Indications for implant-supported rehabilitation of the posterior atrophic maxilla: A multidisciplinary consensus among experts in the field utilising the modified Delphi method.

PURPOSE: To establish consensus-driven guidelines that could support the clinical decision-making process for implant-supported rehabilitation of the posterior atrophic maxilla and ultimately improve long-term treatment outcomes and patient satisfaction. MATERIALS AND METHODS: A total of 33 participants were enrolled (18 active members of the Italian Academy of Osseointegration and 15 international experts). Based on the available evidence, the development group discussed and proposed an initial list of 20 statements, which were later evalu-ated by all participants. After the forms were completed, the responses were sent for blinded ana-lysis. In most cases, when a consensus was not reached, the statements were rephrased and sent to the participants for another round of evaluation. Three rounds were planned. RESULTS: After the first round of voting, participants came close to reaching a consensus on six statements, but no consensus was achieved for the other fourteen. Following this, nineteen statements were rephrased and sent to participants again for the second round of voting, after which a consensus was reached for six statements and almost reached for three statements, but no consensus was achieved for the other ten. All 13 statements upon which no consensus was reached were rephrased and included in the third round. After this round, a consensus was achieved for an additional nine statements and almost achieved for three statements, but no consensus was reached for the remaining statement. CONCLUSION: This Delphi consensus highlights the importance of accurate preoperative planning, taking into consideration the maxillomandibular relationship to meet the functional and aesthetic requirements of the final restoration. Emphasis is placed on the role played by the sinus bony walls and floor in providing essential elements for bone formation, and on evaluation of bucco-palatal sinus width for choosing between lateral and transcrestal sinus floor elevation. Tilted and trans-sinus implants are considered viable options, whereas caution is advised when placing pterygoid implants. Zygomatic implants are seen as a potential option in specific cases, such as for completely edentulous elderly or oncological patients, for whom conventional alternatives are unsuitable.

Metal Nanoparticles Released from Dental Implant Surfaces: Potential Contribution to Chronic Inflammation and Peri-Implant Bone Loss.

Peri-implantitis is an inflammatory disease affecting tissues surrounding dental implants. Although it represents a common complication of dental implant treatments, the underlying mechanisms have not yet been fully described. The aim of this study is to identify the role of titanium nanoparticles released form the implants on the chronic inflammation and bone lysis in the surrounding tissue. We analyzed the in vitro effect of titanium (Ti) particle exposure on mesenchymal stem cells (MSCs) and fibroblasts (FU), evaluating cell proliferation by MTT test and the generation of reactive oxygen species (ROS). Subsequently, in vivo analysis of peri-implant Ti particle distribution, histological, and molecular analyses were performed. Ti particles led to a time-dependent decrease in cell viability and increase in ROS production in both MSCs and FU. Tissue analyses revealed presence of oxidative stress, high extracellular and intracellular Ti levels and imbalanced bone turnover. High expression of ZFP467 and the presence of adipose-like tissue suggested dysregulation of the MSC population; alterations in vessel morphology were identified. The results suggest that Ti particles may induce the production of high ROS levels, recruiting abnormal quantity of neutrophils able to produce high level of metalloproteinase. This induces the degradation of collagen fibers. These events may influence MSC commitment, with an imbalance of bone regeneration.

Interpretations of complications following third molar extraction.

OBJECTIVE: Surgical removal of third molars is often associated with complications. The aim of the present study was to analyze the incidence of complications following extraction of third molars relative to the risk factors. METHOD AND MATERIALS: This retrospective study included 463 patients who had mandibular third molar extraction (performed by a single surgeon, DSA) in the years 2001 to 2011. In total, 665 mandibular third molars were extracted. The average patient's age was 29 ± 11.30 years, median 26 years, and the patient age ranged from 13 to 75 years. Patients' records were obtained for medical/general data. RESULTS: The overall prevalence of postsurgical complications was 17%. Dry sockets showed the highest incidence (11.6%). Partially impacted teeth showed the highest incidence of complications (67.3%). Cigarette smoking correlated with increased complications and dry sockets, and complications were more prevalent on the left side (62.8%). CONCLUSION: Complications after mandibular third molar extraction increase with age, level of impaction, side of extraction, and cigarette smoking.

