The Survival Rate of Posterior Immediate Implants in the Maxilla and Mandible: An Observational Retrospective Study of 158 Dental Implants.

BACKGROUND: Immediate implants are popular for the anterior sextants of the mouth and have shown a high success rate for the same. However, their installation in a fresh extraction socket in the posterior segments can also be beneficial to the patients and limit the time for the patient to start the masticatory function. However, there have been contradicting results in different studies. OBJECTIVES: The primary objective of this retrospective study was to establish correlations between factors such as implant dimensions, implant categories, implant location, and various demographic parameters in relation to the longevity of implants. This investigation was conducted through a comprehensive clinical evaluation of immediate implants situated within the molar sections of both the upper (maxillary) and lower (mandibular) jaws. METHODS: Between October 2015 and August 2022, a total of 158 implants were implanted, with 87 males and 71 females undergoing implant placement following tooth extraction. All implants were reinstated between 12 and 18 weeks after they were placed. Inferential statistics were performed using SPSS Statistics version 23 (IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.). The Chi-square test was employed to determine statistical significance (p=0.05) between survived and failed implants in relation to various study factors. Lastly, in order to measure the survival rate under different time periods after implant placement, the life table method and Kaplan-Meier survival rate analysis were used. RESULTS: Success of implants was observed at 149 sites, whereas implant failure was seen at nine sites in total. From placement to loading, the implant failed at five sites, and the cumulative survival rate was found to be 96.83%, from loading to one year, implant failure was seen at three sites, and the cumulative survival rate was found to be 94.9%, from one to two years after loading implant failure was seen at only one site with cumulative survival rate to be 94.93%. From two to three years after loading, implant failure was not seen at any site. CONCLUSIONS: Regardless of implant size or insertion location, rapid implant implantation in fresh extraction sockets can result in predictable clinical outcomes.

The severely atrophic maxilla: Decision making with zygomatic and pterygoid dental implants.

The severely atrophic maxilla can present with some challenges during treatment planning with communication between those performing the surgical and prosthetic aspects of the treatment as well as communication with the patient as to what is being suggested for treatment. This article simplifies the communication and understanding of treating the severely atrophic maxilla and based on the Bedrossian classification gives a guideline for the surgical approach to be adapted based on the patient residual anatomy.

Autologous Tooth Dentin Graft: A Retrospective Study in Humans.

Background and Objectives: The aim of this study is to evaluate the efficacy of an autologous dentin graft, via extracted teeth that are processed into bacteria-free particulate dentin in a Smart dentin grinder and then grafted immediately into alveolus post extraction or into bone deficiencies. Materials and Methods: Ten healthy, partially edentulous patients with some teeth in the mandible were recruited in the study. After their own teeth were grinded, particulate teeth were placed in empty sockets and bone defects after teeth extractions. Furthermore, after three, six, 12 and 24 months, core samples using a 3 mm trephine were obtained. Results: At three months, the particles of grinded tooth were immersed inside a new connective tissue with a small new bone formation (16.3 ± 1.98). At six months, we observed small particles of dentin integrated in new immature bone, without inflammation in the soft tissue (41.1 ± 0.76). At twelve months, we observed a high amount of bone formation surrounding tooth particles (54.5 ± 0.24), and at twenty-four months, new bone, a big structure of bone, was observed with dentin particles (59.4 ± 1.23), statistically different when compared it with at three months. Conclusions: A particulate dentin graft should be considered as an alternative material for sockets' preservation, split technique, and also for sinus lifting. One of the special characteristics after 24 months of evaluation was the high resorption rate and bone replacement without inflammation. This material could be considered as an acceptable biomaterial for different bone defects due to its osteoinductive and osteoconductive properties.

Clinical and radiographic findings without the use of bone substitute materials in extraction sockets and delayed implant placement- A case series.

AIM: To observe clinically and radiographically (CBCT), the extent of bone resorption in extraction socket without the use of bone graft substitutes and delayed implant placement. MATERIAL AND METHODS: 50 compliant patients were selected for study. All the patients who were advised extraction were followed up for entire duration of the treatment, at 5th week CBCT showed horizontal and vertical bone loss. To prevent further bone resorption, after 5 weeks implant was placed along with bone graft. RESULTS: Bone resorption after extraction is an unavoidable phenomenon. Clinical and radiographic (CBCT) analysis showed massive bone resorption by 5th week. At 5 month CBCT, all patients showed stable implant integration. There was no implant failure at the end of the study. CONCLUSION: Alveolar preservation is proven to slow down socket wall collapse with the use of a bone substitute material without which larger procedures maybe needed to restore alveolar integrity and harmony. Immediate implant placement is effective when bone graft is placed in the jumping distance.

