Emanuel Bratu

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.

The influence of remaining alveolar bone upon lateral window sinus augmentation implant survival

Background of Problems:Sinus augmentation is a predictable procedure to increase bone height in the posterior maxilla to facilitate ideal implant placement. However, the effect of residual alveolar bone height upon overall implant success remains unclear. Aims:Hence, the objective of this study was to review and evaluate the correlation between amount of remaining crest alveolar bone before sinus augmentation and implant survival rate in grafted areas. Materials:Medline search was used to identify articles published through September 2006, with preset selection criteria. Results:A total of 156 peer-reviewed publications were selected. Eighteen publications fulfilled the selection criteria. Despite the great het erogeneity found among the selected studies, we were able to group the selected articles in 2 distinct groups and show average implant survival rate in the following residual bone categories: (1) <5 mm: 96% (80%–100%); and (2) >4 mm 99% (97%–100%). Conclusion:The data reviewed from the literature suggests a higher implant survival predictability as available residual bone increases. However, prospective studies with adequate sample size and control of confounding factors are needed to validate this observation.

Implant survival rate and marginal bone loss of 6-mm short implants: a 2-year clinical report.

PURPOSE This study aimed to evaluate (1) the association between implant diameter and marginal bone loss (MBL) of short (6 mm) implants and (2) the survival rates of short implants. MATERIALS AND METHODS Thirty-three 6-mm implants were placed in the mandibles of 16 qualified patients. The selected sites had > 5 mm ridge width and < 9 mm bone height. None of the implant sites required bone augmentation procedures. All implants were uncovered 3 months after placement, and all patients were rehabilitated with 2- or 3-unit implant-supported fixed partial dentures. Standardized periapical films were taken after 24 months of function. Radiographs were digitalized, and MBL was assessed. RESULTS For all implants, the mean MBL was 0.17 mm at the point of uncovering. At the 2-year follow-up, all implants were immobile and functional. Implants with 4.2-mm diameters had significantly more MBL (1.95 mm) than wider implants (0.47 mm and 0.35 mm for 5.0-mm and 6.0-mm implants, respectively). CONCLUSION This 2-year study illustrated that short implants are a viable option in selected clinical scenarios. Short implants with wider diameters are preferred because they have less marginal implant bone loss.

Utilization of Ceramic Inlays for Sealing Implant Prostheses Screw Access Holes: A Case-Control Study.

PURPOSE The aim of this study was to evaluate, in a case control study, the esthetic and functional clinical performance of ceramic inlays used for covering the screw access hole in single monolithic lithium disilicate full-contour crowns bonded on computer-aided design/computer-aided manufacturing (CAD/CAM) prefabricated titanium abutments in order to eliminate the drawbacks of alternative restorative methods. MATERIALS AND METHODS Twenty-eight patients with missing teeth in the lateral areas (premolars and molars) received screw-retained implant restorations. In half of the restorations (n = 14), composite fillings were used to seal the access hole (control group), while the other half was sealed with ceramic inlays (test group). To determine the restoration occlusal wear, impressions were obtained after the restorations were finalized, at 1 year, and at 2 years follow-up. The casts were scanned with a 3D Scanner Design System recording the anatomical surfaces of the white model replicates. Wear amounts (μm) were calculated as the maximum loss in height of the occlusal surface. The clinical evaluation was carried out using a kit specifically designed for assessing the FDI criteria. Statistics were performed using analysis of variance (ANOVA). RESULTS A total of 58 restorations were delivered, and after 2 years of follow-up, the wear values were 228.20 ± 54.68 μm for the control group and 65.20 ± 7.24 μm for the ceramic inlay group. One-way ANOVA showed significant differences among the vertical loss between these two groups (P < .001). Clinical outcomes according to the FDI score for assessing dental restorations revealed substantial deterioration within 2 years of follow-up. CONCLUSION The use of ceramic inlays appears to be a predictable, esthetic, and successful method of sealing the screw holes of the screw-retained implant restorations.

Crestal bone remodeling around implants placed using a short drilling protocol

PURPOSE The aim of the study was to examine the influence of a short drilling protocol on peri-implant crestal bone levels. MATERIALS AND METHODS Forty implants were placed in the posterior mandibles of 20 patients. The implants (diameter, 4.2 mm; length, 10 to 11.5 mm) were inserted in pairs: one implant was inserted using the standard drilling protocol (five drills in sequence), while the other was inserted using the short drilling protocol sequence (three drills). All implants received healing abutments and were restored with single-unit restorations after 3 months of healing. Analysis of crestal bone level was based on radiographs taken at insertion and at 3, 6, and 12 months after insertion. The results were analyzed using software Image J 1.46r (National Institutes of Health). Crestal bone level was measured in millimeters at the distal aspect of each implant. RESULTS None of the implants in either group was lost during the 12-month follow-up period, and all patients completed the follow-up examination. The drilling time for the insertion of one implant with the short drilling protocol was 1.03 ± 3.63 minutes compared to 1.57 ± 2.88 minutes for the standard protocol. The mean values of crestal bone loss at 12 months were 0.94 ± 0.43 mm for implants placed using the standard protocol and 0.90 ± 0.33 mm for implants placed using the short drilling protocol. No statistically significant differences were noted. CONCLUSION Using the short drilling protocol reduced the surgery time by approximately 50% and did not affect crestal bone remodeling during the first year postinsertion.

Maintaining Tissue Architecture in Immediate ImplantPlacement Following Extraction of Natural Teeth UsingCustom Healing Screw

The aim of this study was to compare the conventional healing screw with custom healing screw in terms of maintenance of soft tissue architecture. Twenty-four patients who underwent single tooth extraction and single immediate implant placement were included in the study. Twelve patients were treated with conventional healing screw after immediate implant placement (control group) and 12 were treated with screwretained custom healing screw (test group). After minimally traumatic tooth extraction, a temporary abutment was fabricated utilizing flowable composite, which adapted to the socket architecture, to serve as a customized healing screw. In order to evaluate soft tissue remodeling in all cases, digital impressions were made before tooth extraction, at implant insertion, at 6 months after insertion, and after placement of the final restorations. After 6 months of the Osseo integrated period, the custom healing screw served successfully as a tooth profile for peri-implant tissue. In cases of implants with conventional healing screw, soft tissue remodeling around the implants is observed, in contrast to cases of custom healing abutments. Correct design of a healing abutment is important for maintaining the emergence contour in cases of immediate implant placement. In our study, a considerable difference was observed between the standard healing screw and customized healing screw. The selection between provisional restoration and customized healing abutment is only based on esthetic considerations.