Alveolar ridge widening by distraction osteogenesis: a case report.

Alveolar width deficiencies have generally been corrected by guided tissue regeneration or bone augmentation with and without membranes. The use of distraction osteogenesis is proposed for the correction of horizontal alveolar width defects. In this case report, horizontal bone generation by distraction osteogenesis was achieved prior to implant placement. Following implant restoration, favorable bone response was observed after two years of function. Distraction osteogenesis to widen the alveolus may prove to be a clinically useful treatment option in selected cases.

Histologic analysis of clinically retrieved titanium microimplants placed in conjunction with maxillary sinus floor augmentation.

In this study, a new approach involving placement and subsequent retrieval of titanium microimplants was employed for the histologic investigation of the implant-tissue interface in conjunction with maxillary sinus floor augmentation. Nine patients scheduled for sinus floor augmentation and simultaneous placement of Brånemark implants were included in the study. After a sinus graft procedure and placement of implants, an additional microimplant was placed into the graft through the lateral wall of the sinus. At abutment connection, the microimplants were retrieved using a 3- or 5-mm-wide trephine drill. Six specimens were retrieved after 6 to 14 months from sites augmented with particulate radiated mineralized cancellous allograft. Another six implants were retrieved after 6 to 12 months from maxillary sinuses augmented with particulate autogenous bone grafts. The histologic analysis showed distinct differences between the two types of grafts. The sites with autogenous bones grafts displayed a normal morphology of bone and bone marrow, including formation of bone on the surfaces of the grafted particles and remodeling of newly formed as well as grafted bone. The bone was more mature after 11 to 14 months than at 6 months. The allografted sites had a mixed morphologic appearance of newly formed bone and nonviable allograft particles (about 75% of the total bone area) in loose connective tissue. Significantly more bone was found at the autografted than at the allografted implants. The use of autogenous bone for augmentation of the maxillary sinus floor resulted in a greater amount of viable bone surrounding the implant; however, simultaneous placement of implants apparently resulted in a low proportion of bone-implant contact after 6 to 14 months irrespective of graft type.

Report of the Sinus Consensus Conference of 1996.

Retrospective data from sinus floor augmentation bone grafts were collected from 38 surgeons for 1007 sinus grafts that involved the placement of 2997 implants over a 10-year period, with the majority of the implants followed for 3 years or more postrestoration. There were 229 implant failures reported. Various root-form implants and grafting modalities were used. A consensus conference was organized to evaluate the data and reach a consensus on optimal treatment protocols. The complete database demonstrated a 90.0% success rate for implants placed in sinus grafts with at least 3 years of function. Differences in grafting materials, implant surfaces, and timing protocols were statistically analyzed. However, the database was so multivariate and multifactorial that it was difficult to draw definitive conclusions; these must await controlled prospective studies. The consensus conference therefore developed and voted on multiple consensus statements derived by committee review for bone graft materials, type of implants, timing for implant placement, failure analysis, radiographic analysis, indications/contraindications, prosthetics, and nomenclature. Several consensus statements were obtained, the most significant being that the sinus graft should now be considered a highly predictable and effective therapeutic modality.

Vertical guided bone-graft augmentation in a new canine mandibular model.

Using the mandibular inferior border of four fox hounds from an extraoral approach, six high-profile Brånemark implants were placed in each animal and bone grafted. Graft materials studied included demineralized freeze-dried allograft with and without irradiation sterilization (3.8 x 10(4) Gy), corticocancellous iliac autograft, blood clot, and a control. Corticocancellous grafts were studied with and without expanded polytetrafluoroethylene (EPTFE) barriers. The barrier function improved both graft volume incorporated and bone-implant interface contact. The autograft performed better than the allograft. Irradiation of the allograft did not appear to affect graft performance. The barrier functioned to improve graft incorporation for augmentation and interface contact and gives credence to the use of barriers in conjunction with vertical augmentation grafting of jawbone.

Nasofacial prostheses supported by osseointegrated implants.

Surgical ablation in the nasofacial area may lead to defects that can be treated with maxillofacial prosthetic restorations retained by osseointegrated implants. When the prosthesis is large or impacted by masticatory or orbicularis muscle forces, the use of implants placed in available facial skeleton bone may be desirable. Available sites for implant placement in the facial skeleton are described, and a craniofacial site classification is suggested. Two examples of patients treated for nasofacial defects are presented.

Esthetic maxillary arch vertical location for the osseointegrated cylinder implant.

The single tooth edentulous space can be treated with an osseointegrated implant if presurgical prosthetic planning is specific and accurate. To establish accurate placement of the implant, the position of the mandibular incisor must be studied in relation to the exit point of the implant in the maxillary arch. A sufficient space for placing the implant abutment components, as well as for the crown, must be provided.

Combined hydroxylapatite augmentation and lip-switch vestibuloplasty in the mandible.

A system in which hydroxylapatite is used for augmentation of the mandibular ridge in conjunction with vestibuloplasty is presented. This technique was found to have the benefit of combining a vestibular procedure with an augmentation procedure and thus avoiding an additional surgical operation. The results were uniformly good in the twelve cases presented.

Advantages of long-acting local anesthesia using etidocaine hydrochloride.

A double-blind clinical evaluation comparing 1% etidocaine with 1/200,000 epinephrine and 2% lidocaine with 1/100,000 epinephrine for third molar surgery was done on 42 patients. Aspects of long-acting and short-acting local anesthesia were compared, including time of onset, potency, regression, duration, and appraisal by the patient. The preference of patients and the experience of postoperative pain are emphasized.