Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 12 de 12
Filtrar
1.
Clin Implant Dent Relat Res ; 26(1): 170-182, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37438839

RESUMO

INTRODUCTION: Alveolar ridge augmentation is often required before dental implant placement. In this context, autologous bone grafts are considered the biological gold standard. Still, bone block harvesting is accompanied by some serious potential disadvantages and possible complications, such as pain, bleeding, and nerve irritation. Several studies aimed to compare autologous to allogeneic bone grafts concerning bone quality and implant survival rates; this is the first prospective study analyzing and comparing morbidity-related parameters after alveolar ridge augmentation using autogenous and allogeneic bone blocks from patients' perspective. METHODS: Using a questionnaire, 36 patients were asked to evaluate the surgery as well as the post-operative period concerning pain, stress, sensibility deficits, satisfaction with, and consequences from the surgery as well as the preferred procedure for future alveolar ridge augmentations. RESULTS: No significant differences were shown regarding stress and pain during and after surgery, whereas the rate of nerve irritations was twice as high in the autologous group. The swelling was significantly higher in patients with autologous bone blocks (p = 0.001). Nevertheless, the overall satisfaction of patients of both groups was very high, with over 8/10 points. CONCLUSIONS: The swelling was the main reason for patients' discomfort in both groups and was significantly higher after autologous bone augmentation. Since this side effect seems to be a highly relevant factor for patients' comfort and satisfaction, it needs to be discussed during preoperative consultation to allow shared decision-making considering the anticipated morbidity.


Assuntos
Aumento do Rebordo Alveolar , Transplante de Células-Tronco Hematopoéticas , Humanos , Aumento do Rebordo Alveolar/efeitos adversos , Aumento do Rebordo Alveolar/métodos , Implantação Dentária Endóssea/métodos , Estudos de Coortes , Estudos Prospectivos , Transplante Ósseo/métodos , Dor
2.
Int J Implant Dent ; 9(1): 52, 2023 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-38117445

RESUMO

OBJECTIVES: Autogenous and allogeneic blocks for shell augmentation of the jaw have shown comparable results. This observational clinical study aimed to compare both materials for shell augmentation concerning surgery time and intra- and postoperative complications. MATERIAL AND METHODS: Bone augmentation with the shell technique using autogenous or allogenous bone was performed in 117 patients with segmental jaw atrophy. The primary study parameter was the surgical time, comparing both materials. Subsequently, intra- and postoperative complications were recorded. RESULTS: Allogeneic (n = 60), autogenous (n = 52), or both materials (n = 5) were used. The use of allogeneic material led to a significantly shorter operation time (p < 0.001). A more experienced surgeon needed significantly less time than a less experienced surgeon (p < 0.001). An increasing number of bone shells (p < 0.001), an additional sinus floor elevation, and intraoperative complications also significantly increased the operation time (p = 0.001). Combining allogeneic and autogenous shells (p = 0.02) and simultaneous sinus floor elevation (p = 0.043) significantly impacted intraoperative complications. No correlations were found between the included variables for postoperative complications (all p > 0.05). In total, 229 implants were inserted after a healing time of 4-6 months, with a survival of 99.6% after a mean follow-up duration of 9 months. CONCLUSIONS: Compared to the autogenous technique, allogeneic shell augmentation has a shorter surgical time and a similar rate of intra- and postoperative complications as autogenous bone. Together with its promising clinical results, this technique can be recommended.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Levantamento do Assoalho do Seio Maxilar , Humanos , Duração da Cirurgia , Estudos Prospectivos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Intraoperatórias
3.
Int J Implant Dent ; 8(1): 48, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36316597

