Bone Augmentation Using Allogeneic Bone Blocks With Recombinant Bone Morphogenetic Protein-2.

PURPOSE: Because of limitations of the absorbable collagen sponge (ACS), recombinant bone morphogenetic protein (rhBMP-2) requires a scaffolding device for ridge augmentation. MATERIALS AND METHODS: Twenty-one patients were treated with 37 allogeneic block grafts and rhBMP-2/ACS. Cone-beam computed tomography (CBCT) was used to measure the ridge at 2 points preoperatively, postoperatively, and after graft healing. Dental implants were placed after 6 months of healing. RESULTS: The CBCT scan measurements revealed variable graft resorption at 2.0 mm and 5.0 mm above the crest (point A: 0%-33.82%; point B: 0%-31.51%). The graft resorption at point A averaged 14.7 ± 11.59% and at point B averaged 6.67 ± 8.25%. There was no statistically significant difference between these 2 points. All 37 bone blocks were found well incorporated. The range of horizontal augmentation gain at the crest (point A) was 2.8 mm to 7.7 mm (average horizontal gain 4.61 ± 0.82 mm). Sixty dental implants were inserted into the blocks in all planned sites. One implant failed during prosthetic treatment for an implant survival of 98.3%. Follow-up at 3 to 34 months found no additional failures. CONCLUSION: This case series suggests that allogeneic bone blocks may be a suitable replacement for titanium mesh as a resorbable scaffold with rhBMP-2/ACS. The growth factor may also improve allogeneic block graft incorporation.

Indications for implant-supported rehabilitation of the posterior atrophic maxilla: A multidisciplinary consensus among experts in the field utilising the modified Delphi method.

PURPOSE: To establish consensus-driven guidelines that could support the clinical decision-making process for implant-supported rehabilitation of the posterior atrophic maxilla and ultimately improve long-term treatment outcomes and patient satisfaction. MATERIALS AND METHODS: A total of 33 participants were enrolled (18 active members of the Italian Academy of Osseointegration and 15 international experts). Based on the available evidence, the development group discussed and proposed an initial list of 20 statements, which were later evalu-ated by all participants. After the forms were completed, the responses were sent for blinded ana-lysis. In most cases, when a consensus was not reached, the statements were rephrased and sent to the participants for another round of evaluation. Three rounds were planned. RESULTS: After the first round of voting, participants came close to reaching a consensus on six statements, but no consensus was achieved for the other fourteen. Following this, nineteen statements were rephrased and sent to participants again for the second round of voting, after which a consensus was reached for six statements and almost reached for three statements, but no consensus was achieved for the other ten. All 13 statements upon which no consensus was reached were rephrased and included in the third round. After this round, a consensus was achieved for an additional nine statements and almost achieved for three statements, but no consensus was reached for the remaining statement. CONCLUSION: This Delphi consensus highlights the importance of accurate preoperative planning, taking into consideration the maxillomandibular relationship to meet the functional and aesthetic requirements of the final restoration. Emphasis is placed on the role played by the sinus bony walls and floor in providing essential elements for bone formation, and on evaluation of bucco-palatal sinus width for choosing between lateral and transcrestal sinus floor elevation. Tilted and trans-sinus implants are considered viable options, whereas caution is advised when placing pterygoid implants. Zygomatic implants are seen as a potential option in specific cases, such as for completely edentulous elderly or oncological patients, for whom conventional alternatives are unsuitable.

A Prospective, Randomized, Controlled, Multicenter Evaluation of Extraction Socket Management Comparing a Wound Dressing and a Soft Tissue Substitute.

Postextraction bone grafting and implant placement help preserve alveolar bone volume. Collagen wound dressings and soft tissue graft substitutes may help protect extraction socket bone grafts and provide better gingival contours. This randomized, controlled, multicenter, and double-blinded study was conducted to compare a control (wound dressing) and a test (soft tissue graft) substitute in nearly intact extraction sockets. Both test and control sockets were grafted with a xenogeneic bone graft. Graft containment, extraction socket soft tissue gap closure, gingival contour, and gingival thickness were examined over 16 weeks, at which time implants were placed. Healing was uneventful for both groups, and there was no significant difference (P < .05) between the times required to close the extraction socket soft tissue gap (~80% of sites closed by 8 weeks). Bone grafts were covered and contained longer in the test group (~4 weeks vs ~2 weeks), with less contour disruption out to 4 weeks; however, at implant placement, soft tissue contours in both groups were comparable, and soft tissue thicknesses were not significantly different.

