Effects of Corticobasal Implant Protrusion inside the Nasal and Maxillary Sinus.

BACKGROUND: Implant protrusion into the nasal and maxillary sinuses presents a challenge in cases of severely resorbed maxillae. AIM: The aim of this study was to evaluate the clinical and radiographic effects of BECES® implant penetration depth into the nasal and maxillary sinuses. SETTING AND DESIGN: This was an observational study conducted in a tertiary institution. MATERIALS AND METHODS: Forty-nine BECES® implants were inserted into the maxilla of patients who presented with severely resorbed ridges but no history of sinusitis. Forty-five implants protruded into the sinus cavities. Patients were examined clinically and radiographically at 1 week and 3, 6, 12, and 18 months after insertion. Maxillary sinus health, survival and success rates, and peri-implant health were assessed using the plaque index (PI), calculus index, modified gingival index (MGI), and probing pocket depth (PPD). STATISTICAL ANALYSIS: Wilcoxon signed-rank test and Mann-Whitney test were used in this study. RESULTS: Four (8.16%) of the 45 implants that penetrated the cavities reached the sinus floor without disrupting the membrane; the penetration depth was ≥4 mm in 20 implants (44.44%) and <4 mm in 25 (55.56%). No patient showed clinical or radiographic signs of sinusitis during the observation period. There were significant differences in the PI, MGI, and PPD values between baseline and the 18-month follow-up with no association with the penetration depth. All implants showed radiographically direct bone-to-implant contact. Where the implant tip barely reached the sinus floor, the membrane healed uneventfully while when deeply penetrating the sinus, the membrane healed around the implant but did not cover the tip. All prostheses and implants survived during the observation period. CONCLUSION: Penetration depth of polished implants with cortical engagement into the maxillary sinus or the floor of the nose does not negatively affect implant survival, the success rate of the treatment, nor peri-implant soft-tissue health. It also does not provoke the development of sinusitis.

Esthetic Indication for Dental Implant Treatment and Immediate Loading (3). Case Report and Considerations Regarding the Aspect of the Patient's Right to Self-Determination in Medical Decision-Making.

The technology of the Strategic Implant® has expanded the indications for tooth and bone removal. This case report shows what kind of results are possible and how much the appearance of a patient can be changed within a few days if both teeth and bone are removed. The treatment option explained here could be considered by patients with a gummy smile. This treatment conflicts with the traditional thinking of dentists, who are educated to keep and maintain teeth. This can be compared to other fields of esthetic surgery where the patient's right to self-determination in medical decision-making has been established for a considerable period of time and is more frequent than in dentistry.

Consensus Regarding 16 Recognized and Clinically Proven Methods and Sub-Methods for Placing Corticobasal® Oral Implants.

This Consensus-Document is issued by the International Implant Foundation (Munich/Germany). It describes distinct methods of placement of cortico-basal oral implants in different areas of the jaw bone and the maxillo-facial skeleton. The implants utilize the method of "osseofixation" instead of "osseointegration" for achieving primary, functional stability, hence they work according to the (AO-) principles of fracture treatment. The concept of the technology allows for immediate functional loading, just as it allows for various types of loading following orthopaedic surgery. The 16 methods and sub-methods as described and displayed here have been undergoing extensive observation and testing and they have been approved by the Board of the International Implant Foundation. All Consensus Documents of the International Implant Foundation are revised every three years. This is the 3rd version of the Consensus Document on placement of corticobasal oral implants Level of Evidence: S3 (evidence based, systematically developed consensus guideline).

A Single-Step Implant Treatment of a Patient Presenting with a High Smile Line (Gummy Smile) - Surgical, Prosthetic, and Financial Considerations of Full-Mouth Rehabilitation with One-Piece Implants Anchored in Cortical Bone - A Case Report.

Dental implant treatment and immediate loading protocol in the front maxillae provides severe esthetical difficulties, for example in cases where the transition zone of the patients' teeth and the gums is visible during habitual movements of the upper lip or when the patient presents excessive gingival display. In this case report, it is shown in detail how to overcome the esthetic problems in a straightforward manner in such clinical situations. The article also discusses in which financial environments treatments on teeth are endlessly continued and under which conditions patients manage to get (and prefer) an early switch to implant borne teeth.

Indications and Treatment Modalities with Corticobasal Jaw Implants.

This consensus document describes treatment modalities with corticobasal implants in the field of oral and maxillofacial implantology.

Dental Implant Treatment and Immediate Functional Loading (1). Case Report and Considerations: Extended Treatment Options Using the Strategic Implant® and Indications and Objectives for Comprehensive Dental Implant Treatment.

