Radiographic Evaluation of Crestal Bone Level in Split-Crest and Immediate Implant Placement: Minimum 5-Year Follow-up.

PURPOSE: This study aimed to evaluate the radiographic bone level changes of implants positioned via the split-crest procedure both in the maxilla and mandible at a long-term follow-up. MATERIALS AND METHODS: Seventy-one patients were retrospectively enrolled in the study. The placement of 137 dental implants was performed in the edentulous premolar or molar region after a split-crest ridge expansion procedure. Implants followed a delayed loading protocol. Intraoral digital radiographs were performed at baseline, upon implant placement, at 70 days (following placement of the provisional prosthesis), and on a yearly basis during followup. Crestal bone levels were evaluated at the baseline, upon provisional prosthesis placement, at 12, 36, and 60 months, and at the long-term follow-up of healing from implant placement. RESULTS: The patients underwent a mean follow-up of 6.54 ± 1.32 years, from which the implant survival rate was reported at 98.54%. Within the first year from implant placement, a bone loss resulted at a mean value of -1.11 ± 0.44 mm. After almost 3 years from implant placement, a mean bone gain of +0.89 ± 0.39 mm was reported, which was statistically significant compared with 12-month values (P < .05). From this point, bone levels remained stable, reporting similar values over time, with no significant differences (P > .05). CONCLUSION: A mean vertical bone gain of +0.89 ± 0.39 mm was observed after almost 36 months after implant positioning.

Immediate Loaded Implants in Split-Crest Procedure.

BACKGROUND: The aim of this study was to assess survival rate of immediate loading implants placed after split-crest technique. METHODS: Thirty-six patients were enrolled in the study. They underwent placement of 93 dental implants in edentulous region after split-crest ridge expansion procedure. Implants followed an immediate loading procedure. Crestal bone levels were measured at baseline, at temporary prosthesis placement, at 1 year, and at 2 years from implant placement. RESULTS: For dental implants, a survival rate of 98.92% was reported at 2-year follow-up, with a mean value bone loss of -1.02 ± 0.48. CONCLUSION: This study assessed immediate loading implant placement after split-crest procedure at 2-year follow-up.

Clinical study of flap design to increase the keratinized gingiva around implants: 4-year follow-up.

Since the presence of keratinized gingiva is so important for peri-implant outcome, the aim of this study is to describe a partial thickness flap design to increase the amount of keratinized peri-implant tissue as well as its thickness. A total of 131 implants were placed in 85 patients: 103 implants (78.63%) in the mandible and 28 implants (21.37%) in the maxilla. Before implant placement in edentulous ridge the residual keratinized mucosa usually was measured with a periodontal probe in a buccal-palatal direction. A palatal or lingual incision was made to raise a partial thickness flap with the residual keratinized tissue. After implant placement the flap was apically repositioned and secured with loose periosteal sutures. Keratinized tissue levels were calculated at baseline, at 6 months, and every year follow-up. Measurements were reported for each implant diameter. At 4-year follow-up, implant survival rate of 87.79% was reported. Peri-implant keratinized mucosa confirmed clinical gain in all cases; mean levels at 1- and 4-year follow-ups were 7.26 ± 2.01 mm and 7.37 ± 2.12 mm, respectively. The levels remained stable over time. This flap design allows immediate correction of adaptation of the keratinized tissue around the implant, increasing the thickness and amount of the keratinized tissue.

The utility of the electric mallet.

The aim of this study was to evaluate the efficiency of electrical mallet for tooth extraction evaluating the integrity of fresh sockets walls. From July 2009 to February 2012, 427 hopeless teeth were extracted in 156 patients: 96 males and 60 females, with a mean age of 53.2 ± 26.4 years. Two hundred fifty teeth were extracted from the maxilla and 177 from the mandible. Extractions were performed using an electrical mallet. It pushed blade in a longitudinal movement along central axis, moving up and down toward the periodontal ligament space in a repetitive manner, providing a driving mechanism of longitudinal movements. Intraoral digital radiographic examinations were performed before and immediately after dental extractions to evaluate the lamina dura setting. No fracture or loss of cortical bone plate was observed in fresh sockets of teeth extracted by electrical mallet. All the alveoli revealed full soft tissue secondary healing 2 weeks after complete root extraction. During the healing period, there were no signs of inflamed tissue or exposed bone in any of the cases. As reported in this clinical study, maximum preservation of the alveolar housing and related gingival structures may be achieved following assisted atraumatic tooth extraction by electrical mallet.

Radiographic evaluation of crestal bone levels of delayed implants at medium-term follow-up.

