Comparison of anorganic bovine mineral with and without synthetic peptide in a sinus elevation: a case study.

A new tissue-engineered bone substitute that reportedly has the capability to enhance bone regeneration over the more classical bone substitutes, such as decalcified freeze-dried bone allograft and xenograft, was evaluated in bilateral sinus procedures. Anorganic bone mineral with and without a synthetic peptide (P-15) were grafted separately in bilateral sinuses. At the time of implant placement and at four months, trephine cores were obtained and the quality of the grafts deciphered by histomorphometry. The P-15 grafted sinus yielded 45% vital bone compared with 13% for the anorganic bovine material alone. The P-15 dramatically increased the quality and quantity of grafted bone in the sinus.

Advances in endosseous implants: the 'sandwich' split cortical graft for dental implant placement.

Endosseous implants have restored normal function and dental health to many patients. When implants were introduced as an effective treatment modality, their efficacy was limited by the amount of available bone. Today, various grafting procedures can surgically create bone width and volume. Implants can be placed in more ideal locations for successful prosthetic reconstruction. Autogenous bone has been considered the "gold standard," and the most predictable graft material. However, harvesting autogenous bone requires a second surgical site, increased surgical and healing time, and increased morbidity. A loss of a single tooth or multiple teeth leads to atrophy of the alveolus and reduction of osseous width and height (volume). "Sandwich" split cortical graft surgery can be used as the surgical procedure of choice to re-establish bone volume and contour. With this procedure, the recipient site is also the site for the donor cortical bone. A bone replacement graft material is placed within the cancellous compartment and is contained by the autogenous cortical block harvested from the recipient bed. Sandwich split cortical graft surgery offers the obvious advantage of autogenous bone without the need for a second surgical site.

The sinus lift graft: basic technique and variations.

Following an early controversy concerning its efficacy, the sinus lift and graft technique is now considered to be a state-of-the-art surgery. In 1975, Tatum introduced the technique that increased maxillary bone height by placing graft material under the maxillary sinus and Schneiderian membrane; by the early 1990s, a modification of Tatum's original technique had become a standard procedure. This article describes and illustrates three variations of the basic sinus lift surgery and graft operation--the hinge osteotomy, the elevated osteotomy, and the complete osteotomy. Additional considerations affecting the surgical outcome are also discussed as is the management of possible complications. The learning objective of this article is to obtain up-to-date information regarding the basic technique and variations of the sinus lift procedure to the general practitioner as well as the specialist.

Small-segment symphysis graft: augmentation of the maxillary anterior ridge.

The loss of a tooth results in loss of alveolar bone, required for the placement and retention of implants. Bone can be replaced by various augmentation modalities, including a small-segment symphysis graft. The selection of the donor site, the preparation of the recipient and donor sites, the procedures of graft placement, and the closure of the donor site are presented and described. The corticotrabecular graft is obtained with a trephine drill from the mandibular symphysis and grafted to a recipient site that has been prepared with ridge-expanding osteotomes. The graft is then mortised with a combination of an alloplast, freeze-dried demineralized bone, and autogenous bone harvested from the symphysis donor site. The learning objective of this article is to describe the procedures of a small-segment symphysis graft, using a clinical case to illustrate the text. After graft healing and lost bone regeneration, implants can be placed.

Proper function, phonetics, and aesthetics achieved with implant-supported restorations: a multidisciplinary approach.

In a multidisciplinary restoration of the edentulous patient, close cooperation of involved personnel is essential during the treatment planning and the restorative procedures. This presentation is an overview of the rehabilitation of the edentulous maxilla, posterior maxilla, and the challenges of the single tooth implant-supported restorations. The prerequisite of teamwork is emphasized, past achievements and benefits of this treatment modality are reviewed, and three prosthetic challenges addressed. Clinical cases are used to illustrate the presentation.

Onlay bone grafting to the anterior maxilla: preparation for placement of implants.

Placement of implants in the dental alveolus of the maxilla is limited by bone width and the height of bone between the alveolar crest, the maxillary sinus, and the floor of the nose. In the anterior maxilla, the thin cortices can be split and grafted, or an onlay graft can be positioned on the labial/buccal cortex. This paper and presentation discuss the onlay bone graft to the anterior maxilla. This surgical procedure enables implant placement in previously deficient bone within the maxilla.

Surgical solutions to prosthetic problems.

Placement of implants in the dental alveolus crest of the mandible and maxilla is limited by the height of bone between the alveolar crest and the maxillary sinus, floor of the nose, and the inferior alveolar canal. This paper discusses three surgical grafting procedures--the sinus lift and graft, the split cortical (or sandwich) graft, and the onlay graft--these add additional bone to the anterior and posterior maxilla, and also the procedure to reposition and protect the neurovascular bundle so that endosseous implants may be placed.

Treatment of the adolescent trauma patient with endosseous implants: a case study.

Adolescent patients who lose permanent dentition through trauma require treatment that considers factors not involved in the treatment of adults. Endosseous implants and a temporary prosthesis were utilized in this case to provide optimum aesthetics in a manner that addressed the evolving dentition, growing skeletal bases, and social and psychologic needs. The learning objective of this case study is the treatment of adolescent trauma and a detailed surgical procedure.

Repositioning the inferior alveolar nerve for placement of endosseous implants: technical note.

Placement of implants in the posterior mandible is limited by the height of bone between the alveolar crest and the inferior alveolar canal. This paper discusses a surgical technique to reposition and protect the neurovascular bundle so that endosseous implants may be placed. A rectangular window is cut in the cortical bone posterior to the mental foramen. The mental foramen is not violated and the mental nerve is not relieved peripherally into the soft tissue. Cancellous bone is removed from the window and the canal is uncovered. A vessel loop placed around the bundle repositions and protects the nerve laterally. After implant placement, the bundle is replaced within the cortical window and the mucoperiosteal flap is sutured. Avoiding manipulation of the terminal branches of the inferior alveolar nerve reduces the risk of permanent nerve damage.

Sinus lift grafts and endosseous implants. Treatment of the atrophic posterior maxilla.

Patients from multicenters were treated with sinus lift graft operations and placement of implants. Surgical procedures healed uneventfully with minimum pain, swelling, or morbidity. Grafts healed with few complications or failures. Implants placed into the grafts support prosthetic reconstruction and are predictable over time. The question of what graft material to use is discussed. Grafts of non-resorbable HA (Interpore 200), bovine cortical HA (Bio-Oss), resorbable HA (OsteoGen), and freeze-dried demineralized bone powder and granules are presented. Results of biopsy, histometry, backscattered electron microscopy, cell labeling, and special stain suggest consistent bone growth into a variety of graft materials. In the authors' opinion investigation must continue to 1. Determine the healing time for different graft materials. At present, anecdotal evidence suggests that sinus grafts of autogenous bone heal for 4 to 6 months; freeze-dried demineralized bone heals for 12 to 16 months; and alloplastic materials with freeze-dried demineralized bone heal for 9 to 11 months. 2. Evaluate histologic evidence of bone growth into different bone replacement graft materials. 3. Evaluate the long-term follow-up and success of implants placed within sinus grafts. 4. Determine the remodeling potential of different hard tissue graft materials under implant functional loads.