Comparing Operators and Imaging Techniques When Performing Trans-Crestal Sinus Augmentation: A Pilot Study.

The aim of this article was to compare baseline residual ridge height using Cone-beam Computed Tomography (CBCT) and panoramic radiographs. A secondary aim was to examine the magnitude of vertical bone gain 6 months after trans-crestal sinus augmentation and compare it between operators. Thirty patients, who underwent trans-crestal sinus augmentation simultaneously with dental implant placement, were included in this retrospective analysis. Surgeries were done by 2 experienced surgeons (EM and EG) using the same surgical protocol and materials. Preoperative residual ridge height was measured on panoramic and CBCT images. The final bone height and the magnitude of the vertical augmentation were measured on panoramic X ray taken 6 months after surgery. Mean residual ridge height measured preoperatively using CBCT was 6.07 ± 1.38 mm, whereas these same measurements on the panoramic radiographs yielded similar results (6.08 ± 1.43 mm), which were statistically insignificant (P = .535). Postoperative healing was uneventful in all cases. All 30 implants were successfully osseointegrated at 6 months. The mean overall final bone height was 12.87 ± 1.39 mm (12.61 ± 1.21 and 13.39 ± 1.63 mm for operators EM and EG, respectively; P = .19). Likewise, mean postoperative bone height gain was 6.78 ± 1.57 mm, which was 6.68 ± 1.32 and 6.99 ± 2.06 mm for operators EM and EG, respectively (P = .66). A moderate positive correlation was found between residual bone height and final bone height (r = 0.43, P = .002). A moderate negative correlation was found between residual bone height and augmented bone height (r = -0.53, P = .002). Sinus augmentation performed trans-crestally produce consistent results with minimal interoperator differences between experienced clinicians. Both CBCT and panoramic radiographs produced similar assessment of the preoperative residual bone height.

Histological and dimensional changes of the alveolar ridge following tooth extraction when using collagen matrix and collagen-embedded xenogenic bone substitute: A randomized clinical trial.

AIM: To assess the horizontal and vertical dimensional changes of the alveolar ridge when using a collagen matrix in combination with collagen embedded xenogenic bone substitute, in comparison with natural healing after tooth extraction. METHODS: Patients that required extraction in non-molars areas were included. Test group-15 sockets were treated with deproteinized bovine bone mineral containing 10% collagen (DBBM-C), covered by a procaine collagen membrane (CMXs). Control group-15 sockets left for spontaneous healing. We used a custom-made acrylic stent as a reference for alveolar ridge measurements. Six-month postoperative, a single implant was placed in the experimental site. A core biopsy was taken from the site, using a trephine bur. Histomorphometric analysis assessed bone area, connective tissue, bone marrow, and residual bone graft. RESULTS: Six months later, horizontal ridge width at -3 mm showed a significant (p < 0.05) reduction in both groups albeit smaller in the test group 1.19 ± 1.55 mm, compared with the control 2.27 ± 1.52 (p = 0.087). At -5 mm sub-crestally, statistically non-significant reduction was noted in both groups, 1.61 ± 1.53 and 1.96 ± 1.52 mm for the test and control groups, respectively (p = 0.542). Vertical changes were smaller in the test group (0.14 ± 1.84 mm) compared with control (0.98 ± 1.49 mm). Keratinized tissue (KT) width was 7.3 ± 2.13 and 7.5 ± 3.49 mm in the test and control groups, respectively. Newly formed bone occupied 33.79 ± 17.37% and 51.14 ± 23.04% in the test and control groups, respectively, (p = 0.11). Connective tissue volume was 33.74 ± 13.81% and 30.12 ± 18.32% in the test and control groups, respectively (p = 0.65). Bone marrow occupied 19.57 ± 10.26% and 18.74 ± 17.15% in the test and control groups, respectively (p = 0.91). Residual graft occupied 12.9 ± 9.88% in the test group. CONCLUSION: Alveolar ridge preservation using DBBM-C resulted in reductions of the vertical and horizontal dimensions albeit not reaching statistical significance. The larger than anticipated standard deviation and smaller inter-group differences might account for this phenomenon.

