Crestal Sinus Floor Augmentation Using Hydraulic Pressure and Vibrations: A Retrospective Single Cohort Study.

PURPOSE: To evaluate the sinus membrane perforation and implant survival rate after crestal minimally invasive sinus floor augmentation using hydraulic pressure and vibrations. MATERIALS AND METHODS: In this retrospective single cohort study, all patients who underwent minimally invasive sinus floor augmentation between 2007 and 2015 using hydraulic pressure and vibrations were included. The sinus membrane is elevated by physiologic saline at 1.5 bar. The fluid is then set into vibration to further separate the sinus membrane from the bony floor. The endpoints were sinus membrane perforation and the survival rate of implants. RESULTS: The hydraulic pressure and vibration technique was applied in 156 patients. Seven patients with perforations of the sinus membrane were treated with the lateral window approach and excluded from the follow-up analysis. In the remaining 149 patients, 184 crestal sinus floor augmentations were performed and 184 implants were placed. In 10 of these 184 cases, a perforation was suspected in the postoperative computed tomography (CT) scan. In total, the perforation rate was 8.9% (17/191). Nineteen implants were lost during the follow-up period ranging from 0.2 to 8.4 years with a median of 2.3 years. The cumulative implant survival rates after 1, 3, and 5 years were 94.4%, 87.7%, and 87.7%, respectively. No severe perioperative complications were noted. CONCLUSION: The hydraulic pressure and vibration technique allows a minimally invasive crestal sinus augmentation with a perforation rate less than 10% and implant survival rates of approximately 90%.

An up to 17-year follow-up retrospective analysis of a minimally invasive, flapless approach: 18 945 implants in 7783 patients.

BACKGROUND: This study investigates gender, age, jaw, implant position, loading protocol (immediate vs delayed), smoking, and type of surgery (punch vs flap) as influential factors of implant survival in a large patient collective. PURPOSE: To evaluate the survival rates of implants in patients using a mucoperiosteal punch for flapless implantation in the majority of cases in order to evaluate its medical efficacy and safety. MATERIALS AND METHODS: Between 1994 and 2015 all patients with complete data treated at the Wienerberg Dental Clinic, Vienna, Austria, were included and statistically analyzed in Cox proportional hazard (PH) models. As patients with multiple implants were included, a clustering term was added to the Cox PH model to respect pooled failures in patients. RESULTS: Of the initial 24 282 ANKYLOS/Dentsply implants placed in 8137 patients a total of 7783 patients with 18 945 implants were finally included. The mean follow-up was 2.8 ± 3.2 up to 17.9 years. Cumulative survival rates (CSRs) after 1, 3, 5, and 10 years were 98.5%, 97.7%, 96.7%, and 93.0%, respectively. Of these, 17 517 (92.5%) implants were placed minimally invasive via a flapless approach by use of the ATP-Punch with comparable survival rates as observed for flap surgery. The Cox PH models proved smoking (hazard ratio [HR] = 2.2) and implant position as significant factors of implant survival. In the maxilla, canines and third molars were identified as low risk sites in comparison to the most frequently implanted first premolar site. In the mandible, the central incisor and second premolar were identified as high-risk sites, the canine as low risk site in comparison to the most frequently placed first molar site. CONCLUSION: The analyzed data concludes the safety and medical efficacy of the ATP-Punch. The CSRs using this flapless technique are comparable to the classic surgical flap approach.

The frequency of dental abscesses increases in periods of low barometric pressure.

Bioclimatic conditions are thought to have an impact on the frequency of dental abscesses but previous studies have suffered from small patient cohorts, methodological obstacles, and restriction to a single site resulting in limited geographic and meteorological variability. The aim of the present study was to investigate the influence of environmental temperature and barometric pressure on the frequency of dental abscesses. Three maxillofacial and two dental clinics in Vienna retrospectively provided a total of 19,218 patients with dentoalveolar abscesses who were treated by intraoral incision between 1998 and 2011. Daily records from six local meteorological stations were consulted to assess daily meteorological parameters. Univariate and multivariate hurdle count regression models were fitted to estimate the effect of daily average barometric pressure and temperature on registered abscess frequencies. Temporal confounders causing variance of the observed abscess frequencies - such as weekday, business day, and month - were taken into consideration. On days of low barometric pressure a significant rise in dental abscess frequency was observed, even when adjusting for confounders. Environmental temperature, in contrast, did not show any effect. In conclusion, bioclimatic conditions affect health as low barometric pressure increases the number of patients with dental abscesses.

Does Timing of Implant Placement Affect Implant Therapy Outcome in the Aesthetic Zone? A Clinical, Radiological, Aesthetic, and Patient-Based Evaluation.