Long Term Follow-Up of Dental Implants Placed in Autologous Onlay Bone Graft.

PURPOSE: The aim of this study was to evaluate the efficacy of autologous intraoral onlay bone grafting (OBG) in correlation with long-term survival rates of dental implants placed in the augmented bone. MATERIALS AND METHODS: A retrospective study was conducted on 214 patients who received a total of 633 dental implants placed in 224 autologous intraoral block OBG augmentations, combined with Bio-Oss - mixed with platelet-rich plasma (PRP) and covered by platelet-poor plasma (PPP) - as scaffold, with a follow-up time up to 137 months (mean 39.9 ± 30.9 months). RESULTS: A total of 216 OBG cases were successful (96.4%), and most of the augmentations were uneventful (88.4%). Bone graft exposure was moderately associated with bone graft failure (χ(2) = 3.76, p = .052). The healing period after implant placement was 4-6 months (mean 5.6 ± 2.56). The majority of the 591 implants survived (93.4%). The cumulative survival rate of the implants was 83%. CONCLUSIONS: We suggest that augmentation of severely atrophied jaw bone through the placement of horizontal and/or vertical intraoral OBGs in combination with Bio-Oss saturated with PRP and covered by PPP should be considered a reliable, safe, and very effective surgical technique for obtaining high bone graft survival rate and high long-term implant survival rate.

Effect of age on single implant submersion rate in the central maxillary incisor region: a long-term retrospective study.

BACKGROUND: It is contraindicated to place dental implants before growth and development are completed as they are at a risk of submersion due to growth arrest, creating a potential aesthetic problem. PURPOSE: The present study evaluated the effect of age on mean submersion rate of single dental implant in the central maxillary incisor area as compared with the adjacent natural tooth in implants placed after growth has ceased. MATERIALS AND METHODS: A retrospective study was conducted on 35 patients (mean age 29.3 ± 9.9 years, 21 females) who received a single dental implant replacing a missing maxillary central incisor from 1992 to 2008 with a follow-up of at least 3 years. Clinical photos from last follow-up were digitally analyzed to measure the vertical change between the incisal edge of the implant supported crown and the adjacent natural central incisor. RESULTS: In the younger age group (≤30 years), the submersion rate was more than three times higher than in the older age group (>30 years), yielding submersion rates of 1.02 and 0.27% per year, respectively. CONCLUSIONS: Whereas implant submersion continues throughout adult life, its rate varies with age. It is evident that this phenomenon is much more conspicuous during the second and third decades of life as compared with the fourth and fifth.

The importance of histopathological diagnosis in the management of lesions presenting as peri-implantitis.

PURPOSE: This study is a histopathological analysis of lesions clinically diagnosed as peri-implantitis (PI). MATERIALS AND METHODS: This retrospective study included microscopic findings in 117 peri-implant biopsies from lesions presenting clinical and radiographic features of peri-implantitis. RESULTS: The study group included 117 biopsies, mean age 55.2 years; 60.9% of biopsies were from failing implants during explantation, the remaining from surviving implants. All cases showed microscopic evidence for inflammation; however, although 41% exhibited only nonspecific inflammation, 29.9% exhibited actinomyces-related inflammation, 18.8% pyogenic granuloma (PG), and 10.3% giant cell granuloma (GCG). Differences in implant failure rates between pathological diagnostic groups were not statistically significant. Lesions with simple inflammation could not be distinguished clinically or radiographically from the potentially destructive lesions. CONCLUSIONS: There were no clinical features which could distinguish PI with simple inflammation from potentially destructive lesions mimicking PI, such as GCG, PG, and actinomycosis. However, to control GCG and PG surgical procedures would be recommended, actinomycosis would indicate specific antibiotics, whereas in nonspecific inflammation, these measures may not be indicated. The results of the present study provide evidence for the importance of early microscopic examination of lesions presenting clinically as peri-implantitis, a step toward more accurate diagnosis and improved treatment of PI and lesions mimicking PI.

