An evidence-based concept of implant dentistry. Utilization of short and narrow platform implants.

As a profession, we must remember that tooth replacement is not a luxury; it is often a necessity for health reasons. Although bone augmentation and CBCT and expensive surgical guides are often indicated for complex cases, they are being overused. Simple or straightforward implant cases, when there is sufficient natural bone for narrow or shorter implant, can be predictable performed by well-trained GPs and other trained specialists. Complex cases requiring bone augmentation and other complexities as described herein, should be referred to a surgical specialist. Implant courses and curricula have to be based on the level of complexity of implant surgery that each clinician wishes to provide to his or her patients. Using a "logical approach" to implant dentistry keeps cases simple or straightforward, and more accessible to patients by the correct use of narrow and shorter implants.

Alternative to the gold standard for sinus augmentation: osteotome sinus elevation.

The development of sinus augmentation procedures has diminished the problem of proper implant placement in the posterior maxilla in patients that have a pneumatized maxillary sinus and reduced alveolar bone. The gold standard approach to augmentation--the external sinus augmentation--was developed years ago and is still touted as the best approach for creating maxillary posterior bone. However, external sinus augmentation procedures are often quite traumatic, time-consuming, and costly, and they have anatomical limitations and considerable documented morbidity. This article discusses the external procedure and contrasts it with an internal sinus augmentation with osteotomes that is as effective in promoting sinus augmentation, is localized and relatively atraumatic, can be performed rapidly, is reasonable in cost, and has negligible morbidity. In addition, a modification of future site development augmentation, in preparation for secondary implant placement, is described, as are three cases, to demonstrate the impressive augmentation that can be achieved with osteotome sinus elevation.

Iliac crest autogenous bone graft versus alloplastic graft and guided bone regeneration in the reconstruction of atrophic maxillae: a 5-year retrospective study on cost-effectiveness and clinical outcome.

BACKGROUND: Reconstruction of the atrophic maxillae with autogenous bone graft and jawbone-anchored bridges is a well-proven technique. However, the morbidity associated with the concept should not be neglected. Furthermore, the costs for such treatment, including general anesthesia and hospital stay, are significant. Little data are found in the literature with regard to a cost-benefit approach to various treatment alternates. PURPOSE: The aim of this retrospective study was to compare from a health-economical and clinical perspective the reconstruction of the atrophic maxillae prior to oral implant treatment either with autogenous bone grafts harvested from the iliac crest or the use of demineralized freeze-dried bone (DFDB) in combination with a thermoplastic carrier (Regeneration Technologies Inc., Alachua, FL, USA) and guided bone regeneration (GBR). MATERIALS AND METHODS: A total of 26 patients (13 + 13) were selected and matched with regard to indication, sex, and age. The study was performed 5 years after the completion of the treatment. Implant survival, morbidity, and complications were analyzed. Furthermore, a detailed analysis of the total cost for the respective treatment modality was performed, including material, costs for staff, sick leave, etc. RESULTS: The study revealed no statistical difference with regard to implant survival for the respective groups. The average total cost, per patient, for the DFDB group was 22.5% of the total cost for a patient treated with autogenous bone grafting procedures. CONCLUSIONS: The study concluded that reconstruction of atrophic maxillae with a bone substitute material (DFDB) in combination with GBR can be performed with an equal treatment outcome and with less resources and a significant reduced cost in selected cases compared with autogenous bone grafts from the iliac crest.

Sinus augmentation for dental implants: the use of alloplastic materials.

The ability to augment the sinus floor has dramatically expanded the scope of implant dentistry. Clinical and scientific studies abound as to the efficacy of this procedure. The debate still ensues as to the best material to use for this augmentation, with autogenous bone, freeze-dried bone, xenografts, and alloplasts all being advocated. This article will substantiate through scientific and clinical studies, how the use of allplastic materials in sinus augmentation techniques can greatly reduce the morbidity and the expense of the procedure while predictably producing bone that has been shown to support dental implants in function for extended periods of time.

Alveolar reconstruction with splitting osteotomy and microfixation of implants.

This report describes a surgical technique for reconstruction of the buccolingually reduced alveolar process. The technique involves the preparation of an artificial socket with immediate implant placement, which reduces total treatment time compared with two-stage procedures. Alveolar preparation comprises lamellar cortical splitting of the alveolus, interlamellar implant placement, and primary stabilization based on a microfixation technique. It was used for a wide range of indications involving single and multiple alveoli related to the partially dentate and the edentulous alveolar process. The results of 24 Branemark standard implants and 97 ITI implants with 44 consecutively treated patients have been reviewed with a mean observation time of 34.3 months (range 6 to 68 months). The main indicator for alveolar reconstruction was the narrow anterior maxillary arch. The 5-year cumulated success rate was 86.2%. Twelve implants failed during the observation period. The mean marginal bone loss was 1.7 mm (range 0 to 7.5 mm). There was a low infection rate compared with membrane-based GTR techniques. Treatment costs were low as a result of shorter treatment time.

[Calibrated autologous bone grafts--their use in oral implantology. Widening--crest augmentation. Personal technic]. / Greffons osseux autologues calibrés--leur utilisation en implantologie orale. L'élargissement--surélévation crestal. Technique personnelle.

Using special trephines moved by a rotary motor, corticospongy graded-cylindrical grafts can be obtained from the iliac crest. These grafts are used to maintain widened and raised maxillary or mandibular crests. Inserted between type Brane-mark implants is useful to increase the height of the alveolar process when it is impossible to implant. Surgical trauma is limited compared with other Lefort 1 type operations advocated for the same indication. Operative effects resolve quickly and patients are hospitalized less than two days. The entire process is quite economical.