action that we hereby present. After the surgical intervention, the degree of ankyloglossia has been improved, considering correction in 29 (28%) of the patients (95% CI: 20%, 38%), reaching, with the post-surgical orofacial rehabilitation, a correction of 97 (96%) of the participants (95% CI: 90%, 98%). CONCLUSIONS: The chosen surgical technique for moderate-severe ankyloglossia in our centre is the frenectomy and lingual plasty. The myofunctional training begins one week before the surgical intervention so that the patients learn the exercises without pain.

Gingival bleeding of a high-flow mandibular arteriovenous malformation in a child with 8-year follow-up.

Intraosseous arteriovenous malformations (AVMs) in the head and neck region are uncommon. There are several types and they can have a wide range of clinical presentations. Depending on the blood flow through the AVM, the treatment may be challenging for the attending team and may lead to life-threatening hemorrhages. A clinical case report is presented. A 9-year-old girl, seen for gingival bleeding during oral hygiene, was found to have a high-flow AVM located within and around the mandible. Two-stage treatment consisted of intra-arterial embolization followed by intraoral injection of a sclerosing agent 8 weeks later. At the 8-year follow-up, imaging study showed no evidence of recurrent lesion inside or outside the bone. The final outcome is a correct occlusion with a symmetric facial result. This case shows that conservative treatment may be the first treatment option mostly in children. Arteriography and transcortical injection were enough to control the AVM.

Effect of implant design in immediate loading. A randomized, controlled, split-mouth, prospective clinical trial.

OBJECTIVES: The aim of this study was to evaluate the effect of two different designs, tapered vs cylindrical, on the primary stability of implants placed with an immediate loading protocol in edentulous mandibles to support fixed prostheses within occlusal contacts during the first 48 h. MATERIAL AND METHODS: Tapered and cylindrical implants were placed in a split-mouth study using the same implant protocol in ten patients with edentulous jaws. A total of 20 tapered implants (test group) and 20 cylindrical implants (control group) were placed. All implants were loaded immediately with provisional fixed prostheses during the healing period before the final restoration. The implants were evaluated at the implant placement by analyzing the insertion torque values (ITVs) and the resonance frequency analysis (RFA) and after the healing period of three months, the success of those implants and the marginal bone loss were evaluated. RESULTS: Two cylindrical implants were mobile within the same patient and no tapered implants failed, resulting in implant survival rates of 90% and 100%, respectively after three months. The ITVs were statistically significantly different (P = 0.0210) for the tapered implants than for the cylindrical implants. However, no statistically significant differences in RFA values were found (P = 0.6063) when comparing the implant designs and the primary stability measured with implant stability quotient (ISQ) values. The control group resulted in a mean bone loss after three months of 0.91 mm while the test group resulted 0.42 mm. CONCLUSION: The tapered implant achieved greater primary stability values measured with ITVs and less marginal bone loss than the cylindrical implants.

Dental pulp of the third molar: a new source of pluripotent-like stem cells.

Dental pulp is particularly interesting in regenerative medicine because of the accessibility and differentiation potential of the tissue. Dental pulp has an early developmental origin with multi-lineage differentiation potential as a result of its development during childhood and adolescence. However, no study has previously identified the presence of stem cell populations with embryonic-like phenotypes in human dental pulp from the third molar. In the present work, we describe a new population of dental pulp pluripotent-like stem cells (DPPSCs) that were isolated by culture in medium containing LIF, EGF and PDGF. These cells are SSEA4(+), OCT3/4(+), NANOG(+), SOX2(+), LIN28(+), CD13(+), CD105(+), CD34(-), CD45(-), CD90(+), CD29(+), CD73(+), STRO1(+) and CD146(-), and they show genetic stability in vitro based on genomic analysis with a newly described CGH technique. Interestingly, DPPSCs were able to form both embryoid-body-like structures (EBs) in vitro and teratoma-like structures that contained tissues derived from all three embryonic germ layers when injected in nude mice. We examined the capacity of DPPSCs to differentiate in vitro into tissues that have similar characteristics to mesoderm, endoderm and ectoderm layers in both 2D and 3D cultures. We performed a comparative RT-PCR analysis of GATA4, GATA6, MIXL1, NANOG, OCT3/4, SOX1 and SOX2 to determine the degree of similarity between DPPSCs, EBs and human induced pluripotent stem cells (hIPSCs). Our analysis revealed that DPPSCs, hIPSC and EBs have the same gene expression profile. Because DPPSCs can be derived from healthy human molars from patients of different sexes and ages, they represent an easily accessible source of stem cells, which opens a range of new possibilities for regenerative medicine.