Esthetic Mucogingival Treatment After Biopsy of Inflammatory Fibroepithelial Hyperplasia.

INTRODUCTION: This case reports a biopsy of a large soft tissue defect with gingival grafting. The therapeutic approach presented here combines a partly de-epithelialized free gingival graft (PDFGG) with an envelope technique, which may be useful for cases needing a large reactive lesion biopsy. CASE PRESENTATION: A patient with an esthetic and functional complaint due to a fibroepithelial hyperplastic lesion was treated by excisional biopsy leaving a 10 mm cervical defect on tooth 23. A palatal PDFGG was harvested and sutured into the defect, using an "envelope technique" to improve the blood supply to the graft. The procedure is aimed at both recession coverage and reduction in root hypersensitivity. Stability of the outcome is demonstrated 9 months post-operative. CONCLUSIONS: Gingival margin biopsies pose a significant challenge due to the need to combine significant tissue removal while providing a predictable esthetic and functional outcome. The case is the first description of a successful grafting of a large residual gingival biopsy defect, resulting from using combined mucogingival surgical approach. This technique may be helpful for similar cases.

Volumetric assessment of changes in the alveolar ridge dimension following guided bone regeneration using a combination freeze-dried bone allograft with collagen membrane or novel resorbable scaffold: A prospective two-center clinical trial.

BACKGROUND: The aim of this study was to examine osseous changes following lateral bone augmentation using a novel scaffold (OV) alone and compare it to combination therapy using freeze-dried bone allograft (FDBA) and resorbable collagen membrane (FDBA/CM). METHODS: Thirty patients completed this 9-months prospective two-center cohort clinical trial. Before surgery and 9-months re-entry, linear measurements were performed, and impressions taken. Cone-beam computed tomography (CBCT) were done at baseline and 9 months. DICOM slice data were converted into volumetric images using 3D Slicer. Following 3D volumetric image construction, pre- and post-op Standard Triangle Language files were superimposed and volumetric data were extracted for a 10-mm region of interest. Linear measurements were compared similarly. RESULTS: Baseline clinical parameters were similar in both groups (4.22 and 4.53 mm for OV and FDBA/CM at -2 mm, respectively). Following treatment, vertical distance from the stent had changed minimally (-0.36 and -0.12 mm, respectively). Similarly, lateral bone gain ranged from 0 to 0.4 mm, for both groups. To the contrary, the CBCT measurements showed a significantly greater increase in horizontal width in the control at -2 mm (0.95 ± 0.2 mm) compared with -0.62 mm for the OV (P = 0.000). Similar changes were observed at -5 mm (0.63 and -0.41 mm, respectively, P = 0.01). Sites volume had increased from 266 ± 149 mm3 to 360 ± 138 mm3 (P = 0.001) for FDBA/CM with negligible changes for OV (from 334 to 335 mm3 , P = 0.952). these between-group changes being statistically significant (P = 0.023). CONCLUSION: FDBA/CM yielded better albeit moderate increase in the volume of the edentulous ridge, while OV scaffolds failed to produce similar results.

Severe Complications Following Maxillary Sinus Augmentation Using Poly L-lactide-co-ε-caprolactone-Coated Bovine Bone: A Retrospective Study.

PURPOSE: To describe the postoperative complications following lateral wall sinus augmentation using (poly L-lactideco-ε-caprolactone; PLCL) and natural polysaccharides polymers-coated bovine bone (PBB). The secondary aims were to examine histologic findings and to propose complication management alternatives. MATERIALS AND METHODS: This retrospective study included 61 subjects who underwent 67 lateral wall sinus augmentation procedures using PBB in the standard protocol. In cases that presented complications, treatment included additional antibiotic therapy, implant removal, or sinus reentry and total removal of the grafting material. In three cases, biopsy specimens were taken from the sinuses, and histologic analyses were performed. RESULTS: The prevalence of postoperative complications was 32.8% (22 of 67 cases) in 18 of the patients (29.5%). The most prevalent symptoms were persistent pain (68.2%), swelling (63.6%), and oroantral fistula (54.5%). Radiographic signs appeared in 45.5% of the complications. A total of 24 implants failed; thus, an overall 80.3% survival rate was established at 19 months. The vast majority of complications (86.4%) were treated eventually with reentry surgery and revealed that the sinus was full with granulation tissue surrounding pieces of a nonossified rubber-like material. In cases where implants were placed, nonosseointegrated implants were surrounded by soft tissue. The sinus was cleaned thoroughly; the graft material remnants were removed together with inflamed parts of the sinus membrane, followed by chlorhexidine and saline lavages. In the biopsy specimens taken from the sinus cavity, there were no histologic features of new bone formation around the grafted material. CONCLUSION: Lateral wall maxillary sinus augmentation using PBB was associated with an acute sinus infection histologic appearance and with a 7-times-higher failure rate compared with previous reports. This serious adverse event suggests that PBB cannot be recommended for maxillary sinus augmentations.

The effect of a surgeon's position on the axial inclination of dental implants placed freehand: a single-blind study.

OBJECTIVES: To examine whether a surgeons' position affects the axial angulation of dental implants placed freehand. METHOD AND MATERIALS: Implants' axial angulation was assessed on digital panoramic radiographs. An occlusal line was plotted based on the neighboring teeth/crowns. The mesial angle between the long axis of the implant and the occlusal line was measured. In addition, post-hoc ideal implant-positioning planning was done on the panoramic digital image, and the angle of the intersection between the long axis of the actual and post-hoc ideal implant was measured. Student t test for unpaired observations and the Kolmogorov-Smirnov nonparametric tests were utilized to compare the ipsi- and contralateral sides and between clinicians. RESULTS: Seventy-seven patients (149 implants) were eligible for the study. Implants had slight mesial inclination (mean 97.7 ± 8.7 degrees) which was similar for both the ipsi- (98.2 ± 8.4 degrees) and contralateral sides (97.2 ± 9.1 degrees), P = .491. For the post-hoc planning versus actual placement comparison, the overall median (interquartile range) of implant angular deviation was minimal (-0.25 degrees [-2.98, +3.47]). This was true for both the ipsilateral (-0.5 degrees [-2.9, +2.9]) and contralateral (-0.2 [-4.2, +5.4]) sides, P = .55. For the actual versus post-hoc planning, most observations clustered around the midline (zero to minimal deviation), while for the implant to occlusal plane angle, a tendency towards slight mesial angulation was observed. CONCLUSIONS: Dental implants placed freehand by experienced clinicians have only slight axial deviation as measured from post-hoc optimal position. Implants placed in ipsilateral and contralateral sides and by left- and right-dominant-hand clinicians had similar angulations.

Emergency department visits at Rambam health care campus, Israel: non-trauma related dental conditions.

OBJECTIVES: Studies of emergency department (ED) visits for non-traumatic dental conditions (NTDCs) have been carried out in the USA and Canada. In Israel, there is a shortage of such studies. In the current retrospective study, we report on the frequency and distribution of NTDCs ED visits at Rambam Health Care Campus (Rambam), in Haifa, which is an academic hospital serving more than 2.4 million residents of Northern Israel. MATERIALS AND METHODS: The data concerning ED visits at Rambam between 2010 and 2017 were obtained retrospectively from Rambam's computerized clinical and personal database of adult patients (≥18 years) visiting the ED for NTDCs. RESULTS: Overall, 1.8% of the patients who visited the Rambam ED, were identified as presenting with NTDCs. From 2010 until 2017, the number of NTDCs admissions increased by 45%, while the total ED admissions rose by 16%. The average waiting time for maxillofacial consultations for patients with NTDCs increased from 102 min in 2010 to 138 min in 2017. The busiest hours in the ED for NTDCs were during the morning shifts (47% of daily visits). CONCLUSIONS: The results of the study show that systemic and conceptual changes are needed to reduce the number of non-trauma related applications to ED.These changes can be by increasing the number of personnel or by introducing recent advances such as tele-medicine for prescreening of patients. This change calls for a greater involvement of the health policy leaders to provide alternative solutions for emergency dental care.

Clinical accuracy of a novel open-lattice-frame implant positioning system: A case series.

OBJECTIVE: The purpose of the study was to assess the clinical accuracy of a novel open-lattice-frame implant positioning system by evaluating the deviation between planned and actual implant positions on pre- and postoperative cone beam computed tomography (CBCT) images of patients treated with dental implants. Secondary aims were to record surgical time from first incision to end of implant surgery and start of suturing, and to record patient and surgeon satisfaction from the implant surgical procedure. Pre- and postoperative CBCT of 10 patients receiving 18 dental implants were used to generate implant angular deviations and implant shoulder and apex deviations. Mean angular deviation was 2.96 ±â€¯1.31 degrees (range 0.75 to 5.60 degrees). Mean shoulder and apex deviations were 1.07 ±â€¯0.49 mm (range 0.38 to 1.85 mm) and 1.35 ±â€¯0.57 mm (range 0.52 to 2.19 mm), respectively. Mean time from first incision to start of suturing was 24 ±â€¯7 minutes. Patient satisfaction ranged between 8 and 10, and surgeon satisfaction regarding the procedure ranged between 9 and 10, on a scale of 1 to 10. The open-lattice-frame implant positioning system provided adequate accuracy, and may aid in improving patient-related and surgeon-related outcomes by improving surgical accuracy and shortening surgical treatment duration.

Dimensional Changes Following Lateral Wall Sinus Augmentation Without Concomitant Implant Placement Using a Composite Bone Graft.

PURPOSE: To evaluate changes in sinus dimensions immediately postoperatively and 1 year later using a composite of bovine-derived xenograft and autogenous bone for lateral bone augmentation of the maxillary sinus. MATERIALS AND METHODS: Patients who underwent lateral wall sinus augmentation procedures without concomitant implant placement were considered for this retrospective analysis if they had three consecutive panoramic radiographs: pretreatment (T0), immediately after lateral wall sinus augmentation (T1), and approximately 1 year postoperatively (T2). Eighteen subjects aged 47 to 69 years were included. The surgical protocol included grafting with a composite of bovine-derived xenograft and autogenous bone (9:1 ratio). Digital panoramic radiographs were transferred into measurement software, and the following measurements were performed: (1) vertical distance from the alveolar crest to the height of the augmented material, (2) sagittal area of the grafted area, and (3) vertical distance from the alveolar crest to the roof of the maxillary sinus. All measurements were performed by one examiner. Double measurements were performed in nine patients at T2, and the calculated Cronbach's alpha statistic was very high (.9658 to .9882). RESULTS: The mean overall sinus sagittal area was 1,330 ± 481 mm2 prior to the grafting procedure, when it decreased to 858.2 ± 436 mm2 (range, 380.7 to 2,134 mm2) immediately postoperatively (P = .0035) and remained stable at 1 year (mean, 882.2 ± 384 mm2, P > .05). Similarly, the overall area of the grafted material at the time of surgery was 468.3 ± 208 mm2 and was only slightly reduced at 1 year (422.2 ± 193 mm2). The midsagittal graft height at T1 (mean, 20.67 ± 4.5 mm) was insignificantly and minimally reduced at 1 year (mean, 19.35 ± 4.9 mm). CONCLUSION: The linear dimensions of composite bone-derived xenograft/autogenous bone grafts following lateral wall sinus augmentation exhibited minimal changes during the 8- to 12-month healing period.

Plaque score change as an indicator for periimplant health in periodontal patients with immediately restored dental implants.

BACKGROUND: Patients with a history of periodontitis might have a higher risk for implant failure as compared with periodontally healthy subjects. The aim of the present study was to look into this risk factor by examining the association between plaque scores, probing depths (PD), and bleeding on probing (BOP) around teeth and immediately restored dental implants up to 1 year after implant surgery. METHODS: Patients with partial edentulism, diagnosed with and previously treated for generalized chronic periodontitis, received dental implants, abutments, and cemented provisional prostheses up to 72 hours after implant surgery. Plaque scores, PD, and BOP were recorded and evaluated 6 and 12 months postsurgery. RESULTS: Plaque scores deteriorated slightly around teeth and improved around implants. No significant change was observed in the distribution of PD around teeth. The proportion of shallow pockets increased around implants. Improvement in plaque scores was associated with a stable/reduced PD, whereas deterioration in plaque scores was associated with increased PD around implants and teeth. CONCLUSIONS: A direct relationship was found between plaque score improvement and stable/reduced PD. Therefore, partially edentulous patients with a history of periodontitis should be encouraged to improve their plaque scores to maintain shallower pockets around implants.

Restauração imediata e tardia de implantes dentários com história de periodontite: avaliação prospectiva até cinco anos / Immediate and delayed restoration of dental implants in patients with a history of periodontitis: a prospective evaluation up to 5 years

Propósito: avaliar as mudanças radiográficas ao nível da crista óssea em implantes dentários restaurados imediatamente até cinco anos pós-inserção em pacientes com histórico de periodontite. Material e Métodos: pacientes previamente tratados para periodontite crônica que necessitavam de uma restauração total na maxila ou mandíbula, ou uma restauração parcial na zona estética, foram tratados. A cirurgia implantar inclui a extração dos dentes comprometidos, debridamento ao redor dos dentes naturais remanescentes e inserção dos implantes com guia cirúrgico. Uma restauração provisória parafusada pré-fabricada foi colocada imediatamente nos implantes selecionados. Radiografias periapicais foram feitas na colocação do implante, seis e 12 meses após a cirurgia e depois anualmente. A distância entre a crista alveolar e o ombro do implante foi mensurada nos aspectos mesial e distal de cada implante. Mudanças ósseas (BC) e a taxa anual de mudança óssea (Rate) foram calculadas para o primeiro ano e nos quatro anos seguintes. Resultados: o BC total (média ± desvio padrão) do ponto inicial aos cinco anos (BCt0-t5) foi -1,41 ± 0,67 mm. O BC no primeiro ano (BCt0-t1) foi -1,14 ± 0,86 mm e o BC nos anos dois a cinco (BCt1-t5) foi -0,27 ± 0,69 mm. O Ratet0-t1 foi -0,98 ± 0,79 mm/ano e o Ratet1-t5 foi -0,06 ± 0,17 mm/ano; 57 dos 61 implantes disponíveis preencheram os critérios de perda óssea cumulativa, sendo não mais do que 1,5 mm no primeiro ano e 0,2 mm/ano em anos subsequentes. Quatro implantes (7%; IC 95%: 0,4% a 13,6%) não atingiram o critério. Conclusão: os implantes dentários em pacientes com história de periodontite mostraram mudanças ósseas radiográficas similares aos relatos prévios na literatura. Após o primeiro ano, implantes restaurados imediatamente exibiram perda óssea na crista similar a dos implantes restaurados convencionalmente.

Immediate restoration of delayed placement of dental implants in patients with treated periodontal disease: 1-year results.

PURPOSE: To evaluate implant and patient characteristics in a prospective clinical study involving immediate fixed restoration of delayed placement of dental implants. MATERIALS AND METHODS: Patients diagnosed with generalized chronic periodontitis and previously treated were accepted into the study when they expressed a wish to receive immediate restoration of dental implants. Treatment planning and implant placement were computer assisted, using computerized tomography, planning software, and a surgical template. Patients received abutments and cemented provisional prostheses no later than 72 hours following implant surgery. Patients were followed at 2 and 4 weeks, and 3, 6, and 12 months. RESULTS: Eighteen patients were accepted and completed the study, ages ranged from 34 to 69 years (mean 54.5±8.5 years). Five patients (27.8%) were smokers (2.5 to 60 pack years). Fifty implants were placed, ranging between 1 to 8 implants per patient. Median implant length was 13 mm (range, 10 to 13 mm) and median implant diameter was 3.75 mm (range, 3.75 to 5 mm). Mean insertion torque was 43 NCm±6.2 SD (range 30 to 50 NCm). Mean implant stability quotient was 71±11 (range 37 to 85). One implant in a patient who smoked and three implants in another patient who smoked failed for a total of four failed implants. At 12 months, the overall survival rate was 92% (100% and 73% among nonsmokers and smokers, respectively). CONCLUSIONS: The survival of immediately restored dental implants in periodontally treated patients is greater than 90%. Smokers with a past history of chronic periodontitis seem to have a lower implant survival rate.

Immediate and delayed restoration of dental implants in patients with a history of periodontitis: a prospective evaluation up to 5 years.

PURPOSE: To evaluate the radiographic crestal bone level changes around immediately restored dental implants up to 5 years after insertion in patients with a history of periodontitis. MATERIALS AND METHODS: Patients previously treated for chronic periodontitis who required a fixed full-arch restoration for the maxilla or mandible or a fixed partial restoration in the esthetic zone were treated. Implant surgery included extraction of hopeless teeth, debridement around remaining adjacent teeth, and implant insertion guided by a surgical stent. A prefabricated screw-retained provisional restoration was immediately placed on selected implants. Periapical radiographs were taken at implant placement, 6 and 12 months postsurgery, and annually thereafter. The distance between the alveolar crest and the implant shoulder was measured at the mesial and distal aspects of each implant. Bone changes (BC) and annual rate of bone change (Rate) were calculated for the first year and the following 4 years. RESULTS: Total BC (mean ± standard deviation) from baseline to 5 years (BC(t0-t5)) was -1.41 ± 0.67 mm. First-year BC (BC(t0-t1)) was -1.14 ± 0.86 mm, and BC in years 2 to 5 (BC(t1-t5)) was -0.27 ± 0.69 mm. Rate(t0-t1) was -0.98 ± 0.79 mm/year and rate(t1-t5) was -0.06 ± 0.17 mm/year. Fifty-seven of 61 available implants met the criterion of cumulative bone loss of no more than 1.5 mm for the first year and 0.2 mm/year for the following years. Four implants (7%; 95% confidence interval: 0.4% to 13.6%) failed the criterion. CONCLUSIONS: Dental implants in patients with a history of periodontitis showed radiographic bone changes similar to previous reports in the literature. After the first year, immediately restored implants exhibited crestal bone loss rates similar to those seen for conventionally restored implants.

Third attempt to place implants in sites where previous surgeries have failed.

BACKGROUND: a lower survival rate for re-implantation in previously failed sites was reported. A third implant attempt in sites where previous implants have failed twice is rare; however, it may be necessary where other treatment alternatives are unacceptable. The aim of the present report is to explore the survival of implants placed three times at the same site. METHODS: patients in whom a third attempt of implant placement at sites where two implants failed previously were evaluated. Medical history and smoking were recorded. The implant dimension, characteristics and survival were documented. The same implant and surgeon were involved in all three attempts. RESULTS: fifteen third attempt implants in 12 patients were evaluated. The average age of the patients at first implantation was 48.8 ± 14.1 years. Six of the 15 second re-do implants have failed (60.0% survival rate). Smoking was reported by two patients. The implants that survived were followed for 44.1 ± 35 months (range 4-86). The mean implant length and diameter did not vary between attempts: the mean implant width/lengths were 3.6 ± 0.3/12.2 ± 1.4, 3.7 ± 0.3/12.6 ± 1.5 and 3.80 ± 0.3/12.4 ± 1.6 mm for the first, second and third attempts, respectively (p>0.05). CONCLUSIONS: a third attempt to place implants in sites where two implants had failed previously results in significantly lower survival rates compared with similar procedures in pristine sites.

Wilckodontics--an alternative adult orthodontic treatment method: rational and application.

Adult orthodontics poses a challenge for practitioners as it involves unique biomechanical considerations due to biologic age related changes and lack of skeletal growth potential. Dental risks in adult orthodontics include, amongst others, root resorption and periodontal complications. As modern life calls for quick and efficient orthodontic treatments, a novel orthodontic modality was developed utilizing adjunctive periodontal surgery that includes bone corticotomy combined with bone augmentation. This multidisciplinary team approach: Periodontally Accelerated Osteogenic Orthodontics (PAOO) or Wilckodontics seems to be promising not only for reducing orthodontic treatment duration, but also for biological aspects during and after orthodontic treatment. PAOO enhances bone remodeling and augmentation, accelerates tooth movement and significantly reduces the duration of treatment. The presented cases manifest the biologic benefit of profound enlargement in the envelope of motion reducing the need for extraction and eliminating the need for aggressive intervention of surgically-assisted rapid maxillary expansion. PAOO serves as a reasonable and safe option for the growing demand of shortened treatment duration of adult teeth movement in three dimensions. Further research is recommended for an in depth evaluation of the long-term stability claimed to be advantageous in this modality.

Accuracy of a computerized tomography-guided template-assisted implant placement system: an in vitro study.

OBJECTIVES: To evaluate the accuracy of computer-assisted 3D planning and implant insertion using computerized tomography (CT). MATERIALS AND METHODS: Nine implants were planned on pre-operative CTs of six resin models, which were acquired with radiographic templates, using a planning software (E implants). Each resin model contained three pre-existing control implants (C implants). Radiographic templates were converted into operative guides containing 4.8-mm-diameter titanium sleeves. A single set of insertable sleeves was used for consecutively drilling the six models, followed by implant insertion through the guide sleeves. Models were further divided into group A (the first three models) and group B (the last three models). Post-operative CTs were used to compare implant positions with pre-operative planned positions. Statistical analysis included the Mann-Whitney U test for E and C implants and the Wilcoxon's signed ranks test for groups A and B. RESULTS: The mean apex depth deviations for E and C implants [0.49 mm+/-0.36 standard deviation (SD) and 0.32 mm+/-0.21 SD, respectively], and the mean apex radial deviations (0.63 mm+/-0.38 SD and 0.49 mm+/-0.17 SD, respectively) were similar (P>0.05). The mean angulation deviations for E and C implants were 2.17+/-1.06 degrees SD and 1.33+/-0.69 degrees SD, P<0.05. E implant deviations of all the parameters in group A were significantly smaller than E implant deviations in group B. CONCLUSIONS: Computer-assisted implant planning and insertion provides good accuracy. Deviations are mainly related to system and reproducibility errors. Multiple use of drills and titanium sleeves significantly reduces system accuracy.

Radiographic changes around immediately restored dental implants in periodontally susceptible patients: 1-year results.

PURPOSE: There is little information available about radiographic bone changes around immediately restored implants in periodontally compromised patients. The aims of this study were to evaluate the effect of immediate restoration on radiographic bone changes and to compare radiographic changes between arches and between healed and extraction sites in periodontally susceptible patients. MATERIALS AND METHODS: Patients received periodontal treatment. "All in one" implant surgery was then performed: Hopeless teeth were extracted, debridement around remaining adjacent teeth was performed, implants were inserted guided by a surgical stent, and a prefabricated screwed provisional restoration was immediately delivered on selected implants. Periapical radiographs using a parallelism appliance were taken at implant surgery and 6 and 12 months postsurgery. The distance between the alveolar crest and the implant shoulder was measured at the mesial and distal aspect of each implant. Bone changes were compared between immediately restored, submerged, and nonrestored implants; between arches; and between healed and extraction sites. RESULTS: Nineteen patients received 74 implants. Twelve implants in 4 patients failed within the first 6 months. Mean bone changes (+/- SE) between baseline and 12 months ranged between -1.19 +/- 0.19 mm and -1.88 +/- 0.3 mm. No difference was found between restored versus nonrestored sites or between maxillary and mandibular sites. Bone loss was slightly higher in healed sites. CONCLUSIONS: First-year bone changes around immediately restored dental implants in periodontally susceptible patients were slightly higher than most reports in the literature. This indicates a potential influence of periodontal disease on the success rate of dental implants.

Dental implants placed in previously failed sites: survival rate and factors affecting the outcome.

OBJECTIVES: The purpose of the present study was to evaluate the survival rate of dental implants in previously failed implant sites. In addition, factors that might affect the outcome of these redo procedures were also explored. MATERIAL AND METHODS: Patients that had failed dental implants, which were replaced with the same implant type at the same site, were included. Data on the failed implants were collected. The same parameters, along with the interval between retrieval and re-implantation, were collected for the second set of implants. Descriptive statistics were used to describe the patients and implants. Life table analysis of these implants was tabulated for both implant sets. The effect of systemic, environmental and local factors on the survival of the redo dental implants was evaluated. RESULTS: Fifty-six patients with a total of 79 redo implants were included in this study. Implants were followed for 7-78 months (mean 29.9+/-2). Thirteen implants failed that resulted in an overall survival rate of 83.5%. Successful implants had greater diameter (4.05+/-0.52 mm) than failed implants (3.72+/-0.56 mm); however, these differences were only marginal (P=0.06). Conversely, smoking habits, implants length and location, mode of placement and spontaneous exposure did not have a significant effect on the outcome of this procedure. CONCLUSION: Redo of dental implants has a lesser survival rate compared with previous reports for implants in pristine sites. These results were not associated with most implant- and/or patient-related factors. Thus, a possible negative effect that is associated with the specific implant's site might account for this phenomenon.

Immediate and delayed restoration of dental implants in periodontally susceptible patients: 1-year results.

PURPOSE: Immediate restoration of dental implants in patients with a history of periodontal disease was examined. The influence of insertion torque and implant stability quotient (ISQ) on the survival rate was compared in immediately restored, nonrestored, and submerged implants. MATERIALS AND METHODS: Patients received periodontal treatment after which "all in one" implant surgery was performed: hopeless teeth were extracted, debridement around remaining adjacent teeth was performed, implants were inserted and, in some cases, a prefabricated screw-retained provisional restoration was immediately delivered. Insertion torque and ISQ were recorded at baseline and 6 and 12 months postsurgery. RESULTS: Nineteen patients were treated, and 74 implants were placed. Twelve implants, 10 of which were maxillary, failed in 4 patients. Survival rates were 100% in partial-arch restorations, 94% in the mandible, and 78% in the maxilla. The survival rate of restored implants was 65% in extraction sites versus 94% in healed, nonextraction sites. Implants exhibited a decrease in ISQ at 6 months followed by an increase at 12 months. There were no statistically significant differences in insertion torque or ISQ between failed and successful implants, restored and nonrestored implants, or extraction-site and nonextraction-site implants. Mandibular implants demonstrated higher insertion torque and higher ISQ at baseline and 6 and 12 months. CONCLUSIONS: Within the limits of this study, immediate restoration of dental implants in periodontally susceptible patients had a variable success rate. Several factors were shown to affect these results.

Dental implants for immediate fixed restoration of partially edentulous patients: a 1-year prospective pilot clinical trial in periodontally susceptible patients.

BACKGROUND: The aim of this study was to evaluate the survival of dental implants in periodontally susceptible patients using immediate loading/restoration (ILR) protocols and the factors that modulate this response. METHODS: Systemically healthy patients who were treated previously for chronic periodontitis and who required implant therapy were recruited. Following data collection, "surgical templates" and provisional fixed restorations were fabricated. Transgingival implants were inserted, and surgical measurements were performed. After abutment connection, the crown/bridge was relined and cemented. Patients were monitored for 12 months, at which time final measurements were performed. RESULTS: Twenty patients (49 implants) completed this study; five implants failed and were removed (90% survival rate). All implants were removed during the first 6 months. At 12 months, the mean implants' probing depth was 2.87 +/- 0.9 mm. The mean electronic mobility testing device value (-1.3 +/- 0.7) was slightly higher than at baseline (-3.53 +/- 10.7). Radiographic bone loss ranged between -1.24 and 2.77 mm (mean +/- SD: 0.91 +/- 0.2 mm). All of the implants (16) that were inserted in the premolar region were successful, whereas three of nine implants in the molar region and two of 24 implants in the canine/incisor region failed (P = 0.0278). Survival in the immediately loaded group (83%) was slightly lower than in the immediately restored group (96%); however, these differences did not reach statistical significance. None of the other variables (smoking, arch, stability, implant length and diameter, and bone width) affected the outcome of this procedure. CONCLUSIONS: ILR protocols are predictable alternatives in periodontally susceptible patients. Results in the molar regions suggested that careful consideration should be given to implants placed in these sites. Long-term success in these patients has not been addressed.