Bach T. Le

Cortical tenting grafting technique in the severely atrophic alveolar ridge for implant site preparation.

Objectives:Alveolar ridge augmentation using intraoral autogenous block grafts to augment localized alveolar ridge defects before implant placement is a predictable method. However, large severely atrophic edentulous segments may require extraoral donor sites. The purpose of this study was to evaluate the effectiveness of using intraoral cortical block grafts in combination with particulate human mineralized allograft, in a “tenting” fashion, to augment large atrophic alveolar ridge defects for implant placement. Materials:This prospective case study evaluated augmentation in 10 consecutive patients with severely resorbed alveolar ridges missing a minimum of 4 adjacent teeth. Before augmentation, all grafted sites were deemed inadequate for placement of a standard 4-mm-diameter implant. Horizontal ridge augmentation was performed using autologous membranous cortical bone grafts from an oral donor site to tent out the soft tissue matrix and periosteum for the adjacent particulate allograft. The ridges were clinically evaluated 4 to 5 months after augmentation, and 42 implants were placed at that time. Results:Implants were successfully placed at all grafted sites 4 to 5 months after the original graft date. Clinical evaluation of the grafted sites upon re-entry revealed uniform ridge anatomy. All edentulous segments had at least 2 implants placed of at least 4.0 mm diameter. In all, 42 implants were placed into grafted sites in the 10 patients. Implants were checked for osseointegration by using a counter torque of 35 N·cm. One implant failed to integrate. Mean follow-up was 22 months after implant placement. All augmented ridges had retained their functional and esthetic integrity at 1 year after original augmentation. Conclusion:Tenting of the periosteum and soft tissue matrix using a cortical bone block maintains space and minimizes resorption of the particulate allograft volume. In addition, bridging the cortical blocks with particulate bone avoids unaesthetic ridge defects between cortical block grafts in larger ridge defects. The result was a more uniform and esthetic alveolar ridge, capable of maintaining an implant-supported prosthesis. The technique offers predictable functional and esthetic reconstruction of large-volume defects without extensive amounts of autogenous bone. This offers a superior functional and esthetic result than with either cortical or particulate grafting alone.

Labial Bone Thickness in Area of Anterior Maxillary Implants Associated with Crestal Labial Soft Tissue Thickness

Objective:To explore the relationship between implants labial bone thickness (ILBT) and crestal labial soft tissue thickness (CLSTT). Materials and Methods:This retrospective study used records of 32 (22 females and 10 males) patients who had 2 implants placed in their maxillary arch (64 implants; diameter range, 3.3–4.6 mm) between the canines at either maxillary lateral incisor (7 and 10) or central incisor (8 and 9) region. All patients had diagnostic and postoperative cone beam computed tomography scans; the ILBT at the crestal and midimplant levels were recorded. CLSTT was measured approximately 4 months after the placement of implants using a digital caliper at the crestal level. Results:Mean (standard deviation) CLSTT and ILBT at crestal and at midimplant levels were 2.45 (0.88), 1.79 (0.68), and 2.33 (1.01) mm, respectively. Overall, 26 implants had prior bone augmentation. Significant relationships between the CLSTT and ILBT at crestal (Spearmans rho = 0.720) and midimplant levels (Spearmans rho = 0.707) were observed (P < 0.001). The determination coefficients (R2) between CLSTT and ILBT at crestal and midimplant levels were 0.649 and 0.542, respectively. Following regression equations were produced: CLSTT = 1.043 * ILBT (crestal level) + 0.586 and CLSTT = 0.955 * ILBT (midimplant level) + 0.955. Conclusion:Based on this study, CLSTT and ILBT were highly associated in the anterior maxillary region.

Alveolar Cleft Repair in Adults Using Guided Bone Regeneration With Mineralized Allograft for Dental Implant Site Development: A Report of 2 Cases

Alveolar bone grafting is an integral part of the surgical management of oral clefts. The rationale behind alveolar cleft repair includes maxillary arch stabilization, closure of the oronasal fistula, nasal base support, nasolabial soft tissue reconstruction, and creation of bony support for tooth eruption or dental implant placement. Currently, the graft material of choice is autogenous bone graft from the anterior iliac crest. Nonetheless, autogenous bone grafting carries the significant risk of donor-site morbidity, leads to postoperative pain, and entails an additional operative cost. With the success of allograft bone material in implant site development, we explore the option of using human mineralized cancellous bone allograft in alveolar cleft patients. This article reports on the success of using mineralized human allograft to treat 2 adult patients with severe alveolar cleft defects. The repairs were accomplished with a guided bone regeneration technique without the use of any autogenous bone, with subsequent successful placement of endosseous implants. This opens up the possibility of avoiding harvesting iliac crest bone graft and its associated morbidities and expense by use of only mineralized allograft and a guided bone regeneration technique in an outpatient office setting.

Esthetic Grafting for Small Volume Hard and Soft Tissue Contour Defects for Implant Site Development

Ridge contour defects around dental implants are caused by underlying bony defects. Although adequate bone may exist to obtain stability of the implant, irregular bony anatomy can result in an unnatural appearance of the final crown. Particulate onlay grafting to support the peri-implant soft tissue along with tension-free closure while using pedicle papilla regeneration techniques can convert unaesthetic gingival contours into favorable sites.

