Tunnel Technique with a Subperiosteal Bag for Ridge Augmentation: A Case Series.

The present prospective case series evaluated the efficacy, the intra- and postsurgical complications, and the patient-related outcomes of a tunnel technique with a subperiosteal bag (TTSB) for horizontal ridge augmentation prior to implant placement. Twenty-five systemically healthy patients searching for implant rehabilitation and presenting with a horizontal ridge deficiency requiring bone augmentation before implant placement were included. Guided bone regeneration (GBR) was performed using the TTSB technique, involving the preparation of a collagen membrane that is perforated, folded, and sutured to form a bag that is then filled with a xenogeneic bone graft material. The bag is then inserted into a subperiosteal tunnel. Horizontal bone gain (HBG) was calculated 6 months after the surgery using CBCT. Healing was uneventful and with minimal morbidity. Average HBG was 3.7 ± 1.8 mm (P < .05), with a vertical component gain of 1.3 ± 1.7 mm (P > .05). In 12 patients, additional bone augmentation was required at the time of implant placement. A higher HBG was achieved in the maxilla than in the mandible (4.3 ± 1.3 mm vs 3.2 ± 1.8 mm, respectively; P < .05), and sites with an initial horizontal ridge width ≤ 3.5 mm were associated with a higher chance of requiring additional bone grafting at the time of implant placement compared to sites with an initial horizontal ridge width > 3.5 mm. The present case series demonstrated that TTSB is an effective approach for ridge augmentation prior to implant placement with minimal intra- and postoperative complications or patient morbidity.

Tunnel Technique with a Subperiosteal Bag for Horizontal Ridge Augmentation.

Several approaches for horizontal ridge augmentation have been proposed, including guided bone regeneration (GBR), ridge split, and block grafts. Minimally invasive techniques for horizontal GBR have been introduced to reestablish an adequate bone volume, minimizing tissue trauma and patient morbidity. The present article describes a tunnel technique with a subperiosteal bag for horizontal GBR. A collagen membrane is partially perforated, folded, and sutured to form a bag that is filled with xenogeneic bone graft. The filled bag is inserted into a subperiosteal tunnel such that the perforated side faces the alveolar ridge and the nonperforated side faces the tunnel flap. The main advantage of this approach is the preservation of the periosteum and the enhanced blood supply to the flap, which may contribute to increased favorable wound healing and a reduced risk of flap dehiscence and membrane exposure. This novel tunnel approach for horizontal GBR using a customized bag made from a collagen membrane, specifically adapted and filled with deproteinized bovine bone, resulted in a significant ridge volume gain that allowed implant placement.

Implant-prosthetic rehabilitation of the edentulous maxilla and mandible with immediately loaded implants: preliminary data from a retrospective study, considering time of implantation.

PURPOSE: This study sought to evaluate treatment outcomes of implant-prosthetic rehabilitation with implants in the edentulous maxilla or mandible that were immediately loaded by fixed prostheses. Special consideration was given to the time of implantation (immediate, delayed, or late implant placement). MATERIALS AND METHODS: Twenty-five patients who received 283 immediately loaded screw-type implants were included in this retrospective study. Data captured included patient file information, panoramic and periapical radiographs obtained during treatment, and clinical parameters examined during the recall period. Clinical and radiographic status of peri-implant soft and hard tissue was evaluated, as well as the function of prostheses and subjective assessment by the patients of the treatment. Survival/success rates were analyzed with respect to the time of implantation. RESULTS: Following a maximum observation period of 120 months (median 29 months) postimplantation and subsequent immediate functional loading, implant survival was 99.6% (one implant failed after 20 months). The success rates were 98.2% for implants and 88% for patients; five implants in three patients did not meet success criteria. Neither the implant site nor the time of implantation were associated with unsuccessful outcomes. Implant-related evaluations revealed a significant association between implant success and implant length of 10 mm or less (P < .018). CONCLUSION: Within the limits of this study, immediate loading of rough-surfaced, screw-type implants supporting fixed dentures for the treatment of edentulous maxilla or mandible appears to be a reliable treatment option with a high probability of success. The time of implantation did not influence implant survival or success rates.

The efficacy of full-arch immediately restored implant-supported reconstructions in extraction and healed sites: a 36-month retrospective evaluation.

PURPOSE: Implants placed in fresh extraction sites and healed sites were restored simultaneously by cross-arch provisional fixed prostheses. Clinical and radiographic parameters were recorded for up to 36 months. MATERIALS AND METHODS: Treatment with a full-arch implant prosthesis, either screw-retained or cemented, was assigned to 54 patients. A total of 676 implants were placed in either immediate extraction sites (n = 367) or in healed alveoli (n = 309), followed by placement of a one-piece provisional prosthesis. The definitive restoration was placed 3 to 6 months after implant placement. Clinical parameters were recorded and digital radiographs obtained at 6, 18, and 36 months. The chi-square test, t test, and analysis of variance with repeated measures were used for statistical analysis of the outcomes. RESULTS: Osseointegration failed in 21 (3.1%) implants; 13 of these (62%) had been placed immediately after extraction. All occurred within 2 months of the surgical healing phase. Short (8-mm) and narrow (3.3-mm) implant configurations were significantly (P < .05) associated with failure. At 6, 18, and 36 months, average crestal bone resorption was 0.18 mm, 0.55 mm, and 0.79 mm for implants placed in fresh extraction sites and 0.31 mm, 0.78 mm, and 1.1 mm for implants placed in healed alveoli, respectively. These differences were statistically significant (P < .05 between sites at all examined periods). Crestal bone resorption also correlated to sites with simultaneous bone augmentation and implant placement. CONCLUSIONS: Implants placed and restored immediately in a cross-arch mode, whether in extraction sites or in healed alveoli, can be clinically successful and maintainable.