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.

Cost-effectiveness analysis of periodontal disease control.

Cost-effectiveness analysis was used to evaluate alternative methods of periodontal disease control. The alternatives considered included non-surgical and surgical procedures as well as the use of antimicrobial agents. Data on costs were obtained from American Dental Association publications of average charges for periodontal services. The concept of quality-adjusted tooth-years (QATYs) was developed to provide an outcome measure which could be compared across treatments. The conclusions of this analysis are as follows: (1) Conservative non-surgical treatments for periodontal disease control not only have costs lower than surgical alternatives, as would be expected, but also maximize expected quality-adjusted tooth-years over a wide range of estimates; (2) antimicrobial therapy used as an adjunct to non-surgical treatment is likely to be both effective and cost-effective; and (3) quality of tooth-years is a critical consideration in the determination of outcome of periodontal treatment. For example, when tooth-years are not adjusted for quality, differences between treatments are diminished, and surgical treatment becomes as good as or better than more conservative treatments for some levels of disease severity.