Vertical ridge augmentation of atrophic posterior mandible with corticocancellous onlay symphysis graft versus sandwich technique: clinical and radiographic analysis.

Alveolar ridge augmentation of atrophic posterior mandibular ridge represents a challenge in oral and maxillofacial surgery to restore aesthetic and function. The aim of the study was to compare the clinical and radiographic outcomes of bone formation in atrophic posterior mandibles augmented using onlay symphysis cortico-cancellous bone block with that augmented using sandwich bone augmentation technique (Inlay). Twelve patients were selected with missing mandibular posterior teeth. CBCT were done for all patients preoperatively to assess the residual bone height, ranged between 5 and 7 mm from the inferior alveolar nerve with adequate sufficient alveolar ridge width more than 4 mm. Patients required bone augmentation procedure with autologous onlay chin graft (group I) versus those used as inlay sandwich technique (group II). Clinical and radiographic analysis were done to analyses the newly formed bone and bone height. Percent of change in bone height was also calculated and revealed that group I was higher than group II, however, statistically insignificant differences between the two groups were found regarding the percentage of newly formed bone. Vertical ridge augmentation procedures using onlay chin graft took lesser time than the interpositional grafting with fixation technique, however, both techniques are promising for vertical ridge augmentation.

Wedge-Shaped Implants for Minimally Invasive Treatment of Narrow Ridges: A Multicenter Prospective Cohort Study.

The present study aims to investigate clinical and patient-centered outcomes after the implant-supported rehabilitation of narrow ridges using a novel wedge-shaped implant. Forty-four patients were treated with the insertion of 59 tissue-level wedge implants (1.8 mm bucco-lingual width) in horizontally atrophic ridges (mean bone width 3.8 ± 0.4 mm). The main outcome measures were: implant stability quotient (ISQ), marginal bone loss (MBL) and patient morbidity. Fifty-eight implants were functioning satisfactorily after one year of loading (98.3% survival rate). ISQ values measured in the mesio-distal direction resulted significantly higher than those in the bucco-lingual direction at all time points (p < 0.001). Both mesio-distal and bucco-lingual ISQ values at 6-month follow-up resulted significantly higher than at 4-month follow-up (p < 0.001 for both). Mean MBL was 0.38 ± 0.48 mm at prosthesis delivery (6 months after implant insertion) and 0.60 ± 0.52 mm after one year of functional loading. The majority of patients reported slight discomfort related to the surgical procedure. Postoperative pain score was classified as mild pain on the day of surgery and the first postoperative day and no pain over the following five days. Within the limitations of the present study, the device investigated showed low morbidity and positive short-term clinical results in narrow ridges treatment.

Are There Alternatives to Invasive Site Development for Dental Implants? Part II.

Despite improvements in bone preservation following tooth extraction, edentulous sites are often deficient in bone volume for conventional dental implant therapy. Missing bone volume is often recaptured by surgery and grafting. This article discusses noninvasive alternatives to bone grafting. Part I of this topic discussed the use of short and narrow diameter implants. Part II discusses three additional alternatives: the use of tilted implants, the use of four or fewer tilted and axially-loaded implants to support a full-arch fixed-dental-prosthesis (FAFDP), and the use of zygomatic implants to restore the severely-atrophic edentulous maxillae lacking adequate bone for conventional treatment.

Immediate rehabilitation of the posterior maxilla with an axial and a tilted post-extractive implant: a technical report and brief literature review.

The atrophic posterior ridges are usually characterized by poor bone quality and quantity: this situation requires the use of bone regenerative techniques. Other alternative surgical approaches are investigated. Nowadays the use of tilted implants offers some advantages due to its feasibility. Today, bone grafting may be practical, but depends on many factors, such as the type of bone graft used (autogenous, alloplastic, or xenograft), host response, age of the patient, various complications associated with grafting procedures, infection, and, most importantly, the time spent while the grafted material matures and is taken up by the bone. So this case report describes the feasibility of an alternative surgical technique.

Mini Dental Implants in the Management of The Atrophic Maxilla and Mandible: A New Implant Design and Preliminary Results.

Although the edentulous population in the UK is falling, those that are rendered edentulous are becoming edentate later in life and with significantly resorbed ridges. This creates a challenge because the management of such patients and their ability to adapt to new dentures is impaired later in life. Despite widespread endorsement of two implants to retain lower complete dentures, the inability to comply has resulted in elderly patients with compromised ability to function and unable to eat a healthy diet. Mini dental implants may offer an ideal solution for the elderly edentulous population who may not be keen on invasive surgery for the placement of conventional dental implants. Further work is required to show the longevity of these restorations, however, existing research and clinical experience show that they potentially offer a simple solution to this group of patients. This paper presents the development of a new design of mini implant, based on clinical problems encountered during a pilot randomised controlled trial. The design of the new implant specifically aims to overcome problems in managing severely atrophic ridges. A preliminary survival study shows survival rates to be equivalent to other mini dental implants and highly satisfactory in the short to medium term.

