Vertical augmentation of the atrofic posterior mandibular ridges with onlay grafts: Intraoral blocks vs. guided bone regeneration. Systematic review.

Background: The high resorption rate of intra-oral Onlay block grafts, coupled with morbidity and limited bone availability, means that the use of guided bone regeneration (GBR) may be preferable for vertical augmentation of mandibular atrophic posterior sectors. Aims: To evaluate the bone gain and surface resorption of the intraoral Onlay block graft compared to the GBR; as well as to study postoperative complications, survival and success rates of dental implant, and peri-implant marginal bone loss. Material and Methods: An electronic search was performed in the PubMed, Scopus, and Web Of Science databases on bone augmentation with intraoral autologous onlay block graft or GBR until December 2021. Results: Of 214 potentially eligible papers, 11 complied with the inclusion criteria: 5 studies on block graft technique, 5 on GBR technique and 1 was a comparison of both treatment groups. In the block graft group, the mean vertical bone gain was 4.05mm with a mean resorption of 0.84mm (17.70%); the complication rate was 20%; the survival and success rates were 100% and 92.23% respectively and the mean peri-implant bone loss was 0.22mm at 12 months. For the GBR group, the mean bone gain was 4.7mm with a mean resorption of 0.33mm (15.08%); the complication rate was 11.6%; the survival rate was 100% and the mean peri-implant bone loss was 0.95mm at 12 months. Conclusions: Despite the limitations, the GBR technique seems to achieve greater bone gain with less superficial resorption as well as fewer complications, but it presents a greater peri-implant loss at 12 months. Key words:Onlay block graft, Guided Bone Regeneration, intraoral bone, augmentation procedure.

Effect of a single initial phase of non-surgical treatment of peri-implantitis: Abrasive air polishing versus ultrasounds. A prospective randomized controlled clinical study.

BACKGROUND: Non-surgical treatment of peri-implantitis includes a correct mechanical debridement of the implant surface to reduce the inflammation and recondition the soft tissues. The aim of the study was to evaluate the results of a single phase of non-surgical therapy by comparing the effect of curettes and ultrasounds versus curettes and abrasive air polisher (Air-Flow) in the peri-implant tissue conditions, and patient satisfaction. MATERIAL AND METHODS: A double-blind randomized and controlled prospective clinical study was conducted on patients in peri-implant maintenance phase diagnosed of peri-implantitis treated in the Oral Surgery Unit of the Stomatology Department of the Faculty of Medicine and Dentistry of the University of Valencia, between September of 2017 and May of 2018. They were divided into 2 groups: Group 1: curettes and ultrasounds, and Group 2: curettes and Air-Flow. The clinical and radiological baseline parameters were evaluated after 3-weeks of treatment, as well as patient satisfaction. RESULTS: The sample included 34 patients. Group 1 (17 patients, 38 implants) and Group 2 (17 patients, 32 implants). All the variables improved statistically significantly after treatment in both groups, with the exception of recessions and keratinized mucosa and bone loss that did not vary. When comparing both groups, the type of treatment did not influence the majority of the variables, with the exception of the plaque index (p=0.011) and modified bleeding index from the palatine (p=0.048), which reduced statistically significant in the group 2, as well as the patient satisfaction which was higher in the group 2 (p<0.001). CONCLUSIONS: An initial phase of non-surgical treatment achieves an improvement of the peri-implant clinical parameters, thought the method of debridement used seems not to influence. Key words:Peri-implantitis, peri-implant disease, non-surgical treatment, air-abrasive device, mechanical debridement.

Patient compliance to postoperative instructions after third molar surgery comparing traditional verbally and written form versus the effect of a postoperative phone call follow-up a: A randomized clinical study.

