Aleksa Markovic

Maxillary sinus floor augmentation: comparing osteotome with lateral window immediate and delayed implant placements. An interim report

OBJECTIVE A retrospective study was performed to observe clinical outcomes of dental implants placed in augmented maxillary sinuses using an osteotome or a lateral approach technique with synchronous or delayed implant placement. STUDY DESIGN A total of 61 patients were enrolled in the study. The distribution and frequency of sinus augmentation techniques and implant placements were evaluated according to the implant site and Cawood-Howell classifications. The implant survival rates were assessed clinically and radiographically over a minimum of 3 years of follow-up. RESULTS The number of implants placed was fewer in the molar region compared with the premolar region and was independent of the surgical techniques used. Significantly fewer implants were placed in implant site class D and Cawood-Howell class V. Optimal survival rates were evident in all groups, with no significant changes. CONCLUSION The most predictable region for sinus augmentation with simultaneous implant placement was the maxillary premolar area. All 80 implants were successful using either osteotome or lateral approaches to augment the maxillary sinus floor.

Evaluation of Primary Stability of Self-Tapping and Non-Self-Tapping Dental Implants. A 12-Week Clinical Study

PURPOSE The aim of this study was to investigate the relationship between surgical techniques and implant macro-design (self-tapping/non-self-tapping) for the optimization of implant stability in the low-density bone present in the posterior maxilla using resonance frequency analysis (RFA). MATERIALS AND METHODS A total of 102 implants were studied. Fifty-six self-tapping BlueSkyBredent® (Bredent GmbH&Co.Kg®, Senden, Germany) and 56 non-self-tapping Standard Plus Straumann® (Institut Straumann AG®, Waldenburg, Switzerland) were placed in the posterior segment of the maxilla. Implants of both types were placed in sites prepared with either lateral bone-condensing or with bone-drilling techniques. Implant stability measurements were performed using RFA immediately after implant placement and weekly during a 12-week follow-up period. RESULTS Both types of implants placed after bone condensing achieved significantly higher stability immediately after surgery, as well as during the entire 12-week observation period compared with those placed following bone drilling. After bone condensation, there were no significant differences in primary stability or in implant stability after the first week between both implant types. From 2 to 12 postoperative weeks, significantly higher stability was shown by self-tapping implants. After bone drilling, self-tapping implants achieved significantly higher stability than non-self-tapping implants during the entire follow-up period. CONCLUSIONS The outcomes of the present study indicate that bone drilling is not an effective technique for improving implant stability and, following this technique, the use of self-tapping implants is highly recommended. Implant stability optimization in the soft bone can be achieved by lateral bone-condensing technique, regardless of implant macro-design.

Implant stability in posterior maxilla: bone-condensing versus bone-drilling: a clinical study

OBJECTIVE The aim of this clinical trial was to compare primary and secondary stability of implants placed by bone condensing versus the standard drilling technique in the posterior edentulous maxilla. STUDY DESIGN Forty-eight SLA Straumann implants 4.1 × 10 mm (Institut Straumann AG, Waldenburg, Switzerland) were placed into edentulous maxillary posterior region in the same positions bilaterally, using the bone condensation technique for one and the standard technique for the other side. Implant stability measurements were performed immediately after implant placement, as well as every week for the next 6 weeks by use of resonance frequency analysis (RFA). Data were analyzed using Mann-Whitney U and Wilcoxon tests. RESULTS After bone condensing, significantly higher implant stability was recorded immediately after surgery as well as during the whole observation period of 6 weeks compared with bone-drilling technique (Mann-Whitney U test, P = .000). CONCLUSIONS The bone-condensing technique can be recommended as an alternate surgical approach for implant site preparation in reduced bone density to achieve greater implant stability in the posterior maxilla.

The closure of oroantral communications with resorbable PLGA-coated β-TCP root analogs, hemostatic gauze, or buccal flaps: A prospective study

OBJECTIVE The aim of this study was to compare the treatment of oroantral communications (OACs) with bioresorbable root analogs made of poly(lactide-co-glycolide) (PLGA)-coated beta-tricalcium phosphate (beta-TCP), hemostatic gauze or a buccal flap technique. STUDY DESIGN In this prospective clinical study, 30 patients with oroantral communications were randomly assigned to a treatment. Clinical success, vestibular depth at the defect site, pain, and swelling were monitored. RESULTS The OAC closure was successful in all cases. The vestibular depth stayed constant in the groups treated with the PLGA-beta-TCP composite or hemostatic gauze. In contrast, a vestibular depth reduction of 1.2 +/- 0.2 mm was observed in the buccal flap group, indicating atrophy of the alveolar ridge in these patients. Furthermore, pain and swelling were more pronounced in this group. CONCLUSION Closures of OACs with PLGA-beta-TCP composite or hemostatic gauze are reliable minimally invasive methods that minimize atrophy of the alveolar ridge, swelling, and pain compared with a buccal flap technique.

