Usefulness of Wedge-Shaped Implants in the Full-Arch Rehabilitation of Severe Maxillary Atrophy: A Case Report.

The management of marked horizontal bone atrophy represents a critical challenge for traditional implantology procedures. For this purpose, clinicians have developed several protocols and procedures to allow the most suitable and accurate surgical and prosthetic implant rehabilitation. Despite the development of guided bone regeneration methods and the use of small-diameter implants, the rehabilitation of thin bone areas is a clinical dilemma for the medium- and long-term survival of implant-prosthetic therapies. This clinical case evaluates the use of wedge-shaped implants for the full-arch rehabilitation of an atrophic maxilla with a thin ridge. This treatment choice allowed a minimally invasive rehabilitation, avoiding regenerative bone surgery, while respecting biologic and prosthetic limits. Furthermore, evaluation of the implant stability quotient and marginal bone loss values during the first year of follow-up allowed analysis of the behavior of this rehabilitation in fullarch maxillary cases.

All-on-4 Concept With Use Of Zygoma Implants for Rehabilitation in the Severely Atrophied Maxilla With a Definitive Immediate Restoration.

This case report of a 45-year-old patient at initial presentation shows an illustration of the limitations of periodontal maintenance therapy and subsequent implant prosthetic therapy. In close consultation with the patient, treatment strategies were adopted to maximize the preservation of prognostically questionable teeth. Eight years later, the patient had a highly atrophied maxilla that could be successfully restored with implants. This was achieved with 2 zygoma implants and 2 anterior conventional implants, which were immediately loaded according to the All-on-4 concept and immediately provided with a definitive prosthetic restoration. The case report demonstrates to the general practitioner that using zygoma implants in such constellations may offer a solution to achieve a fixed, rapid, and financially acceptable prosthetic rehabilitation.

Use of enamel matrix- derived proteins combined with bone graft for the treatment of intrabony defects: overview of reviews (FRISBEE review) / Uso de proteínas derivadas de la matriz del esmalte combinado con injerto óseo para el tratamiento de defectos intraóseos: resumen estructurado de revisiones sistemáticas (revisión FRISBEE)

Introduction: The use of enamel matrix-derived proteins (EMD) has increased in recent years due to their tissue-inducing properties that support periodontal regeneration. This study is an overview of systematic reviews with FRISBEE methodology on the use of EMD alone or combined with autologous bone graft materials (BGM) in the treatment of intrabony defects. Materials and Methods: A systematic search in the Epistemonikos database was performed. RevMan 5.3 and GRADEpro were used for data analysis and presentation Results: Four systematic reviews and two clinical trials were identified. All studies analysed change in probing depth, clinical attachment level, gingival margin level and bone defect depth (all changes in favour of EMD+BGM groups: mean difference (MD): 0.37 mm more, MD: 0.7 mm more, MD: 0.3 mm less, MD: 0.75 more, respectively). Conclusions: Adding autologous bone graft to EMD to treat intrabony defects showed better results, but not a relevant clinical difference compared to the use of EMD alone.

Introducción: El uso de proteínas derivadas de la matriz del esmalte (EMD) ha aumentado en los últimos años debido a sus propiedades inductoras de tejidos que apoyan la regeneración periodontal. Este estudio es una revisión sistemática de revisiones sistemáticas utilizando metodología FRISBEE sobre el uso de EMD solo o combinado con materiales injerto óseo autólogo (BGM) en el tratamiento de defectos intraóseos. Materiales y Métodos: Se realizó una búsqueda sistemática en la base de datos Epistemonikos. Se utilizaron RevMan 5.3 y GRADEpro para el análisis y la presentación de los datos. Resultados: Se identificaron cuatro revisiones sistemáticas y dos ensayos clínicos. Todos los estudios analizaron el cambio en la profundidad de sondaje, el nivel de inserción clínica, el nivel del margen gingival y la profundidad del defecto óseo (todos los cambios a favor de los grupos EMD+BGM: MD: 0,37 mm más, media de diferencia (MD): 0,7 mm más, MD: 0,3 mm menos, MD: 0,75 más, respectivamente). Conclusión: La adición de injerto óseo autólogo a la EMD para tratar defectos intraóseos mostró mejores resultados, pero no una diferencia clínica relevante en comparación con el uso de la EMD sola.

