Serge Szmukler-Moncler

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.

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.

Osteotome Sinus Floor Elevation Technique Without Grafting Material and Immediate Implant Placement in Atrophic Posterior Maxilla: Report of 2 Cases

PURPOSE This case report discusses 2 patients who required implant placement in the atrophic posterior maxilla to support a fixed prosthesis with the least invasive and shortest procedure. MATERIALS AND METHODS The reference standard of care would be to perform sinus augmentation with an autologous bone graft through the lateral approach with delayed implant placement. However, in these cases, the posterior maxillas were treated with an osteotome sinus floor elevation procedure without grafting material and simultaneous placement of short, 8- and 10-mm-long, tapered implants. RESULTS All implants achieved primary stability and were successfully loaded after 3.6 months of healing. At the 1- and 2-year follow-up visits, they were clinically stable and the final prostheses were functioning. The mean endosinus bone gain was 5.1 +/- 1.3 mm. In 1 of the patients, the implants were completely embedded in the newly formed bone and the sinus floor had been relocated apical to its previous demarcation. CONCLUSIONS The findings from these 2 cases suggest that the osteotome sinus floor elevation procedure without grafting material, and immediate placement of tapered implants, might be applied in situations for which previously only the lateral approach was considered (at the condition that implants achieve firm primary stability). More patients and longer follow-up are warranted to investigate how reliable this technique can be when applied to the atrophic maxilla.

Use of Ultrasonic Bone Surgery (Piezosurgery) to Surgically Treat Bisphosphonate-Related Osteonecrosis of the Jaws (BRONJ). A Case Series Report with at Least 1 Year of Follow-Up

This preliminary work documents the use of a powerful piezosurgery device to treat biphosphonate-related osteonecrosis of the jaw (BRONJ) in combination with classical medication therapy. Eight patients presenting 9 BRONJ sites were treated, 2 in the maxilla and 7 in the mandible. Reason for biphosphonate (BiP) intake was treatment of an oncologic disease for 5 patients and osteoporosis for 3. The oncologic and osteoporosis patients were diagnosed with BRONJ after 35-110 months and 80-183 months of BiP treatment, respectively. BRONJ 2 and 3 was found in 4 patients. Resection of the bone sequestrae was performed with a high power ultrasonic (piezo) surgery and antibiotics were administrated for 2 weeks. Soft tissue healing was incomplete at the 2-week control but it was achieved within 1 month. At the 1-year control, soft tissue healing was maintained at all patients, without symptom recurrence. One patient with paraesthesia had abated; of the 2 pa-tients with trismus, one was healed, severity of the second trismus abated. This case report series suggests that bone resection performed with a high power ultrasonic surgery device combined with antibiotics might lead to BRONJ healing. More patients are warranted to confirm the present findings and assess this treatment approach.

Periodontal microbiota of Sardinian children: comparing 200-year-old samples to present-day ones

Introduction: The microrganisms of the human oral cavity include more than 700 species or phenotypes of bacteria. Some “diseases of civilization” are strictly correlated to changes in the microbiome following the food revolution that occurred after WWII. For that reason, a precise recognition of the microbiome profile before and after this period should be useful to determine the health-compatible model of microbiome. The aim of this study was to compare the microbiome profiles (number of total cells, and pathogen types) of dental samples obtained from two distinct groups of children, a 200-year-old retrieved one and a present one. Methods: Two different groups of samples have been studied. The first group was a set of 50 recent subgingival plaque samples obtained from children of age 2-8 years, 14 males and 36 females. They were enrolled by the Department of Dental Disease Prevention (University of Cagliari, in Sardinia, Italy) during standard dental care procedures. None reported periodontal disease and none had been under antibiotic therapy during the previous 6 months. The second group was an old retrieved group that included 24 teeth from 6 different 6- to 8-year-old crania fragments; they were obtained from a 200-year-old charnel-house located in Villaputzu, a city close to Cagliari. Representative periodontal bacteria have been identified by a previously published real-time PCR procedure (Sokransky et al., 1998) in which P. gingivalis and T. forsythia (red complex), A. actinomycetemcomitans (green complex) and F. nucleatum (orange complex) were detected. In addition, the title of each pathogen was expressed as a percentage of the total bacteria (biofilm) in the sample. Results and discussion: The profile of periodontal microbiomes, between recent/ancient samples showed a significant difference relative to Sokransky’s red complex bacteria (p < 0.05). In all analyzed periodontal strains, the pathogenic bacteria P. gingivalis and T. forsythia showed the highest title in the recent group. Conclusions: Our hypothesis is that the transfer of “commensal-pathogen” as an absolute number on the oral biofilm might be linked to the distinct alimentary habits of the two populations. Some diet rich in reducing agents, such as processed meat-based foods, might be able to increase the average number of pathogen anaerobic bacteria in the oral microbiota. The outcome would be an increase of the oral systemic diseases reported with these pathogens. Our data suggest that the ancient Sardinian population was able to control the pathogen oral anaerobic biofilm by some diet rich in antioxidant compounds. Further investigations are required to focus on the genetic profile and the health status of this ancient population but it appears that molecular microbiology might be considered as the “time machine” in oral biology.

Unconventional Implant Placement Part III: Implant Placement Encroaching upon Residual Roots - A Report of Six Cases: Implant Placement Encroaching upon Residual Roots

BACKGROUND When a residual root is found in the way of a planned implant placement, invasive surgery is usually performed in order to remove it. Consequently, implant therapy is rendered more complex and lengthy. PURPOSE We present 6 cases treated according to an unconventional protocol in which invasive surgery was avoided by allowing the implants to encroach upon the residual roots in order to permit a prosthetically driven surgery. MATERIALS AND METHODS Six patients were treated with 7 implants placed through a residual root (4 in the mandible and 3 in the maxilla). The residual roots had to be clinically and radiographically asymptomatic and covered by bone or healthy gingiva. The radiographic follow-up ranged from 20 months to 9 years. RESULTS Healing was uneventful. Implants were clinically stable, and radiographic examination did not show any unusual feature at the root-implant interface. CONCLUSION Several types of new implant-tissue interfaces were created in addition to the classical implant-bone interface, but this did not seem to jeopardize implant integration. Reports of more cases with a longer follow-up are needed before this protocol can be endorsed for routine application. Nonetheless, if confirmed as acceptable, this protocol might open intriguing possibilities; it might also lead to revision of one of the leading concepts in dental implantology.Background When a residual root is found in the way of a planned implant placement, invasive surgery is usually performed in order to remove it. Consequently, implant therapy is rendered more complex and lengthy. Purpose We present 6 cases treated according to an unconventional protocol in which invasive surgery was avoided by allowing the implants to encroach upon the residual roots in order to permit a prosthetically driven surgery. Materials and Methods Six patients were treated with 7 implants placed through a residual root (4 in the mandible and 3 in the maxilla). The residual roots had to be clinically and radiographically asymptomatic and covered by bone or healthy gingiva. The radiographic follow-up ranged from 20 months to 9 years. Results Healing was uneventful. Implants were clinically stable, and radiographic examination did not show any unusual feature at the root-implant interface. Conclusion Several types of new implant-tissue interfaces were created in addition to the classical implant-bone interface, but this did not seem to jeopardize implant integration. Reports of more cases with a longer follow-up are needed before this protocol can be endorsed for routine application. Nonetheless, if confirmed as acceptable, this protocol might open intriguing possibilities; it might also lead to revision of one of the leading concepts in dental implantology.