Clinical Comparison of Vascular Bleeding Time Creep Between Osseodensification and Conventional Drilling of Implant Osteotomy Sites.

This study compared the onset of vascular bleeding between osseodensification and conventional drilling of implant osteotomy sites. Patients with type III trabecular bone requiring a single missing tooth replacement were included and allocated to either Group A (test) or Group B (control). In Group A, the osseodensification group (OD), an implant osteotomy was carried out using Densah Burs (Versah) in the counterclockwise direction; in Group B, the standard drilling group (SD), Densah Burs were run in the clockwise direction. An endoscope was introduced into the osteotomy to visualize and measure the time taken for initiation of bleeding (BI) and for blood to fill the osteotomy site (BF). A total of 40 osteotomy sites (23 in the maxilla and 17 in the mandible) were included in this cross-sectional study. The mean age of study participants was 50.1 ± 8.28 years. The mean BI time for Groups A and B was 18.54 ± 2.48 seconds and 16.89 ± 1.92 seconds, respectively (P = .02); the mean BF time for Groups A and B was 41.92 ± 3.19 seconds and 37.95 ± 2.73 seconds, respectively (P < .001). Osseodensification does not seem to negatively affect or induce loss of bone vascularity. Clinicians should note that osseodensified sites might take slightly longer to fill with blood following an osteotomy.

Comparison of insertion torque, implant stability quotient and removal torque, in two different implant designs with and without osseodensification. - An ex vivo bench top study.

Background: Primary stability is an important factor in influencing the outcome of dental implants. Osteotomy modification techniques mentioned, include osteotomes for bone condensation, under-preparation of osteotomy and Osseodensification (OD). The objective of our twin arm study was to assess how two different implant designs respond to conventional osteotomy drilling and how these values obtained compare with OD. Materials and methods: The study comprised a total of 80 implants inserted in pig tibia bone. Group 1a (n = 20) consisted of tapered internal implants and group 1b (n = 20) consisted of tapered pro implants, both inserted with conventional drilling. Group 2a (n = 20) consisted of tapered internal implants and group 2b (n = 20) consisted of tapered pro implants, both inserted with OD. Each implant inserted was measured for implant stability quotient (ISQ), insertion torque and removal torque. Results: Group 1a showed a significantly lower ISQ, mean insertion and removal torque and as compared to Group 1b. Group 2a and 2b had comparable mean values for all the three parameters. Inter-group comparison showed a higher ISQ and insertion torque value for group 2 than group 1. Intra-group assessment showed a significantly lower value for all parameters for sub-group a than b. Conclusions: OD enhances primary stability of implants in bone; but when no OD is used, the tapered pro implant design offers a better primary stability. This may be attributed to the active thread design.

Comparative Assessment of Bovine Versus Porcine Xenograft for Augmentation: A Randomized Prospective Cohort Study.

This study compared the bone turnover and volume stability of bovine-derived xenografts (Cerabone) vs porcine-derived xenografts (MinerOss XP) in horizontal ridge augmentation (HRA) for veneer contour and extraction socket preservation (ESP), with a 6-month follow-up. Participants were divided into Group 1 (HRA + bovine), Group 2 (HRA + porcine), Group 3 (ESP + bovine), and Group 4 (ESP + porcine). Buccolingual ridge width was measured on CBCT scans at baseline and 6 months. Representative histologic core samples were taken from the ESP groups at 6 months. Each group comprised 10 subjects (40 subjects total). The buccolingual width for Groups 1 and 2 increased from 5.43 ± 1.82 mm and 5.75 ± 1.64 mm (P = .36) to 7.75 ± 1.91 mm and 8.75 ± 1.38 mm (P = .03), respectively. However, the buccolingual widths for Groups 3 and 4 decreased from 6.3 ± 1.26 mm and 6.74 ± 1.29 mm (P = .16) to 5.8 ± 1.21 mm and 6.61 ± 1.56 mm (P = .01), respectively. Significantly lower dimensional changes were noted in Group 4 at 6 months. Porcine xenografts serve as a stable biocompatible osteoconductive bone substitute and expand a clinician's choice of bone grafts in dental applications.

Lateral Window Osteotomy in Maxillary Sinus Augmentation: Does a Combination of Two Surgical Protocols Offer Any Advantage? A Retrospective Analysis of Clinical Outcome.