Elevación unilateral de piso de seno maxilar con ventana lateral utilizando xenoinjerto: reporte de caso / Unilateral elevation of maxillary sinus floor with lateral window using xenografts: report of a case

En maxilares atróficos la elevación de piso de seno es una práctica de alta predictibilidad. El adve- nimiento de materiales osteoconductores que generan andamiaje para la formación ósea propor- cionaron un aumento en la tasa de éxito de los implantes endoóseos. El presente artículo reporta un caso clínico en el cual se llevo a cabo un aumento del nivel de altura del piso de seno unila- teralmente por medio de la técnica de Cadwell- Luck modificada por Tatum, técnica con ventana lateral, donde se utilizó xenoinjerto óseo (OstiumMAX, implante de matriz ósea bovina, Laboratorio Bioxen) y membrana reabsorbible de colágeno( Laboratorio Bioxen) en el primer tiempo quirúrgi- co y seis meses después, en el segundo acto quirúrgico se colocaron tres implantes endoóseos (Sistema de implante dental TRP, Laboratorio Tormicron S.R.L.). Los resultados obtenidos fueron controlados en forma mediata y a distancia a través de radiografías panorámicas y tomografías computadas tipo Cone Beam, donde se midió la altura ósea generada post injerto. Pudo consta- tarse el éxito del procedimiento, basándonos en criterios clínico radiograficos de oseointegración (AU)

Digital vs. Freehand Anterior Single-Tooth Implant Restoration.

Replacing a single tooth in the anterior maxilla is one of the greatest challenges in dentistry. Both functional and aesthetic results are to be strictly pursued. Planning and executing such a case through a totally digital methodology eventually guarantee many advantages, above all patient's operative and postoperative comfort. To ascertain this, a BOP analysis was performed which allowed us to evaluate soft tissues health, and more; crestal bone resorption was measured to evaluate hard tissues stability. This assumption was studied through four cases in which patients were alternatively treated with analogic and digital techniques. Four homogeneous patients were recruited. They all needed to extract one of the upper incisors, due to different clinical reasons, and then to replace it with an implant. Each patient was treated with an immediate postextractive implant which was immediately loaded, and finally, analogical and digital techniques were compared. All patients underwent a preoperative CBCT examination. After surgery, patients were checked by the surgeon after 10 days and one month to evaluate the progress of healing and to exclude any prosthetic problem. At 6 months (T1), one year (T2), and three years (T3), intraoral x-rays were performed using customized centring devices, according to the parallel beam technique. All data have been collected in a table and statistically processed; mean and standard deviation were measured. All patients entered an oral hygiene program with six months recall. Dental hygienist checked the BOP at T1, T2, and T3. At every step, similar levels of BOP were recorded. About interproximal bone loss, all patients showed an initial moderate loss (between T1 and T2), followed by stable values between T2 and T3. Despite the important limitations of a study with few cases, these results show a similar outcome comparing digital and analogical methods.

A Non-Interventional Study Documenting Use and Success of Tissue Level Implants.

Numerous randomised controlled multicentric studies have investigated various responses to different treatment modalities with dental implants. These studies do not always show the results of daily practice as they are performed under controlled and strict clinical conditions. This multicentric, non-interventionist trial aimed to document the behaviour of implants when used in daily dental practice, without inclusion or exclusion criteria. One hundred and ninety-six screw-shaped, tissue-level implants were placed, and each clinician decided which implant, surgical loading and prosthetic protocol to use. At surgery, data related to the implants were recorded. Additionally, the crestal bone level changes were evaluated for up to two years of follow-up. Two implants were lost before they were loaded. The success rate was 98.31%, and the survival rate was 98.79%. The implant stability quotient (ISQ) at surgery was 68.61 ± 10.35 and at 2 years was 74.39 ± 9.64. The crestal-shoulder distances were 1.25 ± 1.09 mm and 1.68 ± 1.07 mm in the mesial and distal aspects on the day of surgery, respectively, and 2.04 ± 0.91 and 2.16 ± 0.99 mm at 2 years, respectively. At 2 years, 69.3% of the patients were highly satisfied. The use of implants under standard conditions seemed to have success rates similar to their placement in controlled studies.