PURPOSE: To compare five different implant treatment protocols in the anterior maxilla, including immediate, early, and delayed implant placement, as well as implant placement in conjunction with simultaneous guided bone regeneration and implant placement 3 months following horizontal autologous bone block grafting. MATERIAL AND METHODS: Aesthetic indices used included the Pink Esthetic Score (PES), Papilla Index (PI), Subjective Esthetic Score (SES), and White Esthetic Score (WES). Subjective evaluation of implant aesthetics was performed using a visual analogue scale (VAS). The VAS consisted of a 10 cm-long line representing the degree of discontent (0%) or satisfaction (100%). RESULTS: A total of 153 implants in 153 patients (80 women, 73 men) were evaluated after a mean follow-up of 4.5 ± 2.9 years. Mean peri-implant bone loss was 1.6 ± 0.9 mm and not affected by treatment protocol, time after implant placement, or crown length. Papilla presence, by contrast, differed significantly between the protocols: Papilla formation was more pronounced following delayed and immediate implant placement. No statistical significance was found among treatment modalities with regard to PES, SES, or WES. Longer crowns were associated with lower PES and PI ratings and correlated with greater midfacial recession. SES was also influenced by time after implant placement and keratinized mucosa. Patient satisfaction differed significantly among treatment protocols, favoring immediate implant placement. Agreement between objective and subjective aesthetic ratings was low. CONCLUSION: The present study suggests that comparable clinical, radiological, and aesthetic results can be achieved with all treatment protocols. Gingival recession, however, seems to occur in the long term irrespective of the technique used.

Causes and timing of delayed bleeding after oral surgery.

OBJECTIVES: This study examines a cohort of patients who suffered bleeding requiring hemostatic intervention after oral surgery. The reasons for bleeding and the interval between surgery and onset of bleeding are investigated. MATERIALS AND METHODS: Between 1998 and 2009, 1,819 cases were eligible for this retrospective study. Factors (independent parameters) influencing the interval (dependent variable) were analyzed using negative binomial count regression models (NegBin II). The significance of each regressor's effect was tested using Wald's test and the total effect using likelihood ratio test. RESULTS: Of the patients examined, 1,101 (60.1 %) did not take anticoagulants, 394 (21.5 %) took phenprocoumon, 233 (12.7 %) took acetylsalicylic acid, 33 (1.8 %) took clopidogrel, 17 (0.9 %) took more than one anticoagulant, and 78 (4.3 %) had a congenital blood disorder. After simple tooth extraction, 95.3 % suffered bleeding; 69.7 % of extractions were performed in the molar region. Later that day of surgery, 66.0 % of all patients showed bleeding. The bleeding interval was significantly prolonged by anticoagulant therapy with phenprocoumon, by congenital clotting disorders. CONCLUSIONS: Normal tooth extractions are underestimated for their risk for postoperative bleeding, especially in the molar region. Anticoagulant therapy or congenital blood disorders present oral surgeons with a further challenge. CLINICAL RELEVANCE: Performing surgery before midday allows surgeons managing postoperative bleeding themselves for a better patient satisfaction. Intensified information about correct postoperative behavior is crucial. Prolonged blood coagulation should intensify follow-up checks. Patients with congenital blood disorders and patients at high risk for bleeding with the need for substitution of platelets or clotting factors should receive inpatient care. More potent, local applicable coagulant agents are required for these patients.

A pilot-study of a minimally invasive technique to elevate the sinus floor membrane and place graft for augmentation using high hydraulic pressure: 18-month follow-up of 20 cases.

OBJECTIVE: To evaluate medical efficacy and safety of crestal, minimally invasive sinus floor augmentation (MISFA) using an innovative method based on high hydraulic pressure. STUDY DESIGN: Twenty MISFA using the novel Jeder-System were performed in 18 patients at 2 study sites in Vienna, Austria. The Jeder-System consists of the Jeder-drill, the Jeder-pump, and a connecting tube-set. The pump generates high hydraulic pressure (1.5 bar) pushing back the sinus membrane from the drill at the first perforation. The pump also monitors the whole procedure by constantly measuring pressure and volume. RESULTS: Five percent membrane perforation rate (1/20) only detected in the postoperative computed tomography scan and without implication for implant placement. Height gain of 9.2 ± 1.7 mm achieved (from 4.6 ± 1.4 mm to 13.8 ± 2.3 mm). Average patient satisfaction was 9.82 on scale from 1 to 10 (10 = very satisfied). Mean duration of sick leave was 0.19 days. 18-month survival rate was 95% (1/20 implant lost). CONCLUSIONS: Within the limits of a prospective open cohort study with 20 cases, our data demonstrate the safety and medical efficacy of the novel method.

Effect of maxillary sinus floor augmentation on sinus membrane thickness in computed tomography.

BACKGROUND: Little is known about maxillary sinus compliance, i.e., the intrinsic potential of the sinus membrane to resume its homeostatic status after the surgical trauma caused by sinus floor elevation. The aim of the present study is to investigate the effect of maxillary sinus floor augmentation on sinus membrane thickness. METHODS: Within-patient comparison of computed tomographic scans before bone grafting versus 4 to 6 months after bone grafting was performed. Changes in membrane thickness were evaluated in 65 maxillary sinus floor augmentation procedures via a lateral approach in 35 patients without clinical signs of sinus pathology at any time. RESULTS: Sinus membrane thickness differed significantly before (0.8 ± 1.2 mm) versus after (1.5 ± 1.3 mm) augmentation surgery (P <0.001), with a mean increase of 0.8 ± 1.6 mm (maximum: 4.4 mm). Only 28% of augmented sinuses did not show membrane thickening. In non-augmented control sinuses, there was no evidence of membrane thickness increase. CONCLUSIONS: The results indicate that the maxillary sinus membrane, even in healthy clinical conditions, undergoes morphologic modifications after sinus floor elevation, yet membrane reactions demonstrate significant variability. Future research on the effect of augmentation surgery on maxillary sinus physiology is recommended.