A comparative volumetric study of symphysis donor defects, unfilled or filled with bone substitute.

OBJECTIVES: Background Intraoral autogenous bone grafts are a convenient source of bone in reconstruction of the residual ridge before dental implant placement. PURPOSE: The aim of this study was to evaluate bone volume of symphysis donor defects filled with bone substitute compared with unfilled symphysis donor defects. PATIENTS, MATERIALS AND METHODS: The study included 26 patients who underwent either alveolar ridge reconstruction or maxillary sinus elevation. Two groups were studied: symphyseal donor defects filled with bone substitute and unfilled symphyseal donor defects. Pre- and postoperative volumetric variables were determined using computed tomography scans and the software program SimPlant® (Materialise Dental Italia, Roma, Italy). RESULTS: At 6 months postsurgery, the filled donor defects exhibited a significant increase in bone volume compared with unfilled donor defects (97.7% and 73.4%, respectively). At 18 months postsurgery, volume of unfilled donor defects was reevaluated with no significant increase in bone volume. CONCLUSIONS: Six months following block harvesting procedure, filled donor defects maintained bone volume, while unfilled donor sites generated defects that cannot achieve full regeneration; even not 18 months postblock harvesting.

Apical and marginal bone alterations around implants in maxillary sinus augmentation grafted with autogenous bone or bovine bone material and simultaneous or delayed dental implant positioning.

OBJECTIVE: A re-pneumatization phenomenon was recorded in sinuses grafted with different materials. The specific aims of this paper were to assess the dental implant survival rate and the behavior of marginal and apical bone remodeling around dental implants placed following sinus augmentation. MATERIALS AND METHODS: A retrospective study was conducted on consecutive patients treated in two surgical centers. Different surgical techniques were adopted for sinus augmentation: simultaneous or delayed dental implant insertion with bovine bone-material augmentation or autologous bone grafting (chin and iliac crest). Survival rates were recorded for the overall number of implants (patients of group A). Apical and marginal bone levels (ABL and MBL, respectively) were radiographically measured, and statistical analysis was performed in implants of a subgroup of patients (group B). RESULTS: A total of 282 dental implants were positioned. Recorded cumulative survival rates (CSRs) were 95.6% and 100% for autogenous and bovine bone material, respectively, while CSRs at 2-year follow-up for immediate and delayed procedures were 99.3% and 96.5%. For the subgroup B, 57 sinus augmentation procedures were performed in 39 patients, with the positioning of 154 implants. Generally, the apical- and marginal-bone resorption of the bovine bone-material group was less than that of the autogenous group. The differences between the ABL values of the bovine bone-material and iliac-crest groups were statistically significant at 1 year, whereas this significance disappeared at the 2-year follow-up; tests showed that a statistical difference was recorded in the bovine bone-material group between the 1- and 2-year follow-ups. With regard to MBL comparisons between simultaneous and delayed implantation, the differences maintained their significance at the 2-year follow-up also. CONCLUSIONS: Differences regarding apical bone alteration between autogenous bone from the iliac crest and bovine bone material at the 1- and 2-year follow-ups, as well as in the bovine bone-material group between the 1- and 2-year follow-ups, attested to slower but more prolonged physiologic bone remodeling in the bovine-graft-material group than in the autogenous-bone group. The MBL analysis showed that remodeling in the delayed implant group demonstrated a greater resorption in the cervical portion than was seen in the simultaneous implant group.

Factors affecting changes in sinus graft height between and above the placed implants.