Two‐Center Prospective, Randomized, Clinical, and Radiographic Study Comparing Osteotome Sinus Floor Elevation with or without Bone Graft and Simultaneous Implant Placement

PURPOSE To evaluate stability and success rate of hydrophilic nanostructured implants placed via osteotome sinus floor elevation (OSFE) without grafting material or using β-tricalcium phosphate (β-TCP), deproteinized bovine bone (DBB), or their combination, and also to assess three-dimensional volumetric stability of endo-sinus bone gained in the aforementioned conditions. MATERIALS AND METHODS OSFE with simultaneous implant placement (10-mm long SLActive-BL® , Straumann, Basel, Switzerland) was performed. Grafting materials were randomly allocated to implant sites, whereas one site was left without graft. Implant stability was measured by resonance frequency analysis over 6 months. Implant success was evaluated after 2 years of loading. Volume of new endo-sinus bone was calculated from CBCT images using 3D Slicer® software. RESULTS A total of 180 implants were inserted into posterior maxilla of 45 patients with 6.59 ± 0.45 mm of residual bone height, and all remained successful after 2 years. Implant stability steadily increased during healing, without significant difference between groups (p = .658). After 2 years, endo-sinus bone significantly shrank (p < .001) in all groups (DBB:66.34%; β-TCP:61.44%; new bone formed from coagulum: 53.02%; β-TCP + DBB:33.47%). CONCLUSIONS Endo-sinus bone gained after OSFE inevitably and significantly shrinks regardless of whether grafting material is applied or not. Grafting material offers no significant advantage to stability nor clinical success of hydrophilic and nanostructured implants placed simultaneously with OSFE.

Connective Tissue Characteristics around Healing Abutments of Different Geometries: New Methodological Technique under Circularly Polarized Light

PURPOSE To describe contact, thickness, density, and orientation of connective tissue fibers around healing abutments of different geometries by means of a new method using coordinates. MATERIALS AND METHODS Following the bilateral extraction of mandibular premolars (P2, P3, and P4) from six fox hound dogs and a 2-month healing period, 36 titanium implants were inserted, onto which two groups of healing abutments of different geometry were screwed: Group A (concave abutments) and Group B (wider healing abutment). After 3 months the animals were sacrificed and samples extracted containing each implant and surrounding soft and hard tissues. Histological analysis was performed without decalcifying the samples by means of circularly polarized light under optical microscope and a system of vertical and horizontal coordinates across all the connective tissue in an area delimited by the implant/abutment, epithelium, and bone tissue. RESULTS In no case had the connective tissue formed a connection to the healing abutment/implant in the internal zone; a space of 35 ± 10 μm separated the connective tissue fibers from the healing abutment surface. The total thickness of connective tissue in the horizontal direction was significantly greater in the medial zone in Group B than in Group A (p < .05). The orientation of the fibers varied according to the coordinate area so that internal coordinates showed a higher percentage of parallel fibers in Group A (p < .05) and a higher percentage of oblique fibers in Group B (p < .05); medial coordinates showed more oblique fibers (p < .05); and the area of external coordinates showed the highest percentage of perpendicular fibers (p < .05). The fiber density was higher in the basal and medial areas (p < .05). CONCLUSIONS Abutment geometry influences the orientation of collagen fibers; therefore, an abutment with a profile wider than the implant platform favors oblique and perpendicular orientation of collagen fibers and greater connective tissue thickness.

Immunohistochemical analysis of blood vessels in peri-implant mucosa: a comparison between mini-incision flapless and flap surgeries in domestic pigs

AIM The aim of this experimental study is to compare the effect of mini-incision flapless versus flap technique of implant placement on the amount of vascular structures and blood vessel elements in peri-implant soft tissue, using immunohistochemical analysis. METHOD The experiment was conducted on five domestic pigs. Each animal received six implants in mandible according to the split-mouth design. On one randomly chosen jaw side, mini-incision flapless surgery was performed, whereas on the opposite jaw side, flap was raised. After 3 months of implant healing through submerged approach, the experimental animals were sacrificed and samples for immunohistochemical analyses were taken from the buccal side of peri-implant mucosa next to the neck of implants, from three levels. The study outcome was the presence of vascular structures and elements of the blood vessels in the peri-implant mucosa per microscopic field, estimated through ordinal scores from 0 to 2. Effects of surgical approach, site of implantation, and their interaction on vascular scores of peri-implant mucosa were assessed by Brunner and Langer nonparametric analysis of longitudinal data. RESULTS Statistically significant effect of surgical approach on vascularity of peri-implant mucosa has been revealed in the second mucosal layer, where flapless approach provided higher vascularity compared with flap approach (P = 0.002). In the remaining two layers, surgical approach did not affect mucosal vascularity significantly (layer 1: P = 0.071; layer 3: P = 0.433). CONCLUSION The flapless surgical implant placement approach using mini-incision provides better vascularization of peri-implant mucosa after 3 months of healing compared with flap surgery.

