Giuseppe Daprile

Buccal bone plate in the immediately placed and restored maxillary single implant: a 7-year retrospective study using computed tomography.

Aim: The aim of this retrospective study is to assess the long-term buccal bone plate changes in cases of single implants in the maxillary aesthetic area placed and restored immediately after extraction. Material and Methods: A private practices database was reviewed to find patients who had a standard computed tomography (CT) scan taken no more than 24 hours after insertion of a single, immediately restored, postextractive implant in the anterior maxilla. After a minimum period of 7 years, a cone beam computed tomography (CBCT) was performed. Buccal bone plate measurements were performed on CT and CBCT Dicom images and in vivo records. Results: Two thousand nine hundred eighty patient records were scanned. Sixteen of them met the primary inclusion criteria. Three CTs were excluded because of poor imaging. Thirteen patients were then eligible to be recalled and 12 of them agreed to a follow-up. One implant failed due to severe periimplantitis. The resulting 11 patients were scanned by CBCT. Vertical mean resorption of 0.5 mm at buccal aspect and an average of 0.9-mm thick buccal bone plate was revealed. In 2 patients (18.18%), the bone peak resorbed under the level of the implant shoulder. Conclusion: The buccal bone plate of single implants placed and restored immediately after tooth extraction in the maxillary aesthetic areas was subjected to a moderate vertical and horizontal reabsorption 7 years after surgery. If a careful selection of the patient and strict clinical protocol are observed, the immediate placement of a single implant in a fresh extraction socket and its immediate restoration do not compromise the preservation of the buccal bone plate.

Primary Stability Determination by Means of Insertion Torque and RFA in a Sample of 4,135 Implants

OBJECTIVES The aims of the present study are to evaluate the primary stability of a sample of 4,135 implants and to investigate the correlations between primary stability and mechanical characteristic of the implant and bone density at insertion time. MATERIAL AND METHODS The study was conducted from March 2002 to January 2009 at a private practice in Bologna (Italy). Patients were eligible for the study if they needed the insertion of single or multiple implants. Bone density, length, and diameter of each implant were recorded. During surgery for each implant, peak insertion torque (IT) was recorded; the resonance frequency analysis (RFA) values were also collected. Finally, it was recorded whether an implant was lost or removed at an early stage (within 6months from insertion surgery). RESULTS A total of 1,045 consecutive patients were included in the study. A total of 4,135 of implants were inserted. The sample presented 1,184 implants inserted in a postextractive site. The mean peak IT was 34.82±19.36. The mean RFA was 71.57±10.63 implant stability quotient. Spearman correlation analysis shows the presence of a weak positive correlation between IT and RFA. The statistical analysis shows a relevant dependency between IT and bone quality and a very weak dependency between RFA and bone quality. Again, the statistical analysis shows a quite weak correlation between length or diameter and IT, but it shows a relevant correlation between length and RFA. Postextractive implants presented a higher mean IT and a lower RFA compared with implants inserted in healed sites. Twenty-eight (0.7%) implants were considered to have failed and removed within 6months. CONCLUSIONS The results show that the implants studied obtain a good primary stability with a standard protocol. The IT and RFA appear as two independent features of primary stability. Data show that only IT is influenced by bone density as well as only RFA is correlated to the length of implants used. Finally, it is possible to obtain a good primary stability also in postextractive sites.

Mandibular third molar removal in young patients: an evaluation of 2 different flap designs.

PURPOSE To evaluate the influence of 2 different flap designs on periodontal healing and postoperative complications, after inferior third molar removal in young patients. PATIENTS AND METHODS Twenty-four mandibular third molars were extracted from 12 patients with an average age of 16 years. Patients were included in the study when radiographs at the time of surgery showed that only the crown of the germ was formed. Each patient underwent 2 extractions, using a triangular flap on one side and an envelope flap on the other. Periodontal probing was recorded at the preoperative visit, and 7 days, 3 months, and 6 months after extraction. Postoperative complications were recorded using a questionnaire completed by the patient for the week after the extraction. RESULTS The examination performed 7 days after the extraction demonstrated a deeper probing depth in all teeth examined. This increase was statistically greater (P < .05) for the first and second molars when an envelope flap was used. After 3 months, the probing depths returned to preoperative values. No significant differences were seen between the 2 flap designs when postoperative complications were considered. The average operating time was 30.66 minutes with the triangular flap, versus 35.66 minutes with the envelope flap. This difference was not significant. After 6 months, the 2 flap designs resulted in no difference in periodontal healing or complications, but 30% of the surgical extractions resulted in a debilitating postoperative period for the patients treated. CONCLUSIONS Although we observed statistically significant differences in probing depth between triangular and envelope flaps 7 days after the extraction of third molars with no root development, this was not important from a clinical perspective, because periodontal healing at 3 and 6 months was comparable. We believe that this is also the case with the extraction of third molars with fully formed roots. Another important finding was the presence of a debilitating postoperative period in most of the patients who underwent extraction, contrary to the beliefs of many surgeons.

