Maxillary vertical alveolar ridge augmentation using sandwich osteotomy technique with simultaneous versus delayed implant placement: A proof of principle randomized clinical trial.

BACKGROUND: The sandwich osteotomy technique usually requires high surgical skills and prolonged intraoperative time and had some technical drawbacks with a subsequent deficient amount of vertical bone gain. The aim of this study was to evaluate the final vertical bone gain using sandwich osteotomy with simultaneous versus delayed implant placement in the anterior maxilla. MATERIAL AND METHODS: This study included 16 patients having multiple missing maxillary anterior teeth with a vertically deficient alveolar ridge. Patients were randomly assigned into two equal groups. Both groups were treated using sandwich osteotomy with interpositional particulate bovine bone graft. In the study group (8 patients, 17 implants), the transport mobilized bone segment was fixed in position using simultaneous implant placement. Whereas in the control group (8 patients, 18 implants), micro-plates and screws were used, followed by a second-stage surgery for plates removal and delayed implant placement. Radiographic assessment included 4 months postoperative mean of vertical gain in alveolar ridge height, taken from cross-sectional cuts of cone beam CT. RESULTS: The mean vertical bone gain in the study group was 4.04 ± 0.59 mm compared to 3.86 ± 0.52 mm in the control group with no statistically significant difference (p = 0.518). The mean value of bone gain percentage in the study group was 33.02% compared to 31.75% in the control group, with no statistically significant difference (p = 0.656). CONCLUSION: The sandwich osteotomy technique with simultaneous implant placement is a reliable method for vertical ridge augmentation that eliminates the need for a secondary surgery.

Predictors of peri-implant bone remodeling outcomes after the osteotome sinus floor elevation: a retrospective study.

BACKGROUND: This study aimed to evaluate the radiographic outcomes of implants after osteotome sinus floor elevation (OSFE), and further identify the separate predictors for these radiographic outcomes. METHODS: In this retrospective cohort study, a total of 187 implants were inserted into 138 patients using the OSFE technique. Seventy-four patients in the grafted group, and 64 patients in the non-grafted group completed this study. The vertical bone gain (VBG) and marginal bone loss (MBL) at 3 years following surgery were assessed as outcome variables. Based on extensive literature results, variables considered potential predictors of outcome variables included sex, age, tooth position, implant length, implant diameter, with or without grafting materials, residual bone height, sinus width, bone density, and sinus membrane thickness. Subsequently, the binary logistic regression analysis was applied with VBG and MBL as dependent variables, respectively. The receiver operating characteristic curve (ROC) with its area under the curve (AUC) was performed to further determine the predictive value of these predictors. RESULTS: One hundred and six implants in grafted group and 81 implants in the non-grafted group were analyzed. The average VBG was 2.12 ± 1.94 mm for the grafted group and 0.44 ± 1.01 mm for the non-grafted group at 3 years (P < 0.05). The mean MBL was 1.54 ± 1.42 mm for the grafted group and 1.13 ± 1.69 mm for the non-grafted group at 3 years (P > 0.05). After the adjustment for confounders, logistic regression analysis demonstrated that implant length, grafting, residual bone height, and sinus membrane thickness were predictors of VBG. The odds ratio for VBG was 3.90, 4.04, 4.13 and 2.62, respectively. Furthermore, grafting exhibited the largest AUC at 0.80. While tooth position and implant length were predictors of MBL, the odds ratio for MBL was 3.27 and 7.85, respectively. Meanwhile, implant length exhibited the largest AUC at 0.72. CONCLUSIONS: OSFE with or without simultaneous grafting materials both showed predictable clinical outcomes. Additionally, the present study is the first quantitative and significant verification that VBG has a significant association with sinus membrane thickness, as well as residual bone height, implant length and grafting. Whereas tooth position and implant length are markedly associated with MBL.

The assessment of the effect of the size of lateral-antrostomy in graftless balloon elevation of the maxillary sinus membrane with simultaneous implant placement (a randomized controlled clinical trial).

BACKGROUND: The overlying maxillary sinus frequently restrains the height of the posterior maxillary bones. PURPOSE: Evaluating the effect of downsizing the antrostomy side-window on the stability of the installed implants and vertical bone gain, after employing a graftless antral membrane balloon elevation (AMBE). MATERIALS AND METHODS: The study is a randomized controlled clinical trial conducted on 20 patients with 30 deficient maxillary alveolar ridges underwent graftless (AMBE) after being allocated into a (5 mm) entry antrostomy group (the test group) and a (10 mm) entry antrostomy group (the control group) implementing a radiographic linear bone height and implant stability quotations (ISQ) comparison among both groups immediately after the placement of 38 Implants and 6 months after. RESULTS: Radiographic bone gain of the test group (5.55 ± 0.93 mm) was significantly higher than the control group (2.86 ± 0.60 mm) (p <0.001). There was no significant difference in primary stability between the test (65 ± 5.32) and control groups (62.67 ± 4.46) (p = 0.202); while the test group (73.43 ± 4.39) showed significantly higher secondary stability than the control group (64.83 ± 6.05) (p <0.001). ISQ values recorded at 6 months were significantly higher than those recorded at insertion in the test group (p <0.001), while they were insignificant in the control group (p = 0.148). CONCLUSION: Undersizing the antrostomy window deemed beneficial concerning the vertical bone gain and the simultaneously placed root form dental implants' secondary stability.

