A comparison of the success of root resected molars and molar position implants in function in a private practice: results of up to 15-plus years.

BACKGROUND: When faced with a furcated molar, today's clinician must decide between a number of treatment options, including root resection, tooth removal, and implant placement. This paper assesses the results in one private clinical practice of root resection and subsequent restoration or molar implant placement and subsequent restoration. Clinical considerations in treatment selection are discussed. METHODS: A retrospective analysis of treated patients was carried out by examining active and inactive patient charts. When patients had discontinued therapy, every effort was made to determine the reason for leaving the private practice, so as to assess the impact of previously undocumented treatment failure on the statistics in question. RESULTS: A total 701 root resected molars and 1,472 molar implants were evaluated after > or = 15 and 13 years in function, respectively. Resection of the distal root of a mandibular molar demonstrated the lowest success rate (75%). All other success rates for various root resected molars in function ranged from 95.2% to 100%. Lone standing implants in second molar positions demonstrated the lowest success rate (85%). All other implant use in molar positions demonstrated a success rate ranging from 97.0% to 98.6%. Root resected molars and molar implants demonstrated the highest degree of failure when they were lone standing terminal abutments. Seven out of 23 (30.4%) root resected molar failures, and 17 of 45 (37.8%) of the molar implant failures were associated with untreated parafunction. Cumulative success rates were 96.8% for root resected molars and 97.0% for molar implants. Success and failure are discussed by tooth and/or implant position, and resected root, where applicable. Possible ramifications of these findings upon treatment planning are also reviewed. CONCLUSIONS: Both molar root resection and appropriate restoration and molar implant placement and restoration demonstrated a high degree of success in function. However, this success rate is markedly affected when either the root resected molar or molar implant is a lone standing terminal abutment. Care must be taken to choose the appropriate treatment modality for a given patient scenario.

The modified trephine/osteotome sinus augmentation technique: technical considerations and discussion of indications.

A technique is presented, which uses trephines of various external diameters followed by an osteotome to implode a core of maxillary posterior alveolar bone before placement of regenerative materials, in anticipation of subsequent implant placement. A mathematical formula is presented, which relates the depth of core displacement to the apico-occlusal dimension of alveolar bone coronal to the floor of the sinus presurgically. Seventy-one sites have been treated. All sites exhibited sufficient regeneration for implant placement. Two of the sites required additional augmentation at the time of implant placement. Fifty-one of the implants have been restored and are in function for up to 3 years. All are functioning successfully, as defined by the Albrektsson criteria. The technique and its indications and contraindications are described in detail.

Treatment options for augmentation of the posterior maxilla.

The uses of conventional sinus augmentation procedures, trephines and osteotomes, with and without concomitant buccal-lingual ridge augmentation are discussed. Indications and contraindications for the application of each therapeutic modality, material selection, and the appropriate timing of implant placement are detailed.

Implant/tooth-connected restorations utilizing screw-fixed attachments: a survey of 3,096 sites in function for 3 to 14 years.

Numerous problems have been reported following various therapies used to attach natural teeth to implants beneath a fixed prosthesis. This study documents the results of 843 consecutive patients treated with 1,206 natural tooth/implant-supported prostheses utilizing 3,096 screw-fixed attachments. After 3 to 14 years in function, only 9 intrusion problems were noted. All problems were associated with fractured or lost screws. This report demonstrates the efficacy of such a treatment approach when a natural tooth/implant-supported fixed prosthesis is contemplated.

The bone-added osteotome sinus floor elevation technique: multicenter retrospective report of consecutively treated patients.

A retrospective clinical evaluation of patients consecutively treated from multiple centers was performed. The treatment of these patients utilized the bone-added osteotome sinus floor elevation (BAOSFE) procedure with immediate implant fixation. The BAOSFE method employs a specific set of osteotome instruments to tent the sinus membrane with bone graft material placed through the osteotomy site. A total of 174 implants was placed in 101 patients. Implants were of both screw and cylinder shapes with machined, titanium plasma-sprayed, and hydroxyapatite surfaces from various manufacturers. The 9 participating clinicians used autografts, allografts, and xenografts alone or in various combinations, and the type of graft was selected by the individual clinicians. The choice of graft material did not appear to influence survival rates. Loading periods varied from 6 to 66 months. The survival rate was 96% or higher when pretreatment bone height was 5 mm or more and dropped to 85.7% when pretreatment bone height was 4 mm or less. The most important factor influencing implant survival with the BAOSFE was the preexisting bone height between the sinus floor and crest. This short-term retrospective investigation suggests that the BAOSFE can be a successful procedure with a wide variety of implant types and grafting procedures.

Maintenance of soft tissue closure following guided bone regeneration: technical considerations and report of 723 cases.