PURPOSE: The aim of this study was to evaluate the radiographic bone level changes after delayed implant placement at medium-term follow-up, with three elements kept constant: keratinized gingiva thickness, implant axes perpendicular to the opposing occlusal surface, and implants with a collar of 2 mm. MATERIALS AND METHODS: Patients treated in a private practice setting were retrospectively enrolled in the study. They underwent delayed placement (4 to 8 weeks after extraction) of dental implants in edentulous premolar or molar regions. Implants followed a delayed loading protocol. Crestal bone levels were measured at baseline; at provisional prosthesis placement; at 1, 3, and 5 years; and at medium-term follow-up of healing from implant placement. RESULTS: One hundred twenty patients received 135 implants (one or two implants per patient); 3 implants were lost. After a mean follow-up period of 9.71 ± 4.88 years, a survival rate of 97.76% was reported. At 1 year after implant placement, mean bone loss of -1.5 ± 0.62 mm was found. At almost 3 years post-implant placement, a mean bone gain of +1.20 ± 0.49 mm was seen, which was statistically significantly different compared with 1 year. After this point, the bone levels remained stable; similar values were reported over time, with no significant differences. CONCLUSIONS: The mean vertical bone gain of +1.20 ± 0.49 mm seen at almost 3 years after implant placement in this study may be supported by both clinical parameters as presence of sufficiently thick keratinized gingiva (3 mm), implants with a 2-mm collar, and the axis of implant insertion perpendicular to the opposing occlusal surface.

New surgical technique and distraction osteogenesis for ankylosed dental movement.

Dental ankylosis often presents a significant vertical alveolar defect that is an esthetic problem for prosthetic rehabilitation. Moreover, surgical-orthodontic treatment by corticotomies and distraction devices provides special attention to avoid the loss of blood supply to the segment; furthermore, gingival recessions may appear because the gingival tissues cannot proliferate as fast as the immediate repositioning of the tooth. This case report presents a surgical technique for buccal, palatal, and vertical movements, and examines the effects of a tooth/arch-borne tooth distractor appliance, for the alignment of ankylosed teeth. The slow movements of tooth and bone block and fine cut simplifies orthodontic treatment in patients and makes it possible to achieve complex movements in a relatively short period. The reported dislocation procedure allows a use of buccal-lingual vertical osteotomy with horizontal osteotomy to correct tooth positions via bony block movement maintaining gingival tissues in position. The used sonic saw have proven to be a valuable alternative to manual or rotating tools, oscillating saws, or piezoelectric units because it is faster and easier for surgical approach.

Localized management of sinus floor technique for implant placement in fresh molar sockets.

BACKGROUND: The use of osteotome for vertical bone augmentation and localized sinus elevation with minimal surgical trauma represents a suitable procedure to increase the vertical dimension of available bone for implant placement. PURPOSE: The aim of this study was to report clinical and radiographic results of localized management of sinus floor (LMSF) in fresh molar sockets at 13-year follow-up. MATERIALS AND METHODS: Fifty-three patients, needing one or two maxillary molar extraction, were enrolled in this study. LMFS procedure was performed and 68 implants were positioned. A presurgical distance from the alveolar crest to the floor of the maxillary sinus and the amount of new radiopacity between the sinus floor and alveolar crest were measured from the mesial and distal surfaces of each dental implant surface. RESULTS: After a mean follow-up period of 9.76 ± 5.27 years (ranged from 4 to 17 years) a survival rate of 100% was reported. Mean bone height at temporary prosthesis placement was 7.99 ± 1.16 mm. They were stable over time, reporting a mean value of 8.01 ± 1.46 mm at 13-year follow-up. CONCLUSIONS: The results of this study demonstrated that LMSF procedure in fresh molar sockets allowed to expand the dimensions of resorbed posterior maxillary alveolar bone both vertically and horizontally with a success rate of 100% of implant osseointegration over time.

Transcrestal sinus floor elevation: a retrospective study of 46 patients up to 16 years.

BACKGROUND: The aim of this study was to evaluate the clinical outcomes and radiographic data of transcrestal sinus floor elevation (TSFE) of residual alveolar bone ≤3 mm. METHODS: Forty-six patients, edentulous in one or both maxillary posterior segments, were enrolled in this study. The residual alveolar ridge was measured. TSFE without bone grafting was performed. Three months after the first surgery procedure, 66 implants were placed without grafting material. A presurgical distance from the alveolar crest to the floor of the maxillary sinus and the amount of new radiopacity between the sinus floor and alveolar crest were measured from the mesial and distal surfaces of each dental implant surface. RESULTS: After a mean follow-up period of 10.43 ± 5.01 years (ranged from 5 to 16 years), a survival rate of 95.45% was reported. Mean bone levels at implant placement were 7.12 ± 0.90 mm and, after 1 year, were 13.28 ± 1.23 mm. They were stable over time, reporting an up to 16 years' value of 13.07 ± 2.63 mm. CONCLUSIONS: The results of this retrospective clinical study confirmed the reliability of the TSFE procedure and the maintenance of bone levels without grafting procedures over time.

A 10-year multicenter retrospective clinical study of 1715 implants placed with the edentulous ridge expansion technique.

This work evaluates the data gathered over a period of 10 years on implants placed with the edentulous ridge expansion (ERE) technique by a group of specially trained and experienced surgeons. Between January 1992 and December 2001, 1715 consecutive implants were placed with the ERE technique by nine different dental surgeons using a common surgical protocol. The implants were followed up using a common protocol and a specific database for the collection of clinical information on the patient, surgery, and follow-up, including the 1986 Albrektsson et al criteria for implant success. All data gathered at the end of the study period were placed in a common database. The overall success rate over the O-year follow-up period was 95.7%.