Buccal bone plate in immediately placed and restored implant with Bio‐Oss® collagen graft: a 1‐year follow‐up study

OBJECTIVES The aim of this study was to radiographically assess the vertical and horizontal alterations of buccal alveolar bone after the insertion of a post-extractive implant using Bio-Oss(®) Collagen graft. MATERIAL AND METHODS The study was designed as a prospective study. Adult patients were eligible for the study if they needed one or more immediately inserted and immediately restored implant replacing teeth to be extracted within region 15-25. After the insertion, the buccal gap was carefully grafted using Bio-Oss(®) Collagen and the implant immediately restored. Cone-Beam Computed Tomography (CBCT) was performed immediately after surgery and a series of measurements were made to determine the dimension of the buccal bone plate and the void between implant and extraction socket. A second CBCT was taken and the measurements repeated after 12 months. RESULTS Altogether, 69 patients were included in the study; a total of 69 implants were inserted. The study demonstrated that the extraction of a tooth and the immediate insertion of an implant together with an xenograft resulted in alterations of the vertical and horizontal dimension of the buccal bone plate (respectively, 25.6% and 29.3%). Nevertheless, the vertical and horizontal gap reduction was nearly complete (respectively, 99.3% and 99.1%) and the implant was normally in contact with buccal bone. CONCLUSIONS Implant placement into extraction sockets can result in favorable radiological results even in the presence of evident alterations of the buccal bone wall.

RFA Values of Implants Placed in Sinus Grafted and Nongrafted Sites after 6 and 12 Months

BACKGROUND Maxillary sinus floor elevation surgery is widely used as a preimplantology method to permit implant insertion. Nevertheless, very few data are available about long-term stability of dental implants inserted in grafted sites. PURPOSE The aims of the present study were to evaluate the evolution of resonance frequency analysis (RFA) values at 6 and 12 months from the implant insertion in sinus grafted sites and nongrafted sites. MATERIALS AND METHODS In 14 patients, 80 Xive implants (Dentsply Friadent GmbH, Mannheim, Germany) were inserted. Sixty-three implants were inserted in a site previously treated with a sinus lift; 17 implants were inserted in healed or postextraction sites. For each implant diameter, length, bone density, insertion torque, and percentage of implant fixed to a nongrafted bone were recorded. RFA values at implant insertion after 6 and 12 months were recorded. RESULTS After 6 and 12 months, grafted sites showed higher RFA values than the control sites; after 12 months, the difference was statistically significant (.007). A statistically significant positive correlation was found between resonance frequency values and bone quality after 12 months (.05). No statistically significant correlation between RFA values and all the other variables considered was found. CONCLUSIONS Sites treated with sinus lift can offer good long-term stability. After 6 and 12 months, the geometric characteristics of the implant are no longer important to obtain high RFA values, and the bone-implant interface seems to be determinant.

Implants Inserted with Low Insertion Torque Values for Intraoral Welded Full-Arch Prosthesis: 1-Year Follow-Up

OBJECTIVES The aim of the present study is to evaluate the osteointegration and crestal bone remodeling after 1 year around implants for intraoral welded immediate full-arch prosthesis inserted with low insertion torque (IT) values. MATERIAL AND METHODS The study was conducted from June 2008 to September 2010. Patients were eligible for the study if they needed an immediate intraoral welded implant-supported full-arch fixed prosthesis and received three or more implants with an IT ≤ 20 Ncm and two or more implants with IT ≥ 25 and ≤ 50. For each implant, peak IT was recorded during insertion surgery; periapical x-rays were taken at the time of surgery and again after 12 months. Finally, it was recorded whether an implant was lost or removed (within 12 months from insertion surgery). RESULTS Thirteen patients were included in the study; the prosthesis presented the following number of implants: nine with six implants and four with seven implants. A totand al of 82 implants were inserted: 51 implants presented an IT ≤ 20 Ncm (test group), 31 implants presented an IT ≥ 25 and ≤ 50 Ncm (control group). Each prosthesis presented at least three test implants and two control implants. The survival rate after 1 year was 98% for the test and 100% for the control group. The mean distance between the fixture-abutment junction and the bone crest was 0.1 ± 0.8 mm for test and 0.2 ± 0.5 mm for control group at implant insertion. After 12 months, it was 0.7 ± 0.9 mm for test group and 0.8 ± 0.6 mm for control group. The differences were not statistically significant. CONCLUSIONS Within the limitations of this study, the results suggested that rigid framework splinting can be a viable technique to improve success rate of implants with low primary stability using immediate loading protocols for full-arch prosthesis.