While materials for the restoration of teeth and new (digital) technologies develop fast, the choices of the treatment provider and the patients get wider. Choosing an adequate and long-lasting treatment is a question of "doing the right thing," and only after that, the dentist has to think about the question how to do the work properly. This case report explains and illustrates a case, where an adequate treatment by means of conventional dentistry would not have been possible on one hand, and where treatment with the technology of the Strategic Implant® provided a perfect result within only a few days. Thanks to this technology, patients can be treated with fixed prostheses regardless of the amount of residual bone. Recently, published long-term observations on large amounts of implants have shown that the results are sustainable.

Functional and Esthetic Indication for Dental Implant Treatment and Immediate Loading (2) Case Report and Considerations: Typical Attitudes of Dentists (and their Unions) toward Tooth Extractions and the Prevention of Early, Effective, and Helpful Dental Implant Treatment in the European Union.

The technology of the Strategic Implant® facilitates dental implant treatment almost regardless of the available bone. This explains its increasing use to resolve problems with the dentition of the middle-aged patient in a radical manner, simply by extracting the residual dentition and placing implants. While a radical change in the implant treatment paradigm has taken place in some countries, in other countries, dentists try hard to keep their work area free of implants or to deliver them only as a last resort. Liberating patients from the burdens of their own teeth are not advocated by dental universities, as their main field of teaching deals with the repair of teeth and conventional ways of replacing them. This case report shows a standard treatment with Strategic Implants®, discussing the topic from the point of view of practitioners, universities, and other parties involved in decision-making. The authors conclude that the interests of the patients are not respected in many cases because the parties involved have vested interests in other treatment modalities.

Anchorage possibilities in case of a unilateral maxillary defect using the concept of Strategic Implant®.

The aim of this article was to present the treatment method applied to a patient who suffered from a multiple fracture of the right maxilla, as a result of an accident that happened to him at an early age. The main consequence of this injury was an inhibited growth of the maxillary bone segment due to the lack of functional stimulus. The treatment consisted of four phases: the removal of all the teeth in the upper right maxilla, the immediate restoration with bicortical implants, the immediate prosthetic rehabilitation, and closing the oroantral communication.

Critical Appraisal Regarding the Publication "Implant Survival between Endo-Osseous Dental Implants in Immediate Loading, Delayed Loading, and Basal Immediate Loading Dental Implants: A 3-Year Follow-Up" as Published in Ann Maxillofac Surg 2017;7; 237-44, by the Authors R. Gharg (Corresponding Author), Neha Mishra, Mohan Alexander, Sunil K. Gupta.

This article analyses published prior article regarding the questions: is the study setup correct (true) and if comparable cases are evaluated for the compared methods. Futhermore the content, the pictures, the tables, the graphs and the pictures legends of the article and statistics are analysed for truth, relevance and applicability. We investigate furthermore if this article addresses all relevant questions regarding bias, the study groups, the evaluation of the outcomes and the evaluation of patient parameters such as burden of the treatment. As a result of the analysis, we state that the analysed article is misleading and it does not provide valuable information regarding decision making for other healthcare professionals in the dental implant field.

Bite Reconstruction in the Aesthetic Zone Using One-Piece Bicortical Screw Implants.

The aim of this article was to present the clinical application of a new, smooth surfaced one-piece bicortical screw implant with immediate loading protocol. An 18-year-old, healthy male patient with a history of total dislocation and replantation of teeth 11 and 21 in early childhood was admitted to the clinic. Teeth 11 and 21 were extracted, and two long one-piece implants were inserted at extraction sockets in one surgical session under local anesthesia. Temporary composite crowns were placed in the patient on the same day. After 3 months, the single-phase two-layer impression was made and the composite crowns were replaced with metal-ceramic crowns. After 12 months, satisfactory aesthetic and functional results were obtained.

Considerations Regarding Dental Implant Surfaces, Bone Reaction and "Peri-implantitis".

This article explains, based on a long-term observation, the hard-tissue reaction to different endosseous implant surfaces and different implant designs. A patient who had received a full maxillary implant-supported restoration on basal implants and compression screws followed by immediate loading presented no clinical problems at the 20-year follow-up, but the X-ray examination revealed different hard tissue reactions to different implant types. No bone loss was found around lateral basal implants with fully polished vertical aspects, whereas crater-like bone loss was observed around the vertical shafts of implants with a roughened surface and macromechanical retentions. The case seems to indicate that roughened surfaces around the crestal transmucosal aspect of a dental implant may promote vertical bone loss and peri-implantitis.

