Aladdin Al-Ardah

Tooth Retention through Endodontic Microsurgery or Tooth Replacement Using Single Implants: A Systematic Review of Treatment Outcomes

INTRODUCTION Clinicians are regularly confronted with difficult choices. Should a tooth that has not healed through nonsurgical root canal treatment be treated through endodontic microsurgery or be replaced using a single implant? Acquiring complete, unbiased information to help clinicians and their patients make these choices requires a systematic review of the literature on treatment outcomes. The purpose of this systematic review was to compare the outcomes of tooth retention through endodontic microsurgery to tooth replacement using an implant supported single crown. METHODS Searches performed in PubMed, Cochrane Library, Web of Science, and EMBASE databases were enriched by citation mining. Inclusion criteria were defined. Sentinel articles were identified and included in the final selection of studies. Weighted survival and success rates for single implants and endodontic microsurgery were calculated. RESULTS The quality of the articles reporting on single implants and endodontic microsurgery was moderate. Data for single implants were much more plentiful than for endodontic microsurgery, but the endodontic microsurgery studies had a slightly higher quality rating. Single implants and endodontic microsurgery were not directly compared in the literature. Outcomes criteria were often unclear. At 4-6 years, single implants had higher survival rates than teeth treated with endodontic microsurgery. Qualitatively different success criteria precluded valid comparison of success rates. CONCLUSIONS Survival rates for single implants and endodontic microsurgery were both high (higher for single implants). Appraisal was limited by a lack of direct treatment comparisons. Long-term studies with a broad range of carefully defined outcomes criteria are needed.

The incidence of maxillary sinus membrane perforation during endoscopically assessed crestal sinus floor elevation: a pilot study.

Transcrestal sinus membrane elevation is a surgical procedure performed to increase the bone volume in the maxillary sinus cavity. Because of visual limitations, the potential for maxillary sinus membrane perforations may be greater than with the lateral approach technique. The aim of this study was to macroscopically investigate ex vivo the occurrence of sinus membrane perforation during surgery using 3 transcrestal sinus floor elevation methods. Twenty fresh human cadaver heads, with 40 intact sinuses, were used for simultaneous sinus membrane elevation, placement of graft material, and dental implants. Real-time sinus endoscopy, periapical digital radiographs, and cone-beam computerized tomography (CBCT) images were subsequently used to evaluate the outcome of each surgical procedure. Perforation rates for each of the 3 techniques were then compared using a significance level of P < .05. No statistically significant differences in the perforation rate (P = .79) were found among the 3 surgical techniques. Although the sinus endoscope noted a higher frequency of perforations at the time of implant placement as compared with instrumentation or graft insertion, the difference was not statistically significant (P = .04). The CBCT readings were judged to be more accurate for identifying evidence of sinus perforations than the periapical radiographs when compared with the direct visualization with the endoscope. This pilot study demonstrated that a sinus membrane perforation can occur at any time during the sinus lift procedure, independent of the surgical method used.

Lateral and crestal bone planing antrostomy: A simplified surgical procedure to reduce the incidence of membrane perforation during maxillary sinus augmentation procedures

This clinical report presents a simplified surgical procedure for accessing the maxillary sinus antrum via lateral and crestal approaches, which reduces the potential for sinus membrane perforation and subsequent complications when graft materials and dental implants are placed into the sinus. Due to visual limitations, perforations and associated complications can jeopardize the success rate of the graft and the implants. While there is a lack of clinical data, clinical observations suggest that the procedure, described by the authors as lateral/crestal bone planing antrostomy, can reduce the possibility of perforation of the maxillary sinus membrane during the lateral and crestal approaches to the grafting of the maxillary sinus floor. The technique involves the use of specially designed rotary instruments that plane away the bone in thinner layers, with less chance of excess bone removal and membrane perforation.

