Liran Levin

Surgical success of intraoral autogenous block onlay bone grafting for alveolar ridge augmentation.

This article evaluates the surgical success of alveolar bone augmentation using intraoral block bone graft prior to dental implantation and measures the amount of bone accumulation using this technique. A consecutive retrospective study was conducted on patients who had onlay bone grafts from 1999 to 2001. Files of 56 healthy patients reporting 64 bone graft operations were reviewed. Medical history, smoking status, area of surgery, bone origin (donor sites) and complications were recorded. Panoramic and tomographic radiographs were measured for the vertical and horizontal bone addition and mesiodistal dimension of the graft. Graft exposure or/and graft removal were defined as failure; hematoma, swelling, inflammation, or temporary paresthesia were defined as complications. The average vertical addition was 5.6 mm measured from the bottom of the vertical lesion before bone grafting tothe top of the graft. The average faciolingual addition was 3.8 mm. The mesiodistal graft length ranged from 4 mm to 67 mm (average 15.2 mm). According to our criteria, 56 (87.5%) of the 64 bone grafts were successful, 46 (71.9%) were totally uneventful, and 10 (15.6%) had complications. Smoking and diabetes were associated with a high rate of complications and graft failure. More complications were observed in the vertical than in the horizontal bone grafts. Intraoral bone block graft is a predictable operation with high success rates that provides faciolingual and vertical bone addition. Onlay bone grafting has a low rate of complications and failures. Intraoral bone graft should not be recommended for diabetic patients and smokers.

Smoking, diabetes mellitus, periodontitis, and supportive periodontal treatment as factors associated with dental implant survival: a long-term retrospective evaluation of patients followed for up to 10 years.

Objectives:To evaluate the factors associated with long-term implant survival in a large cohort of patients in regular follow-up until data collection. Methods:The study population consisted of 475 patients who were referred to a private clinic limited to Periodontics and Implantology between November 1995 and July 2006. Data were collected from patient files with regards to smoking habits, periodontal condition, diabetes mellitus, implant survival, and time when implant failure occurred. Patients were divided into those who participated in a supportive periodontal program in the clinic and those who only attended the annual free-of-charge implant examination. Results:A total of 1626 implants were placed with a follow-up ranging from 1 to 114 months (average 30.82 ± 28.26 months). Overall, 77 (4.7%) implants were lost in 58 (12.2%) patients after a mean period of 24.71 ± 25.84 months. More than one-half of the patients (246; 51.7%) participated in a structured supportive periodontal program in the clinic, and 229 (48.3%) only attended to the annual free-of-charge implant examination. Smoking and attendance in a regular supportive periodontal program were statistically associated with implant survival. Patients with (treated) moderate-to-advanced chronic periodontal disease demonstrated higher implant failure rates but, this difference did not reach statistical significance. Diabetes mellitus was not related to implant survival in this patient cohort. Conclusions:Smoking and attendance in a regular supportive periodontal program were found to be strongly related to implant survival. Special attention should be given to continuous periodontal supportive programs to implant patients.

The effect of cigarette smoking on dental implants and related surgery.

Cigarette smoking is still considered a common habit. Of smokers, increased plaque accumulation, higher incidence of gingivitis and periodontitis, higher rate of tooth loss, and increased resorption of the alveolar ridge have been found in the oral cavity. Cigarette smoking may adversely affect wound healing, and, thus, jeopardize the success of bone grafting and dental implantation. Bone grafts and sinus lift operations are both common and well-documented procedures before dental implant placement. Heat as well as toxic by-products of cigarette smoking, such as nicotine, carbon monoxide, and hydrogen cyanide, have been implicated as risk factors for impaired healing, and, thus, may affect the success and complications of those surgical procedures. An association among dental implants, grafting procedures (i.e., bone grafts, maxillary sinuses augmentation), and history of smoking has been reported. A higher degree of complication, or implant failure rates, were found in smokers with and without bone grafts. The relationship between cigarette smoking and implant-related surgical procedures, including the incidence of complications associated with these procedures, will be described and discussed based on relevant literature and results of our recent studies.

