Evaluation of hard tissue replacement composite graft material as a ridge preservation/augmentation material in conjunction with immediate hydroxyapatite-coated dental implants.

BACKGROUND: Immediate placement of dental implants (DI) in fresh extraction sockets is associated with remaining voids around the DI and often a partial dehiscence or thin facial alveolar plate. Bone replacement grafts are often used to correct these problems. This study evaluated the use of a layered composite of PMMA (poly-methyl-methacrylate), PHEMA (poly-hydroxyl-ethyl-methacrylate), and calcium hydroxide grafts (HTR) as a ridge preservation/ augmentation material used in conjunction with an immediate DI placement technique. METHODS: Twenty-three patients requiring 1 or 2 extractions that were treatment planned for immediate DI placement received 4.0 or 3.25 mm diameter hydroxyapatite-coated cylindrical implants in the extraction sockets. HTR was used to fill the remaining socket void and enhance the facial ridge width. A collagen hemostatic was placed to cover the DI sites, flaps released, and primary closure attempted with sutures. DI uncovering was performed at about 6 months. Measurements were taken to the nearest 0.5 mm of the internal socket width and total ridge width at DI placement and uncovering. RESULTS: Thirty DIs were placed in the 23 patients. Mean initial internal socket width was 6.9 mm. The total ridge width showed a mean change from 9.1 mm to 8.4 mm; 60% of the areas showed a net increase or no change, while 40% showed a decrease in overall ridge width. DI success rate was 97% out to 6 months of loading. CONCLUSION: The results of this study suggest that HTR is a useful adjunct in the placement of immediate DIs for filling of socket voids and preservation of ridge width.

An illustrative study of the role of tomograms for the placement of dental implants.

Before dental implants are placed, an evaluation of a presurgical bone site with tomograms will reveal information not available from panoramic or periapical radiographs. This article illustrates the importance of making tomograms before the placement of dental implants to determine the actual height, width, inclination, and undercut of alveolar bone; the shape, cortication, and irregularities of crestal alveolar bone; the density of alveolar bone; the relative location of anatomical landmarks, such as mandibular canal, maxillary sinus, nasal fossa, incisive canal, submandibular gland fossa, etc.; the bucco-lingual view of dental pathosis; the bucco-lingual evaluation of sinus graft following sinus-lift surgery; and the evaluation of surgically placed dental implants.

Normal anatomy on tomograms for dental implants.

Some dentists may be unfamiliar with reading conventional tomograms made of dental implant sites. The purpose of this article is to aid dentists in identifying normal anatomical landmarks on cross-sectional slices and to correlate them to sagittal slices.