BACKGROUND: The understanding and adherence to postoperative care instructions may be influenced by how they are presented by the professional interfering the recuperation process after surgery. The aim of this study was to evaluate the effect of a postoperative phone call follow-up compared with a traditional verbally and written instructions regarding compliance of postoperative recommendations after third molar surgery; and secondly, to discover the main points of non-compliance. MATERIAL AND METHODS: A randomized clinical study was performed including patients that underwent surgical extraction of an impacted mandibular or maxillary third molar in the Oral Surgery Unit of the University of Valencia from January 2016 to January 2017. Patients were randomly assigned to one of three different test groups according to how the post-operative instructions were delivered: brief written instructions, written extended instructions or brief written instructions plus a phone call follow-up at 3-day postoperative period. Patients were interviewed about their adherence to the instructions one week after surgery. The significance level was set at p<0.05. RESULTS: The higher score of compliance was found to the phone call follow-up group (p=0.001). No statistically significant differences were found between brief written group and the group that received written extended instructions. In the phone call follow-up group all variables assessed to the compliance were fulfilled. To brief written and written extended instructions groups, the main points of non-compliance were hygiene and smoking (p<0.001, p=0.026, respectively), and tended towards significance for chlorhexidine rinses and antibiotic, analgesic and anti-inflammatories medication prescribed. CONCLUSIONS: Telephone call follow-up can promote patient adherence to postoperative recommendations after third molar surgery. The main factors of non-compliance were not maintain a proper hygiene and not smoking, followed by not performing chlorhexidine rinses and not following medication prescribed. Key words:Compliance, postoperative instructions, postoperative recommendations, third molar surgery.

Does Apico-Coronal Implant Position Influence Peri-Implant Marginal Bone Loss? A 36-Month Follow-Up Randomized Clinical Trial.

PURPOSE: Preserving peri-implant bone and reducing exposure of the rough implant surface might influence long-term outcomes of implant therapy. The aim of this study was to compare peri-implant clinical and radiologic parameters after crestal and subcrestal dental implant placement at 36 months' follow-up. MATERIALS AND METHODS: We carried out a randomized clinical trial involving partially edentulous patients in need of an implant-supported, partial fixed dental prosthesis or a single crown. Patients were randomized according to the implant insertion depth: implants placed approximately 2 mm below the bone crest (test group) or implants placed at bone crest level (control group). They were evaluated 6, 12, 24, and 36 months after prosthetic loading. Peri-implant marginal bone loss was the primary outcome, and the following secondary outcomes were registered: coronal bone changes, plaque index, probing depth, modified bleeding index, retraction and width of the peri-implant mucosa, and peri-implant health condition. Implant survival and success rates after 36 months' follow-up were calculated. RESULTS: The study comprised 128 patients (83 men and 45 women; mean age, 54.4 ± 12.2 years) and a total of 265 implants (133 in control group and 132 in test group). No statistically significant differences in the peri-implant clinical parameters were found. After 3 years' follow-up, 53.4% of the crestal implants and 25.8% of the subcrestal implants presented marginal bone loss, with a mean exposed rough surface of -0.2 ± 0.3 mm and -0.09 ± 0.1 mm, respectively (P = .001). The overall success rate was 99.6%. CONCLUSIONS: Crestal and subcrestal implants showed similar clinical outcomes 3 years after prosthetic loading. Significant differences were observed in the radiologic parameters, showing less peri-implant marginal bone loss with subcrestal implants.

Peri-implant Tissues and Patient Satisfaction After Treatment of Vertically Augmented Atrophic Posterior Mandibles with Intraoral Onlay Block Bone Grafts: A Retrospective 3-Year Case Series Follow-up Study.