RESUMO

PURPOSE: Allogeneic cortical bone plates (CP) might be used for alveolar ridge augmentation as an alternative to autogenous grafts (AG) and bone substitutes (BS). We report about a multicenter case series and our experiences of more than 300 cases using CP and the shell technique for reconstruction of the alveolar process to illustrate surgical key steps, variations, and complication management. METHODS: Different types of alveolar ridge defects were augmented using the shell technique via CP. The space between the CP and the alveolar bone was filled with either autogenous or allogeneic granules (AUG, ALG) or a mixture of both. Implants were placed after 4-6 months. Microscopic and histological assessments were performed. In addition, space filling using AUG, ALG and bovine BS was discussed. RESULTS: Scanning electron microscopy demonstrated the compact cortical structure of CP and the porous structure of ALG allowing micro-vessel ingrowth and bone remodeling. Histological assessment demonstrated sufficient bone remodeling and graft resorption after 4-6 months. In total, 372 CP cases and 656 implants were included to data analysis. The mean follow-up period was about 3.5 years. Four implants failed, while all implant failures were caused by peri-implantitis. Next, 30 CP complications were seen, while in 26 CP complications implant placement was possible. CP rehydration, stable positioning by adjusting screws, smoothing of sharp edges, and a tension-free wound closure were identified as relevant success factors. Space filling using ALG and a mixture of AUG/ALG resulted in sufficient bone remodeling, graft resorption and stability of the augmented bone. CONCLUSIONS: CP and the shell technique is appropriate for alveolar ridge augmentation with adequate bone remodeling and low complication rates. Allografts can prevent donor site morbidity and therefore may decrease discomfort for the patient.


Assuntos
Aumento do Rebordo Alveolar , Substitutos Ósseos , Transplante de Células-Tronco Hematopoéticas , Bovinos , Animais , Humanos , Aumento do Rebordo Alveolar/métodos , Implantação Dentária Endóssea/métodos , Transplante Ósseo/métodos
4.
Clin Adv Periodontics ; 11(3): 176-182, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34250744

RESUMO

INTRODUCTION: In recent years, several methods have been described for the treatment of deep Miller Class II recessions. Most of these techniques concentrate on single recessions or one deep recession accompanied by just slight neighboring root denudations. A modified technique is presented for treating two or more deep recessions beyond the mucogingival margin combining a subepithelial connective tissue graft (SCTG), enamel matrix derivative, and a multiple pedicle coronally advanced flap. To the best of our knowledge, this is the first report to describe the treatment of multiple deep Miller Class II recessions exceeding beyond the mucogingival junction using a pedicled advanced flap. CASE PRESENTATION: A 29-year-old woman was referred to the periodontal practice of JT for the treatment of progressive deep Miller Class II recessions. The root coverage procedure was performed by a modified multiple pedicle flap combined with a connective tissue graft harvested from the palate and enamel matrix derivative. The case was followed up for 2 years. CONCLUSIONS: This modified technique of a multiple pedicled flap is a feasible and useful method for treating several deep neighboring recessions. Due to the improved incision techniques, scar tissue formation might be reduced not to interfere with the esthetic result.


Assuntos
Retração Gengival , Adulto , Estética Dentária , Feminino , Retração Gengival/cirurgia , Humanos , Retalhos Cirúrgicos , Raiz Dentária , Resultado do Tratamento
5.
Clin Case Rep ; 9(2): 947-959, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33598278

RESUMO

Atrophic alveolar ridges of five patients were augmented with allografts and autografts on opposite sites, followed by dental implantation. Both augmentation materials led to equivalent bone gains. Allografts did not compromise the clinical outcome.

6.
Artigo em Inglês | MEDLINE | ID: mdl-34076633

RESUMO

During bone augmentation procedures, primary wound healing determines the bone augmentation result. After a crestal incision in the maxilla, the palatal flap might not be an adequate length to correctly couple to the vestibular flap and to seal the wound with horizontal mattress and single sutures. Due to the histologic structure made of dense connective tissue, the palatal flap eversion is impossible, negatively impacting the wound seal and primary healing. This case report describes the effectiveness and efficacy of an incision design to improve palatal flap management during bone augmentation procedures in the maxilla. Indeed, palatal flap verticalization is achieved. The incision line is proportionally shifted on the vestibular side, based on the defect anatomy, to obtain a palatal flap length extending at least 4 mm coronal to the bone graft level prior to wound closure. The described approach simplifies the optimal adaptation of the inner faces of the palatal and vestibular flaps, reducing the risk of nonprimary wound healing.