OBJECTIVE: The aim of this study was to compare the radiographic dimensional changes of sinus graft height above and between placed implants, and evaluate the factors effecting these changes with 2 different grafting materials and both combination. STUDY DESIGN: The study group comprised 42 patients (50 sinus augmentation procedures). Four consecutive panoramic radiographs were evaluated for changes in sinus graft height between and above the placed implants. Factors that may influence graft height reduction were evaluated. RESULTS: The mean percentage of autogenous bone height reduction was 23% between implants and 13% above the implants. Bovine xenograft showed a mean of 6.5% graft height reduction between implants and 0% above implants. The only 2 parameters that correlated with reduction of graft height above and between the implants were time elapsed from surgery and the type of bone graft. Autogenous bone graft presented significantly more reduction (P = .022), whereas anorganic bovine bone graft had only minor or no changes in height. CONCLUSION: The most important factor influencing reduction in vertical bone height on the time axis, following sinus augmentation is the grafting material, followed by the presence of a functional implant. Anorganic bovine bone was found superior in graft height maintenance in an up to 10 years of follow-up.

Bisphosphonate-related osteonecrosis of the jaw associated with dental implants.

PURPOSE: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-documented devastating side effect of long-term bisphosphonate (BP) use. There is scarce information in the literature on BRONJ associated with dental implants (DIs). The purpose of this study was to present a large series of cases of this association. PATIENTS AND METHODS: The files of all patients with BRONJ associated with DIs who were treated in the department of oral and maxillofacial surgery from 2003 to 2009 were reviewed. Data on demographics, medical background, type, and duration of BP treatment before the development of BRONJ, mode of therapy, and therapeutic outcome were retrieved. RESULTS: Of the 27 patients enrolled into the study, 11 (41%) developed BRONJ while taking oral BPs and 16 (59%) developed BRONJ associated with intravenous BPs. BRONJ developed after mean periods of 68 months (median, 60), 16.4 months (median, 13), and 50.2 months (median, 35) in patients on alendronate, zoledronic acid, and pamidronate, respectively. Only 6 patients developed BRONJ during the first 6 months after DI placement. When BP treatment had been started before DI placement, there was a mean duration of 16.2 months (median, 11) until the appearance of BRONJ development. Long-term antibiotics and only essential surgical procedures comprised the treatment of choice, and the response rate was considerably better for patients taking the oral type of BPs. There was no significant association between BRONJ and diabetes, steroid intake, or smoking habits. CONCLUSION: Patients undergoing BP treatment and who receive DIs require a prolonged follow-up period to detect any development of BRONJ associated with DIs.

Survival of immediately provisionalized dental implants: a case-control study with up to 5 years follow-up.

PURPOSE: The aim of this study was to evaluate the survival rate of immediately provisionalized implants with up to 5 years follow-up. MATERIALS AND METHODS: The study consisted of 226 patients, 113 consecutive patients with immediately provisionalized dental implants (cases) and 113 randomly selected, age-, gender-, and implant position-matched controls with conventional late implant loading. Survival rate and incidence of complications were recorded. RESULTS: Follow-up ranged from 6 to 60 months. Smoking was reported by 20.8% of patients. Maxillary incisors and mandibular lateral incisors were the most common areas for implant placement. Conventionally loaded implants were narrower (p = .03) and shorter (p = .001). Immediate implantation into a fresh extraction socket was performed in 69% of the cases and in 36.3% of the controls (p = .001). Implant survival rate was 96.5%. Of the eight failed implants, six were immediately provisionalized and two were conventionally loaded. No statistically significant difference was found in survival rates between groups (p > 0.05). Five of the failed implants (case group) were immediately loaded implants placed in fresh extraction sockets. CONCLUSION: Immediate implant provisionalization achieved similar high success rates compared with the conventional, delayed approach. As immediate implant provisionalization is mainly desired in the anterior region, the high success rates are encouraging.

Symphysis revisited: clinical and histologic evaluation of newly formed bone and reharvesting potential of previously used symphysial donor sites for onlay bone grafting.

