Molar Septum Expansion with Osseodensification for Immediate Implant Placement, Retrospective Multicenter Study with Up-to-5-Year Follow-Up, Introducing a New Molar Socket Classification.

The ideal positioning of immediate implants in molar extraction sockets often requires the osteotomy to be in the interradicular septum, which can be challenging in some cases, with traditional site preparation techniques. Patients who had undergone molar tooth extraction and immediate implant placement at five different centers, and followed up between August 2015 and September 2020, were evaluated. Inclusion criteria were use of the osseodensification technique for implant site preparation. The primary outcome was septum width measurement pre-instrumentation and osteotomy diameter post expansion. Clinical outcomes, such as implant insertion torque (ISQ) and implant survival rate, were also collected. A total of 131 patients, who received 145 immediate implants, were included. The mean overall septum width at baseline was 3.3 mm and the mean osteotomy diameter post instrumentation was 4.65 mm. A total of ten implants failed: seven within the healing period and three after loading; resulting in a cumulative implant survival rate of 93.1%. This retrospective study showed that osseodensification is a predictable method for immediate implant placement with interradicular septum expansion in molar extraction sockets. Furthermore, it allowed the introduction of a new molar socket classification. In the future, well-designed controlled clinical studies are needed to confirm these results and further explore the potential advantages of this technique.

A Novel Guided Zygomatic and Pterygoid Implant Surgery System: A Human Cadaver Study on Accuracy.

The aim of this human cadaver study was to assess the accuracy of zygomatic/pterygoid implant placement using custom-made bone-supported laser sintered titanium templates. For this purpose, pre-surgical planning was done on computed tomography scans of each cadaver. Surgical guides were printed using direct metal laser sintering technology. Four zygomatic and two pterygoid implants were inserted in each case using the guided protocol and related tools. Post-operative computed tomography (CT) scans were obtained to evaluate deviations between the planned and inserted implants. Accuracy was measured by overlaying the real position in the post-operative CT on the virtual presurgical placement of the implant in a CT image. Descriptive and bivariate analyses of the data were performed. As a result, a total of 40 zygomatic and 20 pterygoid implants were inserted in 10 cadavers. The mean deviations between the planned and the placed zygomatic and pterygoid implants were respectively (mean ± SD): 1.69° ± 1.12° and 4.15° ± 3.53° for angular deviation. Linear distance deviations: 0.93 mm ± 1.23 mm and 1.35 mm ± 1.45 mm at platform depth, 1.35 mm ± 0.78 mm and 1.81 mm ± 1.47 mm at apical plane, 1.07 mm ± 1.47 mm and 1.22 mm ± 1.44 mm for apical depth. In conclusion, the surgical guide system showed accuracy for all the variables studied and allowed acceptable and accurate implant placement regardless of the case complexity.

Healing Dynamics Following Alveolar Ridge Preservation with Autologous Tooth Structure.

The objective of this clinical study was to assess the outcomes of autologous tooth structure in alveolar ridge preservation procedures. Extraction sites were grafted with autologous tooth structure prepared from the extracted teeth, and histologic samples were obtained at varying intervals to allow observation of bone-healing dynamics over time. Grafted areas were occupied by dentin particles that had begun to connect via bridges of woven bone at 3 months posthealing, and vital bone was in direct contact with residual particles with no inflammatory infiltrate. Further clinical investigation is warranted on the comparative effectiveness of autologous tooth structure against established bone-substitute biomaterials.

A Multicenter Retrospective Clinical Study with Up-to-5-Year Follow-up Utilizing a Method that Enhances Bone Density and Allows for Transcrestal Sinus Augmentation Through Compaction Grafting.

PURPOSE: To evaluate the effectiveness and predictability of a novel biomechanical, minimally invasive bone instrumentation technique that enhances bone density through compaction grafting, called osseous densification, and allows for transcrestal sinus membrane elevation and augmentation with simultaneous implant placement. MATERIALS AND METHODS: Patients who were consecutively treated with the bone densification and transcrestal sinus augmentation technique and were followed up in three treatment centers between May 2012 and September 2017 were included in this retrospective study. The summary statistics are presented as means for continuous variables and percentages for categorical variables. RESULTS: In total, 222 patients with 261 implants were included in the final clinical analysis. The included follow-up period ranged from 6 to 64 months with a mean of 35 months. The subsinus residual bone height at baseline was 5.4 mm (SD: 1.9). Following the sinus augmentation, a significant vertical increase of 7 mm (SD: 2.49) was observed. No sinus membrane perforations and no late implant failures were observed from 6 up to 64 months follow-up, yielding a cumulative implant survival rate of 97%. CONCLUSION: This osseous densification technique for maxillary implant site preparation with transcrestal sinus augmentation and simultaneous implant placement led to favorable clinical outcomes with up to 64 months of follow-up.