PURPOSE: To evaluate the peri-implant soft and hard tissues of dental implants placed in vertically regenerated posterior mandibles with intraoral onlay block bone grafts and patient satisfaction at 3-year follow-up. MATERIALS AND METHODS: A retrospective study of patients with dental implants placed in posterior mandibular sites vertically augmented with intraoral onlay block bone grafts was carried out between 2005 and 2009 at the University of Valencia. The outcomes assessed at the 3-year follow-up visit were the peri-implant soft tissues (Plaque Index and Bleeding Index, probing depth, keratinized mucosa width, and recession), implant survival and success rates, marginal bone loss, and patient satisfaction. RESULTS: Sixteen patients with 36 implants were included. The mean Plaque Index and Bleeding Index scores were ≤ 0.4. The mean band of facial keratinized mucosa was ≥ 3 mm in 52.7% of implants; 38.8% of the implants showed facial recession. The mean midfacial recession was -0.31 ± 0.75 mm. Implant survival reached 100%, while the success rate was 85%, and the mean marginal bone loss was 1 ± 1.03 mm (range: 0.1 to 5.3). Good quality of life (9.19 ± 0.40) was reported for all patients, and the overall general satisfaction score was 8.07 ± 1.04 (mucosa esthetics: 7.71 ± 1.45; prosthesis esthetics: 8.42 ± 0.6; chewing: 8.68 ± 0.94; ease of cleaning: 8.01 ± 1.03). CONCLUSION: Considering the limitations of the study, implants in vertically augmented posterior mandibular areas with intraoral onlay block bone grafts showed good soft tissue levels and high patient satisfaction. No implants were lost at 3 years postloading, though one-fifth of the patients showed a statistically significant marginal bone loss.

Non surgical predicting factors for patient satisfaction after third molar surgery.

BACKGROUND: In the third molar surgery, it is important to focus not only on surgical skills, but also on patient satisfaction. Classically studies have been focused on surgery and surgeon's empathy, but there are non-surgical factors that may influence patient satisfaction. MATERIAL AND METHODS: A cross-sectional study was performed on 100 patients undergoing surgical extractions of impacted mandibular third molars treated from October 2013 to July 2014 in the Oral Surgery Unit of the University of Valencia. A questionnaire (20 questions) with a 10-point Likert scale was provided. The questionnaire assessed the ease to find the center, the ease to get oriented within the center, the burocratic procedures, the time from the first visit to the date of surgical intervention, waiting time in the waiting room, the comfort at the waiting room, the administrative staff (kindness and efficiency to solve formalities), medical staff (kindness, efficiency, reliability, dedication), personal data care, clarity in the information received (about the surgery, postoperative care and resolution of the doubts), available means and state of facilities. Outcome variables were overall satisfaction and recommendation of the center. Statistical analysis was made using the multiple linear regression analysis. RESULTS: Significant correlations were found between all variables and overall satisfaction. The multiple regression model showed that the efficiency of the surgeon and the clarity of the information were statistically significant to overall satisfaction and recommendation of the center. The kindness of the administrative staff, available means, the state of facilities and the comfort at the waiting room were statistically significant to the recommendation of the center. CONCLUSIONS: Patient satisfaction directly depends on the efficiency of the surgeon and clarity of the clinical information received about the procedure. Appreciation of these predictive factors may help clinicians to provide optimal care for impacted third molar surgery patients.

Peri-implant Hard and Soft Tissue Stability in Implants Placed Simultaneously Versus Delayed with Intraoral Block Bone Grafts in Horizontal Defects: A Retrospective Case Series Study.

PURPOSE: To compare the 3-year outcome of dental implants placed simultaneously or delayed with intraoral onlay block bone grafts. MATERIALS AND METHODS: A retrospective study was conducted of patients subjected to localized lateral alveolar ridge augmentation with intraoral onlay autogenous block bone grafts before or at implant placement between 2005 and 2010 in the Oral Surgery Unit of the University of Valencia (Valencia, Spain). The parameters evaluated at follow-up visits were implant survival and success rates, peri-implant soft tissue conditions (Plaque Index and Bleeding Index, probing depth, width of keratinized mucosa, and facial mucosal retraction), radiographic peri-implant marginal bone loss, and patient satisfaction. RESULTS: Thirty-four patients with 53 implants (23 delayed and 30 simultaneous) were included. After 3 years of loading, the cumulative implant success rate was 83.3% for simultaneous and 96.9% for delayed implants (P = .217). Average marginal bone loss was 1.15 ± 1.67 mm for simultaneously inserted implants and 0.29 ± 0.35 mm for delayed implants (P < .01). There were no significant differences in Plaque Index or modified Bleeding Index between the groups. Peri-implant facial mucosal recession was more frequent in the simultaneous implant group (26.6% vs. 13%), though the difference was not statistically significant. General patient satisfaction averaged 9.05 ± 0.82, and good quality of life was reported by all patients. CONCLUSION: Despite its sample size and design limitations, the delayed procedure showed less marginal bone loss and a lower prevalence of facial mucosal recession than the simultaneous implant placement procedure at 3 years postloading.