Immediate implants following tooth extraction. A systematic review

Objectives: The aim of this article is to review the current state of immediate implants, with their pros and contras, and the clinical indications and contraindications. Material and Methods: An exhaustive literature search has been carried out in the COCHRANE library and MEDLINE electronic databases from 2004 to November 2009. Randomized clinical trials and clinical trials focused on single implants placed in fresh extraction sockets were included and compared. A meta-analysis could not be performed due to heterogeneity of the data. Results: Twenty studies out of 135 articles from the initial search were finally included, which summed up a total of 1139 immediate implants with at least a 12-month follow-up. Our results have been compared with other current available papers in the literature reviewed that obtained similar outcomes. Discussion: Immediate implants have predictable results with several advantages over delayed implant placement. However, technical complications have been described regarding this technique. Also, biomaterials may be needed when the jumping distance is greater than 1mm or any bone defect is present. Conclusions: Few studies report on success rates rather than survival rates in the literature reviewed. Short-term clinical results were described and results were comparable to those obtained with delayed implant placement. Further long-term, randomized clinical trials are needed to give scientific evidence on the benefits of immediate implants over delayed implant placement (AU)

Pansinusitis y afectación intracraneal por implante dental / Pansinusitis and intracranial impact of a dental implant

Las sinusitis odontógenas son una patología relativamente frecuente causada por infecciones dentales, quistes periapicales así como tras procedimientos bucodentales como una endodoncia, una elevación sinusal o la colocación de un implante. A continuación se presenta un caso extremo de una pansinusitis derecha con fistulización a espacio epidural causada por un implante osteointegrado. Ante la sospecha de una sinusitis maxilar de origen odontogénico se debe iniciar rápidamente un tratamiento antibiótico correcto y un seguimiento estrecho ya que pueden tener consecuencias fatales como la pérdida de un ojo, abscesos cerebrales o incluso la muerte(AU)

Odontogenic sinusitis is a relatively common disease caused by dental infections, periapical cysts and oral procedures such as root canal, sinus lift or implant placement. We report an extreme case of a right pansinusitis with an epidural space fistula caused by osseointegrated implants. When maxillary sinusitis of odontogenic origin is suspected, we should quickly start effective antibiotic treatment and monitor the patient closely because odontogenic sinusitis can have serious consequences, such as the loss of an eye, brain abscess or death(AU)

Thermal changes and drill wear in bovine bone during implant site preparation. A comparative in vitro study: twisted stainless steel and ceramic drills.

OBJECTIVES: The purpose was to assess thermal changes and drill wear in bovine bone tissue with the use of twisted stainless steel and zirconia-based drills, during implant site preparation. METHODS: A total of 100 implant site preparations were performed on bovine ribs using a surgical unit linked to a testing device, in order to standardize/simulate implant drilling procedures. Bone temperature variations and drilling force were recorded when drilling at a depth of 8 and 10 mm. A constant irrigation of 50 ml/min. (21±1°C) and drilling speed of 800 r.p.m. were used. Scanning electron microscopy analysis was preformed prior and after drilling. RESULTS: Mean temperature increase with both drills at 8 mm was 0.9°C and at 10 mm was 2°C (P<0.0001). Statistical significant higher bone temperatures were obtained with stainless steel drill (1.6°C), when comparing with the ceramic drill (1.3°C) (P<0.05). Temperature increase was correlated with higher number of perforations (P<0.05) and drilling load applied. There was no significant association between drilling force applied and temperature increase by either drill or at either depth. No severe signs of wear of either drill were detected after 50 uses. CONCLUSIONS: Drill material and design, number of uses, depth and drilling load applied appear to influence bone temperature variations during implant site preparation. Drilling depth was a predominant factor in bone temperature increase. Both drills can be used up to 50 times without producing harmful temperatures to bone tissue or severe signs of wear and deformation.

Envelope” approach for onlay bone grafting: Preliminary surgical and prosthetic results

Minimally invasive surgery principles have been applied to preprosthetic-implant surgery, and an adequate presurgical planning reduces morbidity in both harvesting and stabilization of the bone grafts. Objective: A new “envelope” approach for onlay bone grafting at the alveolar process is presented, this avoids releasing incisions yetallowing adequate reconstruction of the defective site. Study design: To be included in the study the patient had to have an antero-posterior defect of the alveolar crest. Patient age and sex, location of the defect, type and size ofgraft, and complications appeared during follow up were recorded. Results: Ten consecutive patients (4 men and 6women) have been succesfully treated with this technique between June/2006 and February/2008. Eight defectswere located at the anterior maxilla (between canines), and the remaining two at the anterior mandible (betweencanines). Four patients received bone grafts harvested from the chin, and the remaining six patients received bonegrafts from the mandibular body. Mean size of the graft was: width 11,5mm (range 8 to 17), height 14,7mm (range9 to 18), depth 4,3mm (range 3 to 6). Conclusion: This technique improves vascularization of the mucoperiostealflap and avoidance of releasing incisions which has an aesthetic impact in patients with gingival smile (AU)