Analysis of marginal bone loss and implant stability quotient by resonance frequency analysis in different osteointegrated implant systems. Randomized prospective clinical trial.

BACKGROUND: The aim of the present prospective clinical study is to compare the stability of the implant-bone interface by the ISQ quotient and marginal bone loss (MBL) rate during one year of follow-up in four system implants with the same surface and different design. MATERIAL AND METHODS: Prospective randomized clinical trial of 21 patients in which four implant systems with the same surface and different design were placed. Patients were treated by the same operator following a similar surgical protocol with submerged technique. The second surgery to perform the prosthesis was performed at 3 months. All patients went to their review at 6 months and a year. A periapical radiograph for crestal bone analysis and an Implant stability quotient by resonance frequency analysis (ISQ) analysis were taken at baseline and the reviews. RESULTS: No statistically significant differences were found in the Implant stability quotient by resonance frequency analysis and Marginal Bone Loss in the four types of implants. The ISQ increased from the moment of insertion of the implant until the revision to the year, showing an increase of the stability implant, being this increasing less between the 6 months and the year. CONCLUSIONS: Differences in the design of the four implants tested in this study did not show statistically significant differences in any of the variables studied, so the implant design does not influence implant stability and marginal bone loss in the first year after placement.

Undesirable course of an oral implant rehabilitation in a patient with a long history of bulimia nervosa: case report and review of the literature.

BACKGROUND: Bulimia nervosa is an eating disorder resulting in an intended weight loss due to decreased food intake, induced vomiting, or hyperactivity, and is observed frequently between 12 and 25 years of age. One of the complications is early tooth loss. Moreover, since bulimia nervosa patients suffer from increased atrophy of the alveolar processes, oral rehabilitation even with short dental implants may be impossible. In these cases, lateralization or transposition of the inferior alveolar nerve (IAN) followed by implant placement can be useful. CASE PRESENTATION: A 40-year-old woman with a long-lasting history of bulimia nervosa requested a fixed rehabilitation of her partially edentulous mandible. In 2012, a bilateral IAN transposition approach was performed using piezosurgery, and without any postoperative neurosensory alterations. Two years later, bilateral insertion of each two implants was followed by an inflammatory destabilization of the lower left mandible; subsequent to the implant removal, a fracture occurred, and the latter was stabilized by osteosynthesis plates. In 2017, three additional implants were placed, finally providing the patient with a fixed restoration on five implants. CONCLUSION: Eating disorders may have a tremendous impact on both physical condition and oral health, resulting in early tooth loss and severe bone atrophy. IAN transposition is a viable treatment option to enable installing fixed prostheses via dental implants, but the latter will clearly increase the risk of inflammation and interruption of mandibular continuity. Close clinical and radiologic monitoring is mandatory to adequately respond to complications such as peri-implant mucositis, peri-implantitis, osteomyelitis, or concomitant fractures.

Osteogenesis ability of CAD-CAM biodegradable polylactic acid scaffolds for reconstruction of jaw defects.