Dental implants with versus without peri-implant bone defects treated with guided bone regeneration.

BACKGROUND: The guided bone regeneration (GBR) technique is highly successful for the treatment of peri-implant bone defects. The aim was to determine whether or not implants associated with GBR due to peri-implant defects show the same survival and success rates as implants placed in native bone without defects. MATERIAL AND METHODS: Patients with a minimum of two submerged dental implants: one suffering a dehiscence or fenestration defect during placement and undergoing simultaneous guided bone regeneration (test group), versus the other entirely surrounded by bone (control group) were treated and monitored annually for three years. Complications with the healing procedure, implant survival, implant success and peri-implant marginal bone loss were assessed. Statistical analysis was performed with non-parametric tests setting an alpha value of 0.05. RESULTS: Seventy-two patients and 326 implants were included (142 test, 184 control). One hundred and twenty-five dehiscences (average height 1.92±1.11) and 18 fenestrations (average height 3.34±2.16) were treated. At 3 years post-loading, implant survival rates were 95.7% (test) and 97.3% (control) and implant success rates were 93.6% and 96.2%, respectively. Mean marginal bone loss was 0.54 (SD 0.26 mm) for the test group and 0.43 (SD 0.22 mm) for the control group. No statistically significant differences between both groups were found. CONCLUSIONS: Within the limits of this study, implants with peri-implant defects treated with guided bone regeneration exhibited similar survival and success rates and peri-implant marginal bone loss to implants without those defects. Large-scale randomized controlled studies with longer follow-ups involving the assessment of esthetic parameters and hard and soft peri-implant tissue stability are needed. Key words:Guided bone regeneration, peri-implant defects, dental implants, marginal bone level, success rate, survival rate.

Immediate Versus Conventional Loading of Complete-Arch Implant-Supported Prostheses in Mandibles with Failing Dentition: A Patient-Centered Controlled Prospective Study.

PURPOSE: The aim of this study was to compare, from the patients' perspective, immediate and conventional loading of fixed complete-arch prostheses to rehabilitate mandibles with failing dentition. MATERIALS AND METHODS: This controlled, prospective, nonrandomized study included 36 consecutive patients: 18 treated with conventional loading (control) and 18 with immediate loading (test). Patient general satisfaction and specific satisfaction with esthetics, chewing, speaking, comfort, self-esteem, ease of cleaning, and treatment duration were evaluated using 10-cm visual analog scales before treatment and 3 and 12 months after treatment. Postoperative pain and swelling were monitored daily for 1 week. Statistical analysis was performed applying Mann-Whitney and Wilcoxon tests (α = .05). RESULTS: Between baseline and 3 months, satisfaction in the test group increased significantly with the exception of speech; in the control group, satisfaction increased significantly for esthetics and decreased significantly for speech, chewing, and comfort, but did not vary for general satisfaction or self-esteem. After 3 months, satisfaction was significantly higher in the test group with the exception of ease of cleaning. Between 3 and 12 months, satisfaction improved in both groups but more so in the control group, so that after 12 months there were no differences. The test group showed lower mean pain, which began after the third day postsurgery. Mean swelling and maximum pain/swelling did not show significant differences at any point. CONCLUSIONS: Patient satisfaction was reported as significantly higher with immediate loading. However, at the end of the observation periods, reported functional differences had disappeared. Significant differences were only noted for postoperative pain after the third day.

Use of buccal fat pad to repair post-extraction peri-implant bone defects in the posterior maxilla. A preliminary prospective study.