Improvised Neutral Zone Technique in a Completely Edentulous Patient with an Atrophic Mandibular Ridge and Neuromuscular Incoordination: A Clinical Tip.

Resorption of mandibular ridges is a multifactorial and biomechanical disease that is chronic, progressive, irreversible, and cumulative leading to loss of sulcular depth, vertical dimension loss, and decreased lower facial height. Some common neurological, hormonal, and metabolic disorders affect the adaptability of dentures, and this can be diagnosed by a trained prosthodontist with proper history-taking and clinical examination.The denture becomes passive due to complex neuromuscular control and causes difficulties in impression-making, mastication, and swallowing, which in turn leads to loss of retention and stability in complete dentures. Hence, residual ridge resorption becomes a challenging scenario for a clinician during fabrication of complete dentures. The neutral zone concept plays a significant role in overcoming these challenges. The neutral zone is the area where the outward forces from the tongue are neutralized or nullified by the forces of the lips and cheeks acting inward during functional movements.The neutral zone technique is an alternative approach for the construction of lower complete dentures. It is most effective for dentures where there is a highly atrophic ridge and history of denture instability. The technique aims to construct a denture that is shaped by muscle function and is in harmony with the surrounding oral structures. The technique is by no means new, but it is a valuable one. It is rarely used because of the extra clinical step involved and its complexity. Complete and partial denture failures are often related to non-compliance with neutral zone factors. Thus, the evaluation of the neutral zone is an important factor. Increased retention and stability with reduced chairside time are the salient features of this new approach to any clinically challenging situation in complete dentures.This clinical report describes a modification of the conventional neutral zone technique using improvised procedures to minimize chairside visits for a patient with an atrophic mandibular ridge and neuromuscular incoordination.

The Effect of Ridge Expansion on Implant Stability in Narrow Partially Edentulous Ridges - A Preliminary Clinical Study.

INTRODUCTION: Currently, dental treatments with better aesthetic results and less treatment time is more acceptable by the patients. Inadequate amount of bone for implant placement at functionally and aesthetically most appropriate position is a common problem. AIM: To assess the effect of ridge expansion on implant stability in narrow partially edentulous ridges and to evaluate clinically and radiographically the success of dental implants, placed immediately following ridge expansion procedure. MATERIAL AND METHODS: Ten participants (nine males, one female, average age - 28 years) with partial edentulism associated with narrow atrophic alveolar ridges with adequate height and willing to participate in the study were included. The ridge expansion was performed using osteotomes and simultaneous implant placement was done. A total of 10 implants were placed. Stability, achieved ridge width and radiographic crestal bone loss were assessed three months post-operatively. RESULTS: Three months follow-up revealed stable implants both clinically and radiographically. All 10 implants were surrounded by adequate amount of bone required for successful functional rehabilitation. CONCLUSION: The study reveals that the technique of ridge expansion using osteotomes is successful in horizontal expansion, in cases of atrophic alveolar ridges thus, eliminating the need for more complex treatment as well as reduces the rehabilitation time along with improving the quality of bone support.

An Innovative and Simple Technique of Hollow Maxillary Complete Denture Fabrication.

Prosthetic rehabilitation of severely atrophic ridges has always been an ordeal for the clinician due to decreased support, stability and retention. Because of severe resorption the restorative space between maxillary and mandibular residual ridges is increased. Rehabilitation in such cases may result in increased height and weight of the prosthesis further compromising its retention and stability. This in turn overloads the underlying hard and soft tissues exacerbating ridge resorption so, in order to break this vicious cycle, the weight of the prosthesis needs to be reduced which can be achieved by making hollow prosthesis. This article describes a novel technique of fabricating a hollow maxillary complete denture.

Bone augmentation of the atrophic anterior maxilla for dental implants using rhBMP-2 and titanium mesh: histological and tomographic analysis.

The loss of multiple teeth or trauma to the anterior maxilla often results in a deficient ridge width for prosthetic tooth rehabilitation. This study evaluated the use of titanium mesh and recombinant human bone morphogenetic protein 2 (rhBMP-2) for the repair of major bone defects in the alveolar bone. Five patients were enrolled in the study; these patients required implant replacements for two contiguous missing teeth in the anterior maxilla, which lacked sufficient bone. Residual ridges were augmented with rhBMP-2 and titanium mesh to direct the geometry of the newly formed bone. Seven months later, a bone biopsy specimen was removed from the implantation site before osteotomy and insertion of dental implants. Cone beam computed tomography (CBCT) scans were obtained preoperatively, postoperatively (baseline), and 48 months after implantation to evaluate implant healing. All dental implants were placed in the grafted sites without the need for further bone augmentation. The most frequent adverse effects were facial oedema and oral erythema. Biopsy specimens were used to evaluate bone quality. CBCT scans provided a prediction of alveolar restoration and long-term success. The combination of rhBMP-2 and titanium mesh provided effective augmentation of the atrophic anterior maxilla prior to implant placement.