STATEMENT OF PROBLEM: Reconstruction of alveolar bony defects is difficult using grafting materials in a powder form. A biodegradable scaffold material might simplify the procedure. PURPOSE: The purpose of this in vivo study was to evaluate osteogenesis ability of a biodegradable CAD-CAM-fabricated polylactic acid (PLA) scaffold enriched with calcium phosphate salts including hydroxyapatite (HA) and beta tricalcium phosphate (ß-TCP) used to reconstruct mandibular defects in a dog model. MATERIAL AND METHODS: Surgical defects were made bilaterally in the mandible of male beagle dogs. Computerized tomography images were obtained for determination of the 3-dimensional shape of the defects after 3 months of healing. Porous PLA scaffolds were fabricated by milling custom-made CAD-CAM blocks into the desired shape. After milling, half of the scaffolds were prepared by filling the pores of the scaffolds by a mixture of HA and ß-TCP. Scaffolds were inserted in the mandibular defects bilaterally. After a healing time of 8 weeks, the bone-scaffold interface was analyzed histomorphometrically to detect the amount of new bone formation. Stained histological sections were examined using a computer software and depth of new bone formation was assessed (n=14, α=.05). RESULTS: Histomorphometric analysis revealed that enriched scaffolds with calcium phosphates had significantly (t=4.4, P<.001) higher amounts of new bone formation (1.3 ±0.33 mm) compared with the controls (0.7 ±0.39 mm). Average new bone growth in enriched scaffolds was 1.3 mm while almost half this value was observed in uncoated scaffolds, 0.7 mm. CONCLUSIONS: Within the limitations of this animal study, HA and ß-TCP enhanced osteogenesis ability of CAD-CAM-fabricated PLA scaffolds.

Does the Presence of a Cantilever Influence the Survival and Success of Partial Implant-Supported Dental Prostheses? Systematic Review and Meta-Analysis.

PURPOSE: To investigate if the presence of a cantilever influences the survival and success of partial fixed implant-supported prostheses, through a systematic review and meta-analysis, with additional analysis of the survival and marginal bone loss rates and prosthesis complications. MATERIALS AND METHODS: The register protocol of the review in the PROSPERO database is CRD42016052008. The MEDLINE and Scopus databases were used for an electronic search of relevant studies up to November 2016, by means of two independent reviewers. The keywords included the combinations "fixed partial denture" with "dental implants", and with "extension" or "cantilever"; and "implant-supported dental prosthesis" with "extension" or "cantilever". The inclusion criteria were randomized clinical trials and prospective and retrospective clinical studies in English that addressed the comparison of success and survival of the use of implant-supported fixed prostheses, with and without cantilevers. Data from the selected studies were used to perform the statistical analysis. RESULTS: Among the 408 articles identified, 4 articles met the eligibility criteria. The presence of a cantilever did not compromise marginal bone loss or the survival of the prostheses. However, minor complications were encountered for the group of partial fixed prostheses without cantilevers, with a statistical difference (P = .008). CONCLUSION: Cantilevers can be used in fixed prostheses and do not interfere negatively in the survival or success of the prosthesis or the marginal bone loss. However, there are minor complications when prostheses without cantilevers, or short cantilevers, are used.

Prosthetic, orthodontic and implant-supported rehabilitation of five maxillary anterior teeth with alveolar bone loss.

INTRODUCTION: Treatment of maxillofacial injuries is complex and requires the establishment of a comprehensive and accurate diagnosis and correct treatment planning. OBJECTIVE: The objective of this case report was to describe the re-treatment of a 27-year-old woman who was involved in a severe car accident that resulted in the loss of five anterior teeth and alveolar bone, and whose previous orthodontic and surgical treatments had been unsuccessful. CASE REPORT: In this case, the space for the missing mandibular molar was reopened to allow for rehabilitation. The positions of the mandibular incisors were improved. The right mandibular canine was moved to the mesial, allowing for correction of the Class II canine relationship on that side, and implants were placed to replace the maxillary anterior teeth. CONCLUSION: Anterior aesthetic and functional rehabilitation using a multidisciplinary approach was essential to improve the patient's facial aesthetics, to obtain great improvement in function and to achieve occlusal stability after 2 years of follow-up.

Posterior atrophic jaws rehabilitated with prostheses supported by 6 mm long × 4 mm wide implants or by longer implants in augmented bone. 3-year post-loading results from a randomised controlled trial.