Segmental Dento-alveolar Intrusive Osteotomy in Posterior Maxilla with Lack of Inter-arch Distance for Prosthetic Rehabilitation. A Technique Combined with Sinus Floor Elevation.

UNLABELLED: The aim of this paper is to present a technique for segmental dento-alveolar intrusive osteotomy in a posterior maxilla with lack of inter-arch distance for prosthetic rehabilitation combined with sinus floor elevation. METHODS: A full thickness flap is elevated exposing the lateral wall of the maxillary sinus. A lateral window is opened and the Schneiderian membrane elevated. Segmental dento-alveolar osteotomy is performed. After complete detachment of the segment, it is adapted and fixed to the new position using the pre-prepared guide, making sure not to damage or perforate the Schneiderian membrane. RESULTS: Four cases of segmental dento-alveolar intrusive osteotomy in a posterior maxilla combined with sinus floor elevation were performed utilizing the above-mentioned technique. All surgeries went according to plan, and healing was uneventful except for swelling and pain that lasted for 10-14 days post- operatively. The opposing dentition was later treated by implant placement. The average follow-up time for those cases was 5.4 months. Vitality test four months after surgery was positive. CONCLUSION: The presented technique for segmental dento-alveolar intrusive osteotomy combined with sinus floor elevation can serve as a viable treatment option in the posterior maxilla with lack of inter-arch distance due to severe overeruption.

Computer-guided implant placement for rehabilitation of the edentulous maxilla with two impacted canines: an approach without extraction of the impacted teeth.

The aim of this report was to suggest an alternative approach to avoid impacted canine extraction by utilizing computer-guided implant placement for providing an implant adjacent to the impacted canine without contact to the impacted tooth. In cases when the adjacent area is available for implant placement, a computerized three-dimensional (3D) planning system can be used to place implants in a way that avoids the impacted canine. Tilted implants could be used to achieve the proper support for implant-supported fixed dentures without damaging the impacted teeth. Following careful 3D planning, a computer-derived surgical stent is used to guide the surgical placement of the implants in the proper place. Since the position of the implants is known prior to the surgical procedure, a prefabricated provisional restoration is delivered immediately at the end of the surgery. Following a waiting period of 6 months, the implant-supported definitive restoration is fabricated using the same technique and delivered to the patient, making sure that proper maintenance and oral home care hygiene are feasible. This suggested treatment modality, when suitable, could provide a relatively short treatment time, a less invasive procedure, and fewer potential complications compared to the extraction of an impacted canine, massive bone grafting, and implant placement. Also, it might be assumed that the use of the native bone, as suggested here, rather than an augmented bone could lead to better long-term results.

Effect of Nanocrystalline Calcium Sulfate Bone Graft in a Bilateral Sinus-Augmentation Procedure: A Case Report.

INTRODUCTION: Patients with an edentulous posterior maxillary segment frequently lack adequate bone mass to support dental implants. Implant placement into the posterior maxillary ridge can be complicated by limited quantity and poor quality of bone. Sinus lift and bone grafting result in bone regeneration as well as an increase in bone volume and hence help stabilize implants. The challenge of bone deficiency of this segment has been traditionally addressed by two approaches: 1) lateral maxillary window (hinge osteotomy) and 2) the crestal approach via osteotome technique. CASE PRESENTATION: A 70-year-old female patient presented needing a full maxillary rehabilitation. The osteotome-closed approach was used on the right side, which was grafted with nanocrystalline calcium sulfate (nCS) bone graft. The lateral window sinus elevation approach was used on the left side, which was grafted with nCS in combination with platelet-rich fibrin. Implants were placed simultaneously. Computed tomography scans showed bone formation in the augmented sites at 6 months. Implants were restored at this time. A 2-year follow-up showed satisfactory results with good implant stability. CONCLUSION: This case demonstrates the effective use of nCS for sinus-augmentation cases.

A simplified approach to the minimally invasive antral membrane elevation technique utilizing a viscoelastic medium for hydraulic sinus floor elevation.