Accuracy of Cone Beam Computerized Tomography and a Three-Dimensional Stereolithographic Model in Identifying the Anterior Loop of the Mental Nerve: A Study on Cadavers

The objective of this ex vivo cadaver study was to determine the accuracy of cone beam computerized tomography (CBCT) and a 3-dimensional stereolithographic (STL) model in identifying and measuring the anterior loop length (ANLL) of the mental nerve. A total of 12 cadavers (24 mental nerve plexus) were used for this study. Standardized CBCT scans of each mandible were obtained both with and without radiographic contrast tracer injected into the mental nerve plexus, and STL models of the two acquired CBCT images were made. The ANLL were measured using CBCT, STL model, and anatomy. The measurements obtained from the CBCT images and STL models were then analyzed and compared with the direct anatomic measurements. A paired sample t test was used, and P values less than .05 were considered statistically significant. The mean difference between CBCT and anatomic measurement was 0.04 mm and was not statistically significant (P = .332), whereas the mean difference between STL models and anatomic measurement was 0.4 mm and was statistically significant (P = .042). There was also a statistical significant difference between CBCT and the STL model (P = .048) with the mean difference of 0.35 mm. Therefore, CBCT is an accurate and reliable method in determining and measuring the ANLL but the STL model over- or underestimated the ANLL by as much as 1.51 mm and 1.83 mm, respectively.

Assessment of the Anterior Loop of the Mental Nerve Using Cone Beam CT-Scan

The purpose of this study is to use cone-beam computerized tomography (CBCT) scans with oblique-transverse reconstruction modality to measure and compare the anterior loop length (AnLL) of the mental nerve between gender and age groups and to compare the difference between the right and left sides. Sixty-one female and 61 male CBCT scans were randomly selected for each age group: 21-40, 41-60, and 61-80 years. Both right- and left-side AnLLs were measured in each subject using i-CATVision software to measure AnLLs on the oblique transverse plane using multiplanar reconstruction. The anterior loop was identified in 85.2% of cases, with the mean AnLL of the 366 subjects (732 hemimandibles) being 1.46 ± 1.25 mm with no statistically significant difference between right and left sides or between different gender groups. However, the mean AnLL in the 21-40 year group (1.89 ± 1.35 mm) was larger than the AnLL in the 41-60 year group (1.35 ± 1.19 mm) and the 61-80 year group (1.13 ± 1.08 mm). In conclusion, when placing implants in close proximity to mental foramina, caution is recommended to avoid injury to the inferior alveolar nerve. No fixed distance anteriorly from the mental foramen should be considered safe. Using CBCT scans with the oblique-transverse method to accurately identify and measure the AnLL is of utmost importance in avoiding and protecting its integrity.

A 3D-printed guide for lateral approach sinus grafting: A dental technique

Lateral approach sinus grafting has become a routine and predictable surgical method of augmenting the pneumatized sinus for implant placement. Outlining the lateral window access can be a challenging task for the clinician to envision and execute. Improper extension and access to the maxillary sinus can prevent proper placement of graft materials and lead to complications. The purpose of this report was to demonstrate a technique that will allow the precise planning of the lateral approach using radiographic information and 3-dimensional (3D) software to 3D-print a surgical guide.

Using Virtual Ridge Augmentation and 3-Dimensional Printing to Fabricate a Titanium Mesh Positioning Device: A Novel Technique Letter

This technique describes a novel approach for planning and augmenting a large bony defect using a titanium mesh (TiMe). A 3-dimensional (3D) surgical model was virtually created from a cone beam computed tomography (CBCT) and wax-pattern of the final prosthetic outcome. The required bone volume (horizontally and vertically) was digitally augmented and then 3D printed to create a bone model. The 3D model was then used to contour the TiMe in accordance with the digital augmentation. With the contoured / preformed TiMe on the 3D printed model a positioning jig was made to aid the placement of the TiMe as planned during surgery. Although this technique does not impact the final outcome of the augmentation procedure, it allows the clinician to virtually design the augmentation, preform and contour the TiMe, and create a positioning jig reducing surgical time and error.