BACKGROUND: This article reports on the reharvesting potential of newly formed bone in previously used symphysial donor sites. METHODS: This study included five patients who were scheduled for sequential onlay bone augmentations prior to dental implant placement using the symphysis area as a donor site. At 5 months after bone augmentation, computed tomography scans of donor sites revealed healing from the first surgery. Because additional bone augmentation was required, the same sites were revisited for bone harvesting. Reharvesting was performed 5 months after the first harvesting. A small portion of the harvested bone from two patients was evaluated histologically. RESULTS: Five months postharvesting, clinical observation of the donor sites resembled newly formed bone as a conglomerate of bovine bone particles. In the five patients, bone continuity was observed between new bone at the donor defect sites and surrounding bone. Additional blocks were reharvested from the same sites and successfully grafted to recipient sites. Dental implants were inserted 5 months after the second augmentation, which healed uneventfully. Histologically, bovine bone particles were surrounded by woven bone, with areas of mature bone with well-organized osteons. CONCLUSIONS: Remodeling of a symphysial donor area enabled reuse of the site for additional harvesting. Intraoral bone sources could serve as a long-lasting renewable source of high-quality bone.

Long-term marginal bone loss around single dental implants affected by current and past smoking habits.

PURPOSE: To compare the long-term marginal implant bone loss, survival, and radiographic success of single dental implants among current, past smokers, and nonsmokers. PARTICIPANTS AND METHODS: The study was based on a consecutive cohort of patients who received single implants between 2 adjacent natural teeth. Only implants with 5 or more years follow-up were considered with no less than 3 follow-up radiographs at different time points with at least 1 year interval between radiographs. All radiographs were analyzed for changes in marginal bone loss. RESULTS: The study consisted of 64 patients, ranging in age from 18 to 78 (mean, 45 years) with a total of 64 single implants. Average follow-up time was 6.14 years (range, 5-14). Success rate was 93.75%; 4 implant failed. Two of the failures were due to mechanical neck brake and 2 resulted from peri-implantitis and bone loss. Survival rates were not related to smoking habits. The mean marginal bone loss measured for all implants was 0.145 mm during the first year, 0.07 mm per year during years 1 throughout 5 and 0.026 mm per year from the sixth year till the end of follow-up. Current smokers demonstrated higher marginal bone loss during all time intervals than former smokers and both demonstrated higher marginal bone loss during all time intervals than nonsmokers. CONCLUSION: Our results reaffirm the relation between smoking and peri-implant bone loss. Former smokers still demonstrated an increase in marginal bone loss as compared with nonsmokers. There was no difference in implant survival in relation to smoking habits.

Morphologic changes of the nasopalatine canal related to dental implantation: a radiologic study in different degrees of absorbed maxillae.

BACKGROUND: Implant rehabilitation of the edentulous anterior maxilla remains a complex restorative challenge. Intricate preexisting anatomy dictates meticulous and accurate osteotomy planning. With progressive bone loss, the alveolar crest may approach anatomic structures. The nasopalatine nerve and vessels may ultimately emerge from the ridge crest. The radiologic changes of the nasopalatine canal were evaluated in different resorption phases of the premaxilla alveolus with regard to dental implantation. METHODS: The study consisted of 207 subjects who had maxillary computed tomography scans before dental implantation. The Lekholm and Zarb classification was used to divide images according to the residual bony ridge: Class A (control group) and classes B to E (study group). Anatomic mapping of the nasopalatine canal structure was carried out in both groups. RESULTS: The canal diameter was wider along the degree of ridge resorption from classes A to E in all dimensions, mainly in the palatal opening (P <0.01), middle area (P <0.001), and nasal area. The mean diameter of the enlargement was 1.8 mm, which reached 5.5 +/- 1.08 mm (P <0.01) in type E bone. In the severely resorbed ridges (classes C through E), when the palatal opening was situated on the ridge, it occupied a mean of 35.6% (13% to 58%) of the area devoted to implant placement. Tooth loss was the main reason for ridge resorption (P <0.01). CONCLUSIONS: Canal diameter enlargement was greater anteriorly to the ridge and posteriorly to the palatal bone, mainly because of tooth extraction. The atrophy of disuse may influence surrounding structures, similar to the maxillary sinus tendency to expand into surrounding bone mainly after tooth loss.

