Autogenous bone versus beta-tricalcium phosphate graft alone for bilateral sinus elevations (2- and 3-dimensional computed tomographic, histologic, and histomorphometric evaluations): preliminary results.

The aim of this research was to compare 2 different graft materials, beta-tricalcium phosphate (Cerasorb) and autogenous bone, used in the same patient. Bilateral sinus grafting was performed on 4 selected patients; Cerasorb only was used on the experimental side, and autogenous bone only was used on the control side. In all 4 patients, the maxilla was atrophied to such an extent that the reconstruction included not only sinus grafting but also onlay plasty. The procedure was followed by implant placement 6 months later. In addition to routine panoramic radiographs, 2- and 3-dimensional computed tomographic (CT) examinations were performed pre- and postoperatively and after implantation. Information from CTs is necessary when alveolar bone atrophy is extensive, complications appear probable, and in difficult cases, when exact documentation is important. A total of 16 bone biopsies were taken at the time of implant placement. The histologic and histomorphometric results indicated that when the formation of new bone was slow, it was slow on both sides; when it was fast, then it was fast on both sides. Individual patient factors strongly influenced the fates of the various graft materials in the organism. Comparisons of the present results with the findings of other investigators demonstrated that beta-tricalcium phosphate is a satisfactory graft material, even without autogenous bone.

[Gardner syndrome--on the basis of three cases]. / A Gardner-szindrómáról több eset kapcsán.

Based on the 3 cases, the authors describe the Gardner-syndrome which is not so well-known in Hungary. The most important features of the Gardner syndrome are the malignized large intestine polyposis, the multiplex osteomies and the different skin tumours. The earliest symptoms suspecting the clinical picture, are usually dental and/or mandibular lesions. Being aware of the above mentioned facts the dentist noticing the symptoms first is highly responsible.

[The value of beta-tricalcium-phosphate (CERASORB) in pre-prosthetic surgery]. / A beta-tricalcium-foszfát (CERASORB) jelentósége a preprotetikai sebészetben.

Short- and medium-term experience with a pure-phase beta-tricalcium phosphate bone-substitute material (Cerasorb) is reported on the basis of clinical, radiological (panorama, 2-3D CT records) and histological examination on 52 patients. The treatment modes on these patients included the filling of cysts, sinus grafting, augmentation and the filling of parodontal lesions. Disturbance of wound healing was not observed in any of the cases, and both the radiological and the histological examinations revealed that transformation of the implanted beta-tricalcium phosphate into bone could be detected as early as in the second month. During the 10-month follow-up period, this transformation was continuous, but was not complete; completion is to be expected only after 12 months. It is important that load-bearing tissue had already developed after 4-6 months. Studies to date suggest that autologous bone is not necessary for either sinus grafting or the filling of large cysts: Cerasorb alone is suitable for this purpose.

[Sinus elevation and its control by 3D computer tomography]. / Sinuselevatio tervezése és kontrollja a 3d komputertomográfia segítségével.

We have performed 3D CT examinations before and after 21 uni- and bilateral sinus elevations, immediately prior to loading of the implants and 1 year after the loading. Comparison of the results with those of panoramic and the customary CT examinations yielded the following useful information. Any possible difference between planning and performance may be controlled. The fate of biomaterial implanted in the maxillary sinus was followed. The 3D CT projections providing most information were established (from a superior position downwards; from lateral and posterior positions forwards). Possible errors can be discovered before the implant is loaded. The cases in which it is worthwhile to perform this costly examination were determined: surgical complications, documentation, extensive alveolar atrophy etc. The results of sinus elevation with different bone substitute materials can readily be compared (e.g. autogenous bone + HTR Bioplant on one side, and autogenous bone + Algipore on the other side).

2D and 3D computer tomography and sinus graft analysis with various graft materials.

Sinus grafting has been a routine surgical procedure since the 1970s. Computer tomography (e.g., SIM/Plant) is available for planning and simulation, but it has not been used to control the success and the long-term results of the planned surgery. The aim of this work was to apply a prospective examination method to determine (a) the extent to which the success of sinus grafting can be followed through 2D (two-dimensional) and 3D (three-dimensional) CT (computer tomography) reconstruction, (b) when choosing this method is worthwhile, and (c) how to visualize incorporating and transforming various graft materials. Twelve patients received 21 sinus graftings, with immediate implantation. Four 2D and 3D CT reconstructions were performed: (1) preoperatively, (2) 1-2 weeks postoperatively, (3) before loading, and (4) 1 year after completing prosthodontic treatment. The sinus grafts were composed of a mixture of HTR Bioplant polymer and autograft, or from a mixture of Algipore (HA, hydroxyapatite) and autograft. In the bilateral cases, both sinus graft mixtures were used, one on each side. The posterior-anterior, the lateral, and the superior-inferior views provided the most useful information; the usefulness of serial images is very limited. Individual 2D and 3D CT reconstructions are proposed, however, in cases of extensive bone atrophy, if complications are expected, if complications arise during surgery, if healing is protracted, or if the documentation is important for other reasons. The long-term results of the two graft materials could be followed up extremely well. Both materials proved outstandingly suitable for sinus grafting.