Carlo Barausse

Posterior atrophic mandible rehabilitation with onlay allograft created with CAD-CAM procedure: a case report.

Aim:Implant rehabilitation of the atrophic right posterior mandible in a 48-year-old woman using dehydrated homologous bone block, shaped with a computer aided design-computer aided manufacturing (CAD-CAM) system, to avoid harvesting of autologous bone block and to assure a perfect fitting of the block above the alveolar crest. Results:After 7 months, 6.09, 7.36, and 8.08 mm (mean, 7.18 mm) of total horizontal bone gain was observed at sites 6, 12, and 18 mm posterior to the right mental foramen, respectively. Conclusions:The use of a bone block with CAD-CAM system for alveolar ridge augmentation is a valuable alternative to autograft because it reduces time, cost, and complications for the patients. Data from a computerized tomographic scan can be used to shape a precise 3-dimensional homogolous bone block using a CAD-CAM system.

Guided "Sandwich" Technique: A Novel Surgical Approach for Safe Osteotomies in the Treatment of Vertical Bone Defects in the Posterior Atrophic Mandible: A Case Report

Purpose:A novel technique to perform safe osteotomies during inlay block regenerative procedures in the posterior atrophic mandible is described. Material and Methods:A 52-year-old male patient with vertical atrophy of the left posterior mandible was treated adopting an inlay block “sandwich” technique using an allogenic cancelous block and a mixture of mineralized and demineralized human bone allograft in putty form as graft. The horizontal osteotomy for the lifting of the osteotomized bone segment was performed using a template prepared from a virtual anatomical replica of the patients mandible obtained from cone beam computed tomography data. In the second surgical phase, 3 months after the augmentation, 2 implants were easily placed. Results:The horizontal osteotomy was carried out, with no risk, very close to the nerve structures after the precise osteotomy line established preoperatively on the three-dimensional computed tomography (3D-CT) virtual reconstruction. No neurological complications were observed in the first days after the procedure, and no subsequent problems were recorded during the 3-month healing period. Conclusion:Radiographic evaluations and complication-free clinical healing demonstrate the effectiveness of this technique to obtain safe and precise osteotomies.

The modified "sandwich" technique: a novel surgical approach to regenerative treatment of horizontal bone defects in the posterior atrophic mandible. A case report.

Purpose:A new augmentation procedure for bone reconstruction of horizontal defects in a posterior atrophic mandible is described. Materials and Methods:A 47-year-old male patient with horizontal atrophy of the left posterior mandible was treated using a 2-stage modified “sandwich” osteotomy technique with an interposed mixture of mineralized and demineralized human bone allograft in putty form. Results:The osteotomized superior segment was slightly raised and then drawn and rotated in the buccal direction to augment the horizontal width of the crest. The osteotomized segment was kept in this position with a titanium miniplate and miniscrews. No complications were reported during the 3-month healing period. In the second surgical phase, 2 implants were correctly placed. Conclusions:Cone beam computed tomography (CBCT) outcomes confirm the effectiveness of this technique in the treatment of horizontal defects. However, further randomized controlled studies are required to confirm the techniques reliability.

Interpositional Augmentation Technique in the Treatment of Posterior Mandibular Atrophies: A Retrospective Study Comparing 129 Autogenous and Heterologous Bone Blocks with 2 to 7 Years Follow-Up

The aim of this retrospective study was to compare clinical and radiographic outcomes of the interpositional (inlay) augmentation technique in atrophic posterior partially edentulous mandibles using three different types of block bone grafts: autogenous bone block harvested from the iliac crest, deproteinized bovine bone mineral block, and collagenated equine bone block. A total of 115 patients were included with a 4.2-year mean after-loading follow-up. Data seem to suggest that heterologous bone blocks are similar in results to autogenous bone blocks, so they might be considered preferable as they avoid invasive harvesting surgeries.

Clinical Relevance of Bone Density Values from CT Related to Dental Implant Stability: A Retrospective Study

Purpose The majority of the techniques used to assess the primary implant stability are subjective and empirical and can be used during or after the surgery. The aim of this study is to evaluate the bone density prior to surgery, in order to give recommendations to the clinician about the best surgical technique and the type of implant which is needed. Materials and Methods A surgeon operated on 75 patients for 269 implants over the period 2010–2014. He required a CT to plan the surgery and he documented the type, the diameters, and the lengths of the implants, the insertion torque, and the ISQ values. At a later stage another clinician measured bone density and cortical thickness. We endeavoured to get the most accurate superimposition between the implants placed by the surgeon and those placed by the clinician. Results In maxilla ISQ showed a significant positive correlation with HU values detected for coronal-buccal (r = 0.302; p = 0.020) and middle-lingual (r = 0.295; p = 0.023). Torque showed a positive correlation with cortical bone thickness at the middle of the ridge (ρ = 0.196; p = 0.032). Conclusion It is important to take into consideration the Hounsfield Units and the cortical thickness as predictive parameters during the preoperative assessment, with regard to the choice of the implant type as well as the surgical technique.

A Minimally Invasive Approach Using a 4-mm Implant Without Extraction of Impacted Maxillary Canine: Four-Year Postloading Results

The aim of this case report was to suggest an alternative minimally invasive surgical approach to an impacted maxillary canine using a 4-mm-long implant for a fixed prosthetic rehabilitation, avoiding tooth extraction or surgically forced extrusion and exploiting the 6 mm of coronal bone availability. At 4 years postloading, the implant was healthy and well integrated with stable marginal bone levels. The 4-mm length of the implant reduced operative times, postsurgical morbidity, possible complications, and costs. Short implants might be an alternative to traditional, more invasive surgical procedures used in the rehabilitative treatment of impacted maxillary canines.

Rehabilitation of the atrophic posterior mandible with short (4-mm) implants: a case report.

This case report describes a successful implant-prosthetic rehabilitation of an atrophic posterior mandible with 4-mm-long implants. The patient refused to undergo any reconstructive surgery, and because the available bone up to the inferior alveolar nerve was only 5 mm or less, the patient received four implants of 4-mm length. Four months after implant placement, a provisional prosthesis was put in place; after another 4 months, this was then in turn replaced with a definitive prosthesis. The use of such short implants allows a fixed prosthetic solution without the need for vertically augmenting the mandibular bone. This procedure considerably reduces intra- and postoperative patient discomfort compared with reconstructive surgery for the placement of longer implants. The follow-up time was 1 year after implant loading.