Maxillary implant-retained partial overdenture with Dolder bar attachment: a clinical report.

This article describes a technique for maintaining a maxillary Kennedy III partial removable dental prosthesis design in a patient who had non-restorable failing abutments by replacing the abutments with dental implants. Two implants were placed immediately after extraction of the abutment teeth in the anterior maxilla. After the implants were fully integrated, a Dolder bar attachment was fitted onto the implants. A new maxillary partial removable dental prosthesis was fabricated using the implants and the remaining natural teeth as abutments to restore function and esthetics. With the aid of dental implants, this Kennedy III maxillary removable dental prosthesis design could provide additional retention and support by promoting cross-arch stability and tissue, implant and tooth support. The patient's satisfaction was significantly increased.

A comparative analysis of bone formation induced by human demineralized freeze-dried bone and enamel matrix derivative in rat calvaria critical-size bone defects.

BACKGROUND: Human demineralized freeze-dried bone allograft (DFDBA) and enamel matrix derivative (EMD) have been used with varying success for the treatment of bone and periodontal defects. The purpose of this study was to compare qualitatively and quantitatively the bone formation induced by DFDBA and EMD to that of a positive control, recombinant human bone morphogenetic protein 2 (rhBMP-2), in the 8-mm rat calvaria critical-size bone defect. METHODS: Five groups of five rats each were used. The two test groups were DFDBA and EMD. A negative control consisted of a defect without any biomaterial implanted, a positive control consisted of a defect filled with collagen carrying rhBMP-2, and a non-surgical control consisted of the intact rat calvaria. Eight weeks after implantation of the biomaterials, histologic analysis was used for qualitative assessments and microcomputed tomography was used for quantitative assessments of bone formation. Statistical evaluation was performed by analysis of variance followed by the Fisher's least significant difference multiple-comparison test. RESULTS: In the negative control and EMD groups, the histologic analysis showed no bone formation within the center of the defect and limited bone repair at its margins. In the DFDBA group, granules of DFDBA were still present 8 weeks after implantation, and a limited degree of osteoinduction was seen at the center of the defect. The microcomputed tomography quantitative analysis showed a limited capacity of DFDBA and EMD to induce bone formation, and no statistically significant difference was detected among DFDBA, EMD, and the negative control. On the contrary, the positive control (rhBMP-2) consistently showed regeneration of bone throughout the critical-size defects. CONCLUSION: Unlike rhBMP-2, DFDBA and EMD had limited ability to induce bone formation in the rat calvaria critical-size bone defect; therefore, they may not be effective as bone-regenerative therapy for critical-size defects.

A new tunnel technique with acellular dermal matrix for soft tissue preparation prior to symphyseal block graft--a description of technique and case report.

The aim of this report was to describe a newly designed tunnel technique (A New Tunnel Technique) using acellular dermal matrix (ADM) allograft for soft tissue augmentation prior to mono-cortical block graft. Two cases with vertical and horizontal ridge deficiency in the mandibular anterior area were indicated for mono-cortical block grafting before implant placement. Soft tissue evaluation and measurements showed thin tissue covering the defect area composed mainly of nonkeratinized alveolar mucosa measuring 1 to 2 mm in most of the sites. Soft tissue augmentation was done first using a new tunnel technique with ADM allograft. After 2 months of healing, mono-cortical block graft was harvested from the mandibular symphysis area and fixed to the recipient site. Soft tissue measurements were made before soft tissue graft and immediately before block graft. Healing was evaluated at 2, 4, 12, and 24 weeks post-block grafting surgery to evaluate healing. In both cases, there was generalized 1- to 2-mm increase in soft tissue thickness covering the defect areas following allograft. Both cases had healed uneventfully with no soft tissue complications following block grafting procedure to the time of implant placement. The new tunnel technique for soft tissue augmentation using acellular dermal matrix allograft seems to be a valid approach in soft tissue preparation prior to mono-cortical block grafting. Further research is needed to evaluate if this procedure will help to prevent soft tissue complications associated with block grafting.

Calcium sulfate and platelet-rich plasma make a novel osteoinductive biomaterial for bone regeneration.

BACKGROUND: With the present study we introduce a novel and simple biomaterial able to induce regeneration of bone. We theorized that nourishing a bone defect with calcium and with a large amount of activated platelets may initiate a series of biological processes that culminate in bone regeneration. Thus, we engineered CS-Platelet, a biomaterial based on the combination of Calcium Sulfate and Platelet-Rich Plasma in which Calcium Sulfate also acts as an activator of the platelets, therefore avoiding the need to activate the platelets with an agonist. METHODS: First, we tested CS-Platelet in heterotopic (muscle) and orthotopic (bone) bone regeneration bioassays. We then utilized CS-Platelet in a variety of dental and craniofacial clinical cases, where regeneration of bone was needed. RESULTS: The heterotopic bioassay showed formation of bone within the muscular tissue at the site of the implantation of CS-Platelet. Results of a quantitative orthotopic bioassay based on the rat calvaria critical size defect showed that only CS-Platelet and recombinant human BMP2 were able to induce a significant regeneration of bone. A non-human primate orthotopic bioassay also showed that CS-Platelet is completely resorbable. In all human clinical cases where CS-Platelet was used, a complete bone repair was achieved. CONCLUSION: This study showed that CS-Platelet is a novel biomaterial able to induce formation of bone in heterotopic and orthotopic sites, in orthotopic critical size bone defects, and in various clinical situations. The discovery of CS-Platelet may represent a cost-effective breakthrough in bone regenerative therapy and an alternative or an adjuvant to the current treatments.

Using transitional implants as fixation screws to stabilize a surgical template for accurate implant placement: a clinical report.

This article describes a method of using transitional implants as surgical fixation screws to orient a surgical template predictably during the placement of implants in the anterior mandible for an implant-supported bar-retained overdenture. Ridge reduction, transitional implant placement, implant placement, and removal of the transitional implants were completed in a single surgical appointment. Details of the template fabrication, incorporating transitional implants and surgical techniques, are described.

Intraosseous sarcoidosis of the jaws mimicking aggressive periodontitis: a case report and literature review.

BACKGROUND: Sarcoidosis is a relatively common systemic granulomatous disease of unknown etiology. The skeletal system is affected in up to 39% of patients, but intraosseous sarcoidosis affecting the maxilla and mandible is rare. Only 20 cases have been reported previously in the English literature. This paper presents a case of generalized intraosseous sarcoidosis of the jaw bones that mimicked rapidly progressive periodontitis. METHODS: A 46-year-old male patient presented with loose teeth for assessment of implants. He had been gradually losing his teeth since 1999. His past medical history was significant, with sarcoidosis diagnosed in 1998. A panoramic radiograph showed a bilateral cotton-wool appearance of the mandible. A soft tissue and bone biopsy was performed and sent for histological examination. RESULTS: Microscopic examination of hematoxylin and eosin-stained sections revealed non-caseating granulomatous inflammation consistent with skeletal sarcoidosis. CONCLUSIONS: Intraosseous sarcoidosis of the jaw bones is rare and presents commonly as progressive and rapid alveolar bone loss similar to periodontitis. Therefore, it is important for periodontists to be knowledgeable and able to diagnose this condition, as rapid alveolar bone loss may be the first sign of sarcoidosis.