Giovanni Franceschetti

Ridge dimensions of the edentulous posterior maxilla: a retrospective analysis of a cohort of 127 patients using computerized tomography data

OBJECTIVES to evaluate the edentulous ridge dimensions of maxillary posterior sextants with a tridimensional radiographic technique. The influence of the presence/absence of teeth adjacent to the edentulous site on the dimensions of the edentulous ridge was also evaluated. MATERIAL AND METHODS computerized tomography (CT) scans of 127 patients (65 males and 62 females; mean age: 55.2 ± 10.1 years) with at least one missing tooth in the maxillary posterior sextants were analyzed. On CT cross sections, bone height (BH), bone width (BW) at 1, 3, and 7 mm from the most coronal point of the alveolar crest (BW(1 mm) , BW(3 mm) , and BW(7 mm) , respectively) and the relative vertical ridge position (rVRP) were assessed at the first premolar, second premolar, first molar and second molar edentulous sites. RESULTS the results of the study indicate that (i) the maxillary sinus was radiographically evident in about 50% of first premolar sites and 90-100% of second premolar and molar sites; (ii) BH showed a significant decrease from first premolar to molar sites; (iii) BW(1 mm) was higher at second molar site compared with the first and second premolar sites, BW(3 mm) and BW(7 mm) were higher at each molar site compared with each premolar site; (iv) the proportion of sites with BH ≥ 8mm and BWI mm ≥ 6mm was 28.3%, 18.4%, 8.0% and 18.2% [corrected] at first premolar, second premolar, first molar and second molar sites, respectively. The absence of teeth adjacent to the edentulous site negatively affected rVRP, but not BH and BW. CONCLUSIONS The results of the study indicate that at premolar and molar sites, [corrected] the dimensions of the alveolar crest may call for bone augmentation procedures for proper implant placement in a substantial amount of edentulous patients. When both mesial and distal tooth adjacent to the edentulous site are absent, the placement of implants of adequate dimensions may be more challenging due to a more apical position of the alveolar ridge compared with sites where both adjacent teeth are present.

Alveolar ridge dimensions in maxillary posterior sextants: a retrospective comparative study of dentate and edentulous sites using computerized tomography data

AIM To compare the alveolar ridge dimensions between edentulous sites and contralateral dentate sites of maxillary posterior sextants in the same individuals. MATERIALS AND METHODS Computerized tomography scans of 32 patients with one fully edentulous and one fully dentate maxillary posterior sextants were analyzed. RESULTS When compared with dentate sextants, edentulous sextants showed (i) a lower bone height (BH) at second premolar, first molar and second molar sites, which was associated with a more coronal position of the maxillary sinus floor at second premolar site; (ii) a more apical position of the ridge at second premolar and second molar sites; (iii) a lower bone width (BW)(1 mm) at first and second premolar sites, and a lower BW(3 mm) at all sites, (iv) a lower, although not significant, prevalence of premolar and molar sites with BH ≥8 mm and BW(1 mm) ≥6 mm. CONCLUSIONS The edentulous sextants in the posterior maxilla showed a reduced height and width of the ridge when compared with contralateral dentate sextants. The reduced vertical dimensions observed in edentulous sextants were variably associated with ridge resorption as well as sinus pneumatization.

Adjunctive effect of chlorhexidine in ultrasonic instrumentation of aggressive periodontitis patients: a pilot study

AIM The aim of the present pilot randomized clinical trial was to evaluate the effects of ultrasonic mechanical instrumentation (UMI) associated with the professional use of chlorhexidine (CHX) formulations compared with UMI alone during periodontal supportive therapy in patients with generalized aggressive periodontis (G-AgP). MATERIAL AND METHODS Nine patients (test group) received a single session of UMI associated with subgingival irrigation under cavitation with CHX 0.02%. A 0.2% CHX solution was used for professional tongue brushing and mouthrinsing. Ten patients (control group) received a similar session of UMI associated with subgingival irrigation and professional tongue brushing and mouthrinsing with a control formulation. Clinical and microbiological parameters were assessed pre-treatment at 3, 6 and 12 weeks post-treatment. RESULTS UMI either with or without additional CHX use determined a significant reduction of supragingival plaque and gingival inflammation as well as a significant reduction of subgingival bacterial pathogens. The additional use of CHX did not result in any additional clinical and microbiological benefit with respect to mere UMI. CONCLUSIONS The adjunctive professional use of CHX formulations to UMI seems to produce no additional effects over UMI alone during supportive therapy in G-AgP patients.

Transcrestal Sinus Floor Elevation With a Minimally Invasive Technique

BACKGROUND Recently, we proposed a minimally invasive technique to limit the postoperative morbidity of transcrestal sinus floor elevation procedures. The technique is based on the use of specially designed drills and osteotomes. The purpose of the present study is to present data on the clinical outcomes and postoperative morbidity of sinus floor elevation procedures performed using the proposed technique. METHODS Fourteen implants were placed in the posterior portions of the maxilla areas of 11 patients using the proposed technique. Postoperative pain and discomfort were assessed using a 100-mm visual analog scale (VAS). The incidences of intra- and postoperative complications were recorded. The position of the grafted sinus floor with respect to the implant apex was assessed on periapical radiographs 6 months post-surgery. RESULTS The augmented sites had a presurgery residual bone height of 6.1 mm, whereas the mean length of the implants inserted in augmented sites was 10.3 +/- 0.9 mm. Immediately after surgery, VAS scores for pain and discomfort were 9.4 +/- 13.4 and 17.0 +/- 22.2, respectively. The 7-day VAS score for pain was 2.1 +/- 4.9. No complications were observed during or after the surgical procedure. Six months after surgery, a newly formed mineralized tissue was found at or beyond the level of the implant apex in all cases. CONCLUSION The proposed technique represents a suitable option to elevate the sinus floor due to a predictable displacement of the sinus floor and a limited post-operative morbidity.