Vertical Bone Gain after Sinus Lift Procedures with Beta-Tricalcium Phosphate and Simultaneous Implant Placement-A Cross-Sectional Study.

OBJECTIVES: The objective of this cross-sectional study was to evaluate the vertical bone gain achieved after the sinus lift procedure with beta-tricalcium phosphate (ß-TCP) used as a bone substitute and simultaneous implant placement. METHODS: One hundred and twenty-eight sinus lift procedures (utilizing a synthetic ceramic containing 99.9% tricalcium phosphate as a bone substitute) and simultaneous implant placements were performed on 119 patients. The lateral window approach surgical protocol for maxillary sinus lift was performed on the patients. The implants were evaluated using cone-beam computed tomography (CBCT) at 6 months following placement. The vertical bone gain was considered a primary variable, while implant length, diameter, and location were considered secondary variables. RESULTS: The ANOVA results showed no statistical difference in vertical bone gain with implant parameters like implant length, width, and position. Pearsons correlation revealed a statistically significant positive correlation with vertical bone gain and implant length and diameter. A further multivariate linear regression analysis was performed and it observed statistically significant associations between the variables in the study after adjusting for confounding factors. CONCLUSIONS: This study concluded that there was vertical bone gain with the usage of ß-TCP in maxillary sinus lift surgical procedure with immediate implant placement and that implant variables like length and diameter had a significant influence on the average bone gain values. The implant position did not have a statistically significant influence but there was considerable variation in the bone gain between first, second premolar, and molar regions.

Assessment of vertical ridge augmentation and marginal bone loss using autogenous onlay vs inlay grafting techniques with simultaneous implant placement in the anterior maxillary esthetic zone: A randomized clinical trial.

BACKGROUND: Bony reconstruction and dental rehabilitation of patients with posttraumatic anterior maxillary alveolar defects is a very complicated procedure. The aim of this study is the assessment of vertical ridge augmentation using autogenous onlay vs inlay bone grafting techniques in the anterior maxilla. MATERIALS AND METHODS: Sixteen patients (40 implants) with vertically deficient anterior maxillary alveolar ridges were equally allocated into two groups; Autogenous block bone graft was harvested from the chin with simultaneous implant placement was done either onlay (control) or inlay (study). Radiographic assessment was performed preoperatively, 1 week and 6 months postoperatively. Assessment included measurements of linear changes in the vertical height on cross sectional cuts of cone beam computed tomography (CBCT) using special software. Finally, the amount of vertical gain and marginal bone loss in each group was compared to that of the other. RESULTS: Wound healing was uneventful for all cases except three cases of the onlay group showed wound breakdown and graft loss. The mean vertical bone gain in the control group was -0.02 mm while in the study was 3.34 mm. While the mean of the crestal bone loss of the control group was 4.77 mm and that of the study group was 1.65 mm. CONCLUSION: The final vertical bone gain was statistically significant in the study group, so the inlay bone grafting technique with immediate implant placement could be used successfully for vertical alveolar ridge augmentation in the esthetic zone.

Collagen vs expanded polytetrafluorethylene membranes during guided-bone regeneration simultaneous with implant placement: a systematic review / Membranas de colágeno vs politetrafluoretileno expandido para regeneração óssea guiada simultânea à colocação de implante: uma revisão sistemática

Purpose: This systematic review evaluated the influence of the membrane type (resorbable collagen or non-resorbable expanded polytetrafluorethylene; e-PTFE) on the guidedbone regeneration associated to implant placement. Methods: Any type of clinical study or literature review was searched at MEDLINE/PubMed and Cochrane databases. Two independent reviewers screened titles/abstracts of articles and the full-text of potentially eligible studies. When data was available, pairwise meta-analysis was performed using random statistical model. Results: Nine studies met the inclusion criteria, considering 685 implants in 360 patients. Vertical bone regeneration did not differ with the use of the two membranes in 8 of the 9 studies included. Meta-analysis did not show either greater vertical bone gain or vertical bone loss after regeneration with any of the membranes. The results have shown a tendency of higher bone gain in horizontal guided-bone regeneration with nonresorbable e-PTFE membranes (reported by 2 of 3 studies). All studies clearly showed that both membranes were effective in increase bone volume. There was no clear tendency of any of the two membranes in cause more complications. Conclusion: resorbable collagen and nonresorbable e-PTFE membranes are similarly effective in vertical guided-bone regeneration; however, horizontal guided-bone regeneration seems to benefit with the use of non-resorbable ones. Both membranes showed to be effective in guided-bone regeneration and similar in regards to complications(AU)