PURPOSE: Maxillary sinus augmentation surgery is frequently employed to provide adequate vertical bony dimensions in posterior maxillary sites. When significant gain in bone height is sought for, an invasive lateral-window approach is routinely used to achieve sinus floor elevation. The minimally invasive antral membrane elevation technique was initially conceived as a surgical improvisation that has been shown to lead to up to, or exceeding, 10 mm of bone height, while enhancing the safety profile of the transalveolar sinus augmentation technique. This approach is based on the use of hydraulic pressure that is applied to the schneiderian membrane via a saline-inflatable balloon. Even though this technique has been shown to be a safe and efficacious treatment modality, the need for specialized equipment, training, and corresponding costs may hinder its widespread application. The purpose of this clinical paper is to introduce a simplified approach to the minimally invasive antral membrane elevation technique. METHODS: The simplified minimally invasive antral membrane elevation technique is based on the application of hydraulic pressure by a viscous bone graft that acts as an incompressible fluid. The specific clinical steps of this technique will be demonstrated to illustrate how grafting of the maxillary sinus is achieved simultaneously with the atraumatic elevation of the schneiderian membrane, thus resulting in even less operative time. CONCLUSIONS: This simplified technique may make the minimally invasive antral membrane elevation technique more accessible to implant surgeons as it eliminates the need for purchase of specialized equipment and aids in further decrease of intra-operative time accomplished with the original technique.

Implant Tooth-Supported Removable Partial Denture with at Least 15-Year Long-Term Follow-Up.

PURPOSE: The aim of the present report is to describe the long-term follow-up of cases treated with implant tooth-supported removable partial denture (ITSRPD) after at least 15 years. MATERIALS AND METHODS: The study sample comprised 20 consecutively partially edentulous patients treated with ITSRPD. Implants were placed in order to improve unfavorable removable partial denture design resulting from unfavorable teeth distribution and biomechanical considerations, esthetic, or periodontal challenges. All patients were followed up every 6 months for the first 2 years and annually thereafter for at least 15 years. Recall visits for professional cleaning and oral hygiene re-enforcement were scheduled every 3 to 6 mounts. RESULTS: A total of 42 implants were placed in 20 patients and restored with ITSRPD. All implants and prosthetic devices functioned successfully throughout the 15 years of follow-up. Three patients had gone through further implant placement several years after ITSRPD was provided, and a fixed implant-supported restoration was provided on the original and new implants. No implant failure was noted during follow-up, resulting in a rate for implant survival of 100% for the study. Marginal bone loss around implants ranged between 0 and 2 mm (mean 0.64 ± 0.6 mm). During the follow-up period, prosthetic complications were minor and included one rest rupture. All patients answered a questionnaire and were satisfied with the prosthesis. They reported good chewing ability and stability of the prosthetic devices. CONCLUSIONS: ITSRPD can be used with predictable long-term results in carefully selected and well-maintained population. Patients should be advised of their role in maintenance, and a comprehensive recall system is mandatory to obtain satisfactory long-term results.

A clinical and radiographic case series of implants placed with the simplified minimally invasive antral membrane elevation technique in the posterior maxilla.

The aim of the present case series was to evaluate a simplified minimally invasive transalveolar sinus elevation technique utilizing calcium phosphosilicate (CPS) putty for hydraulic sinus membrane elevation. The simplified minimally invasive antral membrane elevation technique is based on the application of hydraulic pressure via a viscous bone graft that acts as an incompressible fluid. In this retrospective study, 21 patients (mean age: 48.5 ± 12 years) consecutively treated with the simplified minimally invasive transalveolar sinus elevation technique were evaluated. 28 tapered implants were placed in posterior maxillary sites with less than 6 mm of residual bone height as determined radiographically on cone beam volumetric tomographs. No sinus membrane perforations were noted and none of the patients complained of symptoms of sinusitis post-operatively (0%). The mean gain in bone height post-operatively was 10.31 ± 2.46 mm (p < 0.001). All implants successfully integrated (100% success rate) and were loaded with cement-retained prostheses. The proposed technique is a simple, efficacious, minimally invasive approach for sinus elevation that can be recommended for sites with at least 3 mm of residual height.

Implants placed simultaneously with lateral window sinus augmentation using a putty alloplastic bone substitute for increased primary implant stability: a retrospective study.

INTRODUCTION: The aim of this retrospective study was to evaluate the primary stability of implants placed in significantly pneumatized maxillary sinuses with minimum residual bone height. MATERIALS AND METHODS: Seventeen patients who had been treated with simultaneous implant placement in sites with <5 mm of vertical bone height using a modified direct sinus lift technique were included. Implants placed in adjacent sites with at least 5 mm of bone height were included as quasi-controls. RESULTS: A total of 30 implants were inserted with a maximum insertion torque number >20 N/cm. Logistic regression analysis failed to show any association between residual bone height and primary implant stability. Implant survival was 96.67% (29/30) during a mean follow-up of 15.74 months postloading. CONCLUSIONS: The diminished preoperative vertical dimensions of the residual ridges did not seem to negatively influence the osseointegration of implants placed in this study. The prerequisite for simultaneous sinus augmentation and implant placement is an adequate primary stability of the implant and not a fixed minimum bone height level.