Minimally invasive transcrestal sinus floor elevation with deproteinized bovine bone or β‐tricalcium phosphate: a multicenter, double‐blind, randomized, controlled clinical trial

AIMS To evaluate the outcomes of transcrestal sinus floor elevation (tSFE) performed with a minimally invasive procedure (Smart Lift technique) combined with the additional use of deproteinized bovine bone mineral (DBBM) or β-tricalcium phosphate (β-TCP). METHODS In a multicenter randomized controlled trial, 38 sites in 38 patients were treated with the Smart Lift technique in association with DBBM (n = 19) or β-TCP (n = 19). The extent of the sinus lift (SL) and the height of the graft apical to the implant apex (aGH) were assessed on periapical radiographs taken immediately after surgery and at 6 months following surgery. RESULTS (i) Substantial aGH and SL were observed immediately after surgery and at 6 months, with no significant differences between DBBM and β-TCP groups; (ii) a significant graft remodelling was observed from post-surgery to 6-months in the β-TCP group and (iii) limited incidence of complications as well as limited post-operative pain and discomfort were associated with the use of both graft materials. CONCLUSIONS The Smart Lift technique in conjunction with the additional use of either DBBM or β-TCP may provide a substantial elevation of the maxillary sinus floor along with limited post-surgical complications and post-operative pain/discomfort.

Incremental, transcrestal sinus floor elevation with a minimally invasive technique in the rehabilitation of severe maxillary atrophy. Clinical and histological findings from a proof-of-concept case series.

In the posterior maxillary sextants, the residual dimensions of the edentulous ridge can considerably limit the insertion of implants with the desired length and diameter. A minimally invasive procedure for transcrestal sinus floor elevation (tSFE), namely the Smart Lift technique, which is based on a standardized sequence of specifically designed drills and osteotomes, was introduced in 2008 and subsequently validated in a series of recent studies. The present technical note describes the use of the technique by a staged approach, called incremental tSFE (i-tSFE), in the augmentation of severely resorbed edentulous ridges. The i-tSFE consists of 2 staged tSFE procedures performed with a transcrestal access, the second of which is performed concomitantly with implant placement. In the present case series, 3 patients with severe bone atrophy (residual bone height, 2 to 3 mm) in the edentulous posterior maxilla were treated with i-tSFE. At the second surgical stage of i-tSFE, implants at least 8 mm long were placed at all sites, and the success of the implant-supported restoration was monitored to 6 months (1 patient) or 3 years (2 patients). Histologic findings from an augmented site showed the presence of newly formed bone, bone marrow spaces with numerous vascular canals, and residual graft particles occupying approximately 50%, 15%, and 35% of the total area, respectively. The results of the study showed that i-tSFE can be performed successfully with the Smart Lift technique to rehabilitate atrophic maxillary posterior sextants.

Learning Curve of a Minimally Invasive Technique for Transcrestal Sinus Floor Elevation: A Split-Group Analysis in a Prospective Case Series With Multiple Clinicians.

Aims:To assess the learning curve of a minimally invasive procedure for maxillary sinus floor elevation with a transcrestal approach (tSFE) and evaluate the influence of clinicians experience in implant surgery on its outcomes. Materials and Methods:Patients were treated by clinicians with different levels of experience in implant surgery and inexperienced with respect to the investigated tSFE technique. The initial (n = 13) and final (n = 13) groups treated by the expert clinician were compared for tSFE outcomes. Additionally, the high, moderate, and low groups (n = 20 each) treated by the expert, moderately experienced, and low experienced clinician, respectively, were compared. Results:(1) No significant differences in clinical and radiographic outcomes were observed between initial and final groups; (2) high, moderate, and low groups showed substantial vertical augmentation in limited operation time with treatment outcomes being influenced by the level of experience in implant surgery. Conclusions:The investigated technique allows for a substantial vertical augmentation at limited operation times when used by different clinicians. The extent of sinus lift (as radiographically assessed) seems to be influenced by the clinicians level of experience in implant dentistry.

Morbidity following transcrestal and lateral sinus floor elevation: A randomized trial

Abstract Aim To comparatively evaluate the morbidity following maxillary sinus floor elevation according to either transcrestal (tSFE) or lateral (lSFE) approach with concomitant implant placement. Materials & Methods Patients with ≥1 edentulous maxillary posterior site with residual bone height (RBH) of 3–6 mm were enrolled. tSFE was performed in association with a xenograft and a collagen matrix. For lSFE, the sinus was grafted with the xenograft, and the antrostomy was covered with a membrane. Implants were inserted concomitantly. The postoperative course was assessed through questionnaires. Pain level (VAS pain) was recorded using a 100‐mm visual analogue scale. Results Twenty‐nine and 28 patients were included in tSFE and lSFE group, respectively. On the day of surgery, VAS pain was significantly higher for tSFE compared to lSFE, and similar from day 1 to 14. tSFE was characterized by significantly lower incidence of swelling, bruising and nasal discharge/bleeding. Significantly less severe limitation in swallowing, continuing daily activities, eating, speaking, opening the mouth and going to school/work was found for tSFE only at specific postsurgery intervals. Conclusions lSFE was associated with lower pain on the day of surgery, and tSFE revealed lower postoperative morbidity as well as more tolerable postoperative course.