Influence of Underpreparation on Primary Stability of Implants Inserted in Poor Quality Bone Sites: An In Vitro Study

PURPOSE The purpose of this present study was to investigate the relation between implant site underpreparation and primary stability in the presence of poor-quality bone. MATERIALS AND METHODS A study was performed on fresh humid bovine bone; samples presented no cortical layer with a cancellous structure inside and were obtained from the hip. The bones were firmly attached to a base device. Sixty sites were prepared according to the protocol provided by the manufacturer: a 2-mm pilot drill was introduced to the proper depth and then twist drills of 3 and 3.4 mm were used. After site preparation, 20 3.4- × 11-mm (standard protocol group), 20 3.8- × 11-mm (10% undersized group), and 20 4.5- × 11-mm (25% undersized group) implants were inserted at a calibrated maximum torque of 70 N-cm at the predetermined speed of 30 rpm. After implant insertion, variable torque work (VTW), maximum insertion torque (peak IT), and resonance frequency analysis (RFA) values were recorded. RESULTS The standard protocol group showed a mean VTW of 565.77 ± 219.12 N-cm, a peak IT of 11.3 ± 4.44 N-cm, and an RFA of 69.35 ± 7.35 implant stability quotient (ISQ). The 10% undersized group showed a mean VTW of 1,240.24 ± 407.78 N-cm, a peak IT of 20.26 ± 7.03 N-cm, and an RFA of 73.40 ± 2.33 ISQ. The 25% undersized group showed a mean VTW of 1,254.96 ± 727.49 N-cm, a peak IT of 17.15 ± 10.39 N-cm, and an RFA of 72.30 ± 6.70 ISQ. For VTW, the difference between the standard and undersized protocol values was statistically significant; for peak IT, the difference between the standard and 10% undersized protocol values was statistically significant; no other statistical differences were found between mean values. CONCLUSIONS In the presence of poor-bone quality, a 10% undersized protocol is sufficient to improve the primary stability of the implant; additional decreases do not seem to enhance primary stability values.

Development of a new implant primary stability parameter: insertion torque revisited.

PURPOSE The aims of the study are to introduce a new parameter to measure primary stability and to evaluate the possible correlations between this parameter and bone density, initial bone-to-implant contact (IBIC), Resonance Frequency Analysis (RFA), and peak insertion torque (IT). MATERIAL AND METHODS The study was performed on three different types of fresh humid bovine bone: type I, type II, and type III. A total of 90 XiVE implants (30 per bone type) were used; implant insertion was performed with a calibrated maximum torque of 70 Ncm at predetermined 30 rpm. The IT data were recorded and exported as a curve; using a trapezoidal integration technique, the area underlying the curve was calculated: this area represents the variable torque work (VTW). Furthermore, peak IT and RFA were recorded; finally IBIC was calculated from histological specimens. RESULTS Spearman correlation analysis of the entire sample reveals that VTW presents a significant (p < .01) positive correlation with bone density; a significant (p < .05) positive correlation with IBIC, and a significant (p < .01) positive correlation with all the other primary stability parameters. Spearman correlation analysis of the three different groups show that VTW presents a significant positive correlation with IT in all three types of bone; on the other hand, VTW shows a negative not significant correlation with RFA in bone I, a positive significant correlation in bone II, and a positive not significant correlation in bone III. Furthermore, VTW shows a negative significant correlation with IBIC in bone I and a positive significant correlation in bone II and III. CONCLUSIONS Within the limitations of an in vitro study, the VTW seems to be a promising parameter to measure implant primary stability.

Primary stability determination of implants inserted in sinus augmented sites: 1-step versus 2-step procedure.

Objectives:The aim of this study was to evaluate the primary stability of implants placed immediately after a sinus lift, compared with implants placed in the area treated with a sinus lift 6 months before. Material and Methods:Patients with a residual bone height of at least 4 mm were treated with a 1-stage procedure (group A) and patients with a residual bone height < 4 mm with a 2-stage approach (group B). Sinus lift was always performed with 50% autogenous bone and 50% deproteinized bovine bone mineral. Data recorded included maximum insertion torque (IT), resonance frequency analysis (RFA) values, and bone density, length, and diameter. It was recorded whether an implant was removed within 6 months after insertion. Results:Fourteen patients were included in group A and 16 patients in group B; 96 implants were inserted. Mean IT was 23.77 ± 12.63 N·cm in group A and 26.48 ± 20.80 N·cm in group B. Mean RFA was 65.25 ± 4.45 implant stability quotient (ISQ) in group A and 67.92 ± 10.99 ISQ in group B. No statistically significant differences were found. All implants were osseointegrated. Conclusions:The results show that the implants studied can obtain a sufficient primary stability in both clinical situations without statistically significant differences.

Immediate provisionalization of implants placed in fresh extraction sockets using a definitive abutment: the chamber concept.

The purpose of this case series is to present radiographic results of implants immediately placed and restored with a definitive abutment and followed for 18 months. Ten patients who required extraction of the maxillary central or lateral incisor were treated with immediate extraction, implant placement, and provisionalization. Hard tissue measurements were performed using cone beam computed tomography. At follow-up, the mean buccal horizontal gap was -0.21 ± 0.3 mm. The mean vertical gap was 0.15 ± 0.23 mm. The mean distance between the bone crest and implant bevel was 1.73 ± 0.17 mm. The favorable results are related to a three-dimensional biologic space created around the abutment called the chamber.