Lateral ridge split and immediate implant placement in moderately resorbed alveolar ridges: How much is the added width?

BACKGROUND: Lateral ridge split technique is a way to solve the problem of the width in narrow ridges with adequate height. Simultaneous insertion of dental implants will considerably reduce the edentulism time. MATERIALS AND METHODS: Twenty-five patients who were managed with ridge splitting technique were enrolled. Thirty-eight locations in both jaws with near equal distribution in quadrants received 82 dental fixtures. Beta Tricalcium phosphate (Cerasorb(®) ) was used as biomaterial to fill the intercortical space. Submerged implants were used and 3 months later healing caps were placed. Direct bone measurements before and after split were done with a Collis. Patients were clinically re-evaluated at least 6 months after implant loading. All the data were analyzed by Statistical Package for Social Sciences (SPSS) software version 11.5 (SPSS Inc, Chicago Illinois, USA). Frequency of edentulous spaces and pre/post operative bone width was analyzed. Paired t-test was used for statistical analysis. Difference was considered significant if P value was less than 0.05. RESULTS: Mean value for presplit width was 3.2 ± 0.34 mm while post-split mean width was 5.57 ± 0.49 mm. Mean gain in crest ridge after ridge splitting was 2 ± 0.3 mm. Statistical analysis showed significant differences in width before and after operation ((P > 0.05). All implants (n = 82) survived and were in full function at follow up (at least 6 months after implant loading). CONCLUSION: Ridge splitting technique in both jaws showed the predictable outcomes, if appropriate cases selected and special attention paid to details; then the waiting time between surgery and beginning of prosthodontic treatment can be reduced to 3 month.

Expansão cirúrgica de rebordo alveolar atrófico: uma revisão sistemática / Atrophic alveolar ridge surgical expansion: a systematic review

Os implantes osseointegrados têm sido constantemente indicados e considerados uma opção viável para reabilitação protética de pacientes que tiveram seus dentes perdidos. Entretanto, em alguns casos, o rebordo apresenta-se atrófico e com defeitos ósseos, fatores que impedem a instalação dos implantes. O objetivo deste trabalho foi revisar sistematicamente a literatura relacionada à técnica de expansão de rebordo alveolar atrófico para subseqüente instalação de implantes. O levantamento bibliográfico sistemático foi realizado na base de dados Medline e da Biblioteca Cochrane, entre os anos de 1966 e 2007. Além disso, uma busca manual em revistas odontológicas impressas também foi realizada. O resultado dessa revisão de literatura identificou apenas 18 estudos, relacionados a essa técnica, que preenchiam os critérios de inclusão. A espessura do rebordo aumentou significantemente após a expansão cirúrgica do rebordo. Os implantes instalados imediatamente após a realização desse procedimento cirúrgico apresentaram altos índices de sobrevivência/sucesso. Além disso, o padrão de perda óssea marginal anual foi limitado nos poucos estudos que estudaram esse parâmetro. Dentro dos limites dessa revisão, é possível concluir que existem poucos estudos longitudinais e controlados do efeito de expansão cirúrgica do rebordo seguida de instalação de implante. Os poucos estudos apresentados indicam que a instalação de implante seguida desse procedimento cirúrgico pode ser previsível dentro de períodos de até 5 anos. Não há na literatura, no entanto, informações sobre as condições dos tecidos moles periimplantares e sobre o destino da parede óssea vestibular expandida após esse procedimento. Portanto, mais estudos são necessários para confirmar que a expansão cirúrgica da maxila seguida da instalação de implante é um procedimento eficaz.

Dental implants have been constantly indicated and considered as a viable choice for supporting prosthetic rehabilitation in patients that had lost their teeth. In some cases the ridge is, however, atrophic and presents bone defects that may prevent implant installation. The objective of this study was to systematically review of the literature related to the atrophic alveolar ridge expansion technique. The systematic review of the literature was performed on the Medline and Cochrane Library electronic databases between the years 1966 and 2007. In addition, a hand-search in dental journals was done. The results of this literature review identified only 18 studies related to this technique that filled the criteria of inclusion. The results presented in the studies indicated that the alveolar ridge width increased significantly after the surgical expansion of the ridge. The implants installed immediately after this surgical procedure presented high rates of survival/success. Besides, the annual marginal bone loss rate was limited in the few studies where this parameter was analyzed. Within the limits of this review, it was possible to conclude that there are few longitudinal and controlled studies about the effects of surgical expansion of the ridge followed by implants installation. The few studies presented indicated that the implant installation followed by this surgical procedure may be predictable within periods up to 5 years. However, there is in literature no information about the conditions of the periimplant soft tissue and the fate of expanded vestibular bone wall. Therefore, more studies are necessary to confirm that alveolar ridge surgical expansion followed by implant installation is an efficient procedure.