Relationship Between Third Mandibular Molar Angulation and Distal Cervical Caries in the Second Molar.

Third lower molar partially erupted is commonly encountered in dental practice. This situation challenges clinicians with the dilemma whether to remove or to monitor it, because this molar can cause pathology of the adjacent second molar. The aim of this retrospective study is to evaluate the relationship between third mandibular molar and distal cervical caries in second molar. This retrospective study analyzed 55 digital orthopantograms of adult patients and a total number of 95 mandibular third molars were assessed for eruption status, angulation, radiographic evidence of caries or restoration in the mandibular third molar, and radiographic evidence of caries or restoration in the distal surface of the mandibular second molar. The distal cervical caries in second molar is associated with fully erupted and partially erupted wisdom molar in horizontal, mesioangular and vertical position and less with presence of caries in third molar. There are caries lesions in distal second molars in mesioangular position when adjacent third molar is caries free.

Comparison of Two Techniques for Lateral Ridge Augmentation in Mandible With Ramus Block Graft.

UNLABELLED: The purpose of this manuscript was to assess mandibular ramus block grafts used for augmentation of mandibular posterior segments, followed by subsequent implant placement. Twenty-four human subjects in need of lateral ridge mandibular augmentation were included in the current patient series. INCLUSION CRITERIA: recipient site had at least 10-mm residual height, but less than 4.3-mm bucco-lingual dimension. Autogenous bone blocks were harvested from the mandibular ramus. In the first group ramus block was used in association with platelet-rich fibrin and in the second in association with pericardium membrane. Implant surgery was performed 4 months after bone graft surgery when a total number of 44 implants were placed. Abutments were placed 4 months after implant surgery followed by final restoration. Ramus bone graft was successful in 100% patients for the first group and in 91.67% patients for the second group. Measurement on cone beam computed tomography revealed an average of 5.35 mm of lateral ridge augmentation for group 1 and 5.099 mm for group 2, achieved 4 months after surgery. All implants placed received fixed prosthetic restorations and are in use. Ramus block grafts can be used to allow optimal implant placement, with favor long-term success. Lateral ridge augmentation using mandibular ramus bone graft in association with platelet-rich fibrin is a more predictable and successful technique.

Segmental Dento-alveolar Intrusive Osteotomy in Posterior Maxilla with Lack of Inter-arch Distance for Prosthetic Rehabilitation. A Technique Combined with Sinus Floor Elevation.

UNLABELLED: The aim of this paper is to present a technique for segmental dento-alveolar intrusive osteotomy in a posterior maxilla with lack of inter-arch distance for prosthetic rehabilitation combined with sinus floor elevation. METHODS: A full thickness flap is elevated exposing the lateral wall of the maxillary sinus. A lateral window is opened and the Schneiderian membrane elevated. Segmental dento-alveolar osteotomy is performed. After complete detachment of the segment, it is adapted and fixed to the new position using the pre-prepared guide, making sure not to damage or perforate the Schneiderian membrane. RESULTS: Four cases of segmental dento-alveolar intrusive osteotomy in a posterior maxilla combined with sinus floor elevation were performed utilizing the above-mentioned technique. All surgeries went according to plan, and healing was uneventful except for swelling and pain that lasted for 10-14 days post- operatively. The opposing dentition was later treated by implant placement. The average follow-up time for those cases was 5.4 months. Vitality test four months after surgery was positive. CONCLUSION: The presented technique for segmental dento-alveolar intrusive osteotomy combined with sinus floor elevation can serve as a viable treatment option in the posterior maxilla with lack of inter-arch distance due to severe overeruption.

Incidence, Size and Orientation of Maxillary Sinus Septa-A Retrospective Clinical Study.