Relation between bone density and primary implant stability

Aims: This study aims to relate bone density in Hounsfield units (Hu) with the primary implant stability measured by insertion torque (Ncm) and resonance frequency analysis (ISQ).Materials and Methods: Ten patients were included in this study. A total of 54 implant sites were provided from 10 computerized tomography scans. The computerized tomography scan was used for the preoperative evaluation of bone density for each patient. The bone mean density around planned implants was determined with Physioplanet TM software. Bone quality according resistance to drilling, insertion torque and resonance frequency measurements were recorded. Results: A statistically significant relationship was observed between bone quality density and location with ISQvalues. Conclusions: This research demonstrates a strong relationship between the bone density values from computerized tomography and the location in the maxillaries. A correlation exists between bone quality, according to the Lekholm & Zarb classification, and Hu computerized tomography values. The primary implant stability measuredwith resonance frequency analysis depends on bone density values, bone quality and implant location (AU)

A novel trephine design for sinus lift lateral approach. Case report

Various techniques are described in the literature, either by crestal or lateral approach. Sinus augmentation hasa high percentage of success, but presents a number of intraoperative and postoperative complications. The most frequent complication is the Schneiderian membrane perforation with a percentage of perforations between 11% and 56% according to authors. The aim of this study is to describe another membrane approach technique for thesinus lateral wall osteotomy that minimizes the risk of Schneiderian membrane perforation. We present a caseof a 50 year old patient attended the University Dental Clinic (UDC) of International University of Catalonia for implant and crown treatment due to the loss of a right maxillary first molar. To insert an implant in position 1.6 acomputerized tomography (CT) was requested to determine with greater accuracy the quantity of residual crestalbone. It showed a height of 5 mm and width of 8 mm. The lateral osteotomy was performed with a (SLA KIT®-Neobiotech) trephine mounted in the same implant handpiece with which the field for the implant and the implant itself were prepared. It can be concluded that in the case described, the use of trephine drills of the SLA systemmounted in a handpiece allows better access to lateral approach due to its perpendicular position relative to thesinus wall minimizing the membrane perforation risk (AU)

A novel trephine design for sinus lift lateral approach. Case report.

Various techniques are described in the literature, either by crestal or lateral approach. Sinus augmentation has a high percentage of success, but presents a number of intraoperative and postoperative complications. The most frequent complication is the Schneiderian membrane perforation with a percentage of perforations between 11% and 56% according to authors. The aim of this study is to describe another membrane approach technique for the sinus lateral wall osteotomy that minimizes the risk of Schneiderian membrane perforation. We present a case of a 50 year old patient attended the University Dental Clinic (UDC) of International University of Catalonia for implant and crown treatment due to the loss of a right maxillary first molar. To insert an implant in position 1.6 a computerized tomography (CT) was requested to determine with greater accuracy the quantity of residual crestal bone. It showed a height of 5 mm and width of 8 mm. The lateral osteotomy was performed with a (SLA KIT®-Neobiotech) trephine mounted in the same implant handpiece with which the field for the implant and the implant itself were prepared. It can be concluded that in the case described, the use of trephine drills of the SLA system mounted in a handpiece allows better access to lateral approach due to its perpendicular position relative to the sinus wall minimizing the membrane perforation risk.

Relation between bone density and primary implant stability.

AIMS: This study aims to relate bone density in Hounsfield units (Hu) with the primary implant stability measured by insertion torque (Ncm) and resonance frequency analysis (ISQ). MATERIALS AND METHODS: Ten patients were included in this study. A total of 54 implant sites were provided from 10 computerized tomography scans. The computerized tomography scan was used for the preoperative evaluation of bone density for each patient. The bone mean density around planned implants was determined with Physioplanet TM software. Bone quality according resistance to drilling, insertion torque and resonance frequency measurements were recorded. RESULTS: A statistically significant relationship was observed between bone quality density and location with ISQ values. CONCLUSIONS: This research demonstrates a strong relationship between the bone density values from computerized tomography and the location in the maxillaries. A correlation exists between bone quality, according to the Lekholm & Zarb classification, and Hu computerized tomography values. The primary implant stability measured with resonance frequency analysis depends on bone density values, bone quality and implant location.