Histological evaluation of two different anorganic bovine bone matrixes in lateral wall sinus elevation procedure: A retrospective study.

INTRODUCTION: Grafting in oral implantology involves bone augmentation procedures with various bone graft materials. Success of such procedures is evaluated through the amount of bone volume and bone formed at the grafted site. The primary aim of this prospective study was to histomorphometrically evaluate and compare the new bone formation with Bio Oss or Cerabone in the lateral approach sinus augmentation procedure. MATERIALS AND METHODS: The research targeted 22 patients who were either partially or completely edentulous posterior maxilla with residual alveolar height 3 mm at the site of implantation and underwent a two staged surgical protocol, with a lateral approach sinus grafting with either Bio Oss or Cerabone. Bone trephine biopsies for histological analysis were harvested 6 months after augmentation while preparing the osteotomies for implant placement trephine. The histologic evaluation was performed comparing the newly formed bone, marrow spaces, biomaterial particles remnants, and presence of osteocytes embedded in both trabecular bone and bone tissue near the anorganic bovine bone. RESULTS: The present study showed that neither of the graft material showed any active osteoclasts and host inflammatory reaction. From sites grafted with Cerabone, an ample amount of mature lamellated bone formation was seen, also host inflammatory response was indicative of minimal reactive inflammatory response suggestive of good acceptability of the graft material by the host. No significant differences between the groups could be detected with regard to new bone formation and residual bone substitute. CONCLUSION: The results of the study illustrates that both the bone substitute materials allow predictable new bone formation in sinus augmentation procedures.

Bacterial Adherence Around Sutures of Different Material at Grafted Site: A Microbiological Analysis.

Closure of the surgical incision has been the primary function of sutures since their introduction. However, whatever the type, they are known to carry bacteria, which can be a source of infection. Five types of surgical sutures, Gut, Silk, Vicryl, PTFE, and Polyamide, were selected and tested on their ability to carry aerobic and anaerobic bacteria and were rated on the basis of forming colony-forming units (CFUs). Aerobic bacteria grown around gut sutures showed minimum CFUs (≈30 × 104/suture). Though very less anaerobic bacteria growth was seen among all tested suture materials, it was maximum around Vicryl and polyamide sutures. Every suture material is capable, albeit not equally, of holding bacterial biofilm formation, which can be a source of surgical site infection.

Survival of Implants after Indirect Maxillary Sinus Elevation Procedure: A Two Years Longitudinal Study.

AIM: The aim of the study was to evaluate the survival rate of two diverse implant systems with different implant surfaces with the same geometrical design. MATERIALS AND METHODS: One hundred fifty patients were included in the study in which 95 were males and 55 were females and 150 implants were placed using indirect sinus floor elevation technique and only one implant was placed in each subject and they were categorized into two groups of 100 in group A and 50 in group B as per two different implant systems. At review appointments, implants were tested clinically and radiographically and were examined for signs of infection. The patients were examined periodically after placement of the implants, and follow-up was conducted annually. RESULTS: Results of the Chi-square analysis showed no significant association between the type of implant surface and rate of success or failure of the implant. There was no significant difference between the observed and expected frequency of successful implants in group A as well as group B, indicating that the surface type of implant had no significant association with the success of the implant in group A and B. CONCLUSION: To date, there is no consensus in the literature regarding the best surface and even on the macrotopography of the implants for better osseointegration. However, Surface treatments improve the result of osseointegration, especially in the early stages, benefiting bone affixation with qualitative and quantitative enhancements. In the present study, we achieved clinical success with both kinds of implant surfaces however Bioetched implant surface showed promising results comparable to Tiunite surface of Nobel BioCare Implants. In the future, more case-controlled studies with longer follow-up are needed to validate the results of the present findings.

Optimal management of intrabony defects: current insights.