PURPOSE: To evaluate whether 6 mm long × 4 mm wide dental implants could be an alternative to implants of at least 10 mm long placed in bone augmented with bone substitutes in posterior atrophic jaws. MATERIALS AND METHODS: A total of 20 patients with bilateral atrophic mandibles, and 20 patients with bilateral atrophic maxillae, having 5 mm to 7 mm of bone height below the maxillary sinus or 6 mm to 8 mm above the mandibular canal, had their side of the jaws randomly allocated according to a split-mouth design. They were allocated to receive one to three 6 mm long × 4 mm wide implants, or implants of at least 10 mm long in augmented bone by two different surgeons at different centres. Mandibles were vertically augmented with interpositional equine bone blocks and resorbable barriers, and implants were placed 3 months later. Maxillary sinuses were augmented with particulated porcine bone via a lateral window and implants were placed simultaneously. After 4 months, all implants were submerged and loaded with provisional prostheses. Four months later, definitive prostheses were delivered. Outcome measures were prosthesis and implant failures, any complication and radiographic peri-implant marginal bone level changes. RESULTS: Five patients (three treated in mandibles and two in maxillae) dropped out before the 3-year post-loading follow-up. Two short maxillary implants affected by peri-implantitis failed together with their prosthesis vs three mandibular prostheses that could not be placed on implants at least 10 mm long due to graft failures; one was associated with the loss of three implants because of infection. There were no statistically significant differences in implant (difference in proportions = 0.000; 95% CI: -0.140 to 0.140; P = 1.000) and prosthesis failures (difference in proportions = 0.057; 95% CI: -0.094 to 0.216; P = 0.625). In total, 18 complications occurred in 13 patients at augmented sites vs four complications in three patients with 6 mm long implants. Significantly more complications occurred at grafted sites in mandibles (difference in proportions = 0.353; 95% CI: 0.005 to 0.616; P = 0.031), but not in maxillae (difference in proportions = 0.222; 95% CI: -0.071 to 0.486; P = 0.219). In mandibles, patients with 6 mm long implants lost an average of 1.25 mm of peri-implant bone at 3 years vs 1.54 mm in patients with implants of at least 10 mm long. The difference was statistically significant (mean difference = 0.29 mm; 95% CI: 0.08 to 0.51 mm; P = 0.010). In maxillas, patients with 6 mm-long implants lost an average of 1.28 mm of peri-implant bone at 3 years vs 1.50 mm in patients with implants of at least 10 mm long. The difference was statistically significant (mean difference = 0.22 mm; 95% CI: 0.08 to 0.35 mm; P = 0.003). CONCLUSIONS: Results at 3 years after loading indicate that 6 mm long implants with a conventional diameter of 4 mm achieved similar, if not better, results than longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation, especially in posterior mandibles, since the treatment is faster, cheaper and associated with less morbidity. However, data obtained 5 to 10 years after loading are necessary before making reliable recommendations.

Immediate Loading of Tilted and Axial Posterior Implants in the Edentulous Maxillary Arch: A Retrospective Comparison of 5-Year Outcomes.

PURPOSE: The purpose of this study was to retrospectively compare long-term outcomes for immediately loaded tilted and axial implants placed in the posterior region of the edentulous maxillary arch. MATERIALS AND METHODS: Data obtained from a 5-year prospective study designed to assess clinical outcomes following immediate loading of implants with screw-retained fixed restorations in the edentulous maxillary arch were retrospectively reviewed. Where insufficient alveolar bone was available for axial placement of the posterior-most implant on each side of the arch, tilted placement was employed. Implant survival and marginal bone level changes for these tilted and axial posterior implants were compared. RESULTS: Fifty-one subjects received 64 tilted and 38 axial posterior implants. Forty subjects with 53 tilted and 34 axial posterior implants returned for follow-up after 5 years. Five tilted and seven axial implants failed, representing an 89% and 86% survival proportion, respectively. The mean marginal bone loss was 0.79 (SD: 1.42) mm for tilted implants and 0.14 (SD: 0.34) mm for axial implants. The differences in survival proportions and marginal bone loss between axial and tilted implants were not statistically significant. CONCLUSION: Predictable long-term implant rehabilitation may be achieved in the edentulous maxillary arch using posterior tilted implants in combination with immediate loading.