Radiographic protrusion of dental implants in the maxillary sinus and nasal fossae: A multidisciplinary consensus utilising the modified Delphi method.

The aim of the present study was to generate an international and multidisciplinary consensus on the clinical management of implant protrusion into the maxillary sinuses and nasal fossae. A total of 31 experts participated, 23 of whom were experts in implantology (periodontologists, maxillofacial surgeons and implantologists), 6 were otolaryngologists and 2 were radiologists. All the participants were informed of the current scientific knowledge on the topic based on a systematic search of the literature. A list of statements was created and divided into three surveys: one for all participants, one for implant providers and radiologists and one for otolaryngologists and radiologists. A consensus was reached on 15 out of 17 statements. According to the participants, osseointegrated implants protruding radiographically into the maxillary sinus or nasal fossae require as much monitoring and maintenance as implants fully covered by bone. In the event of symptoms of sinusitis, collaboration between implant providers and otolaryngologists is required. Implant removal should be considered only after pharmacological and surgical management of sinusitis have failed.

Extraction Socket Grafting and Ridge Augmentation Failures Associated with Clindamycin Antibiotic Therapy: A Retrospective Study.

PURPOSE: The aim of this retrospective study was to determine if penicillin allergy and/or clindamycin therapy may contribute to a higher incidence of postsurgical infections after bone augmentation. MATERIALS AND METHODS: This retrospective study analyzed patients between 2014 and 2019 who received bone augmentation procedures (socket grafting [SG]; ridge augmentation [RA]) prior to placement of dental implants. All the grafting procedures were performed under preoperative and postoperative oral antibiotic coverage with either amoxicillin or clindamycin for patients who reported penicillin allergy. Infections associated with the bone augmentation procedures were recorded. RESULTS: In this study, 1,814 patients received 2,961 bone augmentation procedures (2,530 SG, 431 RA). In the 2,530 SG procedures, 270 (10.7%) were associated with a penicillin allergy. Infections occurred in 91 of the 2,530 SG sites (3.6%). However, the infection rate was 10.7% (29 SG sites) for clindamycin and only 2.7% (62 SG sites) for amoxicillin (P < .02). In the 431 RA procedures, 71 (16.5%) were associated with a penicillin allergy. Overall infections occurred in 31 of the 431 sites (7.2%). However, the infection rate was 22.5% (16 RA sites) for clindamycin and only 4.2% for amoxicillin (15 RA sites; P < .01). Penicillin-allergic patients taking clindamycin demonstrated a higher risk of infection with a risk ratio of 6.9 (95% CI) and 4.5 (95% CI) compared with nonallergic patients taking amoxicillin for RA and SG, respectively. CONCLUSION: Penicillin allergy and the use of clindamycin following SG and RA procedures was associated with a higher rate of infection and may be a risk factor for bone augmentation complications.

An Updated Decision Tree for Vertical Bone Augmentation.

Vertical bone augmentation (VBA) procedures for dental implant placement are biologically and technically challenging. Systematic reviews and meta-analyses of studies on VBA have failed to identify clinical procedures that provide superior results for treatment of the vertical ridge deficiencies. A decision tree was developed to guide clinicians on selecting treatment options based on reported vertical bone gains (< 5 mm, 5 to 8 mm, > 8 mm). The choice of a particular augmentation technique will also depend on other factors, including the size and morphology of the defect, location, and clinician or patient preferences. Surgeons should consider the advantages and disadvantages of each option for the clinical situation and select an approach with low complications, low cost, and the highest likelihood of success.

Clinical outcomes of short implants (≤ 6 mm) placed between two adjacent teeth/implants or in the most distal position: A systematic review and meta-analysis.