PURPOSE: Maxillary sinus augmentation using the lateral bone window approach has been well documented and studied, with the advent of many newer techniques and instruments. It is prudent that operators make a choice based on scientific evidence and feasibility guided by each case. The purpose of this study is to analyze whether a combination of more than one method could prove beneficial when compared to any one method alone. MATERIALS AND METHODS: Radiographic and clinical data from 48 augmented maxillary sinuses in 42 male and female patients was collected and the clinical outcome analyzed based on different clinical parameters. Data collected from 48 augmented maxillary sinuses was divided into 4 groups based on the osteotomy method used. A comparison was made between rotary diamond bur (Group 1), the piezosurgical device (Group 2), a hand-held bone scraper (Group 3) and a combination of method 1 and 3 (Group 4). Mean wall thickness for the maxillary Bucco-facial wall was measured for all cases. Clinical parameters measured included time taken to complete the osteotomy, membrane perforation, operator fatigue, anastomotic vessel damage and autogenous bone collected. RESULTS: Mean time taken for Group 1 was 17.33 min, Group 2 was 34.83 min, Group 3 was 38 min, Group 4 19.5 min. Membrane perforations were highest in Group 1 & 2 at 16.66%. Groups 2 and 4 showed the least chances of damage to the vessel at 16.66%. Significance of operator fatigue was highest at 16.66% in Group 4. CONCLUSIONS: It was concluded that there may be an advantage in selecting a combination of surgical protocols in accordance with the lateral wall thickness. The advantages may extrapolate to safety, simplicity and ergonomics of surgical approach compared to any one technique alone.

Management of complex asymmetric deficiency of hard and soft tissue for implant-based rehabilitation.

Dental implants are a successful treatment modality for rehabilitation of missing dentition. Optimal placement from the prosthetic standpoint is imperative for function, form, and esthetics, but at the same time, attention has to be focused on the biologic aspect of three dimensionally optimal placement within a stable hard and soft-tissue envelope. Bone and soft-tissue quality, quantity, and location of these two important variables are equally important in determining the longevity of osseointegrated fixtures. Numerous methods have been reported to tackle bone and soft-tissue deficit with variable outcomes of each. This report presents one such case where alongside tissue deficit, there is severe arch asymmetry which needs correction for optimal prosthetic rehabilitation.

Inappropriate Socket Shield Protocol as a Probable Cause of Peri-Implant Bone Resorption: A Case Report.

Alveolar ridge remodeling post-extraction is a well-documented process. Alveolar bone is in a continuous state of remodeling even after implant placement, and this leads to changes in the contour of the peri-implant tissues over the years. A vast number of procedures have been described in literature to address and correct this resorption including procedures like socket grafting, dual zone grafting, socket shield (partial extraction therapy) and many more. Socket shield (partial extraction therapy) is a relatively new procedure described in the literature. This technique aims to try and slow down this remodeling and maintain the peri-implant tissues in a state near normalcy. The aim of this article is to assess a case where the possible cause of buccal bone loss around an integrated implant was an inappropriately prepared socket shield. It is recommended that an evidence-based consensus be put forth on both case selection and execution to minimize inappropriate execution of this technique by the average clinician.

Modified 'Cul-De-Sac' approach for management of a large perforation during maxillary sinus elevation- (A case report).

Dental implants have been in used as a successful mode of rehabilitation of lost dentition for over three decades. Science and techniques have undergone significant progress with time and clinical situations that were deemed unfit for insertion of dental implants due to lack of sufficient bone are now being treated using implants with predictable long term results. Clinicians can now rehabilitate the posterior maxilla with a wide variety of implant-based solutions. There are complications associated with this procedure which may be attributed to diagnostics or the surgical protocol itself and a multitude of management approaches have been suggested in the literature. This report elucidates one such case of management of a large perforation in the Schnederian membrane during elevation using a staged approach.

Cystic epithelial lining seen around a dental implant: A case report of a rare finding.

Dental implants have been successfully used for over 30 years, with a low complication rate. Peri-implant pathologies have recently seen an increase in incidence. This case report elucidates a rare case implant failure that occurred shortly after prosthetic loading, where the clinical signs mimicked peri-implant disease and attending bone loss, but the final histological report confirmed presence of a cystic lining around the implant. The manuscript also emphasizes the possible causes and management of such complications. To the best of our knowledge, this represents one of the first publication of an evident peri-implant cystic lining in a case exhibiting no radiographic evidence of the same.

Endoscopically monitored maxillary sinus augmentation - The chairside approach (Rationale and protocol).

Sinus augmentation procedures have been reported since the time of Boyne, with variable techniques and outcomes. Sinus membrane perforations may or may not be detected at the intra-operative stage, thereby compromising the outcome. The aim of this study is to evaluate the usefulness and feasibility of an endoscope used intraorally during manipulation of the schnederian membrane. This would help confirm sinus health and integrity of the membrane during and after the augmentation.

Dimensional changes in soft tissue as a plausible cause for error in computer-aided design and computer-aided manufacturing stent-guided implant osteotomy.

Dental implants have been in vogue for more than three decades as a successful mode of rehabilitation of lost dentition. With time, there have been updates in methods and science including a positive tilt toward incorporation of digital technology into treatment protocols. This report elucidates a rare case of faulty osteotomy preparation through a computer-aided design computer-aided manufacturing stent that was detected and corrected before implant placement. The manuscript also emphasizes the possible shrinkage of soft-tissue graft beyond the normal postulated time frame and the importance of periodical checks on the drilling protocol throughout the flapless placement procedure even though it may have been seamlessly planned on the digital platform.