Three-Year Follow-Up of a Single Immediate Implant Placed in an Infected Area: A New Approach for Harvesting Autogenous Symphysis Graft

A restoration in the anterior region of the mouth is challenging from the surgical and the prosthetic point of view. The goal of implant therapy today is not only to attain osseointegration of the implant but also to enhance and maintain the soft tissue esthetics around dental implants. Maintaining the soft tissue architecture around the implant restoration to mimic the contralateral tooth in the anterior esthetic area is required for a successful restoration. Immediate implant placement and provisionalization maintains the soft and hard tissue architectures, avoids the need for additional surgeries, and shortens treatment time. Clinical trials showed a high success rate of immediate implant placement in fresh extraction alveolus. Careful analysis of soft and hard tissue is a prerequisite for immediate implant placement in the anterior region of the mouth. Kois named 5 diagnostic factors used to assist in predictable immediate implant placement. Of the 5 diagnostic factors, 3—that is, the form, biotype of the periodontium and height of the alveolar crest before tooth extraction—address the importance of soft and hard tissue components. Presence of an active apical and/or periodontal infected residual socket may be considered a relative contraindication for the immediate implant placement. An infected alveolus confirms the presence of bacteria that will induce inflammatory activity, increase the bone resorptive process, and result in a higher risk of implant failure. Lindeboom et al compared the survival rate of immediate and delayed implant placement into infected residual alveolus. The author showed a 92% survival rate of immediately placed implants compared with a 100% survival rate of delayed placement implants. Additionally, there was more midbuccal soft tissue recession in the immediate placement compared with the delayed placement protocol 1 year after placement. Another study by Seigenthaler et al demonstrated an equal survival rate of the immediate and delayed implant placement into infected alveolus. Complete debridement of the alveolus with primary stability of the implant is a prerequisite for immediate placement. Immediate placement of an implant in the presence of a chronic infection and a deficient buccal plate in a patient with a high smile line is very challenging and complex. Autogenous bone graft harvested from intraoral or extraoral sites has been used for predictable guided bone regeneration. Certain complications of the donor sites have been reported. The purpose of this clinical report is to discuss the surgical and restorative protocols for immediate implant placement and provisionalization in the presence of a large periodontal abscess with a buccal plate defect in an area that demands attention to esthetics using a novel technique for harvesting an autogenous mandibular symphysis graft with a single vertical incision. 1 Advanced Education Program in Implant Dentistry, Department of Restorative Dentistry, Loma Linda University School of Dentistry, Loma Linda, Calif. 2 Department of Prosthetic Dental Sciences, Salman bin Abdulaziz University School of Dentistry, Al-Kharj, Saudi Arabia, and Advanced Education Program in Implant Dentistry, Department of Restorative Dentistry, Loma Linda University School of Dentistry, Loma Linda, Calif. * Corresponding author, e-mail: aalardah@llu.edu DOI: 10.1563/AAID-JOI-D-13-00202

Accuracy of CBCT and 3D Stereolithographic Model in Identifying the Anterior Loop of the Mental Nerve: A Study on Cadavers.

Abstract AbstractThe objective of this ex vivo cadaver study was to determine the accuracy of cone beam computed tomography(CBCT) and 3D stereolithographic(STL) model in identifying and measuring the anterior loop length(ANLL) of the mental nerve. A total of 12 cadavers (24 mental nerve plexus) were used for this study. Standardized CBCT scans of each mandible were obtained both with and without radiographic contrast tracer injected into the mental nerve plexus. STL models of the two acquired CBCT images were made. ANLL were measured using CBCT, STL and anatomy. The measurements obtained from the CBCT images and STL models were then analyzed and compared with the direct anatomic measurements. Paired sample t-test was used. P values less than .05 was considered statistically significant. The mean difference between CBCT and anatomic measurement was 0.04mm and not statistically significant (p= .332) while the mean difference between STL and anatomic measurement was 0.4mm and statistically significant (p=.042). There was also a statistical significant difference between CBCT and STL (p=.048) with the mean difference of 0.35mm. Therefore, CBCT is an accurate and reliable method in determining and measuring the ANLL while the STL over or underestimated the ANLL by as much as 1.51mm and 1.83mm respectively.