Lydia Vazquez

Osteotome sinus floor elevation technique without grafting material: 3-year results of a prospective pilot study

OBJECTIVE In a prospective pilot study, short< or =10 mm ITI-SLA implants were placed in the resorbed posterior maxilla by means of an osteotome sinus floor elevation (OSFE) procedure without grafting material. This paper presents 3-year data assessing bone-level changes around implants. MATERIAL AND METHODS Twenty-five implants were placed in 17 patients to rehabilitate 16 molar and nine premolar sites. The mean residual bone height (RBH) was 5.4 +/- 2.3 mm. A healing period of 3-4 months was allowed before abutment tightening. Most implants (21/25) were 10 mm long, and the others were 8 and 6 mm long. At the 3-year control, endo-sinus bone gain, implant length protruding into the sinus and crestal bone loss (CBL) were measured on periapical radiographs. RESULTS All implants fulfilled the survival criteria. Despite the absence of grafting material, implants were embedded into newly formed bone tissue. All implants gained endo-sinus bone; the mean gained bone was 3.1 +/- 1.5 mm. The residual protrusion length decreased from 4.9 +/- 2.1 to 1.8 +/- 2.1 mm. CBL was 0.9 +/- 0.8 mm. CONCLUSIONS This study confirms that the OSFE procedure without grafting material is sufficient to create bone beyond the natural limit of the sinus. On the mid-term of 3 years, the technique was found to be predictable in the posterior maxilla when the RBH is limited. Implants gained endo-sinus bone despite the lack of grafting material. Bone gain was still improving over the first-year control. No shrinkage of the augmented area was observed.

Survival rates of short (6 mm) micro-rough surface implants: a review of literature and meta-analysis.

OBJECTIVE The aim of this review was to test the hypothesis that 6 mm micro-rough short Straumann(®) implants provide predictable survival rates and verify that most failures occurring are early failures. MATERIALS AND METHODS A PubMed and hand search was performed to identify studies involving micro-rough 6-mm-short implants published between January 1987 and August 2011. Studies were included that (i) involve Straumann(®) 6 mm implants placed in the human jaws, (ii) provide data on the survival rate, (iii) mention the time of failure, and (iv) report a minimum follow-up period of 12 months following placement. A meta-analysis was performed on the extracted data. RESULTS From a total of 842 publications that were screened, 12 methodologically sound articles qualified to be included for the statistical evaluation based on our inclusion criteria. A total of 690 Straumann(®) 6-mm-short implants were evaluated in the reviewed studies (Total: placed-690, failed-25; maxilla: placed-266, failed-14; mandible: placed-364, failed-5; follow-up period: 1-8 years). A meta-analysis was performed on the calculated early cumulative survival rates (CSR%). The pooled early CSR% calculated in this meta-analysis was 93.7%, whereas the overall survival rates in the maxilla and mandible were 94.7% and 98.6% respectively. Implant failures observed were predominantly early failures (76%). CONCLUSION This meta-analysis provides robust evidence that micro-rough 6-mm-short dental implants are a predictable treatment option, providing favorable survival rates. The failures encountered with 6-mm-short implants were predominantly early and their survival in the mandible was slightly superior.

Implant-supported Mandibular Overdentures in Very Old Adults A Randomized Controlled Trial

The purpose of this study was (1) to investigate denture satisfaction following the conversion of existing mandibular complete dentures to implant overdentures (IOD) in very old edentulous patients who depend on help for activities of daily living and (2) to evaluate secondary end points, such as functional, structural, nutritional, and patient-centered aspects. For this randomized clinical trial, 2 interforaminal short implants were placed in the intervention group (n = 16, 85.0 ± 6.19 yrs) to retain mandibular IODs; the control group (n = 18, 84.1 ± 5.55 yrs) received conventional relines. During the first year, no implant was lost; however, 2 patients died. IODs proved more stable, and participants in the intervention group demonstrated significantly higher denture satisfaction as well as an increased oral health–related quality of life compared to the control group. Maximum voluntary bite force improved significantly with IODs, yet the chewing efficiency was not different between groups. Masseter muscle thickness increased with IODs, mainly on the preferred chewing side. Body mass index decreased in both groups, but the decline tended to be smaller in the intervention group; blood markers and the Mini Nutritional Assessment did not confirm this tendency. These results indicate that edentulous patients who depend on help for activities of daily living may benefit from IODs even late in life (ClinicalTrial.gov NCT01928004).