Periodontitis is the most common condition, which causes bony defects. Intrabony defects thought not as common as the horizontal bone loss pose a risk of disease progression and thus should be managed optimally; however, it does not mean all the intrabony defects can be treated and all the mobile teeth saved! But, with the advent of new biomaterials prognosis of teeth can be improved. The objective of this article is to discuss old and new concepts toward the optimal management of intrabony defects.

Particulated, Extracted Human Teeth Characterization by SEM⁻EDX Evaluation as a Biomaterial for Socket Preservation: An in vitro Study.

The aim of the study was to evaluate the chemical composition of crushed, extracted human teeth and the quantity of biomaterial that can be obtained from this process. A total of 100 human teeth, extracted due to trauma, decay, or periodontal disease, were analyzed. After extraction, all the teeth were classified, measured, and weighed on a microscale. The human teeth were crushed immediately using the Smart Dentin Grinder machine (KometaBio Inc., Cresskill, NJ, USA), a device specially designed for this procedure. The human tooth particles obtained were of 300⁻1200 microns, obtained by sieving through a special sorting filter, which divided the material into two compartments. The crushed teeth were weighed on a microscale, and scanning electron microscopy (SEM) evaluation was performed. After processing, 0.25 gr of human teeth produced 1.0 cc of biomaterial. Significant differences in tooth weight were found between the first and second upper molars compared with the lower molars. The chemical composition of the particulate was clearly similar to natural bone. Scanning electron microscopy⁻energy dispersive X-ray (SEM⁻EDX) analysis of the tooth particles obtained mean results of Ca% 23.42 0.34 and P% 9.51 0.11. Pore size distribution curves expressed the interparticle pore range as one small peak at 0.0053 µm. This result is in accordance with helium gas pycnometer findings; the augmented porosity corresponded to interparticle spaces and only 2.533% corresponded to intraparticle porosity. Autogenous tooth particulate biomaterial made from human extracted teeth may be considered a potential material for bone regeneration due to its chemical composition and the quantity obtained. After grinding the teeth, the resulting material increases in quantity by up to three times its original volume, such that two extracted mandibular lateral incisors teeth will provide a sufficient amount of material to fill four empty mandibular alveoli. The tooth particles present intra and extra pores up to 44.48% after pycnometer evaluation in order to increase the blood supply and support slow resorption of the grafted material, which supports healing and replacement resorption to achieve lamellar bone. After SEM⁻EDX evaluation, it appears that calcium and phosphates are still present within the collagen components even after the particle cleaning procedures that are conducted before use.

Is Residual Bone Height an Absolute Indicator for Simultaneous Implant Placement in Lateral Wall Sinus Grafting?

Placement of an implant in the posterior maxilla often relies heavily on a variety of procedures that increase the vertical dimensions of available bone. With numerous bone graft substitutes now available and recent advancements having been made in technique, the question arises of whether residual bone height still remains an absolute indicator for simultaneous implant placement in lateral wall sinus grafting. In addition to reviewing the literature, the authors present a case in which a direct sinus lift procedure was performed with simultaneous implant placement. The case report demonstrates how implants can be placed in a severely atrophic posterior maxilla and be successful.

Effect of Addition of Platelet-rich Plasma to Calcium Phosphosilicate Putty on Healing at 9 Months in Periodontal Intrabony Defects.

BACKGROUND AND OBJECTIVE: Combination of platelet-rich plasma (PRP) and bone substitutes for the surgical treatment of periodontal intrabony defects is based on a sound biologic rationale; however, the clinical results indicative of the synergistic effect of PRP remain ambiguous. The objective of the present study was to clinically and radiographically evaluate the use of calcium phosphosilicate (CPS) putty alone and in combination with PRP in the treatment of periodontal intrabony defects. MATERIALS AND METHODS: The study was performed at an outpatient facility at a teaching dental institute in north India. A split-mouth design was employed to assess the clinical parameters and radiographic bone fill following the use of CPS putty with and without PRP in patients scheduled for surgical periodontal treatment of intrabony osseous defects. Each defect was randomized to receive treatment with open flap debridement, with CPS putty alone (Group PUT), or open flap debridement with CPS putty and PRP (Group PRp). Probing pocket depth (PPD), plaque index (PI), gingival index (GI), and clinical attachment levels (CALs) were recorded at the investigated sites utilizing custom-made reference guides for measurement reproducibility. Standardized periapical radiographs were also obtained to evaluate defect fill at the surgical sites. RESULTS: Twenty patients each with at least two defects located in different quadrants were enrolled. The reduction in PPD from baseline to 1st, 3rd, 6th, and 9th month was found to be significant (p < 0.05). The percent reduction in PPD among PUT group was 57.18 ± 10.71% and among PRP group was 51.39 ± 12.60%. No statistically significant difference was observed in the percent reduction in PPD among two groups at 9 months (p = 0.48). Sites in both groups exhibited statistically significant reductions in PI and GI that were maintained throughout the study period. Similar results were seen while measuring CAL. CONCLUSION: Calcium phosphosilicate Putty alone provides significant improvement in outcomes for the treatment of periodontal intraosseous defects. The addition of PRP to CPS putty does not seem to provide any additive benefit to treatment and the additional surgical time and trauma can be avoided.