Assuntos
Maxila , Retalhos Cirúrgicos , Transplante Ósseo , Humanos , Maxila/diagnóstico por imagem , Maxila/cirurgia , Palato , Suturas
7.
Artigo em Inglês | MEDLINE | ID: mdl-29641632

RESUMO

Tooth loss generally leads to a corresponding loss of supporting bone structures, jeopardizing correct implant placement. Bone augmentation procedures facilitate reconstruction of the alveolar contours but lengthen treatment time by about 4 to 9 months. The aim of this case series report is to describe the short-term results of the combination of three-dimensional bone augmentation using the shell technique in conjunction with simultaneous implantation. A total of 10 patients who underwent autologous bone augmentation using the shell technique with simultaneous implantation were retrospectively examined. The shell technique is an augmentation procedure using thin cortical bone plates adapted to the buccal and oral walls of the defect to rebuild the contours of the alveolar ridge. The remaining spaces are filled with bone chips. Healing time before second stage surgery was 4 months. The vertical bone defect at the beginning (VD), the height of the vertical bone graft, resorption at the time of second-stage surgery (BR1) and 1 year after prosthetic rehabilitation (BR2), the total resorption between augmentation and 1 year (BRtot), and the vertical bone loss of the implant (VBL) were measured. VD was 3.1 mm. Values for BR1 and BR2 were 0.4 and 0.45 mm, respectively, resulting in a total bone loss of 0.85 mm of bone loss (BRtot). VBL was 0.45 mm 1 year after prosthetic rehabilitation. The simultaneous approach of vertical bone augmentation in the shell technique and implantation shows excellent results in bone reconstruction and stability up to 1 year after prosthetic reconstruction and can shorten treatment time by 4 to 9 months.


Assuntos
Aumento do Rebordo Alveolar/métodos , Transplante Ósseo/métodos , Carga Imediata em Implante Dentário/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Implantação Dentária Endóssea/métodos , Humanos , Imageamento Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Periodontite/cirurgia , Radiografia Dentária , Radiografia Panorâmica , Estudos Retrospectivos
8.
J Periodontol ; 74(3): 307-11, 2003 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-12710749

RESUMO

BACKGROUND: The aim of the study was to test the efficacy of a novel low-abrasive air polishing powder in subgingival plaque removal at interdental sites during periodontal maintenance therapy (PMT). METHODS: Using a split mouth design, subgingival plaque was removed in 23 PMT patients using a low abrasive powder using a standard air polishing unit (test) or curets (positive control). Before and immediately after treatment, subgingival plaque samples were taken from interdental sites with 3 to 5 mm probing depth (PD) at 2 test teeth and 2 positive control teeth. To evaluate the influence of sampling on the microflora, plaque samples were also taken twice at 2 teeth without therapy with PD of 3 to 5 mm (negative control). PMT treatment and plaque sampling were repeated 3 times at quarterly intervals. Anaerobe cultivation was utilized to assess the mean reduction of total colony forming units (CFU) immediately after treatment. RESULTS: Test treatment resulted in a significantly greater reduction in subgingival bacterial counts (log 1.9 +/- 0.7) than positive control treatment (log 1.1 +/- 0.6) and subgingival plaque sampling alone (log 0.5 +/- 0.5; P < 0.05). Differences between positive and negative control were not significant (P < 0.05). CONCLUSION: The novel low-abrasive air polishing powder is superior to curets in removing subgingival plaque at interdental sites with up to 5 mm probing depth in PMT.