Failure causes, timing, and cluster behavior: an 8-year study of dental implants.

OBJECTIVES: The aim of this study was to analyze implant failure, causes, time of failure, and cluster behavior of implant failure among patients referred to a private surgical center. METHODS: All failed implants placed during the years 1997-2004 were analyzed. Data collected included age, gender, smoking habits, implant type and dimensions, timing of implantation (immediate or nonimmediate), time to failure, and failure causes. RESULTS: Overall, 99 of the 3609 implants placed between the years 1997 and 2004 failed in 61 patients resulting in a 97.3% survival rate. Patients with implant failure ranged in age from 21 to 78 years (average 54 years); 34% were men, 66% women; smoking was reported by 32.8%, pastsmoking 16.4%; time from implant placement to failure ranged from 1 to 99 months (average 24 months, SD = 24.8). Common causes for implant removal were bone loss and/or inflammation (52.5%), and implant mobility (43.4%). Cluster behavior (ie, more than one implant failure per patient, not necessarily in the same area or quadrant) was shown in one-third (32.8%) of the patients in which 56.6% of all failures were found. This cluster pattern was evident in both the surgical and prosthetic phase failures. CONCLUSION: There is a higher probability for a cluster pattern among patients with implant failure. Common signs for failure are implant mobility (surgical phase) and infection and marginal bone loss (prosthetic phase).

Dental and oral trauma during childhood and adolescence in Israel: occurrence, causes, and outcomes.

The occurrence and causes of oral and dental injuries in a young Israeli population during childhood and adolescence were evaluated, as well as participants' awareness of using protective devices, such as mouth guards, during sporting activities. The survey consisted of 427 young adults, aged 18-21 years. A questionnaire was distributed relating to past oral and dental injuries over their lifetime; type of sporting activity practiced, specifying time, place and cause of injury; and use and awareness of protective devices. Participants who reported to be injured were asked to report the type of their injury, treatment provided, and satisfaction with the results. The total number of dental and oral injuries was 133, affecting 31.1% of the participants, in which 72 (16.9%) suffered dental injuries, mostly because of falls (64%), followed by sporting activities (23.2%), street-fights (7.2%), and car accidents (5.6%). Injuries occurred at school in 36.5% of cases and at home in 23.8% of cases. The most frequently reported injury was laceration (47.3%) followed by tooth fracture (41.9%). Of the 427 participants, 239 (56%) were active in at least one type of sport. Only 22.6% were aware of protective devices, e.g. mouth guards, and only 2.8% actually used these devices. These results show the high risk of potential dental and oral injury during childhood and adolescence, a lack of knowledge regarding the benefits of mouth guards and their limited use. Increased awareness of protective measures and devices, and their actual use should be encouraged with public health education.

Denture-related osteonecrosis of the maxilla associated with oral bisphosphonate treatment.

BACKGROUND: Bisphosphonates are a class of agents used to treat various systemic conditions. Despite the benefits of bisphosphonates, osteonecrosis of the jaws is an important complication in a subset of patients who receive this drug treatment. CASE DESCRIPTION: A 66-year-old woman was referred to an oral surgeon at a private surgical center because of a pressure wound in the margins of a removable maxillary denture. The patient reported that she had received oral alendronate sodium treatment for eight years. A clinical examination revealed a palatal ulcer with exposed necrotic gray bone at its center. The clinician performed an excisional biopsy and separated two palatal rotational flaps to enable an adequate blood supply to reach the operated-on area. CLINICAL IMPLICATIONS: This report, together with growing evidence in the literature, serves to alert treating physicians and dental practitioners about the potential complication of maxillary and mandibular bone necrosis in patients receiving bisphosphonate therapy.