Neuralgia-inducing cavitational osteonecrosis - Fact or myth, the debate persists.

Neuralgia-inducing cavitational osteonecrosis (NICO) is a debated condition characterized by cavitary lesions in the maxillary-mandibular region, often missed on conventional radiographs, and the golden standard for diagnostic measures is bone scintigraphy. It may arise secondary to trauma, such as dental extraction and endodontic treatment, and due to a low-grade chronic infection. NICO has been documented as a frequent cause of face pain involving the trigeminal nerve divisions. It may be severe, piercing pain, of short duration or even continuous pain of moderate intensity. It affects females with a greater predilection than males. A lack of awareness of the condition among health professionals is often put into the basket of atypical facial pain. Current studies describe ischemic alveolar bone marrow coagulation disorders as the cause for NICO, which may also be the result of thrombosis with or without hypofibrinolysis, which would obstruct vascular spaces impairing blood flow in the region. Treatment is decided on a case basis, depending on the clinicians' experience, on previous treatments, on the patient's general status, and more importantly, whether the site is edentulous or dentate. If surgical intervention is chosen, tissue should be sent for pathological examination. Over the years, with the advance of imaging diagnosis processes and the study and detection of genetic changes, one may also include as a cause of NICO the decreased bone marrow blood flow causing bone cavities. All of this was also associated with genetic mutations which would predispose patients to thrombophilia and hypofibrinolysis.

MIDAS (Minimally Invasive Drilling And Styptic) protocol - A modified approach to treating patients under therapeutic anticoagulants.

Patients with cardiac or allied medical conditions mandating long term oral anticoagulant therapy form a sizeable database in an implant practice today. The management of such patients during surgical and dental procedures has always been debatable. Literature has documented evidence that indicates towards stopping the anticoagulant for a finite period. However, discontinuing anticoagulants is not always possible, given the risks of greater significance than the edentulous state. In such patients a minimally invasive flapless approach is preferred, having the potential to reduce bleeding, surgical time and postoperative edema. The purpose of this case series is to show a possible modified approach for dental implant placement using a CAD-CAM stent guided flapless approach without stopping of therapeutic anticoagulant medication.

Sinus Grafts: Science and Techniques-Then and Now.

INTRODUCTION: Sinus lifts have been around for more than four decades now, and the amount of changes that we have seen in techniques and armamentarium coupled with the advent of newer materials is worth taking note of. MATERIALS AND METHODS: A complete review of the literature was done since the advent of ways and means to augment the posterior maxilla with a run through of various advantages and disadvantages of the same. CONCLUSION: In conclusion, we can say that this procedure is today very predictable and offers clinicians a possibility to rehabilitate the posterior maxilla with implant-based solutions.

Neuralgia-inducing cavitational osteonecrosis in a patient seeking dental implants.

NICO (Neuralgia-Inducing Cavitational Osteonecrosis) is one of the jawbone versions of ischemic osteonecrosis, a common disease affecting any bone but with special affinity for those of the hips, knees and face. By definition, NICO is associated with pain. Osteonecrosis itself may or may not be painful. It may or may not affect multiple sites. It is a problem of poor blood flow through the marrow Patients can trace the onset of their pain subsequent to one or more extractions, perhaps decades ago. Notably, if patients had infections following their extractions or even dry sockets, there was a greater likelihood of NICO development. NICO's can refer pain across the midline; that is, a lesion in the right jaw can cause pain on the left side of the face, head, neck or body. Yes, NICO's can refer pain to various areas of the body, including the neck, arms and hands, legs and feet, groin.

Implants in maxillary sinus.

Augmentation of the floor of the maxillary sinus is an extremely important technique for posterior site development in the maxilla prior to implant placement. A number of techniques have been suggested and used in the past to deal with membrane perforations such as suturing the membrane, application of fibrin sealants oxidized regenerated cellulose and collagen membranes. The most important aspect of sinus grafting is the integrity of the sinus membrane solely to confine the graft. If membrane tears are not taken care of, graft material can extravasate into the antrum and block the ostium. The fast-resorbing membranes are not good enough to form bone as their integrity is lost before woven bone forms. The novel technique demonstrates the use of a slow-resorbing membrane not only for perforations, but even in circumstances where the sinus is devoid of a membrane, thus bypassing the waiting period for schnederian membrane regeneration prior to grafting.

Oro-mandibular dystonia.

Dystonia is an involuntary, repetitive, sustained (tonic), or spasmodic (rapid or clonic) muscle contraction. The spectrum of dystonias can involve various regions of the body. Oromandibular dystonia (OMD) can involve the masticatory, lower facial and the tongue muscles which may results in trismus, bruxism, involuntary jaw opening or closure and involuntary tongue movement. Here, we report a case of OMD in a 68 year old man.