Alessandro Acocella

Clinical, histological and histomorphometric evaluation of the healing of mandibular ramus bone block grafts for alveolar ridge augmentation before implant placement

BACKGROUND Localized bone defects in the maxilla are commonly reconstructed with autologous mono-cortical bone blocks prior to the placement of dental implants. This study presents a clinical, histological and histomorphometric analysis on the use of mandibular ramus block grafts for ridge augmentation. MATERIALS AND METHODS mono-cortical bone blocks from the mandibular ramus were grafted in 15 patients. The bone grafts were left to heal for period varying from 3 to 9 months. Afterwards, 30 implants were inserted and bone samples were removed for subsequent histological analysis. RESULTS All the bone grafts were successful and resorption was minimal. There were no implant failures. At graft placement, mean lateral augmentation was 4.6+/-0.73mm, which, later, at the time of implant insertion, reduced to 4+/-0.77mm. Histological evaluation indicated signs of active remodelling in all specimens. However, the grafted bone contained substantial amounts of non-vital bone (NVB) and generally weak neo-vascularization regardless of the time of biopsies. CONCLUSIONS The outcome of the study suggests that the larger part of osteocytes in mono-cortical bone do not survive grafting and neo-vascularization of non-vital grafted bone is difficult because of the slow remodelling process into new vital.

Maxillary alveolar ridge reconstruction with monocortical fresh-frozen bone blocks: A clinical, histological and histomorphometric study

BACKGROUND This investigation is a clinical and histological assessment of fresh-frozen bone use in the reconstruction of maxillary alveolar ridges. The study evaluates the effectiveness of this material as a bone filler prior the placement of dental implants. PATIENTS AND METHODS Sixteen patients with atrophic maxillary ridges underwent maxillary reconstruction with fresh-frozen tibial human block grafts prior to implant placement. Sampling procedures were carried out 4, 6 and 9 months later when a bone core was removed from the grafts for histological and histomorphometric analysis. RESULTS Eighteen blocks were placed, and each patient received either 1 or 2 blocks. During the sampling procedures, all of the grafts were found to be firm in consistency, well-incorporated, and vascularized. A total of 34 implants were placed into the grafts with a minimum of 40-Newton-cm torque in all cases. The follow-up period ranged from 18 to 30 months. No implants were lost. The histological analysis revealed vital bone with mature and compact osseous tissue surrounded by marrow spaces. CONCLUSION Bone allografts can be used successfully as graft material for the treatment of maxillary ridge defects. This type of bone graft can be used safely in the areas of implant placement as a suitable alternative to autogenous grafts.

Clinical, histological and histomorphometrical study of maxillary sinus augmentation using cortico-cancellous fresh frozen bone chips.

BACKGROUND Insufficient bone volume in the posterior maxilla can be a major problem when placing dental implants. One of the goals of sinus augmentation procedures is the creation of sufficient volume of vital bone for the subsequent insertion and complete osseointegration of implants placed in the posterior maxilla. The aim of the present study was a clinical, histological and histomorphometrical analysis of maxillary sinus augmentation using human fresh frozen bone (FFB) allografts for maxillary sinus lift augmentation procedures. METHODS Fifteen patients were treated with maxillary sinus augmentation using FFB. After three months, a bone biopsy was taken before implant placement in order to evaluate the healed bone from a histological and histomorphometrical point of view. After further three months, all implants were osseointegrated according to radiographic and clinical examinations. Abutment connection was performed and the patients received prosthetic restoration of the missing teeth. RESULTS Histologically all the specimens showed signs of active remodelling and all the tissues were free of inflammatory cells. After 12 months of assessment, no implants had failed. CONCLUSION Our findings suggest that FFB is a biocompatible material that can be successfully used for maxillary sinus augmentation.

Modified Insertion Technique for Immediate Implant Placement into Fresh Extraction Socket in the First Maxillary Molar Sites: A 3-Year Prospective Study

Background:Immediate implant placement after tooth extraction is a predictable solution in various clinical situations. The purpose of this study was to evaluate the predictability of a treatment, including the placement of implants, using a modified insertion technique at the time of maxillary molar extraction. Materials:Sixty-eight patients with a total of 68 teeth scheduled for tooth extraction and immediate implant placement into fresh sockets were included in the study. Implants were positioned just after teeth removal and, in case of necessity, a regenerative therapy was performed at the same time. After a 3-month period of healing, implants were restored with single crown fixed prostheses. Results:All implants restored with single crowns were monitored for 36 months; only, 3 implants failed with a cumulative survival rate of 97.96%. Conclusion:The combination of atraumatic extraction of maxillary molars, sufficient residual inter-radicular bone, and the use of appropriate regenerative material at the time of implant insertion, represents a predictable long-term treatment.

A systematic review of microsurgical reconstruction of the jaws using vascularized fibula flap technique in patients with bisphosphonate-related osteonecrosis

OBJECTIVE The aim of this systematic review was to assess the role of microsurgical reconstruction of the jaws in patients with bisphosphonate-related osteonecrosis, and biological complications after an observation period of at least 12 months. MATERIAL AND METHODS An electronic MEDLINE search supplemented by manual searching was conducted to identify studies reporting data of at least 12 months observation on the microsurgical reconstruction of the jaws in patients with bisphosphonate-related osteonecrosis. RESULTS Four studies resulted eligible for the analysis yielded. Three out of five studies were free of complications, with a success rate of 100% as no recurrence of osteonecrosis was registered. CONCLUSIONS Microsurgical reconstruction of the jaws represents a valid treatment modality in patients with bisphosphonate-related osteonecrosis at 3rd stage of the disease.