BACKGROUND: The purpose of this study is to analyze if there is any statistical correlation between the surgery's complexity (easy to difficult-depending on the anatomical conditions) and the patient's sex, type of edentulism, and left or right side of the maxilla. METHODS: Cone beam computed tomography records of 1192 maxillary sinuses were evaluated, measured, and statistically analyzed with respect to patient sex, type of edentulism, and left or right side, taking into consideration Wen's proposed sinus septum classification. RESULTS: Our research suggests that most sinus augmentation procedures in patients presenting antral septum fall into the Moderate A category (31.94%) and that there is not a correlation between the surgery's complexity (easy to difficult) and the patient's sex, type of edentulism and left or right side of the maxilla. CONCLUSION: We suggest a minor modification to Wen's classification in view of the fact that our findings revealed a combination of medio-lateral and antero-posterior septa that we could not classify in one of the existing categories.

Immediate postoperative complications after lateral ridge augmentation - a clinical comparison between bone shell technique and sticky bone.

Nowadays, implant dentistry is strongly interconnected to bone augmentation procedures. Lateral ridge augmentation is often an imperative treatment stage for successful, prosthetic-driven implant placement. This study aimed to comparatively analyze the immediate postoperative complications of two horizontal bone grafting procedures: sticky bone and bone shell technique. Records of patients with lateral ridge augmentation were analyzed to identify immediate postoperative complications. The study group included 80 patients divided into 40 control (bone-shell technique - BS) and 40 tests (sticky bone -SB). More patients reported moderate and severe pain in the BS - group (11 patients - 27.5%) than in the SB group (6 patients - 15%). In the BS group, the incidence of severe and moderate trismus, neurosensory disturbances, and important hematoma was higher. There was an increased inflammatory response following the bone shell technique, while the sticky bone technique proved reduced surgical morbidity. There was no difference between the two groups in the risk of dehiscence or infection.

Guided Bone Regeneration with Concentrated Growth Factor Enriched Bone Graft Matrix (Sticky Bone) vs. Bone-Shell Technique in Horizontal Ridge Augmentation: A Retrospective Study.

BACKGROUND: The purpose of this study was to compare clinical results of two different horizontal ridge augmentation techniques: guided bone regeneration with sticky bone (SB) and the bone-shell technique (BS). METHODS: Records of patients who underwent horizontal ridge augmentation with SB (test) and BS (control) were screened for inclusion. Pre-operative and 6-month post-operative ridge widths were measured on cone beam computer tomography (CBCT) and compared. Post-operative complications and implant survival rate were recorded. RESULTS: Eighty consecutive patients were included in the present study. Post-operative complications (flap dehiscence, and graft infection) occurred in ten patients, who dropped out from the study (12.5% complication rate). Stepwise multivariate logistic regression analysis showed a significant inverse correlation between the occurrence of post-operative complications and ridge width (p = 0.025). Seventy patients (35 test; 35 control) with a total of 127 implants were included in the final analysis. Mean ridge width gain was 3.7 ± 1.2 mm in the test and 3.7 ± 1.1 mm in the control group, with no significant difference between the two groups. No implant failure was recorded, with a mean follow-up of 42.7 ± 16.0 months after functional loading. CONCLUSIONS: SB and BS showed comparable clinical outcomes in horizontal ridge augmentation, resulting in sufficient crestal width increase to allow implant placement in an adequate bone envelope.

PRF-Solution in Large Sinus Membrane Perforation with Simultaneous Implant Placement-Micro CT and Histological Analysis.

