Bruno Orlando

Deep-Frozen Allogeneic Onlay Bone Grafts for Reconstruction of Atrophic Maxillary Alveolar Ridges: A Preliminary Study

PURPOSE The purpose of this article was to evaluate the suitability of deep-frozen allograft for ridge augmentation procedures in severely atrophic maxillae and to evaluate the clinical success of dental implants inserted after grafting and before prosthetic rehabilitation. PATIENTS AND METHODS This study included 13 patients (3 men and 10 women) aged 36 to 65 years. All the patients selected for this study required bone augmentation procedures because of severe alveolar ridge atrophy and were scheduled for onlay bone allograft and titanium implants in a 2-stage procedure. The dental implants were inserted 5 months after grafting. The follow-up period for the implants was 6 months after placement at the second stage of implant surgery. RESULTS A total of 24 onlay block allografts were used to augment atrophic maxillae in 13 patients. Of the 24 onlay block allografts, 5 were scheduled for vertical alveolar ridge augmentation and the remaining 19 for horizontal alveolar ridge augmentation. Early exposure of the onlay bone graft was observed in 2 patients. All the block grafts showing early exposure had to be completely removed because of infection. All the observed complications were associated with onlay bone grafts placed to increase the vertical dimension of the alveolar ridges. Thirty-eight implants ranging in length from 10 to 15 mm were placed in the area of bone augmentation. All implants inserted achieved satisfactory primary stability. Two implants failed to integrate 6 months after placement during the second stage of surgery. The failed implants were successfully replaced without any need for additional bone grafting. CONCLUSIONS The use of block allografts to treat maxillary atrophy yielded successful outcomes. Moreover, the augmentation procedure allowed the insertion of implants in the grafted area 5 months after surgery. Therefore, on the basis of this preliminary study, deep-frozen bone allograft can be considered a promising treatment for severe maxillary atrophy, with more extensive follow-up studies being needed to confirm these preliminary data.

Evaluation of the Effectiveness of Biobehavioral Therapy in the Treatment of Temporomandibular Disorders: A Literature Review

Temporomandibular disorders (TMDs) involve a heterogeneous group of clinical conditions affecting the stomatognathic system and its related structures. Because the etiology of these disorders is still unclear, a wide range of therapeutic solutions has been proposed in the literature, including occlusal appliances, physical therapies, drugs, and biobehavioral modalities. Biobehavioral therapy could have a beneficial effect in the treatment of TMDs because of the reportedly high prevalence of psychological dysfunction in TMD patients. The authors reviewed the biobehavioral modalities used to achieve pain relief in patients affected by such disorders, with the aim of synthesizing data on the effectiveness these therapeutic approaches. Literature data suggest that the inclusion of biobehavioral interventions in the management of TMDs may be reasonable, even if no conclusions can be drawn about their long-term effectiveness.

A randomized clinical trial to evaluate and compare implants placed in augmented versus non-augmented extraction sockets: 3-year results.

BACKGROUND The alveolar ridge undergoes reabsorption and atrophy subsequent to tooth removal and thus exhibits a wide range of dimensional changes. Preservation of the alveolar crest after tooth extraction is essential to enhance the surgical site before implant fixture placement. The aim of this randomized clinical study is to investigate and compare the need for additional augmentation procedures at implant insertion, as well as the success rate and marginal bone loss for implants placed in the grafted sites versus those placed in naturally healed sites. METHODS Forty patients with ≥1 hopeless tooth were randomly allocated to: 1) a test group, receiving extraction and grafting corticocancellous porcine bone; and 2) a control group, receiving extraction without any graft. After 7 months of healing, implants were inserted in each of the sites. The implants were submerged and loaded after 4 months with metal-ceramic rehabilitation. The follow-up included evaluation of implant diameter and length, the need for additional augmentation procedures at implant placement, implant failure, and marginal bone level changes. All patients were followed over a 3-year period. RESULTS One implant failed in the control group at the second stage of surgery (6 months after placement); one implant failed in the test group after 2 years of loading. The cumulative implant success rate at the 3-year follow-up visit reached 95% for both groups. No statistically significant differences were detected for marginal bone changes between the two groups. CONCLUSIONS It was concluded that implants placed into grafted extraction sockets exhibited a clinical performance similar to implants placed into non-grafted sites in terms of implant survival and marginal bone loss. However, grafted sites allowed placement of larger implants and required less augmentation procedures at implant placement when compared to naturally healed sites.

Survival Rate for Implants Placed in the Posterior Maxilla With and Without Sinus Augmentation: A Comparative Cohort Study

BACKGROUND The reduced bone height and proximity of the maxillary sinus are the most common limitations for placement of dental implants in the posterior maxilla. Reconstruction of the atrophic posterior maxilla can be performed with a sinus augmentation procedure. The aim of this cohort study is to compare the survival rate of implants placed in augmented sinus to implants placed in native bone in the posterior maxilla. METHODS This study was designed as a prospective cohort study and included consecutively treated patients. Patients who required the sinus augmentation (test group) were treated according to the two-stage technique. Patients were scheduled for follow-up evaluation at 3, 6, and 12 months after implant placement and then every 6 months for ≤ 6 years. RESULTS One hundred and five patients with 393 implants were enrolled in the study. Two hundred and one implants were placed after preliminary sinus floor grafting in 41 patients. The control group contained 64 patients with 192 implants that were placed in pristine bone of the posterior maxilla. The cumulative implant survival rates were 86.1% and 96.4%, respectively. The difference between the two groups was highly significant (P <0.005). CONCLUSIONS These findings show that implants placed in augmented sinuses had a lower survival rate compared to implants placed in pristine bone. All the implant failures in the augmented sinuses occurred before the prosthetic rehabilitation. Moreover, it should be considered that most of the failures were observed in few patients, thus suggesting cluster behavior.