Assessment of Stability of Craniofacial Implants by Resonant Frequency Analysis.

Implant stability is a principal precondition for the success of implant therapy. Extraoral implants (EO) are mainly used for anchoring of maxillofacial epithesis. However, assessment of implant stability is mostly based on principles derived from oral implants. The aim of this study was to investigate clinical stability of EO craniofacial disk implants (single, double, and triple) by resonance frequency analysis at different stages of the bone's healing. Twenty patients with orbital (11), nasal (5), and auricular (4) defects with 50 EO implants placed for epithesis anchorage were included. Implant stability was measured 3 times; after implant placement, at 3 months and at least after 6 months. A significant increase in implant stability values was noted between all of the measurements, except for triple-disk implants between third and sixth months, and screw implants between 0 and third months. Disk implants showed lower implant stability quotient (ISQ) values compared with screw implants. Triple-disk implants showed better stability compared with single and double-disk implants. Based on resonance frequency analysis values, disk implants could be safely loaded when their ISQ values are 38 (single disks), 47 (double disks), and 48 (triple disks). According to resonance frequency analysis, disk implant stability increased over time, which showed good osseointegration and increasing mineralization. Although EO screw implants showed higher ISQ values than disk implants, disk-type implants can be safely loaded even if lower values of stability are measured.

Modeling of load transmission and distribution of deformation energy before and after healing of basal dental implants in the human mandible.

The purpose of this study was to present the amount and distribution of pressure, stress, and deformation energy when basal implants in the mandible are restored with a bridge which is loaded at two different stages of bone healing. The model geometry and material properties of the mandible were gained from CT scans of a human mandible. The material model used in this study defined bone as an inhomogeneous, linear elastic isotropic material. The masseter and temporal muscles were considered as rigid connections between the bones in typical positions and directions. The rotation axis was simulated in the temporomandibular joint. The loading force of 450 N was assumed to be in the middle between the left molar and left canine implant. In freshly operated bone, the total deformation energy is 30% higher than in healed bone, due to the defined energy absorbing soft bone areas. Approximately 90% of the deformation energy is absorbed by the bone, regardless of the healing state of the bone. The immediate rigid implant splinting distributes peak forces. To cope with these energies, the necessity of a reduction of total masticatory forces or the use of additional implants for force distribution should be considered individually.

Differential diagnosis of stafne idiopathic bone cyst with Digital Volume Tomography (DVT).

OBJECTIVES: The distinction between a pseudocyst and an intervention demanding cyst or process cannot always be found by 2D radiology. The differential diagnosis of a pseudocyst may become more difficult when adjacent processes are present. CASE: A symptom free 67-years-old man presented with a periapical radiolucency around the mandibular left second molar as well as at the impacted 3rd molar. A comparison with an older panoramic x-ray showed no expansion during a 27 months period. The new panoramic x-ray and addtional Digital Volume Tomography (DVT) showed asymptomatic separate dental cyst at the impacted wisdom tooth and the missing lingual cortical border in the apical region of the 2nd lower molar. This finding along with clinical vitality of the 1st and 2nd left molars led to the conclusion that the presented pathology was a Stafne Idiopathic Bone Cyst (SIBC) which needed no surgical intervention. DISCUSSION: The additional use of DVT 3D examination may help in diagnosis of SIBC prior to surgical interventions thus avoiding unwanted surgical intervention.

Salt impregnation of implant materials.

Implant infection and peri-implantitis are recurrent and serious complications in implantology. Antibiotic treatment of infected implants in bone is complicated because of limited vascularization of the surrounding tissue on the one hand, and biofilm formation on the implant surface on the other. Therefore, contamination of the implant surface has to be prevented. For this purpose we developed a method of coating Ti6Al4V samples with NaCl in order to reduce the water activity on the sample surface. The resulting NaCl-coated surfaces showed good biocompatibility with osteoblastlike cells and resulted in a significant reduction of bacterial strains. The presented surface modification is hence a promising method to reduce bacterially induced implant failure.

Effects of radiation therapy on craniofacial and dental implants: a review of the literature.