Prosthetic, orthodontic and implant-supported rehabilitation of five maxillary anterior teeth with alveolar bone loss

ABSTRACT Introduction: Treatment of maxillofacial injuries is complex and requires the establishment of a comprehensive and accurate diagnosis and correct treatment planning. Objective: The objective of this case report was to describe the re-treatment of a 27-year-old woman who was involved in a severe car accident that resulted in the loss of five anterior teeth and alveolar bone, and whose previous orthodontic and surgical treatments had been unsuccessful. Case report: In this case, the space for the missing mandibular molar was reopened to allow for rehabilitation. The positions of the mandibular incisors were improved. The right mandibular canine was moved to the mesial, allowing for correction of the Class II canine relationship on that side, and implants were placed to replace the maxillary anterior teeth. Conclusion: Anterior aesthetic and functional rehabilitation using a multidisciplinary approach was essential to improve the patient's facial aesthetics, to obtain great improvement in function and to achieve occlusal stability after 2 years of follow-up.

RESUMO Introdução: o tratamento de danos bucomaxilofaciais é complexo e requer diagnóstico abrangente e preciso, além de um correto plano de tratamento. Objetivo: o objetivo deste relato de caso foi descrever o retratamento de uma paciente do sexo feminino, 27 anos de idade, envolvida em acidente automobilístico grave, que resultou na perda de cinco dentes, além de perda óssea alveolar na região anterior. Relato de caso: a paciente apresentava histórico de insucesso de tratamento ortodôntico e cirúrgico. No caso apresentado, o espaço referente aos molares inferiores ausentes foi reaberto, para possibilitar a reabilitação. Houve melhora no posicionamento dos incisivos inferiores. O canino inferior direito foi deslocado para mesial, possibilitando a correção da relação de Classe II intercaninos do mesmo lado. Implantes foram inseridos a fim de substituir os dentes superiores da região anterior. Conclusão: a reabilitação estética e funcional da região anterior, realizada por meio de uma abordagem multidisciplinar, foi fundamental para valorizar a estética facial da paciente, melhorar a função e promover estabilidade oclusal após dois anos de acompanhamento.

Short dental implants: A scoping review of the literature for patients with head and neck cancer.

STATEMENT OF PROBLEM: Dental implants can be essential in the rehabilitation of various cancer defects, but their ideal placement can be complicated by the limited dimensions of the available host bone. Surgical interventions developed to increase the amount of bone are not all predictable or successful and can sometimes be contraindicated. Short dental implants have been suggested as an alternative option in sites where longer implants are not possible. Whether they provide a successful treatment option is unclear. PURPOSE: The purpose of this study was to review the literature on short dental implants and assess whether they are a viable definitive treatment option for rehabilitating cancer patients with deficient bone. MATERIAL AND METHODS: A scoping review of the literature was performed, including a search of established periodontal textbooks for articles on short dental implants combined with a search of PubMed, MEDLINE, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews. A search for all literature published before June 2016 was based on the following keywords: ['dental implants' OR 'dental implantation, endosseous' OR 'dental prosthesis, implant supported'] AND [short]. RESULTS: The minimum acceptable implant length has been considered to be 6 mm. The survival rates of short implants varied between 74% and 96% at 5 years, depending on factors such as the quality of the patient's bone, primary stability of the implant, clinician's learning curve, and implant surface. Short implants can achieve results similar to those of longer implants in augmented bone and offer a treatment alternative that could reduce the need for invasive surgery and associated morbidity and be safer and more economical. CONCLUSIONS: Short dental implants (6 mm to 8 mm) can be used successfully to support single or multiple fixed reconstructions or overdentures in atrophic maxillae and mandibles. The use of short dental implants lessens the need for advanced and complicated surgical bone augmentation procedures, which reduces complications, costs, treatment time, and morbidity. Short implants could be an alternative in the rehabilitation of patients with cancer.