The effects of sinus membrane pathology on bone augmentation and procedural outcome using minimal invasive antral membrane balloon elevation.

Membrane pathology tends to complicate the postprocedural course of open sinus lift by ostio-meatal complex (OMC) obstruction and consequent acute sinusitis. The objective of this study was to evaluate the outcome of subjects with considerable sinus membrane pathology undergoing maxillary sinus floor augmentation and simultaneous implant placement using the minimal invasive antral membrane balloon elevation (MIAMBE) method. This study was a retrospective chart review of MIAMBE procedures performed in the presence of significant sinus membrane pathology. Sixteen patients with maxillary sinus membrane thickening in well-ventilated OMC as determined by dental computerized tomography underwent sinus augmentation and simultaneous implant placement using the MIAMBE technique. All 16 procedures were successfully concluded without significant procedural or postprocedural complications or implant failure. Post MIAMBE membrane pathology regressed or disappeared in 8 patients (50%) or remained unchanged in 6 patients (37.5%), while in 2 patients the sinus membrane pathology was limited to evaluation by periapical X rays. Sinus augmentation using the MIAMBE technique can be performed safely in asymptomatic patients in the presence of sinus membrane pathology if the OMC is not obstructed. In a significant proportion of these cases, complete resolution of the membrane pathology after MIAMBE is observed. When compared to open sinus lift, OMC obstruction is less likely to occur when employing the MIAMBE method.

Nasal floor elevation combined with dental implant placement: a long-term report of up to 86 months.

PURPOSE: The aim of this paper is to present a large-scale long-term follow-up of dental implants placed simultaneously with nasal floor augmentation using osteoconductive bovine bone substitutes. MATERIALS AND METHODS: Patients who received dental implants combined with nasal floor elevation in three dental centers between 2006 and 2012 were included in this report. Preoperative available bone height was measured on computed tomographic scans. Implant parameters as well as implant survival rates were recorded. The cohort consisted of long-term follow-up of this previously reported cohort, combined with a cohort of newly treated patients. RESULTS: Overall, 67 patients were included in this study. Cigarette smoking was reported by 16 patients. Two hundred three implants were inserted in combination with nasal floor elevation. No nasal mucosa perforations were observed. The mean follow-up periods were 65.93 ± 13.2 months (range, 33 to 86 months) for the original cohort and 23.14 ± 9.4 months (range, 7 to 44 months) for the newly treated patients. The available bone height prior to bone augmentation was 8.89 ± 1.1 mm (range, 5 to 11.2 mm) and a mean of 3.65 ± 0.9 mm (range, 1.1 to 7 mm) of additional height was achieved with nasal floor elevation. During the follow-up period, no implants were lost, resulting in a 100% survival rate. CONCLUSION: Nasal floor augmentation, as shown in this report, might serve as a reliable method for reconstruction of the anterior atrophic maxilla when residual height is insufficient.

Transition from hopeless dentition to full-arch fixed-implant-supported rehabilitation by a staged extraction approach: rationale and technique.

Transition from a hopeless dentition to a fixed-implant-supported full-arch reconstruction can be difficult for patients if wearing a transitional removable denture is involved. In addition, an increased risk for trauma to bone augmentation areas and to the implant-bone interface exists when using a removable transitional complete denture during the implant healing period; such risk can compromise implant success or increase crestal bone loss around implants before the final restoration. This article describes a treatment approach that allows replacement of the hopeless dentition with an osseointegrated fixed prosthesis, without rendering the patient totally edentulous before the delivery of the final implant-supported prosthesis. A staged approach using a few hopeless teeth to support a provisional fixed restoration during the healing process can help avoid discomfort and improve implants' outcome. A treatment plan for a maxillary arch reconstruction is used to illustrate the staged approach protocol. This protocol addresses patients' psychologic need to remain dentate during partial or full-mouth rehabilitation, while providing good esthetics and function during restoration of a dental arch.

Implant diameter and length influence on survival: interim results during the first 2 years of function of implants by a single manufacturer.