BACKGROUND: Extensive literature exists about the use of the BFP in the treatment of oral defects but, to our knowledge, no article refers to the use of the BFP as a substitute of the membrane barriers for treatment of peri-implant bone defects. The aim was to evaluate the use of the buccal fat pad as a coating material for bone grafting in the peri-implant bone defect regeneration of immediate implants placed in the posterior maxilla. MATERIAL AND METHODS: A preliminary prospective study of patients involving immediate implants in which the buccal fat pad was used as a coating material to peri-implant bone defects was carried out. The outcome measures assessed were: postoperative pain and swelling, complications related to buccal fat pad surgery, implant survival and success rates and peri-implant marginal bone loss at 12 months of prosthetic loading. RESULTS: Twenty-seven patients (17 women and 10 men) with a mean age of 55.3 ± 8.9 years, and a total of 43 implants were included. Two-thirds of the patients reported either no pain or only mild intensity pain and moderate inflammation, two days after surgery. Post-operative period was well tolerated by the patients and no serious complications occurred. None wound dehiscence occurred. Implant survival and success rates were 97.6% and the average marginal bone loss 1 year after loading was 0.58 ± 0.27 mm. CONCLUSIONS: Within the limits of this preliminary study, the use of the buccal fat pad as a coating material for bone grafting in peri-implant bone defects placed in the upper posterior maxilla was a well-tolerated technique by patients; high implant success rate was achieved with a minimal peri-implant marginal bone loss at 12 months of prosthetic loading.

Closure of oroantral communication with buccal fat pad after removing bilateral failed zygomatic implants: A case report and 6-month follow-up.

The aim of this study was to assess the use of buccal fat pad (BFP) technique as an option to close oroantral communications (OAC) after removing failed zygomatic implants in a patient with a severely resorbed maxilla, and to determine the degree of patient satisfaction. A 64-year-old woman presented recurrent sinusitis and permanent oroantral communication caused by bilateral failed zygomatic implants, 3 years after prosthetic loading. Zygomatic implants were removed previous antibiotic treatment and the BFP flap technique was used to treat the OAC and maxillary defect. The degree of patient satisfaction after treatment was assessed through a visual analogue scale (VAS). At 6-months follow-up, patient showed complete healing and good function and the results in terms of phonetics, aesthetics and chewing were highly rated by the patient. Key words:Bichat fat pad, buccal fat pad, zygomatic implants, oroantral communication.

Closure of oroantral communications with Bichat´s buccal fat pad. Level of patient satisfaction.

PURPOSE: To report the closure of oroantral communications with the pedicled buccal fat pad in a series of patients, and to determine the level of patient satisfaction after the surgery. STUDY DESIGN: A prospective study of patients diagnosed of unilateral or bilateral oroantral communication (OAC) closed using the buccal fat pad between May 2012 and January 2013 was performed. Data analysis extended to: age, sex, and cause, location and size of oroantral communication. Complications and success related to buccal fat pad surgery were evaluated. Also, patient satisfaction was assessed after six months of surgery. RESULTS: Nine patients (3 men and 6 women) with a mean age of 50.5 years and 11 OAC treated with buccal fat pads were included. The most common cause of oroantral communication was the extraction of molars. The average widest diameter of the oroantral communication was 7.1 mm. One week after the surgeries no complications were found. One month after surgery, one patient presented persistence of the oroantral communication; in this patient, the buccal fat pad technique was considered a failure, and a second intervention was performed using a buccal mucoperiosteal flap to achieve primary closure of soft tissues. After six months, patient showed closure of the communication and complete healing. All the other communications had been solved with Bichat´s ball technique, yielding a success rate of 90.9%. Mean patient overall satisfaction was 9.1 out of 10; patients were satisfied with phonetics (9.4), aesthetics (9) and chewing (9). CONCLUSIONS: The buccal fat pad technique was successful in closing 10 out of 11 oroantral communications and few complications were found. Patients were highly satisfied in overall with the treatment and with phonetics, aesthetics and chewing. Key words:Bichat's fat pad, buccal fat pad, oroantral communication.