A customised digitally engineered solution for fixed dental rehabilitation in severe bone deficiency: A new innovative line extension in implant dentistry.

OBJECTIVES: Numerous procedures including soft and hard tissue reconstructions are necessary to allow for final implant-borne dental rehabilitation in patients with severe alveolar atrophy or resected jaws. In these cases, customised digitally engineered patient solutions for fixed or removable dental rehabilitation provide an innovative line extension to conventional implant dentistry. MATERIAL AND METHODS: A wax-up was performed on plaster models that were scanned by 3D laser. The generated stereolithographic files were then fused with the preoperative 3D imaging data. The individualised "dental" patient solutions were designed digitally and comprised a skeletonised anchorage system and a suprastructure connection system. Insertion of the implants was performed on an outpatient basis. Conventional implant-supported prosthodontic rehabilitation was performed. RESULTS: This digital planning algorithm can be applied to manufacture individualised patient solutions. Similar to conventional implant-supported dentures, these implants can be equipped with individual suprastructure connection systems for internal conical connection, ball-retained attachment, and external conical (telescopic) connection. CONCLUSIONS: In patients with severe atrophy or resected jaws, particularly following ablative tumour surgery, customised digitally engineered solutions allow for an innovative, less invasive line extension to conventional implant dentistry. When conventional implant dentistry reaches its limits, they still offer a strategy for implant-borne dental rehabilitation.

Vertical Ridge Augmentation in the Atrophic Mandible: A Systematic Review and Meta-Analysis.

PURPOSE: To systematically appraise the effectiveness/reliability of vertical ridge augmentation (VRA) in the atrophic mandible. Articles that addressed any one of the following four areas were included in this study: amount of VRA, implant survival (ISR) and success rates (SSR) in the area of newly regenerated bone, complication rate during the bone augmentation procedure, and bone resorption. MATERIALS AND METHODS: An electronic literature search was conducted by two independent reviewers in several databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register databases for articles reporting VRA in the atrophic mandible via distraction osteogenesis (DO), inlay block grafting (IBG), onlay block grafting (OBG), and guided bone regeneration (GBR). For meta-analysis, two primary (VRA and ISR [%]) and two secondary outcomes were studied (SSR [%] and vertical bone resorption [VBR] [%}). Additionally, for qualitative assessment, complications (ie, causes of failure) were further extracted and comprehensively described. RESULTS: Overall, 73 full-text papers were evaluated. Of these, 52 articles fulfilled the inclusion criteria. The weight mean (WM) of VRA (± SD) was 4.49 ± 0.33 mm (95% CI: 3.85 to 5.14 mm). It was most notable that DO involved greater VRA than IBG, and thus, significantly higher than GBR and OBG. The technique significantly influenced the mean VRA obtained (P < .001). Nonetheless, no technique showed superiority in terms of ISR or SSR. VBR and complications were shown to be minimized for GBR. CONCLUSION: If ~ 4 mm of VRA is needed, any technique in optimum local and systemic conditions should be equally reliable in the atrophic mandible. However, when greater VRA is needed, DO and IBG have demonstrated accuracy. By means of complication and VBR rates, GBR was shown to have the lowest. For ISR and SSR, no statistical differences existed among all techniques. Controlled studies are needed to examine the long-term peri-implant bone fate and the frequency of biologic complications in each technique applied for the vertical augmentation of the atrophied mandible.

Alveolar Ridge Dimension 6 Months After Implant Placement with Simultaneous Hard Tissue Augmentation.