OBJECTIVES: The theories of the effects of radiation therapy on craniofacial and dental implants have been challenged by new models. Animal and clinical studies differ on the importance of dose effect and implant location regarding implant survival. Our purpose was to explore the risks of irradiation regarding dose levels, timing of radiation, implant location, and material. STUDY DESIGN: A systematic search of the literature was performed to identify studies reporting animal and human data on the success of implants in irradiated versus nonirradiated bone. RESULTS: Eleven animal studies exploring histomorphometric, biomechanical, and histologic features of implants in irradiated bone were summarized. Sixteen human clinical studies evaluating craniofacial (n = 8) and dental (n = 8) implants in irradiated bone were summarized. No meta-analyses of dental implants in irradiated bone were found. Efficacy studies comparing different implant types in irradiated bone were not found. CONCLUSION: Studies from both animal subjects and human patients indicate that irradiated bone has a greater risk of implant failure than nonirradiated bone. This increase in risk may be up to 12 times greater; however, studies making these comparisons are of poor to moderate quality, so the magnitude of this difference should be accepted with caution.

Comparison of implant survival with implants placed in acceptable and compromised bone: a literature review.

BACKGROUND: Survival rates for conventional dental implant systems are relatively high in normal healthy bone. However, there are subgroups of patients that are at an increased risk of implant failure. In particular, patients with compromised quantity or quality of bone present a significant challenge to the dental implantologist. OBJECTIVE: To perform a review of the literature in an attempt to quantify the relative risk of implant failure in compromised bone compared to good or acceptable bone and to identify whether certain anatomical regions are at greater risk. SEARCH STRATEGY: We conducted a systematic electronic database search of Medline, Cinhahl and the Cochrane Library through March 2006 identifying articles meeting the eligibility criteria. RESULTS: We calculated an increased risk of implant failure in compromised bone compared to healthy bone in both the maxilla and the mandible using conventional dental implant systems. Relative risks ranged from 2 to 12 with the highest risk of failure in the maxilla. Conventional systems are often used in combination or after bone augmentation procedures or more innovative methods for stimulating bone growth in patients with compromised bone. These approaches do have their limitations including high costs, the accumulation of the surgical risks, and delayed time to loading. DISCUSSION: Quantifying the risk of implant failure in patients with compromised bone should assist the implantologist in treatment decision making and patient counseling. Alternative methods for treating patients with compromised bone include zygomatic and lateral implants, neither of which typically require bone augmentation procedures. More studies are needed to evaluate their safety and efficacy.

Implementation of contact definitions calculated by FEA to describe the healing process of basal implants.

AIMS: Bone structure around basal implants shows a dual healing mode: direct contact areas manifest primary osteonal remodeling, in the void osteotomy-induced spaces, the repair begins with woven bone formation. This woven bone is later converted into osteonal bone. The purpose of this study was to develop a model to accurately represent the interface between bone and basal implant throughout the healing process. The model was applied to the biological scenario of changing load distribution in a basal implant system over time. METHODS: Computations were made through finite element analysis using multiple models with changing boneimplant contact definitions which reflected the dynamic nature of the interface throughout the bony healing process. Five stages of bony healing were calculated taking into account the changes in mineral content of bone in the vicinity of the load transmitting implant surfaces. RESULTS: As the bony integration of basal implants proceeds during healing, peak stresses within the metal structure shift geographically. While bony repair may still weaken osteonal bone, woven bone has already matured. This leads to changes in the load distribution between and within the direct contact areas, and bone areas which make later contact with implant. CONCLUSIONS: This study shows that basal implants undergo an intrinsic shift of maximum stress regions during osseointegration. Fatigue testing methods in the case of basal implants must therefore take into account this gradual shift from early healing phase until full osseointegration is achieved.

The use of finite element analysis to model bone-implant contact with basal implants.

OBJECTIVE: The purpose of this study was to develop a model that accurately represents the interface between bone and basal implants throughout the healing process. STUDY DESIGN: The model was applied to the biological scenario of changing load distribution in a basal implant system over time. We did this through finite element analysis (FEA, or finite element method [FEM]), using multiple models with changing bone-implant contact definitions, which reflected the dynamic nature of the interface throughout the bony healing process. RESULTS: In the simple models, peak von Mises stresses decreased as the bone-implant-contact definition was changed from extremely soft contact (i.e., immature bone during early loading) to hard contact (i.e., mature bone). In upgraded models, which more closely approximate the biological scenario with basal dental implant, peak von Mises stresses decreased at the implant interface; however, they increased at the bone interface as a harder contact definition was modeled. Further, we found a shift in peak stress location within the implants during different contact definitions (i.e., different stages of bony healing). In the case of hard contact, the peak stress occurs above the contact surface, whereas in soft contact, the stress peak occurs in the upper part of the contact area between bone and the vertical shaft of the implant. Only in the extreme soft contact definitions were the peak stresses found near the base plate of the implant. CONCLUSION: Future FEM studies evaluating the functional role of dental implants should consider a similar model that takes into account bone tissue adaptations over time.