Full-mouth rehabilitation with immediate loading of implants inserted with computer-guided flap-less surgery: a 3-year multicenter clinical evaluation with oral health impact profile.

Objective:The purpose of this report is to present the clinical outcomes and patients’ satisfaction of full-mouth rehabilitation using computer-aided flapless implant placement and immediate loading of a prefabricated prosthesis. Materials and Methods:The study included 30 consecutive fully edentulous patients who received 312 implants. Mandible and maxilla were treated in the same surgical session with computer-guided flapless approach using the NobelGuide protocol. Prefabricated screw-retained fixed prostheses were inserted at the end of surgery. Clinical and radiographic evaluations were assessed at 6, 12, and 36 months. At baseline and 6 months after surgery, patients answered Oral Health Impact Profile in Edentulous Adults questionnaire to assess satisfaction. Results:The implant survival rate was 97.9%, whereas the average marginal bone loss was 1.9 ± 1.3 mm after 3 years. At 6 months, patients showed significantly greater satisfaction with their fixed rehabilitation when compared with conventional dentures. Conclusions:The results of this study confirm that rehabilitation with a prefabricated fixed prosthesis supported by implants placed with NobelGuide protocol is a viable and predictable treatment and increases patients’ satisfaction and improves oral health-related quality of life.

Peri-implant squamous odontogenic tumor.

Squamous odontogenic tumor (SOT) is a benign, locally infiltrative intraosseous tumor composed of well-differentiated squamous epithelium in a fibrous stroma. It seems to derive from the epithelial rests of Malassez in the periodontal ligament space. It presents an odontogenic origin, involving both the upper and lower maxillary bone, mainly areas without teeth or connective tissue of the odontogenic cysts. Clinically, SOT could be asymptomatic (3 cases), notwithstanding it is mainly characterized by pain, swelling, and tooth/teeth mobility. The most typical presentation of SOT is a slowly growing endobony lesion arising within a single periodontal location. Frequent misdiagnosis concerns either ameloblastoma and squamous cell carcinoma and fibroma. Since its first description in 1975, less than 50 cases have been identified. In light of the few reported cases, there are no consistently recorded clinical and radiographic features of SOT, and there is no predictable sex or site predilection. Diagnosis is predicated on recognition of the histopathologic features of SOT to obviate possible misdiagnosis of malignancy or ameloblastoma.We report the first case of SOT that arose in the vicinity of an implant. Through a meticulous review of literature, we discuss current etiology, pathogenesis, and treatment.

Solitary plasmacytoma of the jaw.

BackgroundThere is a lack of consensus on the appropriate management of solitary plasmacytoma (SP) of the jaw. The aim of the present investigation was to provide scientific evidence for the optimal management of this disease through a systematic literature review. MethodsThe included articles are published in English from 1948 to March 2011 and describe the population affected by SP of the jaw with site, clinical and radiographic features, special findings, initial diagnosis, treatment, and follow-up. ResultsFifty cases of SP of the jaw were identified. It typically presents as a single osteolytic lesion with no plasmocytosis involvement of bone marrow. Long bones and vertebrae are the most common sites of SP. Rarely, it involves the jaw occurring in only 4% of cases, mainly in the bone marrow–rich areas, angulus and ramus. Solitary plasmacytoma of the jaw has a worse prognosis than multiple myeloma (MM), and in half of the cases, it evolves in MM. ConclusionsBecause SP of bones is an uncommon tumor that rarely involves the jaws, through this article we emphasize early diagnosis and appropriate management to avoid progression to MM.

Clinical Evaluation of Immediate Loading of Electroeroded Screw-Retained Titanium Fixed Prostheses Supported by Tilted Implant: A Multicenter Retrospective Study

STATEMENT OF PROBLEM Immediate occlusal loading of dental implants in the edentulous mandible has proven to be an effective, reliable, and predictable treatment protocol. However, there is limited long-term data available in the literature, when an electroeroded definitive cast-titanium fixed prosthesis is used for this treatment protocol. PURPOSE The aim of this study was to evaluate the clinical effectiveness of dental implants (Astra Tech Dental, Mölndal, Sweden) in the edentulous mandible immediately loaded with an electroeroded cast-titanium screw-retained fixed prosthesis. MATERIALS AND METHODS Forty-five patients received five implants each in the interforaminal area. All the implants were inserted with torque up to 40 Ncm and the distal implants were distally tilted approximately 20 to 30 degrees to minimize the length of posterior cantilevers. Implants were loaded within 48 hours of placement with an acrylic resin-titanium screw-retained prosthesis fabricated by electroerosion. RESULTS Two of the 225 inserted implants failed after 3 and 16 months of healing, respectively, with a cumulative survival rate of 99.1% and a prosthetic survival rate of 97.8%. CONCLUSION Immediate loading of tilted dental implants inserted in the edentulous mandible with a screw-retained titanium definitive prosthesis fabricated with electrical discharge machining provide reliable and predictable results.

Maxillary sinus lift using fresh frozen bone chips in presence of sinus cyst: clinical and histological report

The reconstruction of edentulous patients with adequate bone volume and density by the use of bone graft and, subsequently, the placement of dental implants has become a viable treatment option with high predictability. According to many authors, maxillary antral cysts are one of the most common benign pathologies of the maxillary sinus, and they also represent an important contraindication to sinus regenerative surgical technique. The authors report a case of maxillary atrophy which is augmented by fresh frozen bone chips in the presence of antral cysts.