BACKGROUND: The purpose of the study was to analyze the efficacy of platelet-rich fibrin (PRF) as a single augmentation material for complicated cases of maxillary sinus floor elevation, resulting from membrane perforation or previous infections. METHODS: Implant insertion in the posterior region of the maxilla was simultaneously performed with maxillary sinus floor augmentation. Schneiderian membrane elevation can be accompanied by extremely serious sinus membrane perforation, due to accidental tearing or intended incision for mucocele removal. PRFs were placed in the sinus cavity both for membrane sealing and sinus floor grafting. Radiological, histological and micro-CT analyses were performed. Implant survival was assessed every 6 months for 1 to 4 years, with a mean follow up of 1.8 years, after prosthetic loading. Radiological examinations were performed on CBCT at 9 and 12 and 36 months postoperatively and revealed improved degrees of radiopacity. RESULTS: 19 implants were simultaneously placed in the course of nine maxillary sinus floor augmentation surgeries, with successful outcomes in terms of bone grafting and implant integration. New bone formation was evidenced 12 months postoperatively on radiological examination, micro-CT analysis, and histological analysis of a harvested bone segment from the augmented maxillary sinus. The mean gain in bone height of the sinus floor augmentation was 6.43 mm, with a maximum of 9 mm. The mean amount of vital bone obtained from histologic assessment was 52.30%, while bone volume/tissue volume ratio in micro-CT 3D had a mean of 50.32%. CONCLUSIONS: PRF may be considered as an alternative treatment for a single surgery of sinus augmentation with simultaneous implant placement, even in complicated cases with significant sinus membrane tearing.

Bending Fracture of Different Zirconia-Based Bioceramics for Dental Applications: A Comparative Study.

The fabrication of fixed dental prostheses using aesthetic materials has become routine in today's dentistry. In the present study, three-unit full zirconia fixed prosthetic restorations obtained by computer-aided design/computer-aided manufacturing (CAD/CAM) technology were tested by bending trials. The prostheses were intended to replace the first mandibular left molar and were manufactured from four different types of zirconia bioceramics (KatanaTM Zirconia HTML and KatanaTM Zirconia STML/Kuraray Noritake Dental Inc.; NOVAZir® Fusion float® ml/NOVADENT/Dentaltechnik; and 3D PRO Zirconia/Bloomden Bioceramics). In total, sixteen samples were manufactured-four samples per zirconia material. Additionally, the morphology, grain size area distribution, and elemental composition were analyzed in parallelepiped samples made from the selected types of zirconia in three different areas, noted as the upper, middle, and lower areas. The scanning electron microscope (SEM) analysis highlighted that the grain size area varies with respect to the researched area and the type of material. Defects such as microcracks and pores were also noted to a smaller extent. In terms of grain size area, it was observed that most of the particles in all samples were under 0.5 µm2, while the chemical composition of the investigated materials did not vary significantly. The results obtained after performing the bending tests showed that a zirconia material with fewer structural defects and an increased percentage of grain size area under 0.5 µm2, ranging from ~44% in the upper area to ~74% in the lower area, exhibited enhanced mechanical behavior. Overall, the resulting values of all investigated parameters confirm that the tested materials are suitable for clinical use.

Evaluation of 0.2% delmopinol mouth rinse for prevention of peri-implant mucositis and peri-implantitis: A randomized controlled canine study.

OBJECTIVES: To evaluate the effectiveness of 0.2% delmopinol mouth rinse in maintenance of peri-implant tissue health and prevention or inhibition of peri-implant mucositis and peri-implantitis. MATERIALS AND METHODS: Four weeks following tooth extraction, eight titanium dental implants, were placed in six dogs' mandibles. Three dogs were assigned to the test or placebo mouth rinse. Eight weeks following implant installation (T2) ligature was placed to induce peri-implant disease. Clinical and radiographic assessment was performed during the study period as well as micro-CT analysis and histologic assessment to evaluate Bone-Implant Contact at the end of the follow-up (T4). RESULTS: Plaque at implant sites before ligature placement (T2) was lower for the test group (0.7 ± 1.0 vs 1.5 ± 1.3, P < .05). The ratio of affected implant (PD ≧4 mm) at T2 and T4 in the test group was significantly smaller than that of the placebo group (T2, 17% vs 47%, P < .01; T4, 67% vs 83%, P < .05). The test agent also seemed to be effective in partially preventing bone loss induced by ligature placement according to the Computed Tomography and histologic analysis (test, 1.1 ± 0.8 mm; placebo, 1.5 ± 0.9 mm). CONCLUSIONS: Within the limits of this animal model study, the results of the study indicate that the 0.2% delmopinol rinse might play a role in prevention of peri-implant disease development.

