The sandwich osteotomy technique to treat vertical alveolar bone defects prior to implant placement: a systematic review.

OBJECTIVES: The aim of this systematic review was to investigate the predictability of the sandwich osteotomy technique to provide sufficient alveolar bone height for dental implant therapy in vertically atrophic jaws. MATERIAL AND METHODS: A MEDLINE (Pubmed), EMBASE and Cochrane Library electronic search and a manual search were performed until July 2018. Any clinical study published in English, reporting data on at least 10 patients rehabilitated with implant-supported dental prostheses after vertical ridge augmentation by means of the sandwich osteotomy technique and followed for at least 12 months after loading, was included. Data on study and patients' characteristics, interventions provided, implant and prostheses survival rates and complications were extracted from the included studies. Each study design was evaluated using the Cochrane Collaboration's tool for assessing risk of bias. RESULTS: Initially, 415 records were identified, from which 10 full-text articles could be included in the final qualitative analysis. Implant survival rate after a mean follow-up of 3.7 years (median: 3 years; range: 1-7 years) was 94% (median: 93%; range: 91-100%). Peri-implant mean marginal bone resorption was 1.6 mm (median: 1.4 mm; range: 0.6-4.7 mm). The calculated mean alveolar bone height available at the time of implant placement was 11.3 mm (median: 11.5 mm; range: 7.8-16 mm). A temporary sensory disturbance of the inferior alveolar nerve was the most commonly reported complication following the sandwich osteotomy. CONCLUSIONS: The present systematic review documents that implant survival rate after mandibular vertical ridge augmentation using the sandwich osteotomy technique is high after up to 5 years of loading. The complication rate can be considered moderate and has predominantly a transient nature. Data on the long-term behavior of the augmented bone and inserted implants are missing. CLINICAL RELEVANCE: The present technique can be considered a reliable treatment option in cases of moderate vertical bone deficiency of the posterior mandible to provide suitable conditions for later implant placement. Intra- and post-operative complications do not seem to jeopardize the final outcome.

Periodontal Regeneration and Orthodontic Treatment of Severely Periodontally Compromised Teeth: 10-Year Results of a Prospective Study.

The aim of this study was to investigate the long-term clinical conditions of periodontally compromised teeth treated by means of orthodontics after periodontal regeneration (GTR). Forty-eight patients affected by severe periodontitis who presented at least one nonmolar, malpositioned tooth with a pocket depth (PD) ≥ 7 mm, were consecutively enrolled in a private specialist practice. The treatment consisted of the following steps: infection control, provisional splinting, GTR, orthodontic treatment, final splinting, and supportive periodontal therapy (SPT). Thirty-six patients completed the 10-year study, as 12 were lost to follow-up. The total number of sites with PD ≥ 7 mm decreased from 25.4 ± 16.7 to 1.8 ± 2.1. PD of the teeth involved in the orthoperio treatment significantly decreased from 6.3 ± 1.5 mm to 3.1 ± 0.6 mm. One test tooth had to be extracted before the final examination due to root fracture, while two teeth lost vitality and received a root canal treatment. Eight episodes of recurrence, which required additional treatment, occurred during the 10 years of follow-up. The results of this study suggest that if a periodontal infection is under control, the orthodontic treatment does not reduce the long-term benefits of periodontal regeneration, even where the disease has caused massive tissue destruction.