Residual Roots as an Anatomical Guide for Implant Placement: Case Series With Two-Year Follow-up.

As placement of implants into immediate sites involves management of the remaining root structure, these residual roots may be used as a guide for the development of osteotomy. This aids in implant positioning and prevents drill slippage into the residual root spaces during osteotomy drilling. Following completion of the osteotomy, the remaining root structure is extracted prior to implant placement into the site. The aim of this study is to assess the success rate of implants when the residual roots were used as anatomical guides for osteotomy. One hundred implants were placed in 57 patients, and 4 different types of implants were used: 47 Bioner TOP DM implants, 20 Nobel Biocare Replace implants, 25 Biohorizons Tapered Internal implants (Birmingham, Ala), and 8 Alpha-Bio Tec SPI Implants. The implants were placed into 57 patients. Osteotomies were placed through intact residual roots, which acted as anatomical guides for implant surgical placement. Patients had a follow-up period of 2 years, and in that time none reported discomfort after implant placement. There were no signs of peri-implantitis observed in any of the patients. Of all the implants placed, the Bioner TOP DM implant showed the least amount of crestal bone loss. Placing implants through residual roots as an anatomical guide is a useful technique that shows good results over a 2-year follow-up period.

Regeneration in Periodontics: Collagen-A Review of Its Properties and Applications in Dentistry.

Collagen is the most abundant protein in mammals, also making it the most important component of the body structurally and functionally. Collagen provides cell occlusiveness, biocompatibility, and resorbability. It is chemotactic for regenerative cells and may enhance the migration and attachment of fibroblasts through its space-making ability. Collagen also has the advantage of being a hemostatic agent with weak immunogenicity, easy manipulation, and the ability to augment tissue thickness. Additionally, upon breakdown through the resorption process, its byproducts are utilized by the host to form native tissue. Further, these proteins are elastic and enhance repair, properties that make the material useful for various biomedical applications. This review highlights and discusses some of the important aspects of collagen as a biomaterial in dentistry.

Alveolar ridge preservation with the socket-plug technique utilizing an alloplastic putty bone substitute or a particulate xenograft: a histological pilot study.

Following tooth extraction, ridge preservation procedures are employed to regenerate bone in the extraction socket, limit consequent ridge resorption, and provide a stable base for implant placement. The purpose of this study is to histologically evaluate and compare bone regeneration in extraction sockets grafted with either a putty alloplastic bone substitute or particulate anorganic bovine xenograft utilizing the socket-plug technique. Nineteen patients underwent 20 tooth extractions and ridge preservation following a standardized protocol. Ten sites were grafted with calcium phosphosilicate putty (CPS group) and the remaining 10 with anorganic bovine bone substitute (BO group). Patients were recalled after 4-6 months to evaluate the bone regeneration and to proceed with implant placement. A bone core was obtained during the implant procedure from each site and was used for histologic analysis. Histomorphometry revealed that residual graft values were significantly higher in the BO group (25.60% ± 5.89%) compared to the CPS group (17.40% ± 9.39%) (P < .05). The amount of new bone regenerated was also statistically significant higher in the alloplast group (47.15% ± 8.5%) as compared to the xenograft group (22.2% ± 3.5%) (P < .05). Results suggest that ridge preservation using a putty calcium phosphosilicate alloplastic bone substitute demonstrates more timely graft substitution and increased bone regeneration when compared to an anorganic bovine bone xenograft.

Periotest values of implants placed in sockets augmented with calcium phosphosilicate putty graft: a comparative analysis against implants placed in naturally healed sockets.