Management of Schneiderian Membrane Perforations during Sinus Augmentation Procedures: A Preliminary Comparison of Two Different Approaches.

BACKGROUND: The aim of this study was to retrospectively analyze two different sealing techniques for sinus membrane perforations produced during sinus floor augmentation by a lateral approach. METHODS: A total of 172 lateral-approach sinus floor augmentation surgeries were performed on 130 patients. Sixty-one membrane perforations (35%) were reported. Most of the perforations were caused by accidental membrane tearing and 16 (26%) were caused by deliberate incision for mucocele removal. In 31 perforation cases (51%), the Schneiderian membrane was sealed by suturing, while the remaining 30 cases (49%) were sealed using a low-resorption collagen membrane coverage. RESULTS: Out of the 31 cases treated with a suture-sealing techniques, 26 (84%) were successful, presenting graft integration. Failure occurred in the other five (16%) cases. Out of the 30 perforations sealed with low-resorption collagen membranes, 28 (93%) presented successful graft integration, while two (7%) failed. CONCLUSIONS: Both surgical techniques yielded therapeutic success.

Can the Macrogeometry of Dental Implants Influence Guided Bone Regeneration in Buccal Bone Defects? Histomorphometric and Biomechanical Analysis in Beagle Dogs.

The aim of this experimental animal study was to assess guided bone regeneration (GBR) and implant stability (ISQ) around two dental implants with different macrogeometries. Forty eight dental implants were placed within six Beagle dogs. The implants were divided into two groups (n = 24 per group): G1 group implants presented semi-conical macrogeometry, a low apical self-tapping portion, and an external hexagonal connection (whereby the cervical portion was bigger than the implant body). G2 group implants presented parallel walls macrogeometry, a strong apical self-tapping portion, and an external hexagonal connection (with the cervical portion parallel to the implant body). Buccal (mouth-related) defects of 2 mm (c2 condition) and 5 mm (c3 condition) were created. For the control condition with no defect (c1), implants were installed at crestal bone level. Eight implants in each group were installed under each condition. The implant stability quotient (ISQ) was measured immediately after implant placement, and on the day of sacrifice (3 months after the implant placement). Histological and histomorphometric procedures and analysis were performed to assess all samples, measuring crestal bone loss (CBL) and bone-to-implant contact (BIC). The data obtained were compared with statistical significance set at p < 0.05. The ISQ results showed a similar evolution between the groups at the two evaluation times, although higher values were found in the G1 group under all conditions. Within the limitations of this animal study, it may be concluded that implant macrogeometry is an important factor influencing guided bone regeneration in buccal defects. Group G1 showed better buccal bone regeneration (CBL) and BIC % at 3 months follow up, also parallel collar design can stimulate bone regeneration more than divergent collar design implants. The apical portion of the implant, with a stronger self-tapping feature, may provide better initial stability, even in the presence of a bone defect in the buccal area.

Novel electrical conductivity device for osteotomy preparation for dental implants placement: A cadaver study.

OBJECTIVES: To evaluate the accuracy, safety, and anticipation effect of a novel electrical conductivity device (SG) in maxillary osteotomy preparation for placement of dental implants. MATERIALS AND METHODS: Thirty-seven osteotomies were prepared by three operators with different levels of expertise, using the SG protocol in the maxilla of six fresh frozen cadavers. A pre-op CT measurement of the length of bone in the desired implant location was taken and compared with the final length of the osteotomy created using SG during surgery. A comparison was made between the results of the different operators. RESULTS: The pre-op CT bone length measurements and the final depth assessment of the osteotomy with SG had a very high correlation level (0.977) with a significant mean difference of 0.639 mm (P < .0001), with the pre-op CT measurements being longer. The least experienced operator had placed the implants 0.924 mm less deep than the pre-op CT length measurements while the most experienced operator had placed the implants 0.244 mm less deep than the pre op CT length measurements. All implants were placed in the correct position and no breach of the sinus/nasal floor or buccal/palatine bone plates was detected. CONCLUSIONS: The SG electrical conductivity device offers the operator real-time monitoring during the surgical procedure. It provides a simple, safe, and sensitive method of detecting breaches, making it simple and safe for oral surgeons with different levels of expertise to use, with promising results.