PURPOSE: To investigate whether implant position (adjacent to teeth/implants vs most distal position in the arch) influences the clinical outcomes of short (≤ 6 mm) non-splinted implants. MATERIALS AND METHODS: A systematic electronic search of human randomised clinical trials and prospective cohort studies was performed using the PubMed, Embase and Cochrane Central Register of Controlled Trials (Central) databases. A manual search of implant-related journals was also performed. A meta-analysis was conducted to compare survival rate, marginal bone loss and prosthetic complications based on implant position. RESULTS: Overall, 11 studies were included to give a total of 388 non-splinted short implants (269 adjacent, 119 distal) followed up over a period ranging from 12 to 120 months. No significant differences in survival were found when comparing adjacent and distal positioning for both arches, and no significant differences were found for marginal bone loss or prosthetic complications between groups regardless of position. CONCLUSIONS: Short implants supporting single crowns presented similar outcomes when placed in the most distal position in the arch or between adjacent teeth or other implants.

The use of recombinant human bone morphogenetic protein-2 for the repair of extraction socket defects: a technical modification and case series report.

PURPOSE: The purpose of this case series was to evaluate the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in an absorbable collagen sponge (ACS) carrier for the repair of significant bone defects following tooth removal. The surgical technique was modified because primary closure was not obtained over the grafted sockets. MATERIALS AND METHODS: The present series included 10 consecutively treated patients with failed endodontically treated maxillary central incisors. Computed tomographic scans were obtained preoperatively. The extraction sockets all had > 50% buccal bone loss. The sockets were grafted with rhBMP-2/ACS and a small amount of bone substitute. Dental implants were inserted after 4 to 6 months of healing. RESULTS: Healing of the grafted sockets was uneventful. Dental implants were placed in all grafted sites without the need for further bone augmentation. A comparison of preoperative and postgrafting computed tomographic scans found a slight loss in alveolar width at the crest of 1.07 mm. Connective tissue grafts were placed in five patients. All 10 implants integrated well and were restored with single crowns. CONCLUSIONS: The use of rhBMP-2/ACS was effective in repairing osseous defects prior to implant placement. The lack of primary closure over the graft did not appear to complicate healing or compromise bone growth. This modification simplifies the technique and may reduce postoperative morbidity caused by flap manipulation.

A "Graft Less" Approach for Dental Implant Placement in Posterior Edentulous Sites.

Vertical bone augmentation techniques are more invasive than other procedures, and success rates often vary according to the surgical expertise of the clinician. As a result, there has been a trend over time towards minimally invasive treatment options in implant dentistry. This article discusses a "graft less" treatment philosophy that emphasizes the use of less-demanding augmentation techniques for the purpose of placing shorter implants in atrophic posterior sites, avoiding more complicated procedures for implant placement. In the posterior maxilla and mandible, the use of short implants (< 8.0 mm) can reduce the need for vertical bone grafting. Patients often prefer this strategy over more complex procedures that can cause complications, increase morbidity, and require longer treatment times with higher costs. When inadequate available bone is present for implant placement, planned bone augmentation procedures may be performed for the purpose of placing shorter implants; these procedures are less demanding, less invasive, and more predictable, allowing long-term outcomes for the implant-supported restoration.

Use of Narrow-Diameter Implants in Treatment of Severely Atrophic Maxillary Anterior Region With Implant-Supported Fixed Restorations.

The edentulous anterior atrophic maxilla represents a challenge for the surgeon and restorative dentist. Soft- and hard-tissue augmentation procedures are often required prior to, or simultaneously with, implant placement. A well-planned treatment protocol, patient compliance, and collaboration between the treating clinicians and the laboratory are requirements in achieving predictable long-term outcomes that satisfy patient expectations. Avoiding transmucosal loading and movement of the graft during the healing phase are crucial factors in achieving lasting success. In this case report, a fixed provisional restoration supported by four immediately loaded narrow-diameter implants (NDIs) was used to enable function during healing and protect the grafted site. Two of the NDIs, along with three conventional-diameter implants, were subsequently used to support the final restoration. NDIs with diameters of less than 3 mm can achieve excellent long-term osseointegration and may be used together with conventional implants for definitive prosthodontic treatment as demonstrated by the 11-year follow-up reported in this case.