Immediately loaded mini dental implants as overdenture retainers: 1-Year cohort study of implant stability and peri-implant marginal bone level

AIM This 1-year cohort study investigated stability and peri-implant marginal bone level of immediately loaded mini dental implants used to retain overdentures. MATERIALS AND METHODS Each of 30 edentulous patients received 4 mini dental implants (1.8 mm × 13 mm) in the interforaminal mandibular region. The implants were immediately loaded with pre-made overdentures. Outcome measures included implant stability and bone resorption. Implant stability was measured using the Periotest Classic(®) device immediately after placement and on the 3rd and 6th weeks and the 4th, 6th and 12th months postoperatively. The peri-implant marginal bone level (PIBL) was evaluated at the implants mesial and distal sides from the polished platform to the marginal crest. Radiographs were taken using a tailored film holder to reproducibly position the X-ray tube at the 6th week, 4th and 12th months postoperatively. RESULTS The primary stability (Periotest value, PTV) measured -0.27 ± 3.41 on a scale of -8 to + 50 (lower PTV reflects higher stability). The secondary stability decreased significantly until week 6 (mean PTV = 7.61 ± 7.05) then increased significantly reaching (PTV = 6.17 ± 6.15) at 12 months. The mean PIBL measured -0.40 mm after 1 year of functional loading, with no statistically significant differences at the various follow-ups (p = 0.218). CONCLUSIONS Mini dental implants placed into the interforaminal region could achieve a favorable primary stability for immediate loading. The follow-up Periotest values fluctuated, apparently reflecting the dynamics of bone remodeling, with the implants remaining clinically stable (98.3%) after 1 year of function. The 1-year bone resorption around immediately loaded MDIs is within the clinically acceptable range for standard implants.

A 1‐Year Prospective Clinical and Radiographic Study of Early‐Loaded Bone Level Implants in the Posterior Maxilla

PURPOSES The primary aim of the study was to investigate a 1-year success rate of early-loaded bone level implants with a chemically modified sand-blasted, large grit, acid-etched surface (SLActive®, Institut Straumann AG, Basel, Switzerland) in the posterior maxilla. Secondary objectives included stability of these implants and peri-implant bone level. MATERIALS AND METHODS Bone level® implants (Institut Straumann AG) inserted into premolar and/or molar maxillary sites were loaded after 6 weeks of healing. The implants were monitored for 1 year using the following outcome measures: implant success, primary and secondary stability, and peri-implant bone level. RESULTS Out of 37 implants placed in 13 patients, 36 reached sufficient stability and were early loaded, whereas one underwent a delayed loading protocol. One-year success rate of early-loaded implants was 100%. Implant stability at baseline was 71.7 ± 5. 6 to be steadily increased thereafter up to 1 year (80.3 ± 3.3), except at 2 weeks when a nonsignificant decrease was noticed (71.9 ± 3.9). Continuous and significant bone loss was observed, reaching 0.4 ± 0.1 mm in the first postoperative year. CONCLUSION Bone level implants with the SLActive surface placed into low-density bone and loaded after 6 weeks of healing can predictably achieve and maintain a successful tissue integration.

Real‐time thermographic analysis of low‐density bone during implant placement: a randomized parallel‐group clinical study comparing lateral condensation with bone drilling surgical technique

OBJECTIVES To compare the effect of two surgical techniques, lateral condensation and bone drilling, on changes in temperature of the adjacent low-density bone during implant placement into posterior maxilla and to investigate the influence of the host factors - age, gender, region of implantation, bone density, and thickness of the cortical bone at the recipient sites. MATERIAL AND METHODS Local bone temperature was measured thermographically during implant placement into posterior maxilla following lateral bone condensing (test group) or bone drilling (controls). The main study outcomes were baseline bone temperature prior to implantation and maximum bone temperature recorded during implantation. Early implant success was evaluated after 6 months of healing. RESULTS A total of 40 implants were randomly allocated to test and control groups and placed into maxillary premolar and/or molar region of 18 participants of both genders and average age of 51.74 years. All recorded bone temperatures were below the threshold for thermal necrosis. Although both groups showed significant increase in bone temperature during implant placement procedure (P ≤ 0.0005), it was significantly higher for bone condensing compared with drilling (P ≤ 0.0005; 3.79 ± 1.54°C; 1.91 ± 0.70°C respectively). No host factor was singled out as a significant predictor of bone temperature changes, although trend of higher increase was observed in young patients, regardless of gender, during implant placement procedure into maxillary first premolar region with bone density type 3 and cortical layer thicker than 1 mm. Early implant success rate after 6 months follow-up was 100%. CONCLUSION Although both surgical techniques, bone condensing and bone drilling, can be considered safe regarding their thermal effect on the bone of posterior maxilla, bone drilling is associated with fewer local bone heating during implantation. Host factors do not affect the bone thermal changes significantly.