Maxillary Sinus Floor Augmentation to Enable One-Stage Implant Placement by Using Bovine Bone Substitute and Platelet-Rich Fibrin.

Nowadays it is possible to perform an optimal implant placement and to achieve a good long-term prognosis for an implant-borne prosthesis in the grafted posterior maxilla. This study evaluates the efficiency of one-stage piezosurgery by using as graft material a combination of particulate bovine bone substitutes with platelet-rich fibrin to achieve sinus lift. We included in this study 14 cases of one-stage sinus lift surgeries during which we placed 30 standard implants. The mean vertical bone height gain was 10.12 mm six months after surgery, and the mean postoperative follow-up time was 43.79 months. There were no major complications during or after surgery, and all implants are in use. Therefore, it can be concluded that one-stage sinus piezosurgery using particulate bovine bone substitutes and platelet-rich fibrin can be applied as a predictable and effective technique in the treatment of the posterior edentulous maxilla ensuring 4-5 mm vertical bone height.

Incidental findings of implant complications on postimplantation CBCTs: A cross-sectional study.

BACKGROUND: Survival rates of dental implants are reported to be very high and seem to indicate minimal complications related to dental implants. PURPOSE: The aim of this report was to evaluate in a cross-sectional study the prevalence of implant positioning complications as appears in postimplantation Cone-Beam Computerized Tomography (CBCT) in two of the major imaging facilities in Bucharest, Romania. METHODS: Demographic and implant data was collected from two of the three main CBCT facilities in Bucharest, Romania. All postimplantation CBCT imaging were assessed and evaluated for the presence of different implant positioning related complications. Data were entered into Excel spreadsheet and analyzed statistically. RESULTS: Of the 2323 CBCT's that were analyzed, a total of 160 (6.89%) presented with implant positioning related complications. Out of those, 62 cases revealed penetration of the implant to adjacent anatomic structure. More specifically, there were 21 instances of sinus penetration, 19 instances of nasal cavity penetration, 9 instances of inferior alveolar canal penetration, and 13 instances of lingual plate perforations. There were also 15 cases of adjacent tooth injury noted. CONCLUSIONS: Despite the popularity of dental implants, the surgical placement of these implants is not a riskless procedure. Implant mal-positioning might be life-threatening and can lead to serious bleeding, airway obstruction, and unnecessary postoperative surgeries. Complications of dental implants are not obsolete and dental implant associated problems may not be apparent immediately. Surgeons must have proper training and use evidenced-based treatment planning in order to prevent dental implant complications.

Use of Implant-Derived Minimally Invasive Sinus Floor Elevation: A Multicenter Clinical Observational Study With 12- to 65-Month Follow-Up.

The aim of this study is to evaluate the performance of implant-derived minimally invasive sinus floor elevation. A multicenter retrospective study was performed in 5 dental clinics. Patients requiring sinus augmentation for single implant placement were recorded and followed up. The dental implant used in this trial was a self-tapping endosseous dental implant that contains an internal channel to allow the introduction of liquids through the implant body into the maxillary sinus; those liquids include saline and a flowable bone grafting material. Overall, 37 implants were installed in 37 patients. The age range of the patients was 37-75 years (mean: 51.2 years). The average residual bone height prior to the procedure was 5.24 ± 1 mm. Of all cases, 25 implants replaced the maxillary first molar and 12 replaced the maxillary second premolar. All surgeries were uneventful with no apparent perforation of the sinus membrane. The mean follow-up time was 24.81 ± 13 months ranging from 12 to 65 months. All implants integrated and showed stable marginal bone level. No adverse events were recorded during the follow-up period. The presented method for transcrestal sinus floor elevation procedure can be accomplished using a specially designed dental implant. Further long-term studies are warranted to reaffirm the results of this study.

Minimally invasive sinus lift implant device: a multicenter safety and efficacy trial preliminary results.