Assuntos
Placa Dentária/terapia , Raspagem Dentária/instrumentação , Adolescente , Adulto , Idoso , Ar , Bactérias Anaeróbias/crescimento & desenvolvimento , Contagem de Colônia Microbiana , Placa Dentária/microbiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Bolsa Periodontal/prevenção & controle , Pós , Estatísticas não Paramétricas , Curetagem Subgengival/instrumentação
9.
Int J Oral Maxillofac Implants ; 29(4): 921-6, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25032773

RESUMO

PURPOSE: To define the role played by a suspended external-internal (SEI) suture in reducing marginal flap tension after bone augmentation in the maxilla and in enhancing primary wound healing. MATERIALS AND METHODS: Twenty partially edentulous patients requiring bone augmentation (either guided bone regeneration or autogenous bone block placement) before or simultaneous with implant insertion in the maxilla were enrolled in this clinical prospective cohort study. Flap tension was measured by a dynamometer, which was accurate to within 1 g. The force recorded was that needed to enable the vestibular extensible flap to reach the edge of the palatal nonextensible flap. Flap tension was recorded after the periosteum-releasing incision was made (before application of any suture; T1), and after the SEI suture was applied (T2). Final marginal flap adaptation was accomplished via horizontal mattress sutures and simple stitches. Wound healing was monitored at 1, 2, 4, and 16 weeks and classified as "obtained primary closure" or "compromised" as a result of dehiscence or marginal flap necrosis. RESULTS: The mean flap tension measured at T1 was 32.9 ± 7.7 g. After the SEI suture was applied, the mean marginal flap tension decreased to 4.1 ± 1.5 g. The marginal flap tension was reduced by 87.6% compared to the initial strain. All patients healed uneventfully, and no complications such as dehiscences or marginal flap necrosis were recorded. CONCLUSION: The application of the SEI suture reduced the tension on the margins of the flaps and played a decisive role in obtaining primary wound healing. In case of passive wound closure (strain < 5 g), the type of augmentation procedure (guided bone regeneration or autogenous block) was revealed to have no impact on the quality of wound healing.


Assuntos
Aumento do Rebordo Alveolar/métodos , Arcada Parcialmente Edêntula/cirurgia , Retalhos Cirúrgicos/cirurgia , Técnicas de Sutura , Adulto , Idoso , Estudos de Coortes , Feminino , Regeneração Tecidual Guiada Periodontal/métodos , Humanos , Masculino , Maxila/cirurgia , Pessoa de Meia-Idade , Estudos Prospectivos , Procedimentos de Cirurgia Plástica/métodos , Fatores de Tempo , Cicatrização
10.
Int J Oral Maxillofac Implants ; 28(4): 1062-7, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23869364

RESUMO

PURPOSE: The aim of this case series is to propose an approach to help maintain autogenous bone grafts. This is done by applying a collagen membrane (CM) and anorganic bovine bone (ABBM) at the time of implant surgery, rather than at the time of ridge augmentation, to avoid volume loss after implants are inserted. MATERIALS AND METHODS: Ten patients with severe horizontal bone atrophy were consecutively enrolled in this study. A staged approach was chosen for implant placement following horizontal ridge augmentation. A block graft was harvested from the retromolar area and secured to the recipient site with fixation screws; contour overbuilding was avoided. The width of the ridge was measured before and after horizontal augmentation. After 4 months of healing, implants were inserted, the augmented site was relined with ABBM, and CM was applied to prevent bone volume loss. Another 4 months later, at the time of abutment placement, cone beam computed tomography was performed to quantify the end result. RESULTS: The mean horizontal ridge width prior to treatment was 2.1 ± 0.5 mm. Mean postsurgical crest width was 6.9 ± 0.5 mm. After the 4-month healing period, the mean alveolar crest width was 6.6 ± 0.6 mm. At the time of abutment connection, the mean width of the regenerated ridge, as measured on three-dimensional cone beam images, was 7.7 ± 0.8 mm. CONCLUSIONS: Minimal bone loss occurred in unprotected autogenous bone grafts with respect to alveolar bone contour (0.25 ± 0.29 mm). After the implants were inserted, no further remodeling/resorption occurred with sites treated by ABBM and CM relining; moreover, an additional increase in alveolar crest width was evident. The nonresorbable ABBM osseointegrated clinically and radiologically, preventing bone loss prior to implant loading. This layer appeared to maintain the regenerated crest volume.