Temporomandibular Joint Condylar Abnormality: Evaluation, Treatment Planning, and Surgical Approach

The cartilage of the mandibular condyle is locatedbeneath the fibrous articular layer and undergoes atro-phic changes, assuming endochondral bone growthor adaptive growth, according to the absence or pres-ence of functional demand. Normal condylar growthfollows a sequence of transitory stages that are de-fined by molecules synthesized by undifferentiatedmesenchymal cells and differentiating chondrocytes.

Is buccolingual angulation of maxillary anterior implants associated with the crestal labial soft tissue thickness

We aimed to examine the relationship between crestal labial soft tissue thickness (CLSTT, measured with a digital calliper at the crestal level of casts) and implant buccolingual angulation (IBLA). The records of 22 females and 10 males treated with two bone-level implants (3.3-4.6mm) between the maxillary canines were evaluated. IBLA was recorded as cingulum, incisal, or labial based on the screw access hole position on provisional restorations. Postoperative implant labial bone thickness (ILBT) at the crestal (2mm from crest) and mid-implant levels were measured on sectional cone beam computed tomography scans. The mean (SD) ridge width at the crestal level was 6.81 (0.98) mm. Mean (SD) CLSTT for implants with cingulum, incisal, and labial angulations were 2.98 (0.84), 2.24 (0.51), and 1.71 (0.72) mm, respectively. Significant differences were detected between CLSTT of implants with cingulum and incisal, as well as cingulum and labial angulations (P<0.01). Of implants with cingulum, incisal, and labial angulations, 3.4%, 20%, and 53.3%, respectively, had a CLSTT<2mm. Overall, 74.2% of CLSTT variance could be predicted by IBLA and ILBT at the crestal and mid-implant levels. A significant association between CLSTT and IBLA was noted when ILBT (crestal level) was <2mm (P<0.01). Implants with labial angulations carry a higher risk of soft tissue complications when the crestal implant labial bone thickness is <2mm.

Assessment of Short Dental Implants Restored With Single-Unit Nonsplinted Restorations

Objectives:To investigate the survival rate of short (⩽9 mm) implants restored with single-unit, nonsplinted crowns after an average follow-up of 37 months (21–94 months). Materials and Methods:Two hundred and twenty-one implants placed in 168 patients (74 men, 94 women, aged 34–87 years, mean = 61 years). Implant lengths were 6 (n = 16), 8 (n = 166), 8.5 (n = 2), or 9 mm (n = 34). The implant diameters ranged from 3.7 to 5.6 mm. Implants were placed in the maxillary (n = 44) and mandibular arches (n = 176). Results:Survival rate was 94.1% (maxilla [88.6%] and mandible [96.0%]) and 12 early failures (first 4 months) and 1 late failure (4.5 years in the maxillary molar region) observed. Of the 12 early failures, 4 were in the maxilla (2 premolars and 2 molars) and 8 in the mandible (2 premolars and 6 molars). The early failures were 11 implants of 8 mm long and a 9-mm implant. Smoking cigarettes, diabetes mellitus, and bone augmentation procedures were not associated with implant failure significantly (P > 0.05). Conclusions:Survival rate of short implants restored with single-unit, nonsplinted restorations over an average period of 37 months was favorable and comparable with longer implants.

Esthetic Implant Site Development

Bony support is critical for creating and maintaining esthetic and natural-appearing peri-implant soft tissue profiles. A variety of techniques have been shown to be effective for augmenting bone and soft tissue. Ideal implant position and angulation is critical for a natural-appearing outcome. Achieving an ideal esthetic result in the compromised site is often elusive and in many cases, impossible. This article reviews techniques available for esthetic implant site development. A review of the recent literature discovers the most effective techniques for achieving esthetic results.

Three-Dimensional Evaluation of Alveolar Bone and Soft Tissue Dimensions of Maxillary Central Incisors for Immediate Implant Placement: A Cone-Beam Computed Tomography Assisted Analysis.

Introduction:This study explored the relationship between the thickness of bone and soft tissue along the labial and palatal aspect of maxillary central incisors. The influence of overall socket width, labiopalatal positioning of the incisor on the bone, and soft tissue thickness were also investigated. Materials and Methods:This study used cone-beam computed tomography of 150 patients to determine labial, palatal soft and hard tissue thickness, labiopalatal (B-P) socket width and corelated the same to the labiopalatal positioning of maxillary central incisors. Results:Mean (SD) thicknesses of the labial soft tissue at cervical (C), midroot (M), and apical (A) locations and the corresponding bone thicknesses were 1.07 (0.28), 0.987 (0.27), 1.240 (0.41), and 0.928 (0.39), 0.894 (0.52), 1.57 (0.88), respectively. Similarly, palatal soft tissue and bone thicknesses at locations C, M, A were 1.807 (0.66), 1.557 (0.62), 1.639 (0.66), and 1.679 (0.62), 3.439 (1.28), 6.038 (1.63), respectively. Mean (SD) thicknesses of the B-P socket width at location C was 8.047 (0.963). Conclusions:There is a positive correlation between the labial and palatal bone and corresponding soft tissue thickness, between thickness of the labial bone and the labiopalatal thickness of the alveolar socket. No correlation was observed between the thickness of the labial cortical bone and the labiopalatal positioning of the tooth.

A tracheostomy complication resulting from acquired tracheomalacia: case report.

Introduction Intraoperative complications of tracheostomy are well described in the literature. These include hemorrhage, perforation of the walls of the trachea and esophagus, recurrent laryngeal nerve injury, intraoperative fire, pneumothorax and pneumomediastinum, and tube displacement. We present an unusual complication encountered during a routine tracheostomy that resulted from severe tracheomalacia.