AIM: To measure implant stability using periotest values of implants placed in sockets augmented with calcium phospho-silicate putty (CPS Putty) as compared with implant stability in naturally healed sockets. MATERIALS AND METHODS: Twenty two sockets were implanted with CPS Putty immediately after extraction. The sockets were re-entered after a healing period at 5 to 6 months (average 5.3 months) for implant placement. Periotest values were recorded during implant insertion to assess primary stability. These were compared with the Periotest values of 26 implants placed in 22 patients, with naturally healed sockets. RESULT: Periotest values were significantly lower in the grafted group, indicating better implant stability in sites grafted with CPS putty. CONCLUSION: Implant stability seems to be significantly higher in sockets augmented using CPS putty when compared to nongrafted sites. This suggests that socket grafting with CPS putty may enhance the quality of available bone for implantation.

Histomorphometric evaluation of a calcium-phosphosilicate putty bone substitute in extraction sockets.

The objective of this study was to evaluate bone regeneration in 24 sockets grafted with a calcium phosphosilicate putty alloplastic bone substitute. A core was obtained from 17 sockets prior to implant placement for histomorphometry at 5 to 6 months postextraction. Radiographic analysis during the same postextraction healing period showed radiopaque tissue in all sockets. Histomorphometric analysis revealed a mean vital bone content of 31.76% (± 14.20%) and residual graft content of 11.47% (± 8.99%) after a mean healing period of 5.7 months. The high percentage of vital bone in the healed sites in combination with its timely absorption rate suggest that calcium phosphosilicate putty can be a reliable choice for osseous regeneration in extraction sockets.

Extra oral cementation of implant prosthesis: a case report.

Extraoral cementation is a technique that utilizes a stock abutment and a laboratory fabricated crown that is cemented extra orally; the advantage of this technique is that the retained excess luting agent during intraoral cementation, which can be a source of bacterial retention and cannot be observed radio graphically and is not possible to remove with explorer all the time, does not get accumulated and can be trimmed off easily before the final placement of the crown. Thus this technique allows no retention of luting cement, providing better soft tissue contours, no soft tissue inflammation, no retention of plaque and no bone loss. In short it prevents implant failure related to retained cement around implants. This technique provides overall health of peri-implant soft tissues as compared to conventional technique of crown placement where cement retention is a common problem, leading to implant failures.

Peri-implant and periodontal tissues: a review of differences and similarities.

The health and vitality of an osseointegrated implant depends on the surrounding supporting tissues, which not only anchor the implant to the bone but also have the important function of providing a protective seal. The aim of this article is to provide a basic understanding of differences and similarities between the periodontal and peri-implant tissues at the histologic, clinical, and immunologic levels; it is essential to know these differences and similarities during the clinical handling of these similar-looking tissues. The comparative features are of clinical relevance because it is critical to understand the behavior of the soft tissue found around the tooth and implant. This knowledge is vital from the preliminary stage of treatment planning through prosthetic rehabilitation.

Socket grafting with calcium phosphosilicate alloplast putty: a histomorphometric evaluation.

BACKGROUND: Socket grafting with a bone graft substitute immediately after extraction is essential to preserve the ridge architecture for implant placement. Several bone graft substitutes have been tested for their ability to effectively regenerate osseous tissue in the sockets. Evidence suggests that socket bone typically regenerates during a period of 6 to 8 months or longer, depending on several factors including the original ridge dimensions, type of graft, and the overall systemic health of the individual. The purpose of this study is to histologically evaluate the bone regeneration potential of a novel synthetic calcium phosphosilicate putty (CPS) graft substitute. METHODS: After extraction of the involved teeth, CPS putty graft was placed, and the sockets were covered with a collagen plug. Cores were taken from 20 patients for histological evaluation prior to implant placement. Ten cores were processed decalcified with hematoxylin and eosin (H&E) stain and the remaining 10 were processed undecalcified. Histomorphometric data obtained from both sets is presented. RESULTS: Histomorphometric analysis revealed an average vital bone content of 49.5 (± 20.7). A residual graft content of 4.3% (± 7.8) was observed following a healing time of 4.9 (± 0.8) months. CONCLUSIONS: Clinical and histomorphometric data suggests that CPS putty is a good choice for socket bone regeneration in implant-related surgeries.