Osteotome sinus floor elevation technique without grafting: a 5-year prospective study

AIM To evaluate the long-term stability of peri-implant bone formation following implant placement without grafting into resorbed posterior maxillae. MATERIALS AND METHODS Twenty-five implants of 10 mm were placed in 17 patients to rehabilitate atrophic maxillae by means of an osteotome sinus floor elevation (OSFE) procedure without grafting. Mean residual bone height was 5.4±2.3mm. Bone levels were evaluated at 1, 3 and 5 years using periapical radiographs. RESULTS All implants fulfilled survival criteria and gained peri-implant bone (mean increase 3.2±1.3mm). Implant protrusion into the sinus decreased from 4.9±1.9mm after surgery to 1.5±0.9mm after 5 years. Mean crestal bone loss amounting to 0.8±0.8mm stabilized over the 5-year observation interval. Twenty implants showed additional peri-implant bone gain following the 1-year control. CONCLUSIONS Implant rehabilitation of atrophic maxillae may be greatly simplified using implants 10mm and the OSFE technique without grafting. Grafting material is not needed to gain at least 3mm of bone in the atrophic maxilla. The procedure appears predictable with favourable long-term results.

Clinical and histological evaluation of postextraction platelet-rich fibrin socket filling: a prospective randomized controlled study.

Objectives: The aims were to investigate whether the use of platelet-rich fibrin membranes (PRF) for socket filling could improve microarchitecture and intrinsic bone tissue quality of the alveolar bone after premolar extraction and to assess the influence of the surgical procedure before implant placement. Material and Methods: Twenty-three patients requiring premolar extraction followed by implant placement were randomized to three groups: (1) simple extraction and socket filling with PRF, (2) extraction with mucosal flap and socket filling with PRF, and (3) controls with simple extraction without socket filling. Implant placement was performed at week 8, and a bone biopsy was obtained for histomorphometric analysis. Results: Analysis by microcomputed tomography showed better bone healing with improvement of the microarchitecture (P < 0.05) in group 1. This treatment had also a significant effect (P < 0.05) on intrinsic bone tissue quality and preservation of the alveolar width. An invasive surgical procedure with a mucosal flap appeared to completely neutralize the advantages of the PRF. Conclusions: These results support the use of a minimally traumatic procedure for tooth extraction and socket filling with PRF to achieve preservation of hard tissue.

Optical Three‐Dimensional Scanning Acquisition of the Position of Osseointegrated Implants: An in vitro Study to Determine Method Accuracy and Operational Feasibility

PURPOSE Manufacturing complex prosthetic framework on osseointegrated implants requires precision at every step of execution. The purpose of this study was to verify the possibility of applying the technology of image acquisition to determine the spatial position of osseointegrated implants. MATERIALS AND METHODS An optical three-dimensional scanning technique was employed: its measurement systematic error (bias) was calculated by comparing the results with the detection on a coordinates measuring machine. Measurements were carried out on master casts by doing an in vitro simulation of intraoral conditions. RESULT This study showed that the bias error value of the three-dimensional optical acquiring system was situated between 14 and 21 microm. CONCLUSION As far as the accuracy is concerned, it seems possible to use the three-dimensional image acquisition technology as a valid alternative to traditional impression-making procedures. However, the bias levels obtained in this in vitro study will have to be confirmed in a clinical trial.

Accuracy of vertical height measurements on direct digital panoramic radiographs using posterior mandibular implants and metal balls as reference objects