The outcome of intraoral onlay block bone grafts on alveolar ridge augmentations: a systematic review.

AIM: The purpose of this study was to systematically review clinical studies examining the survival and success rates of implants placed with intraoral onlay autogenous bone grafts to answer the following question: do ridge augmentations procedures with intraoral onlay block bone grafts in conjunction with or prior to implant placement influence implant outcome when compared with a control group (guided bone regeneration, alveolar distraction, native bone or short dental implants.)? MATERIAL AND METHOD: An electronic data banks and hand searching were used to find relevant articles on vertical and lateral augmentation procedures performed with intraoral onlay block bone grafts for dental implant therapy published up to October 2013. Publications in English, on human subjects, with a controlled study design -involving at least one group with defects treated with intraoral onlay block bone grafts, more than five patients and a minimum follow-up of 12 months after prosthetic loading were included. Two reviewers extracted the data. RESULTS: A total of 6 studies met the inclusion criteria: 4 studies on horizontal augmentation and 2 studies on vertical augmentation. Intraoperative complications were not reported. Most common postsurgical complications included mainly mucosal dehiscences (4 studies), bone graft or membrane exposures (3 studies), complete failures of block grafts (2 studies) and neurosensory alterations (4 studies). For lateral augmentation procedures, implant survival rates ranged from 96.9% to 100%, while for vertical augmentation they ranged from 89.5% to 100%. None article studied the soft tissues healing. CONCLUSIONS: Survival and success rates of implants placed in horizontally and vertically resorbed edentulous ridges reconstructed with block bone grafts are similar to those of implants placed in native bone, in distracted sites or with guided bone regeneration. More surgical challenges and morbidity arise from vertical augmentations, thus short implants may be a feasible option.

Implant treatment in atrophic posterior mandibles: vertical regeneration with block bone grafts versus implants with 5.5-mm intrabony length.

PURPOSE: To retrospectively compare the outcomes of implants placed in posterior mandibles vertically regenerated with onlay autogenous block bone grafts and short dental implants. MATERIALS AND METHODS: Consecutive patients with vertical bone atrophy in edentulous mandibular posterior regions (7 to 8 mm of bone above the inferior alveolar nerve) were treated with either implants placed in regenerated bone using autologous block bone grafts (group 1) or short implants (with 5.5-mm intrabony length) in native bone (group 2) between 2005 and 2010 and followed for 12 months after loading. The procedure used was the established treatment protocol for this type of patient at the Oral Surgery Unit (University of Valencia, Spain) at the time of surgery. All grafts were obtained using piezosurgery. The outcomes assessed were: complications related to the procedure, implant survival, implant success, and peri-implant marginal bone loss. Statistical analysis was done using the Fisher exact test and the Mann-Whitney test. RESULTS: Thirty-seven patients were included, 20 (45 implants) in group 1 and 17 (35 implants) in group 2. In group 1, 13 implants were less than 10 mm long (2 were 7 mm and 11 were 8.5 mm), and 32 were 10 mm or longer; the diameter was 3.6 mm in 6 implants, 4.2 mm in 31, and 5.5 mm in 8. In group 2 all implants were 7 mm long; the diameter measured 4.2 mm in 14 implants and 5.5 mm in 21 implants. Complications related to the block bone grafting procedure were temporary hypoesthesia in one patient, wound dehiscence with graft exposure in three patients, and exposure of the osteosynthesis screw without bone graft exposure in one patient. After 12 months, implant survival rates were 95.6% in group 1 and 97.1 % in group 2; success rates were 91.1% and 97.1%, respectively. The average marginal bone loss was 0.7 ± 1.1 mm in group 1 and 0.6 ± 0.3 mm in group 2. CONCLUSIONS: When residual bone height over the mandibular canal is between 7 and 8 mm, short implants (with 5.5-mm intrabony length) might be a preferable treatment option over vertical augmentation, reducing chair time, expense, and morbidity.

Replantation of a maxillary second molar after removal of a third molar with a dentigerous cyst: Case report and 12-month follow-up.

