Richard A. Kraut

Outcomes of Placing Short Dental Implants in the Posterior Mandible: A Retrospective Study of 124 Cases

PURPOSEnThe purpose of this retrospective study was to determine the overall success of short dental implants (8 mm in length) placed in the partially or completely edentulous posterior mandible restored with fixed and removable prostheses.nnnPATIENTS AND METHODSnA total of 124 patients had 335 8-mm-long implants placed from May 2005 until June 2007. Of the 124 total patients, 35 were men and 89 were women, with a median age of 56 years and an age range of 18 to 80 years at the time of implant surgery. There were 112 patients who were partially edentulous and 12 who were completely edentulous. Of the patients, 32 had a single implant placed whereas the other 92 had multiple implants placed. One patient had the implants immediately provisionally loaded. All of the implants were restored by use of fixed prostheses. Of these fixed prostheses, 245 were splinted together whereas 75 were restored individually.nnnRESULTSnA total of 335 short dental implants were placed in 124 patients. Of the 335 implants placed, 331 integrated successfully. In the 2 cases that failed, the sites were grafted with porous hydroxyapatite and platelet-rich plasma. The implants were replaced at 5 months after the initial failure in the first patient and at 7 months in the second patient. These replacement implants integrated and have been restored and in function for more than 16 months. There was 1 fracture of an implant with a restoration. The implant had been restored with an individually fabricated fixed restoration, with the fracture occurring at the head of the implant, requiring removal. The implant and restoration had been in function for 10 months before fracture.There were no other fractures of implants or restorative hardware noted in this study. The survival rate for 8-mm implants placed in the mandible was 99% from stage I surgery to a functional prosthesis for up to 2 years.nnnCONCLUSIONSnPlacement of short dental implants is a predictable treatment method for patients with decreased posterior mandibular bone height.

Correlation Between Schneiderian Membrane Perforation and Sinus Lift Graft Outcome: A Retrospective Evaluation of 359 Augmented Sinus

PURPOSEnThe aim of this study was to estimate the incidence of sinus membrane perforation in maxillary sinus augmentation surgery using a lateral approach and the impact of sinus integrity on incidence of sinusitis and bone graft survival in the maxillary sinus.nnnPATIENTS AND METHODSnA total of 359 sinus augmentation procedures (208 patients) were evaluated retrospectively for sinus integrity during augmentation, complications, graft failure, and implant loss.nnnRESULTSnThe incidence of sinus membrane perforation was 41%. There was an overall sinus graft failure rate of 6.7%; of the failed sinus grafts, 70.8% had a perforated sinus membrane at augmentation. There were 11.3% of sinuses with perforated membranes at graft placement that failed compared with 3.4% of sinuses with intact membranes failing (general linear model [GLM], P = .003). Age, gender, and provider type were not significantly associated with sinus integrity at 1 year. Overall, 11.3% of sinuses with perforated membranes at graft placement required secondary antibiotics for sinusitis and infection compared with 1.4% of sinuses with intact membranes (GLM, P < .0006). Of the sinuses requiring secondary antibiotics, 30% failed compared with 5% of untreated sinuses (GLM, P = .0071). Of the sinuses developing sinusitis or secondary infection requiring antibiotics, 85% had a membrane perforation during augmentation compared with 39.2% of those not requiring antibiotics; gender, age, and provider were not associated with antibiotic use.nnnCONCLUSIONSnIn the present study, antibiotic use for postoperative sinusitis and infection and graft failure were shown to be statistically higher in sinuses with perforated membranes at augmentation.

Use of Tilted Implants in Treatment of the Atrophic Posterior Mandible: A Preliminary Report of a Novel Approach

PURPOSEnRestoration of the atrophic partially edentulous posterior mandible with implant retained prostheses has proved to be problematic, with no ideal treatment modality. The purpose of this report is to offer a novel method of treatment using tilted endosseous implants.nnnMATERIALS AND METHODSnA total of 64 patients with edentulous spans of the mandible and less than 9.5 mm of alveolar bone overlying the inferior alveolar nerve had implants placed. The implants were placed in a bicortical manner with the porous hydroxyapatite placed subperiosteally if more than 1 mm of the apex of the implant was placed beyond the lingual cortex of the mandible. These implants were allowed to osseointegrate for 3 to 5 months and restored using custom-angled abutments.nnnRESULTSnA total of 196 implants were placed in 64 patients from March 2003 through July 2008. Two implants were lost owing to a lack of osseointegration. No implants were lost because of prosthodontic failure. No damage to the neurovascular structures or permanent paresthesia was noted.nnnCONCLUSIONSnOur initial results have shown that the use of tilted implants combined with custom abutments is a viable treatment modality for patients with atrophic edentulous mandibular spans that lack the required alveolar height for traditional dental implants.

Cavernous Sinus Thrombosis as a Result of a Fungal Infection: A Case Report

Cavernous sinus thrombosis (CST) is a rare disease with the potential for significant morbidity and even death. Rapid diagnosis and aggressive medical and surgical management are imperative for patients with CST. The cause may be aseptic or infectious. When the cause is infectious in nature, it is most commonly from a bacterial origin. However, we present the case of a 57-year-old man with a fungally related CST that ultimately led to his death.

ENDOSSEOUS IMPLANTS FOR MAXILLOFACIAL RECONSTRUCTION

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