PURPOSE: When failing front teeth are replaced by implants, vestibular bone deficiencies frequently require augmentation, even though the amount of missing alveolar volume may vary. The objective of this study was to analyze the horizontal alveolar ridge dimension after implant placement and simultaneous augmentation, and to compare it to the condition at the contralateral natural site. MATERIALS AND METHODS: Forty-eight patients with a failing maxillary incisor received an immediate or early implant (Straumann Bone Level), according to a randomized study protocol. The vestibular wall of the implant site was reconstructed and moderately overcontoured with bovine hydroxyapatite and a collagen membrane (BioOss, BioGide, Geistlich). Provisional restoration followed either immediately, or after a 6-week healing period. To investigate the vestibular volume 6 months after surgery, a plaster model of the maxilla was scanned with cone beam computed tomography (CBCT; Morita 3D) and evaluated using coDiagnostiX software (Dental Wings). Statistical analysis comprised one- and two-sample t tests. RESULTS: The ridge volume was not significantly influenced by the treatment schedule. The vestibular segments had a mean ± SD volume of 207.9 ± 102.5 mm³ for the implant sites, and 202.1 ± 101.5 mm³ for the corresponding natural sites (P = .28). The difference in vestibular volume between implant sites and natural tooth sites was 10.4 ± 36.2 mm³ for immediate implantation, and 0.00 ± 31.1 mm³ for early implantation (P = .32). Comparing immediate and early restoration, a difference of 0.4 mm³ and 12.5 mm³ between the implant and contralateral site was found (P = .23). CONCLUSION: Six months after treatment, no significant differences between the alveolar volumes at augmented implant sites and natural sites were found. Moderate buccal overcontouring may have been beneficial to achieve a symmetrical contour. Long-term follow-up investigation will document if the restored volume remains stable over time.

Immediate Loading of Implants in the Edentulous Maxilla with a Fixed Provisional Restoration without Bone Augmentation: A Report on 5-Year Outcomes Data Obtained from a Prospective Clinical Trial.

PURPOSE: Successful immediate loading of implants in the edentulous maxilla has been previously reported. The purpose of this 5-year prospective study was to further assess long-term outcomes following immediate loading of implants in the edentulous maxilla with fixed provisional restorations without the use of bone augmentation procedures. MATERIALS AND METHODS: Subjects with edentulous maxillary arches each received six implants placed in native bone without augmentation. Where insufficient posterior bone volume existed, angled implant placement was employed. Fixed provisional restorations were delivered within 24 hours of implant placement. Implant placement locations, insertion torque values, and implant dimensions were recorded. Definitive fixed prostheses were placed within 24 weeks following implantation. Baseline implant site marginal bone levels were measured using periapical radiographs. Baseline peri-implant plaque and bleeding scores were obtained. Subjects were examined 6 months after implant placement and then annually for 5 years with follow-up periapical radiographs and plaque/bleeding scores obtained. RESULTS: Fifty-one subjects received a total of 306 implants. Forty subjects with 232 implants returned for the final follow-up appointment representing a 5-year implant survival proportion of 93% with a mean marginal bone loss of 0.44 ± 1.25 mm for this group. Thirty-nine of these 40 subjects continued to function with fixed restorations with the remaining subject functioning with a non-implant-retained removable prosthesis. CONCLUSION: Within the limitations of this study, predictable long-term implant rehabilitation outcomes were demonstrated for the edentulous maxilla using an immediate loading protocol without bone augmentation.

Radiographic Evaluation Cervical Crestal Bone Resorption aroundDental Implants inMaxilla and Mandible: One Year Study

Objective:To analyze the amount of crestal bone loss in maxilla and mandible around Bredent Sky Blue implants of different dimension a year after implantation. Materialand Methods:36 implants diameter 3.5 x 10 mm were inserted in the maxilla and 12 in the mandible. 52 implants diameter 4.0 x 8 mm were inserted in the maxilla, and 61 in the mandible (two-stage implant surgery). The data were analysed using the IBM SPSS v.17 software package (descriptive statistics, ANOVA -test). Results:No statistically significant differences were found between maxilla right, maxilla left, mandible right and mandible left side at implant sites regarding distal and mesial bone losses. Statistically significant differences were found between maxilla front, maxilla posterior, mandible front and mandible posterior at implant sites regarding distal and mesial bone losses. Conclusion:This study showed more bone loss for anterior implants compared to the posterior ones, but there was no significant different bone loss between maxillary and mandibular implants regarding sites