The purpose of this paper is to present simple clinical techniques which have been utilized in a significant number of consecutive cases to maintain primary closure throughout the course of regeneration. The maintenance of soft tissue primary closure following guided bone regeneration (GBR) therapy, while considered a considerable challenge, is recognized as contributing to the maximization of therapeutic results. A retrospective analysis of the maintenance of such soft tissue primary closure following the utilization of specific mucoperiosteal flap designs during GBR surgery in 723 consecutively treated cases was carried out. Soft tissue closure was maintained over the membranes for the course of regeneration (a minimum of 6 months) in 695 cases (96.1%). The maintenance of soft tissue primary closure following GBR therapy may be predictably attained through proper surgical planning, technical care, and appropriate postoperative management.

Sinus floor augmentation at the time of maxillary molar extraction: technique and report of preliminary results.

A technique is described for accomplishing both localized sinus augmentation and guided bone regeneration at the time of maxillary molar extraction. One hundred nine sites were treated in 92 patients. Of these, 102 procedures (94.0%) were successful and 7 (6.0%) were partially successful. Success was defined as the ability to ideally position an implant at least 10 mm in length and 4.8 mm in width without perforating the floor of the sinus or generating an implant fenestration or dehiscence. Partially successful procedures required an additional osteotome sinus lift at the time of implant placement.

A classification system for sinus membrane perforations during augmentation procedures with options for repair.

A classification system for sinus membrane perforations encountered during a sinus augmentation procedure is presented. Five of the perforations are discussed, as are the therapeutic options for their repair. Class I and Class II perforations are most easily repaired, while Class IV is the most difficult to successfully treat. In addition, the effect of the sinus membrane perforation on the course of proposed therapy is discussed. When classified and managed appropriately, sinus membrane perforations are not an absolute indication for aborting the augmentation procedure which is in progress. This paper provides a system of classification that can be used by clinicians to collect data on membrane perforations and repair results.

Maintenance of regenerated bone beneath pontics: preliminary clinical report of 43 sites.

Ridge augmentation was achieved through the use of guided bone regeneration procedures in pontic areas of 43 planned fixed prostheses. Measurements taken through templates, which fit over the final fixed prostheses, at the time of prosthetic placement and a mean of 123 weeks after prosthesis placement demonstrated a change of less than 0.1 mm in buccopalatal dimensions of the regenerated hard tissues.

Clinically based implant selection.

A hierarchy of implant selection is presented, based on overcoming specific clinical challenges in a variety of situations, including maximization of the esthetic, comfort, and functional potentials of therapy.

Immediate implant placement and GBR in humans: a case report and histologic evaluation.

An IMZ titanium plasma-sprayed implant was placed at the time of removal of a fractured mandibular left first premolar. Porous hydroxyapatite (Interpore 200) was placed on one side of the residual defect around the implant, and the entire defect was covered with a Gore-Tex membrane. The implant, with surrounding newly reformed hard tissues, was removed in a block section 13 months postoperative. Histologic examination demonstrated regeneration of living bone tissues, the attainment of osseointegration, and incorporation of the Interpore 200 into surrounding bone.

Appropriate selection of GTR therapy.

The appropriate application of guided tissue regeneration (GTR) therapy demands both diagnostic and technical acumen. This article discusses the presurgical considerations that must be evaluated before surgical entry and treatment. A diagnostic system for the evaluation of maxillary molar furcation involvements also is presented.

Technical considerations.

Appropriately applied, guided tissue regeneration (GTR) therapy is an important addition to the clinician's treatment armamentarium. However, GTR therapy is highly technique-sensitive, and failure to understand and manage the subtleties of treatment will significantly diminish therapeutic results. This article discusses the technical prerequisites for successful application of GTR therapy to infrabony defects and periodontally involved furcations for maximization of treatment results.

Special considerations, treatment selection criteria, and case reports.

As understanding of the diagnostic and technical prerequisites for maximizing therapeutic results after guided tissue regeneration (GTR) therapy matures, the applications of such treatment have been expanded. This article discusses the use of GTR therapy in the esthetic zone, beneath pontics, and in combination with resective treatment modalities. A hierarchy of appropriate treatment selection is presented.

The need for GTR therapy.

Guided tissue regeneration (GTR) affords the clinician the ability to successfully manage a variety of severe periodontal problems, without engendering the prosthetic commitment necessary for the use of root resective techniques. However, such therapy is highly diagnostic- and technique-sensitive. This article provides a clinical basis for using GTR and maximizing therapeutic outcomes, and discusses the challenges posed by deep infrabony defects and furcation involvements. The discussion also focuses on the need for GTR therapy to treat such lesions comprehensively.

Implant placement in atrophic alveolar ridges: a simplified technique.

A technique is presented that allows for the predictable and simple placement of implants into ideal restorable positions in severely atrophic, knife-edged ridges. Technical considerations and advantages of this treatment approach are discussed.