Objetivo: Esta revisão sistemática avaliou a influência do tipo de membrana (colágeno reabsorvível ou politetrafluoretileno expandido não reabsorvível; e-PTFE) na regeneração óssea guia associada à colocação do implante. Métodos: Qualquer tipo de estudo clínico ou revisão de literatura foi pesquisada nas bases de dados MEDLINE / PubMed e Cochrane. Dois revisores independentes examinaram títulos / resumos de artigos e o texto completo de estudos potencialmente elegíveis. Quando os dados estavam disponíveis, a meta-análise pareada foi realizada usando modelo estatístico aleatório. Resultados: Nove estudos preencheram os critérios de inclusão, considerando 685 implantes em 360 pacientes. A regeneração óssea vertical não diferiu com o uso das duas membranas em 8 dos 9 estudos incluídos. Meta-análise não mostrou maior ganho ósseo vertical ou perda óssea vertical após a regeneração com qualquer uma das membranas. Os resultados mostraram uma tendência de maior ganho ósseo na regeneração óssea guiada horizontal com membranas de e-PTFE não reabsorvíveis (relatadas por 2 de 3 estudos). Todos os estudos mostraram claramente que ambas as membranas foram eficazes no aumento do volume ósseo. Não houve uma tendência clara de qualquer uma das duas membranas em causar mais complicações. Conclusão: o colágeno reabsorvível e as membranas não-reabsorvíveis de PTFE-e são igualmente eficazes na regeneração óssea guiada vertical; no entanto, a regeneração óssea guiada horizontal parece se beneficiar com o uso das membranas não reabsorvíveis. Ambas as membranas mostraram-se eficazes na regeneração óssea guiada e similares em relação às complicações(AU)

O uso de rhBMP-2/beta-TCP para técnica de enxerto vertical interposicional: relato de caso com quatro anos de acompanhamento / The use of rhBMP-2/beta-TCP for interpositional vertical graft technique: a case report with 4 years of follow-up

A reconstrução óssea de mandíbulas atróficas para o posicionamento de implantes dentários ainda é um grande desafio na Implantodontia atual. Para um ganho ósseo vertical, a técnica de enxerto interposicional com a utilização de enxerto de osso autógeno, ou algum substituto ósseo, apresentou excelentes resultados. Neste relato de caso, um paciente com 58 anos de idade e ausências entre os elementos 34 e 38 apresentava 3 mm de altura entre a crista óssea e o nervo alveolar inferior pelo exame de TCFC, impossibilitando o posicionamento de implantes sem enxertos prévios para ganho em altura e espessura. Com a utilização de rhBMP-2 como osteoindutor, associada ao beta-TCP como osteocondutor, foi possível regenerar o local com pouca morbidade e com ganho ósseo satisfatório (8 mm) para o posicionamento dos implantes. Após sete meses da consolidação do enxerto, implantes de diâmetro estreito (3,3 mm) foram posicionados e o paciente foi reabilitado sem complicações ou intercorrências durante todo o tratamento. Os autores sugerem que essa técnica tem um grande potencial para reconstruções de regiões atróficas, com um excelente ganho ósseo vertical, pouca morbidade e grande previsibilidade de resultados.

Bone reconstruction of atrophic mandibles for correct implant positioning is a great challenge on contemporary dentistry. Also, the interpositional graft technique using autogenous or bone substitute materials for vertical augmentation has presented excellent outcomes. This case report presents a 58 years-old patient with tooth loss from 34 to 38 regions having 3 mm from the bone crest to the inferior alveolar nerve canal according to the CBCT exam preventing implant placement without previous grafts for horizontal and vertical augmentation. With the aid of rhBMP-2 (osteoinductive) and beta-TCP (osteoconductive) materials it was possible to regenerate the area with less morbidity and satisfactory bone gain (8 mm) for implant placement. Seven months after graft healing narrow diameter implants (3.3 mm) were positioned and the patient rehabilitated without complications during the course of treatment. The authors suggest that this technique has a great potential for reconstruction of atrophic sites with excellent vertical bone gain, less morbidity, and great outcome predictability.

Alveolar ridge augmentation using distraction osteogenesis: a clinical trial.

BACKGROUND: Severely resorbed ridges present a great challenge to prosthodontic rehabilitation. Available reconstructive options include autologous/alloplastic augmentation with questionable results, or regeneration of new bone under gradual and controlled tension using distraction osteogenesis. This study focused on use of distraction osteogenesis for the treatment of vertically deficient alveolar ridges to assess its feasibility and outcome. MATERIALS AND METHODS: Alveolar distraction osteogenesis (ADO) was studied at 10 different intra-oral, partial or complete edentulous sites. After a latency period of 5 days, distraction was carried out for 6-7 days at the rate of 0.5 mm every 12 hours (1 mm/day). Distractor was removed after a consolidation period of 12 weeks. RESULTS: The mean height gained at the 10 intra-oral sites was 4.8 mm with standard deviation of ± 0.056. The mean follow-up period was 2 years. Complications of therapy included hardware failure, wound gape and extra-oral scar. The overall complication rate was 10%. CONCLUSION: Distraction osteogenesis is a promising option to aid uneventful prosthodontic rehabilitation of severe vertically resorbed alveolar ridges.