The aim of this study was to describe the replantation of a maxillary second right molar, which had been removed for surgical reasons in order to remove a dentigerous cyst associated with the adjacent third molar, and the case's 12-month follow-up. A 51-year-old man presented swelling in the right maxillary area. Radiographic examination showed a large radiolucency in close proximity to the third molar, suggesting a follicular cyst. The third molar was extracted and the cyst underwent curettage. The second molar had to be extracted to enable complete removal of the cyst and to achieve primary closure of the wound, which would have been impossible without repositioning the molar. With this objective, extraoral endodontic treatment was performed, the root-end was resected and prepared with ultrasonic retrotips, and root-end filling was accomplished with MTA before the molar was replanted. At the 12-month follow-up, the tooth showed no clinical signs or symptoms, probing depth was no greater than 3 mm and radiographic examination showed no evidence of root resorption or periapical lesion. Key words:Replantation, maxillary molar, follicular cyst, dentigerous cyst.

Localized lateral alveolar ridge augmentation with block bone grafts: simultaneous versus delayed implant placement: a clinical and radiographic retrospective study.

PURPOSE: To retrospectively evaluate the 1-year outcome of implant therapy involving localized lateral alveolar ridge augmentation with block bone grafts, and to compare outcomes of implants inserted simultaneously with grafting or after a healing period. MATERIALS AND METHODS: Consecutively treated patients undergoing alveolar ridge augmentation with autogenous intraoral block grafts before or simultaneous with implant placement between 2005 and 2010 in the Oral Surgery Unit of the University of Valencia were included. The selection of procedure (simultaneous vs delayed implant placement, donor site) was based upon the criterion of the surgeon and thorough evaluation of each patient. All grafts were obtained with piezosurgery. Complications related to augmentation, implant survival, implant success, and peri-implant marginal bone loss were assessed. RESULTS: Forty-two patients were included; 45 sites were augmented and 71 implants were inserted (33 delayed and 38 simultaneously). Complications (temporary paresthesia, wound dehiscence with bone graft exposure, and exposure of osteosynthesis screw) occurred after bone harvesting in nine patients; four were in the simultaneous group and five were in the delayed group. Six grafts were not successful; four were lost and two provided insufficient bone (after resorption) for ideal implant placement. The implant survival rate was 98.5% (100% for simultaneous and 96.9% for delayed implants) and the implant success rate was 92.9% (89.5% for simultaneous and 96.9% for delayed implants). Average marginal bone loss 1 year after loading was significantly higher for simultaneously placed implants (0.69 ± 0.67 mm) than for delayed implants (0.20 ± 0.50 mm). CONCLUSIONS: In lateral bone atrophy, block bone grafts provided sufficient bone for implant therapy, with few complications. Both simultaneous and delayed implant placement yielded high implant survival and success rates. Average marginal bone loss was significantly higher around simultaneously inserted implants.

Implants placed simultaneously with particulated bone graft in patients diagnosed with recessive dystrophic epidermolysis bullosa.

PURPOSE: To describe the rehabilitation with implants placed simultaneously with particulated bone graft in 4 patients diagnosed with recessive dystrophic epidermolysis bullosa. MATERIALS AND METHODS: A retrospective study was conducted of 4 patients diagnosed with recessive dystrophic epidermolysis bullosa and treated with dental implants and simultaneous particulate bone graft from January 2005 to December 2009. All patients had marked oral involvement, with devastating alterations in the soft and hard tissues and were rehabilitated with a fixed prosthesis. RESULTS: Eighteen implants showed dehiscence or fenestration and were placed simultaneously with particulated bone grafts to cover exposed threads: 14 received autologous bone and 4 tricalcium betaphosphate. In 16, the bone graft was covered with resorbable collagen membranes and in 2 with a nonresorbable titanium-reinforced membrane. Of the 18 implants, 8 were placed in the maxilla combining drills and osteotomes and 10 in the mandible with the conventional drilling procedure. All implants survived after a minimum follow-up of 12 months (range 12 to 48). CONCLUSIONS: The results of this small-sample clinical study suggest that endosseous implants can be placed simultaneously with particulated bone graft, providing support for a fixed prosthesis in patients with recessive dystrophic epidermolysis bullosa and considerably improving these patients' quality of life.