Inter-implant bone height changes in anterior maxillary immediate and non-immediate adjacent dental implants.

BACKGROUND: The purpose of this study was to evaluate inter-implant bone crest height changes between immediate and non-immediate dental implants placed in the anterior maxillary region. METHODS: A retrospective study was conducted on consecutively treated patients requiring at least two adjacent implants in the anterior maxillary region that were placed in the same operation during 1994 to 2004. Files of 45 healthy patients reporting 200 implants were reviewed. Age, gender, smoking status, and implant characteristics (coating and dimensions) were recorded. Inter-implant bone measurements were taken on two panoramic radiographs from each patient: one after implant placement and the other at the last follow-up. The distance between adjacent implants was measured at the implant-abutment interface (implant platform). RESULTS: Overall, 130 inter-implant gaps were found. Follow-up ranged from 8 to 146 months. Two-tailed Pearson correlation tests revealed a negative correlation between inter-implant distance and bone loss (P = 0.036). Mean peak-crest bone loss for immediate implants was higher than for delayed implants (P = 0.026). There was more bone loss when hydroxyapatite (HA)-coated implants were used, although no statistical significance was observed. No statistically significant difference was found between the different locations in the anterior maxilla. No correlation was found between patient's age, smoking habits, and bone loss or between follow-up time and bone loss. CONCLUSIONS: A negative correlation was found between inter-implant distance and bone loss at the inter-implant bone crest in the anterior maxillary region. Bone loss was small in this study cohort.

Multitier technique for bone augmentation using intraoral autogenous bone blocks.

PURPOSE: Intraoral bone grafts are a convenient and acceptable source of autogenous bone for alveolar reconstruction due to bone origin similarity and less morbidity. In large bone defects, 1 tier might be insufficient to achieve the desired bone shape. The purpose of this article was to describe a multitier technique for reconstruction of extensive bone deficiency, using only intraoral block bone grafts for implant site augmentation. MATERIALS: After clinical and radiographic evaluation of the recipient site, measurements were taken to determine the size of the bone deficiency. The first tier of bone graft was harvested from the mandibular ramus. After additional clinical and radiographic evaluation of the recipient site 5 months later, bone graft blocks for the second tier were harvested either from the second ramus or the mandibular symphysis. CONCLUSIONS: A new technique, the multitier intraoral bone block graft, for the future use of dental implants, is described. This technique can serve as an optional operation procedure for extensively atrophic alveolar bone augmentation.

Survival of immediately provisionalized dental implants placed immediately into fresh extraction sockets.

BACKGROUND: The aim of this study was to evaluate the survival rate of immediately provisionalized dental implants immediately placed into fresh extraction sockets. METHODS: The study consisted of 87 consecutive patients, ranging in age from 21 to 76 years (average: 53.30 +/- 13.34 years), who received 210 immediately provisionalized, immediately placed dental implants between the years 2000 and 2005. Data were recorded regarding the survival rate of these implants and the incidence of complications. RESULTS: Follow-up ranged from 6 to 52 months (mean: 15.60 +/- 12.60 months). Smoking, past and present, was reported by 28.7% and 20.7% of patients, respectively. The maxillary incisors were replaced most frequently, followed by the mandibular lateral incisors. Most of the implants were >13 mm in length and > or = 3.75 mm in diameter. There were 47 (22.4%) single restored implants and 163 (77.6%) splinted implants. Overall, the implant survival rate was 97.6% (five implants failed). Complications, such as swelling, inflammation, and pain, were observed in 24 (11.4%) of the implants. No relation was found between complications and failure. The present study failed to reveal a relationship between implant survival rate and smoking, implant dimensions, and area of implantation. CONCLUSION: Immediately provisionalized immediate implants can serve as a predictable procedure with high survival rates.