Arun K. Garg

Platelet-rich plasma for bone graft enhancement in sinus floor augmentation with simultaneous implant placement: patient series study.

The use of autologous platelet-rich plasma (PRP) as a source for growth factors in bone grafting is a relatively new and promising technique. Early controlled studies indicate that combining PRP with autologous bone grafts significantly enhances the rate of bone formation and maturation. The study consisted of 105 patients who required sinus augmentation with crestal bone height of less than 5 mm in the posterior maxilla. All patients received a composite bone graft that consisted of 30% to 40% autogenous bone harvested from the lateral wall of the maxilla zygomatic–maxillary buttress and the tuberosity and 60% to 70% xenograft. A total of 50 mL of blood was obtained from each patient before the surgical treatment for preparation of 10 mL of PRP. The graft–PRP mixture was activated by human thrombin. All sinus augmentations were carried out simultaneously with dental implants. At 6 months postoperatively, implants were exposed showing no clinical evidence of crestal bone loss around the implants both clinically and radiographically. All implants were clinically osseointegrated and loaded with fixed porcelain fused to metal prosthesis. The use of PRP in augmenting the severely atrophic posterior maxilla has obvious clinical benefits in terms of reducing the healing period of bone maturation, better graft handling, and accelerated soft tissue healing.

Piezosurgery: Basics and Possibilities

Useful in a variety of oral surgery procedures, piezosurgery has therapeutic features that include a micrometric cut (precise and secure action to limit tissue damage, especially to osteocytes), a selective cut (affecting mineralized tissues, but not surrounding soft tissues), and a clear surgical site (the result of the cavitation effect created by an irrigation/cooling solution and oscillating tip). Because the instruments tip vibrates at different ultrasonic frequencies, since hard and soft tissues are cut at different frequencies, a “selective cut” enables the clinician to cut hard tissues while sparing fine anatomical structures (e.g., schneiderian membrane, nerve tissue). An oscillating tip drives the cooling-irrigation fluid, making it possible to obtain effective cooling as well as higher visibility (via cavitation effect) compared to conventional surgical instruments (rotating burs and oscillating saws), even in deep spaces. As a result, implantology surgical techniques such as bone harvesting (chips and blocks), crestal bone splitting, and sinus floor elevation can be performed with greater ease and safety.

Augmentation grafting of the maxillary sinus for placement of dental implants: anatomy, physiology, and procedures.

In patients with an inadequate amount of bone for implant placement, sinus lift surgery can be performed to restore a sufficient amount of alveolar bone to allow for successful implant placement and subsequent prosthetic reconstruction. In this article, the anatomy and physiology of the maxillary sinus, the mechanisms of bone grafting, bone grafting material, preoperative evaluation, surgical technique, and the grafting procedure, as well as intraoperative bleeding and postoperative complications, are discussed.

Bone Structure, Metabolism, and Physiology: Its Impact on Dental Implantology

When placing implants in the mandible or maxilla, it is important for clinicians to understand the process of bone remodeling, the different types of bone, and how these factors can affect the integration of osseous dental implants. Approximately 0.7% of a human skeleton is resorbed daily and replaced by new healthy bone. With aging and metabolic disease states, the normal turnover process may be reduced, resulting in an increase in the mean age of the present bone. This increase can affect the placement and integration of implants. Herein follows a discussion of different types of bone cells, the metabolism of bone, the microscopic, macroscopic, and molecular structure of bone, and the process of bone modeling and remodeling.

Autogenous mandibular bone grafts in the treatment of the resorbed maxillary anterior alveolar ridge: rationale and approach.

Patients can present with a variety of conditions that limit, or prevent, the ideal placement of endosteal implants. One of these situations is depicted by an insufficient amount of bone for implant placement in the maxillary anterior alveolar ridge. Autogenous bone grafting can be used to augment the ridge to provide a sufficient amount of bone for implant placement. Using the mandibular symphysis as a donor site offers ease of access, good bone quality for localized repair, a corticocancellous block graft morphology, low morbidity, and minimal graft resorption. A procedure for harvesting and placing an autogenous mandibular bone graft is presented; as are the advantages of using this location as a donor site compared with other locations.

A Comparative Study of Bilateral Sinus Lifts Performed with Platelet-Rich Plasma Alone Versus Alloplastic Graft Material Reconstituted with Blood

The objective of this study was to compare the alveolar bone growth in the 2 sides of the maxillary sinus after bilateral sinus lift procedures were performed with the simultaneous placement of dental implants in 20 consecutive patients. After elevation of the Schneiderian membrane, one side had only platelet-rich plasma (PRP) gel applied, while the other had placed only alloplastic graft material reconstituted with blood. Both open window and closed window techniques were usedin ridges with ≥9 mm residual crest of bone. Results indicate that using PRP alone in cases with >7 mm residual crest can produce bone growth. Preliminary results indicate that in cases with a minimum of 7-mm crestal bone, it is possible to use a crestal approach for sinus grafting, with PRP alone and implant placement for bone growth.

Immediate loading of implant overdentures using modified loading protocol.

To our knowledge, this study shows the first longitudinal results (range 12-30 months) of immediate loading of implant-support overdenture with ball attachment connection placed in the anterior mandible. Immediately after surgery, the overdenture was connected to the implants with 2-ball attachments. The housings were filled with Impregum™ (3M Espe AG; Seefeld, Germany) impression material to provide retention as well as reduce forces in the initial phase of loading. Of the 28 implants placed, only 1 failed; the 1 failed implant for total implants placed represents a success rate of 96.4%. The minimal bone loss (1 mm) in 2 sites represents a success rate of 92.8%.

DENTAL IMPLANTS AND THE GERIATRIC PATIENT

Dental care of the aging patient presents a number of problems not encountered in younger patients. Most of these problems result from tissue changes that occur during aging. Dental implants and implant-retained and/or implant-supported prostheses are viable treatment options for older patients. The majority of elderly patients in their younger retirement years are relatively healthy and not limited in activity. The clinician must be aware of the physical, metabolic, and endocrine changes associated with aging and how these changes may affect implant treatment. The elderly deserve the best care the dental profession can offer.

A novel aid to elevation of the sinus membrane for the sinus lift procedure.

A maxillary sinus augmentation graft floor can increase vertical bone height for implant placement in patients with a pneumatized sinus. A simple technique can make this routine procedure even more predictable. After the sinus membrane has been adequately reflected, a cottonoid soaked with 1 carpule of 2% Lidocaine with 1:100,000 epinephrine and left in place for 5 to 15 minutes in each maxillary sinus can help create vasoconstriction and hemostasis. By arresting the oozing type of bleeding from the sinus membrane and the floor of the maxillary sinus, the cottonoid technique enhances direct visualization of the sinus and sinus membrane, further reflects the sinus membrane bluntly and gently with minimal risk of a membrane perforation, and serves as a volume indicator to assess the graft volume required.

Nutrition and the geriatric implant patient.

The clinician must be cognizant of nutritional factors and deficiencies that can adversely affect implant surgery and subsequent prosthodontic rehabilitation for the geriatric patient. There are many nutrients, vitamins, and minerals that may be useful and even necessary for the geriatric implant patient. Dental implants and implant-retained and/or supported prostheses are viable treatment options for older patients when certain age-related and nutritional factors are considered.