Marginal bone loss in relation to platform switching implant insertion depth: An update.

A review is made, analyzing marginal bone loss in relation to the depth of implant insertion with platform switching, according to the position of the neck (supracrestal, crestal or subcrestal), and evaluating survival of the implants. A PubMed search was made of the studies in animals and humans published between 2005 and 2011, specifying platform insertion depth (supracrestal, crestal or subcrestal) and registering marginal bone loss from the time of prosthetic restoration to the end of follow-up (minimum 6 months). A total of 30 studies were included. The bone loss associated with implants placed at supracrestal level was slightly smaller than in the case of implants placed at subcrestal level, though statistical significance was not reached. The mean marginal bone loss values were 0.0 mm to 0.9±0.4 mm for the implants with the neck located at supracrestal level; 0.05 mm to 1.40±0.50 mm for those at subcrestal level; and 0.26±0.22 mm to 1.8±0.39 mm for those in a crestal location, after 6-60 months of follow-up. The survival rate was 88.6-100% for the implants with the neck positioned at crestal level, versus 98.3-100% below the crest, and 100% above the crest. The heterogeneity of the studies (surgical technique, platform surface texture, radiographic measurement techniques, etc.) made it difficult to establish a relationship between marginal bone loss and the supracrestal, crestal or subcrestal location of platform switching. Key words:Dental implants, platform switching, insertion depth, crestal insertion level, bone loss.

Clinical characteristics, treatment, and evolution in 14 cases of pediatric orofacial lymphangioma.

PURPOSE: To present the largest series of orofacial lymphangioma in children published to date, analyzing the clinical characteristics and evolution of, and the treatment used for, these lesions. MATERIALS AND METHODS: The clinical data from patients diagnosed with orofacial lymphangioma, who were treated from 1998 to 2008 at the Oral and Maxillofacial Surgery Unit, Children's Hospital La Fe of Valencia (age 0 to 14 years), were reviewed. All patients with a clinical, radiographic, or, in surgical cases, histopathologic, diagnosis of orofacial lymphangioma were included. RESULTS: A total of 14 patients (8 boys and 6 girls; mean age 4.6 years) were included in the present study. Of the 14 cases, 9 had been diagnosed before the patients were 2 years old and 2 of which were congenital; 8 cases were located on the dorsum of the tongue. The lesion diameter was 1 to 2 cm in 9 patients, with 1 less than 1 cm, and was larger than 2 cm in 5. For treatment, 4 lymphangiomas were monitored periodically and resolved spontaneously, 1 was treated with sclerotherapy, and 9 with surgical extirpation. After surgery, 2 patients developed a recurrence within 13 months. CONCLUSIONS: Most of the lymphangiomas diagnosed in children occurred before 2 years of age, were on the dorsum of the tongue, and had a mean size of 1 to 2 cm. Of those treated with surgical extirpation, 2 recurred.

Marginal bone loss in relation to the implant neck surface: an update.

A review is made of the publications on the marginal bone loss of implants with a polished neck, rough neck with microthreading, and rough neck without microthreading. A PubMed search was carried out with the following key words: machined neck implant, polished neck implant, marginal bone loss, covering the period between January 1998 and March 2009. Inclusion was limited to those human clinical studies involving a minimum follow-up of 12 months, and registering the level of bone loss from the time of placement of the implant or prosthetic restoration to the end of follow-up. For most of the authors there were no significant differences in marginal bone loss between polished neck and rough neck implants. On the other hand, implants with a rough neck and microthreading showed significantly less bone loss than those with a polished neck or with a rough neck without microthreading. The survival rate of the implants with a polished neck ranged from 87% to 97.7%, versus 94.5% to 100% for those with a rough neck, and 100% for the rough neck implants with microthreading. No peri-implant disease was registered in the different studies.