Gingival recession in young adults: Occurrence, severity, and relationship to past orthodontic treatment and oral piercing

INTRODUCTIONnGingival recession can be localized or generalized and associated with at least 1 tooth surface. As a result, gingival recession leads to root surface exposure, often causing esthetic impairment, fear of tooth loss, increased susceptibility for root caries, and dentin hypersensitivity. The prevalence, extent, and severity of gingival recession in a young adult Israeli population were evaluated, and the relationship between orthodontic therapy and other potential risk indicators and gingival recession was assessed.nnnMETHODSnOur cohort included 303 consecutive healthy patients who had routine dental examinations at a military dental center. Information was collected regarding age, smoking habits, oral piercing, oral hygiene habits, and past orthodontic treatment. Clinical examination included visible gingival inflammation, visible dental plaque, and gingival recession on the facial aspects of all teeth.nnnRESULTSnGingival recession was found in 14.6% of the subjects and in 1.6% of all examined teeth. The prevalence, extent, and severity of recession correlated with past orthodontic treatment. A negative correlation was found between plaque on the buccal tooth aspect and gingival recession. There was no correlation between gingivitis or smoking habits and recession. Prevalence was related to oral piercing.nnnCONCLUSIONSnGingival recession is not uncommon in young adults and is related to past orthodontic treatment and oral piercing. Patients undergoing orthodontic treatment or about to pierce the tongue or lips should be advised regarding these findings.

Failure Causes, Timing, and Cluster Behavior: An 8-year Study of Dental Implants

Objectives:The aim of this study was to analyze implant failure, causes, time of failure, and cluster behavior of implant failure among patients referred to a private surgical center. Methods:All failed implants placed during the years 1997–2004 were analyzed. Data collected included age, gender, smoking habits, implant type and dimensions, timing of implantation (immediate or nonimmediate), time to failure, and failure causes. Results:Overall, 99 of the 3609 implants placed between the years 1997 and 2004 failed in 61 patients resulting in a 97.3% survival rate. Patients with implant failure ranged in age from 21 to 78 years (average 54 years); 34% were men, 66% women; smoking was reported by 32.8%, pastsmoking 16.4%; time from implant placement to failure ranged from 1 to 99 months (average 24 months, SD = 24.8). Common causes for implant removal were bone loss and/or inflammation (52.5%), and implant mobility (43.4%). Cluster behavior (ie, more than one implant failure per patient, not necessarily in the same area or quadrant) was shown in one-third (32.8%) of the patients in which 56.6% of all failures were found. This cluster pattern was evident in both the surgical and prosthetic phase failures. Conclusion:There is a higher probability for a cluster pattern among patients with implant failure. Common signs for failure are implant mobility (surgical phase) and infection and marginal bone loss (prosthetic phase).

Long-term marginal bone loss around single dental implants affected by current and past smoking habits.

Purpose:To compare the long-term marginal implant bone loss, survival, and radiographic success of single dental implants among current, past smokers, and nonsmokers. Participants and Methods:The study was based on a consecutive cohort of patients who received single implants between 2 adjacent natural teeth. Only implants with 5 or more years follow-up were considered with no less than 3 follow-up radiographs at different time points with at least 1 year interval between radiographs. All radiographs were analyzed for changes in marginal bone loss. Results:The study consisted of 64 patients, ranging in age from 18 to 78 (mean, 45 years) with a total of 64 single implants. Average follow-up time was 6.14 years (range, 5–14). Success rate was 93.75%; 4 implant failed. Two of the failures were due to mechanical neck brake and 2 resulted from peri-implantitis and bone loss. Survival rates were not related to smoking habits. The mean marginal bone loss measured for all implants was 0.145 mm during the first year, 0.07 mm per year during years 1 throughout 5 and 0.026 mm per year from the sixth year till the end of follow-up. Current smokers demonstrated higher marginal bone loss during all time intervals than former smokers and both demonstrated higher marginal bone loss during all time intervals than nonsmokers. Conclusion:Our results reaffirm the relation between smoking and peri-implant bone loss. Former smokers still demonstrated an increase in marginal bone loss as compared with nonsmokers. There was no difference in implant survival in relation to smoking habits.

Multitier Technique for Bone Augmentation Using Intraoral Autogenous Bone Blocks

Purpose:Intraoral bone grafts are a convenient and acceptable source of autogenous bone for alveolar reconstruction due to bone origin similarity and less morbidity. In large bone defects, 1 tier might be insufficient to achieve the desired bone shape. The purpose of this article was to describe a multitier technique for reconstruction of extensive bone deficiency, using only intraoral block bone grafts for implant site augmentation. Materials:After clinical and radiographic evaluation of the recipient site, measurements were taken to determine the size of the bone deficiency. The first tier of bone graft was harvested from the mandibular ramus. After additional clinical and radiographic evaluation of the recipient site 5 months later, bone graft blocks for the second tier were harvested either from the second ramus or the mandibular symphysis. Conclusions:A new technique, the multitier intraoral bone block graft, for the future use of dental implants, is described. This technique can serve as an optional operation procedure for extensively atrophic alveolar bone augmentation.