PURPOSE: In cases of advanced maxillary sinus atrophy of the bone (pneumatization), the sinus floor has to be augmented in order to obtain acceptable bone volume for implantation. The objective of the present study is to evaluate a new procedure and device, designed as a closed sinus lift using a dedicated dental implant that allows for Schneiderian membrane elevation and the placement of a flowable bone replacement graft. MATERIALS AND METHODS: Eighteen patients (8 males, 10 females) underwent 23 procedures. All procedures were completed successfully, with elevation of the sinus membrane and insertion of bone graft and the dental implant at the planned site. No membrane tears were noted. No intraoperative or postoperative adverse events were observed in any of the cases. There were no postprocedural emergency or distress calls. RESULTS: The patients' average age was 52 (range 38-72). The mean residual alveolar ridge height was 5.5 mm (range 4.0-7.0). The average bone gain was 11.2 mm (range 9-13) after an average healing period of 8.7 months (range 6.7-13.1). All implants achieved clinical stability and prosthetic rehabilitation was uneventful. CONCLUSIONS: A closed sinus floor elevation procedure can be accomplished using a dedicated dental implant that allows for hydraulic elevation of the Schneiderian membrane and placement of a flowable bone replacement graft and dental implant placement all at the same time with minimal patient discomfort.

Nasal floor elevation combined with dental implant placement: a long-term report of up to 86 months.

PURPOSE: The aim of this paper is to present a large-scale long-term follow-up of dental implants placed simultaneously with nasal floor augmentation using osteoconductive bovine bone substitutes. MATERIALS AND METHODS: Patients who received dental implants combined with nasal floor elevation in three dental centers between 2006 and 2012 were included in this report. Preoperative available bone height was measured on computed tomographic scans. Implant parameters as well as implant survival rates were recorded. The cohort consisted of long-term follow-up of this previously reported cohort, combined with a cohort of newly treated patients. RESULTS: Overall, 67 patients were included in this study. Cigarette smoking was reported by 16 patients. Two hundred three implants were inserted in combination with nasal floor elevation. No nasal mucosa perforations were observed. The mean follow-up periods were 65.93 ± 13.2 months (range, 33 to 86 months) for the original cohort and 23.14 ± 9.4 months (range, 7 to 44 months) for the newly treated patients. The available bone height prior to bone augmentation was 8.89 ± 1.1 mm (range, 5 to 11.2 mm) and a mean of 3.65 ± 0.9 mm (range, 1.1 to 7 mm) of additional height was achieved with nasal floor elevation. During the follow-up period, no implants were lost, resulting in a 100% survival rate. CONCLUSION: Nasal floor augmentation, as shown in this report, might serve as a reliable method for reconstruction of the anterior atrophic maxilla when residual height is insufficient.

Patients perceptions of recovery after maxillary sinus augmentation with a minimally invasive implant device.

OBJECTIVE: Patients' perceptions of recovery following sinus augmentation procedures have scarcely been documented. The aim of the present prospective pilot clinical study was to evaluate the patient's perception of immediate postoperative recovery after sinus augmentation, using a minimally invasive implant device. METHOD AND MATERIALS: Eighteen patients (8 men, 10 women), average age 52 (median 48, range 38 to 72), who had been scheduled for sinus augmentation procedures, were asked to enroll in a prospective clinical study. A healthrelated quality-of-life questionnaire was given to the patient. The questionnaire was designed to assess patient's perception of recovery in four main areas: pain, oral function, general activity, and other symptoms. The questionnaire was compared to the surgical chart that described the surgical details and to the outcome. RESULTS: Patients' perceptions of postoperative symptoms in the four tested areas: pain, oral function, general activity, and other symptoms were mostly scored "not at all" or "very little" from postoperative day (POD) 1. Most patients returned to work on POD 1. CONCLUSION: The current results offer a preliminary indication that patients undergoing sinus augmentation using a minimally invasive implant device can expect to experience minimum discomfort and immediate return to everyday activity.