OBJECTIVES Conventional panoramic radiography, a widely used radiographic examination tool in implant treatment planning, allows evaluation of the available bone height before inserting posterior mandibular implants. Image distortion and vertical magnification due to projection geometry is well described for rotational panoramic radiographs. To assess the accuracy of vertical height measurements on direct digital panoramic radiographs, implants and metal balls positioned in the posterior mandible were used as radio-opaque reference objects. The reproducibility of the measuring method was assessed by the inter- and intraobserver agreements. METHODS Direct digital panoramic radiographs, performed using a Kodak 8000C (Eastman Kodak Company, Rochester, NY), of 17 partially edentulous patients (10 females, 7 males, mean age 65 years) were selected from an X-ray database gathered during routine clinical evaluation of implant sites. Proprietary software and a mouse-driven calliper were used to measure the radiological length of 25 implants and 18 metal reference balls, positioned in mandibular posterior segments. The distortion ratio (DR) was calculated by dividing the radiological implant length by the implants real length and the radiological ball height by the balls real height. RESULTS Mean vertical DR was 0.99 for implants and 0.97 for balls, and was unrelated to mandibular sites, side, age, gender or observer. Inter- and intraobserver agreements were acceptable for both reference objects. CONCLUSIONS Vertical measurements had acceptable accuracy and reproducibility when a software-based calibrated measurement tool was used, confirming that digital panoramic radiography can be reliably utilized to determine the pre-operative implant length in premolar and molar mandibular segments.

Reliability of the vertical magnification factor on panoramic radiographs: clinical implications for posterior mandibular implants

OBJECTIVES Panoramic radiographs allow evaluation of the available bone height for implant treatment planning while imparting a low radiation dose. As panoramic radiography produces image distortion, reference objects are required to determine the exact magnification. This study aims to estimate a panoramic units vertical magnification factor (MF) by measuring the length of dental implants used as radiopaque reference objects on postoperative panoramic radiographs. We compared our findings to the vertical MF listed by the panoramic unit manufacturer, and studied the reproducibility and accuracy of our measuring method by analyzing the inter- and intraobserver agreements. MATERIAL AND METHODS Using a digital calliper, we measured the length of 32 implants on 17 postoperative panoramic radiographs taken with a Scanora unit. The implants were 10mm-long standard Straumann implants placed in the posterior segments of mandibles. The MF was calculated by dividing the implants radiological length by the implants real length. RESULTS The mean calculated vertical MF was 1.27 ± 0.01 (1.245-1.295) and was lower than the manufacturers MF (1.3). The vertical MF was 1.28 ± 0.01 in the premolar and 1.27 ± 0.01 in the molar regions. There was an excellent intraobserver reliability (0.96 for observer 1; 0.93 for observer 2) and a good interobserver reliability (0.85 at measurement session 1; 0.8 at measurement session 2) CONCLUSIONS The observed reliability of the MF confirms that a panoramic radiograph can be used for preoperative implant length evaluation in the posterior mandibular segments. MF stability should be verified with other panoramic units. In clinical practice, using the implant length as a reference object on postoperative panoramic radiographs is a simple and effective evaluation method to estimate a panoramic units MF.

Ultrasonography: A Noninvasive Tool to Diagnose a Caliber-Persistent Labial Artery, an Enlarged Artery of the Lip

Currently, practitioners use clinical and histopathologic examination to diagnose a caliber‐persistent labial artery (CPLA). We illustrate the use of ultrasonography as a noninvasive diagnostic tool to visualize this enlarged artery of the lip.

Osteotome Sinus Floor Elevation without Grafting: A 10-Year Prospective Study

BACKGROUND Little is known about the long-term outcome of implants placed in the atrophic maxilla using osteotome sinus floor elevation (OSFE) without grafting. PURPOSE The study aims to evaluate the long-term efficiency of the procedure and stability of the peri-implant bone formed following implant placement without grafting into resorbed posterior maxilla. MATERIALS AND METHODS Twenty-five implants (≤10 mm in length) were placed in 17 patients using OSFE without grafting. The mean residual bone height was 5.4 ± 2.3 mm. Bone levels were evaluated at 1, 3, 5, and 10 years using periapical radiographs. RESULTS Fifteen patients (23 implants) participated in the 10-year examination. All implants fulfilled the survival criteria. Following surgery, the implant sites gained endo-sinus bone (mean: 3.0 ± 1.4 mm). The mean crestal bone loss (CBL) was limited to 1.0 ± 0.9 mm. The difference in mean endo-sinus bone gain and CBL was statistically significant between 1 and 10 years, but not between 3 and 5, 3 and 10, and 5 and 10 years. CONCLUSIONS At 10 years, the implant survival rate was 100%. Endo-sinus bone was mainly gained during the first year. This study demonstrates the long-term predictability of OSFE without grafting and simultaneous implant placement.