Dento-alveolar and maxillofacial injuries: a 5-year multi-center study. part 1: general vs facial and dental trauma

Maxillofacial injuries are a significant cause of morbidity and demand meticulously planned treatment. The aim of this present multi-center study was to evaluate the occurrence of dento-alveolar and maxillofacial injuries over a 5-year period. A retrospective cohort study of data from the Israel Trauma Registry was conducted for the years 2000-2004. The registry includes all trauma patients admitted and hospitalized due to an injury. Of the 111,010 hospitalized trauma patients, 5886 (5.3%) were diagnosed with maxillofacial or dental injuries. The main causes of injuries for hospitalized trauma patients were falls (48.1%) and motor vehicle accidents (25.2%), while the major causes of facial and dental injuries were vehicle accidents (39.6%, 56.8%, respectively) and falls (32.1%, 26.7%, respectively). High-risk age groups for dental and facial trauma were 10-18 years and 19-28 years, respectively, while for other trauma, ages for the greatest risk ranged from 0 to 9 years and over 59 years. Males were injured two to three times more frequently than females. A better understanding of the etiology of maxillofacial and dental injuries and identifying the high-risk groups should lead to appropriate prevention programs and treatment methods.

Dento-alveolar and maxillofacial injuries: a 5-year multi-center study. Part 2: severity and location.

Maxillofacial and dental injuries are not uncommon. These injuries may cause morbidity and demand meticulously planned treatment. Part 1 of this study focused on the incidence of general trauma injuries, as well as facial or dental trauma. The aim of part 2 is to evaluate the severity and location of the dento-alveolar and maxillofacial injuries over 5 years. A retrospective cohort study was conducted based on data from the Israel National Trauma Registry. Patients admitted and hospitalized due to trauma injuries during the years 2000-2004, totaled 111,010 in which 5886 (5.3%) were maxillofacial or dental injuries. Most of these injuries were traffic-related (54.5%), followed by events at home (18.7%). Facial injuries combined with injuries to other organs involved occurred in 3721 (63.2%) of the patients. Most minor injuries were noted when no other organs were involved, while severe injuries were more common when multiple organs were involved. More than 25% of facial injuries required surgery. Meticulous epidemiologic studies are needed to support the leading role, extent, and severity of maxillofacial trauma.

Survival of Immediately Provisionalized Dental Implants: A Case-Control Study with up to 5 Years Follow-Up

Purpose: The aim of this study was to evaluate the survival rate of immediately provisionalized implants with up to 5 years follow-up. n n n nMaterials and Methods: The study consisted of 226 patients, 113 consecutive patients with immediately provisionalized dental implants (cases) and 113 randomly selected, age-, gender-, and implant position-matched controls with conventional late implant loading. Survival rate and incidence of complications were recorded. n n n nResults: Follow-up ranged from 6 to 60 months. Smoking was reported by 20.8% of patients. Maxillary incisors and mandibular lateral incisors were the most common areas for implant placement. Conventionally loaded implants were narrower (pxa0=xa0.03) and shorter (pxa0=xa0.001). Immediate implantation into a fresh extraction socket was performed in 69% of the cases and in 36.3% of the controls (pxa0=xa0.001). Implant survival rate was 96.5%. Of the eight failed implants, six were immediately provisionalized and two were conventionally loaded. No statistically significant difference was found in survival rates between groups (pxa0>xa00.05). Five of the failed implants (case group) were immediately loaded implants placed in fresh extraction sockets. n n n nConclusion: Immediate implant provisionalization achieved similar high success rates compared with the conventional, delayed approach. As immediate implant provisionalization is mainly desired in the anterior region, the high success rates are encouraging.PURPOSEnThe aim of this study was to evaluate the survival rate of immediately provisionalized implants with up to 5 years follow-up.nnnMATERIALS AND METHODSnThe study consisted of 226 patients, 113 consecutive patients with immediately provisionalized dental implants (cases) and 113 randomly selected, age-, gender-, and implant position-matched controls with conventional late implant loading. Survival rate and incidence of complications were recorded.nnnRESULTSnFollow-up ranged from 6 to 60 months. Smoking was reported by 20.8% of patients. Maxillary incisors and mandibular lateral incisors were the most common areas for implant placement. Conventionally loaded implants were narrower (p = .03) and shorter (p = .001). Immediate implantation into a fresh extraction socket was performed in 69% of the cases and in 36.3% of the controls (p = .001). Implant survival rate was 96.5%. Of the eight failed implants, six were immediately provisionalized and two were conventionally loaded. No statistically significant difference was found in survival rates between groups (p > 0.05). Five of the failed implants (case group) were immediately loaded implants placed in fresh extraction sockets.nnnCONCLUSIONnImmediate implant provisionalization achieved similar high success rates compared with the conventional, delayed approach. As immediate implant provisionalization is mainly desired in the anterior region, the high success rates are encouraging.