Implant survival after sinus elevation with Straumann® BoneCeramic in clinical practice: ad-interim results of a prospective study at a 15-month follow-up

OBJECTIVES Elevation of the sinus floor with Straumann(®) BoneCeramic gave promising results in some recent clinical studies. However, no study has evaluated the long-term survival of implants after this surgical procedure. We are conducting a prospective, observational study to evaluate the long-term implant survival after this surgical procedure in clinical practice. We present here an ad-interim report of this study, including only patients with ≥12-month follow-up after implant placement. METHODS This prospective cohort study will last until a follow-up of 5 years will be achieved in at least 50 patients. Inclusion criteria are: age ≥18 years; presence of a maxillary partial unilateral or bilateral edentulism involving the premolar/molar areas; elective rehabilitation with oral implants; and physical capability to tolerate conventional surgical and restorative procedures. Patients are treated according to the two-stage technique and the preparation is filled with Straumann(®) BoneCeramic. Implant survival is evaluated every 3 months for the first 2 years, and then every 6 months up to 5 years. RESULTS Fifteen patients are considered in this ad-interim analysis. Mean follow-up was 14.9 ± 3.1 (range: 6-18 months). In total, three implants failed, in one single patient, 6 months after insertion. The cumulative implant survival rate was 92.5% (95% confidence interval: 83.0-100%). CONCLUSIONS This ad-interim analysis suggests that the elevation of the sinus floor with Straumann(®) BoneCeramic may be an effective clinical option over >1-year follow-up. A longer term follow-up will allow a deeper characterization of these preliminary findings.

Immediate rehabilitation of completely edentulous jaws with fixed prostheses supported by implants placed into fresh extraction sockets and in healed sites: a 4-year clinical evaluation

Purpose:To evaluate the outcome of treatment in the rehabilitation of edentulous jaws with early loaded full-arch screw-retained prostheses after up to 4 years of function. Methods:Patients with completely edentulous maxillae and/or mandibles, or presenting natural teeth with a poor or hopeless prognosis, received 6 implants each in the mandible and/or 8 in the upper jaw. All patients received a full-arch prosthetic reconstruction. Results:A total of 19 patients were treated with a total of 164 implants. One hundred nineteen implants were placed immediately after tooth extraction, and 45 implants were placed in healed sites. Overall, 8 implants failed, leading to a 4-year cumulative survival rate of 95.1%. Conclusions:The rehabilitation of the edentulous maxilla and mandible with an early loaded prosthesis represents a viable alternative treatment to classic loading protocols.

Leader genes in osteogenesis: a theoretical study

Little is still known about the molecular mechanisms involved in the process of osteogenesis. In this paper, the leader genes approach, a new bioinformatics method which has already been experimentally validated, is adopted in order to identify the genes involved in human osteogenesis. Interactions among genes are then calculated and genes are ranked according to their relative importance in this process. In total, 167 genes were identified as being involved in osteogenesis. Genes were divided into 4 groups, according to their main function in the osteogenic processes: skeletal development; cell adhesion and proliferation; ossification; and calcium ion binding. Seven genes were consistently identified as leader genes (i.e. the genes with the greatest importance in osteogenesis), while 14 were found to have slightly less importance (class B genes). It was interesting to notice that the larger part of leader and class B genes belonged to the cell adhesion and proliferation or to the ossification sub-groups. This finding suggested that these two particular sub-processes could play a more important role in osteogenesis. Moreover, among the 7 leader genes, it is interesting to notice that RUNX2, BMP2, SPARC, PTH play a direct role in bone formation, while the 3 other leader genes (VEGF, IL6, FGF2) seem to be more connected with an angiogenetic process. Twenty-nine genes have no known interactions (orphan genes). From these results, it may be possible to plan an ad hoc experimentation, for instance by microarray analyses, focused on leader, class B and orphan genes, with the aim to shed new light on the molecular mechanisms underlying osteogenesis.

Chondrocalcinosis of the temporomandibular joint: clinical considerations and case report

Abstract The calcium pyrophosphate dihydrate crystal deposition disease (CPPD) is a disorder that occasionally affects the temporomandibular joint (TMJ) and is characterized by the presence of crystals in the intra-articular and peri-articular tissues. Diagnosis of CPPD is challenging because clinical symptoms and imaging features are not characteristic and may mimic a chondrosarcoma. A case of a 74-year-old woman with CPPD of the TMJ is reported. This disease rarely involves the TMJ and is not usually considered in the differential diagnosis of temporomandibular disorders (TMD).