OBJECTIVES: The aim of the present study was to evaluate the influence of implant length and diameter on implant survival. METHODS: A retrospective cohort of 787 consecutive patients from 2 private practices between the years 2008 and 2011 had been evaluated. Patient demographics, site and implant characteristics, and time of follow-up were recorded from the medical files. RESULTS: Overall, 3043 implants were investigated. Overall survival rate was 98.7% with 39 implant failures recorded. Survival rates for narrow- (<3.75 mm), regular- (3.75-5 mm), and wide- (>5 mm) diameter implants were 98.2%, 98.7%, and 98.5%, respectively (P = 0.89). Survival rates of short (<10 mm) and regular (10 mm and above) implants were 97% and 98.7%, respectively (P = 0.22). CONCLUSIONS: Implant length and diameter were not found to be significant factors affecting implant survival during the first 2 years of function in the present investigation of this specific implant system by a single manufacturer. Further long-term follow-up studies are warranted because 2-years are only interim short-term results when dealing with dental implants.

Enhancing extraction socket therapy with a biphasic calcium sulfate.

Studies have shown that tooth extraction results in loss of bone volume, which compromises dental implant placement. Prevention of site collapse at the time of extraction is recommended. In this 4-month case series, 40 patients were treated with an innovative biphasic calcium sulfate graft, demonstrating its ability to preserve or augment socket volume and resorb in the time period desired between extraction and implant placement. Some representative samples were retrieved at the time of implant placement and evaluated histologically and morphometrically for vital bone formation.

Nasal floor elevation combined with dental implant placement.

OBJECTIVES: The aim of the present study was to report on the survival of dental implants placed in conjunction with nasal floor elevation. METHODS: A retrospective cohort of 32 consecutive patients from two private practices was evaluated. All patients presented with alveolar bone height deficiency in the anterior region, which was not sufficient to place a dental implant according to a computed tomography (CT) scan preformed prior to implantation. Elevation and augmentation of the nasal mucosa was performed simultaneously with dental implant placement. Data collection included demographic information, as well as records of the pre-operative available bone height, implant dimensions, bone addition following nasal floor augmentation, and survival of the implants at last follow-up. RESULTS: Overall, 32 patients received 100 implants that were performed in conjunction with nasal floor elevation. The average pre-operative available bone height according to a CT scan that was preformed prior to implantation was 9.1 ± 0.9 mm and ranged from 7.3 to 11.2 mm. Bone addition following nasal floor augmentation was 3.4 ± 0.9 mm and ranged between 1.1 and 5.7 mm. The mean follow-up time was 27.8 ± 12.4 months, and during that follow-up period, no implant failure was recorded, resulting in 100% implant survival. CONCLUSION: Nasal floor elevation might serve as a predictable procedure, which allows implant placement in areas with significant atrophy together with increased implant stability due to the bicortical support.

Replacement of a molar with 2 narrow diameter dental implants.

OBJECTIVES: The aim of the present study was to present results of single molar area rehabilitated by 2 narrow diameter dental implants. METHODS: A retrospective cohort of 33 consecutive patients from 2 private practices between the years 2008 and 2009 had been evaluated. Patients who had a first molar single replaced by 2 narrow diameter implants (3 mm wide) were included in this case series. Patients' demographics, site and implant characteristics, and time of follow-up were recorded from the medical files. RESULTS: Overall, 33 patients received 66 implants replacing 33 missing first molars. Patients' age ranged from 23 to 76 years with an average of 49.2 ± 12.7 years. Most of the implants were used to replace a mandibular molar (76%) and 16 were used to replace 8 maxillary molars. In 2 patients, immediate implantation was performed. The mean distance between the adjacent teeth was 12.1 ± 1.0 mm. Follow-up time ranged from 10 to 18 months (average, 12.2 ± 1.9 months). All implants survived the follow-up time. One implant presented with 1 mm of bone loss at 12-month follow-up. CONCLUSION: Replacing a single missing molar with 2 narrow diameter dental implants might serve as a viable treatment option providing good and predictable long-term results.

Minimally invasive subnasal elevation and antral membrane balloon elevation along with bone augmentation and implants placement.

Atrophic edentulous anterior maxilla is a challenging site for implant placement and has been successfully treated surgically by anterior maxillary osteoplasty. This procedure is associated with considerable discomfort, morbidity, and cost-and consequently reduced patient acceptance. The efficacy and safety of minimally invasive bone augmentation of the posterior maxilla has not been extended thus far to the anterior subnasal maxilla. We present 2 representative cases in which minimally invasive subnasal floor elevation was performed along with minimally invasive antral membrane balloon elevation. Both segments underwent bone grafting and implant placement during the same sitting. Minimally invasive anterior maxilla bone augmentation appears to be feasible. Designated instruments for alveolar ridge splitting and nasal mucosa elevation are likely to further enhance this initial favorable experience.