Assuntos
Perda do Osso Alveolar/prevenção & controle , Perda do Osso Alveolar/cirurgia , Aumento do Rebordo Alveolar/métodos , Adulto , Regeneração Óssea , Transplante Ósseo , Colágeno , Implantação Dentária , Feminino , Humanos , Masculino , Membranas Artificiais , Pessoa de Meia-Idade , Transplante Autólogo , Transplante Heterólogo , Adulto Jovem
11.
Artigo em Inglês | MEDLINE | ID: mdl-23998161

RESUMO

The aim of this study was to report the outcome of the management of alveolar crest vertical defects using the tunnel technique approach associated with autogenous bone blocks prior to implant placement in 10 partially dentate consecutively treated patients. Four clinical linear measurements were taken: maximal extension of the vertical defect (VD) at the time of the augmentation procedure (time 0), vertical bone graft (VBG) recorded at time 0, bone resorption at implant placement (time 1), and bone resorption during implant healing at the time of abutment connection (time 2). All patients healed uneventfully, and no complications were recorded. Both mean VD and VBG at time 0 were 6.50 ± 1.43 mm. Mean bone resorption at time 1 was 0.30 ± 0.48 mm and mean bone resorption at time 2 was 0.25 ± 0.26 mm, yielding an overall vertical bone remodeling of 0.55 ± 0.49 mm (8.4%) after 8 months. This study supports the capability of a minimally invasive approach to regenerate bone in vertical defects prior to implant placement.


Assuntos
Perda do Osso Alveolar/cirurgia , Aumento do Rebordo Alveolar/métodos , Transplante Ósseo/métodos , Adulto , Idoso , Remodelação Óssea , Reabsorção Óssea , Implantação Dentária Endóssea , Feminino , Humanos , Arcada Parcialmente Edêntula/cirurgia , Masculino , Mandíbula/cirurgia , Maxila/cirurgia , Pessoa de Meia-Idade , Retalhos Cirúrgicos , Resultado do Tratamento , Dimensão Vertical , Cicatrização
12.
Artigo em Inglês | MEDLINE | ID: mdl-23820699

RESUMO

The aim of this case series report is to compare the results of the increase in keratinized mucosa using three different techniques of stage-two surgery. Thirty-two patients with one to eight dental implants who received prosthetic rehabilitation of the maxilla were included. Patients were divided into three groups based on preoperative anatomical considerations. Stage-two surgery was performed using either the apically repositioned flap (ARF; n = 14), the roll flap (RF; n = 10), or an apically repositioned flap combined with a connective tissue graft (ARFCT; n = 8). The height of the keratinized mucosa and relative tissue thickness were measured preoperatively and postoperatively at 2 weeks and 3, 6, and 12 months after surgery. The mean gains of keratinized mucosa and tissue thickness were calculated from these measurements. After 1 year, the mean gains in tissue thickness and keratinized tissue were 1.37 and 4.63 mm in the ARF group, 2.41 and 1.35 mm in the RF group, and 3.10 and 4.10 mm in the ARFCT group, respectively. There was no significant statistical difference between the 12-month and postoperative measurements (P > .05). In patients with deficient tissue thickness, a roll flap or an apically repositioned flap should be performed, while a lack of keratinized mucosa indicates the use of an apically repositioned flap with or without a connective tissue graft. When an increase in both keratinized mucosa and tissue thickness is necessary, an apically repositioned flap combined with a free connective tissue graft can be recommended. After a 12-month healing period, the obtained results showed excellent stability.


Assuntos
Gengiva/patologia , Gengivoplastia/métodos , Maxila/cirurgia , Retalhos Cirúrgicos/cirurgia , Adulto , Idoso , Autoenxertos/transplante , Tecido Conjuntivo/transplante , Implantes Dentários , Feminino , Seguimentos , Gengiva/transplante , Humanos , Arcada Edêntula/cirurgia , Arcada Parcialmente Edêntula/cirurgia , Masculino , Pessoa de Meia-Idade , Retalhos Cirúrgicos/transplante , Resultado do Tratamento , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA