Five-year prospective clinical evaluation of highly crystalline HA MP-1-coated dental implants.

Contemporary plasma-sprayed hydroxylapatite (HA) coatings with high crystalline content are much more resistant to in vivo degradation than HA coatings of a decade ago but reportedly exhibit reduced wettability, which could potentially negatively affect tissue adhesion and long-term clinical outcome. The present prospective study was undertaken to determine if highly crystalline HA MP-1-coated implants could meet a minimum 5-year implant success rate standard of 85% in view of their previously reported decreased wettability. Study subjects were consecutive patients with 1 or more missing teeth in the maxillary and/or mandibular jaw who presented in 3 university dental clinics and 1 private dental practice. A total of 120 patients were treated per protocol and successfully restored with implant-supported prostheses. Four implants failed in 3 patients and were withdrawn from the study. There were no other irresolvable adverse events. Cumulative implant success at 5 years was 97% (n = 184 implants in 88 patients), which exceeded the 85% standard for implant success after 5 years of clinical function.

Ridge preservation and augmentation using regenerative materials to enhance implant predictability and esthetics.

Dentistry has entered an era in which patients no longer need to accept an edentulous or partially edentulous condition, or one in which their candidacy for tooth structure replacement (ie, implants with subsequent restoration) must be dismissed because of insufficient alveolar bone volume, height, or width. The supporting bone can be preserved at the time of tooth extraction, or augmented at the time of case presentation, using a variety of available regenerative materials. Among them are mineralized human allograft bone and collagen membranes that can be placed in combination with specific growth factor complexes and implant designs. This article reviews the challenges associated with adequately preserving or augmenting the alveolar bone after tooth extraction or loss and before implant placement. The research and benefits to support using allogenic bone graft and membrane materials for such procedures are detailed, and 3 clinical cases are presented to demonstrate the clinically successful incorporation of these materials with the host tissues.

Clinical and histologic evaluation of a mineralized block allograft: results from the developmental period (2001-2004).

This article reports on a multicenter evaluation of a novel, sterile, antigen-inactivated, mineralized block allograft in humans during a 3-year developmental period. Consecutive partially edentulous patients (n = 73) with severe localized ridge defects (n = 82) were treated with the material. After 4 to 6 months of healing, tapered screw implants were placed in the grafted bone and subsequently restored. Patients were monitored 25 to 36 months after prosthetic restoration. A biopsy was taken of one patient and submitted for histomorphometric analysis. Block allograft survival was 93% at 12 months, and resorption ranged from none (69%) to slight (0 to 2 mm) (31%) for all surviving allografts. Seven block allografts failed and were removed because of improper contouring, prosthesis impingement, and/or infection. The sites were successfully re-treated and restored with dental implants. Soft tissue dehiscence was successfully treated in seven other sites. Implant survival was 99%. One implant failed without allograft failure. It was replaced with a larger-diameter implant, treated with guided bone regeneration, and subsequently restored. Histomorphometric analysis showed rapid incorporation of the allograft at 6 months without inflammation or necrosis. The block allografts were more technique-sensitive than autografts, which necessitated meticulous surgical technique and follow-up. Short-term results for the block allografts indicated a high degree of predictability, but long-term follow-up is needed.

Localized ridge augmentation with a block allograft followed by secondary implant placement: a case report.

A 37-year-old woman presented with severe ridge resportion of the mandibular left first molar and requested placement of a dental implant in lieu of a traditional fixed partial denture. The patient preferred an allograft to avoid a second surgical site to harvest an autogenous bone graft. A new solvent-dehydrated, allogeneic, corticocancellous bone graft material was selected for the case. The allograft was shaped to fit the defect, rehydrated in sterile saline, stabilized with fixation screws, and covered with platelet-rich plasma and a resorbable collagen membrane prior to soft tissue closure. Four months later, the bone graft was incorporated into the host tissue without complications and effectively expanded the ridge from 3 to 9 mm. The implant osseointegrated and was restored with a computer-milled abutment and single crown. The allograft maintained its strength and structural integrity, and was well-tolerated by the host tissues. A screw-design implant was placed in the previously augmented bone site and successfully restored with a computer-milled post and cemented single-tooth prosthesis. The allograft material was a highly effective modality for restoring the case, and it may significantly reduce the need to obtain autogenous bone from a secondary site.