Zirconia removable telescopic dentures retained on teeth or implants for maxilla rehabilitation. Three-year observation of three cases.

This report addresses maxillary restoration with removable telescopic crown-retained palatal free dentures. One patient with 7 natural teeth (PERIO), a second patient with 6 dental implants (IMPL), and a third patient with 2 natural teeth and 4 dental implants (IMPL-PERIO) were treated. Zirconia copings for natural teeth and individual zirconia implant abutments were fabricated in CAD/CAM and used as primary crowns. Electroformed gold copings were used as secondary telescopes. All maxilla supraconstructions were fabricated with zirconia and CAD/CAM. Patients were monitored during a 3-year period; all teeth and implants survived, and no biological or mechanical complications occurred. The peri-implant and periodontal conditions were healthy. While recognizing the limitations of this report, results showed that fabricating removable zirconia structures by means of CAD/CAM can yield highly functional and esthetic results. Galvanoforming technology is the preferable means of fabricating secondary crowns. The combination of these techniques and materials results in a prosthetic reconstruction of high quality, good fit, and biocompatibility. Long-term studies of large populations are necessary to investigate the clinical properties of the material utilized in this type of construction.

Use of engineered bone for sinus augmentation.

BACKGROUND: Tissue-engineered bone grafts represent an appealing alternative for maxillary sinus augmentation because they eliminate the significant drawbacks associated with extra- and intraoral bone-harvesting procedures. In the present case series, we document the outcomes of sinus augmentation surgery using tissue-engineered bone grafts. METHODS: Three patients requiring bilateral sinus augmentation received tissue-engineered bone grafts combined with xenograft prior to implant placement. Implants were placed and loaded 6 and 12 months postaugmentation, respectively. Radiographs were taken and clinical examinations were performed preoperatively and at 4, 6, 12, and 18 months postaugmentation. Biopsies were obtained at 4 and 6 months postaugmentation. Standardized orthopantomograms were used to measure the posterior maxilla bone height. RESULTS: None of the patients experienced untoward complications during or following the therapeutic procedures. Ten implants were inserted into the augmented sinuses and loaded. Biopsies revealed a lack of inflammation or pathology; newly formed fibrous bone with osteoblastic activity and xenograft particles was evident. Compared to 4 months postaugmentation, augmented tissue was more mature at 6 months. The postoperative (18 months) bone height in augmented areas was significantly greater than the preoperative height (P <0.0001), representing an approximately 4.5-fold increase in bone height. CONCLUSIONS: Sinus augmentation using tissue-engineered bone grafts was successful in all three cases, permitting the subsequent insertion and loading of dental implants. The present cases demonstrated the feasibility of using engineered bone for sinus augmentation. Controlled clinical trials will be required to evaluate this new and evolving treatment modality.

Alveolar bone preservation in extraction sockets using non-resorbable dPTFE membranes: a retrospective non-randomized study.

BACKGROUND: The aim of this study was to investigate the clinical regeneration of extraction sockets using high-density polytetrafluoroethylene (dPTFE) membranes without the use of a graft material. METHODS: A total of 276 extraction sockets were evaluated in 276 subjects (151 males and 125 females; mean age, 50.2 years; age range: 24 to 73 years). After extraction, flaps were elevated and a dPTFE membrane was placed over the extraction site. The flaps were repositioned and sutured into place. Primary closure was not obtained over the membranes. The cemento-enamel junctions of the adjacent teeth were used as reference points. Measurements were taken postextraction and 12 months after surgery in the same areas with the help of a stent and were defined as the distance from the reference points to the bone level. Hard tissue biopsies were taken from 10 representative cases during implant placement 12 months after socket preservation. The bone core samples were submitted for histologic evaluation. A stringent plaque-control regimen was enforced in all subjects during the 12-month observation period. RESULTS: A significant regeneration of the volume of sockets could be noted by histologic evaluation, indicating that the newly formed tissue in extraction sites was mainly bone. No influence of gender, smoking, age, or clinical bone level before treatment was found on the percentage of bone gain. CONCLUSION: The use of dPTFE membranes predictably led to the preservation of soft and hard tissue in extraction sites.

Combined periodontal and implant treatment of a case of aggressive periodontitis.

Aggressive periodontitis renders a great challenge to clinicians with regards to treatment and prosthodontic rehabilitation. A compromised remaining dentition and a tendency toward refractory disease make it difficult to establish a treatment plan that renders an adequate long-term prognosis. Although the use of implants has become a common treatment modality, limited data are available on the use of dental implants in patients with aggressive periodontitis, especially for cases necessitating the use grafting procedures preceding implant placement. In this case report the successful treatment of a patient with aggressive periodontitis by the combined use of periodontal and implant treatment necessitating preceding augmentive procedures is described.

Immediate implant placement: a case series.

A major drawback of implant therapy is the comparatively long healing period involved. Early and immediate loading of dental implants can significantly decrease the treatment time and thus result in an increase in patients' comfort. In this report, 3 cases of placement and immediate loading of the final implants are presented. In 2 of these cases, where preliminary augmentation was necessary, provisional implants were placed after the procedure and immediate provisional dentures were delivered. With the exception of 1 case, in which 1 implant failed, no adverse events were observed. All cases are in function now for 3 to 5 years after implant placement. The observations from this limited number of cases confirm that immediate loading of implants could be a viable treatment option.

Telescopic crowns as attachments for implant supported restorations: a case series.

The use of dental implants to support mandibular or maxillary overdentures is a widely used treatment modality. Advantages are an increase in retention, an increase in chewing ability, and easy access for oral hygiene procedures. While telescopic and conical crowns have been used for decades to connect natural teeth to overdentures, not many cases have been reported in the literature of telescopic crowns placed on implants to support overdentures. This article describes 7 patients with overdentures supported by telescopic crowns who received 65 implants (ITI Straumann). The cases presented in this report have been in function for up to 4.5 years. During that time no adverse events were reported. The use of telescopic crowns as attachments for implant-supported overdentures may be a viable treatment option.

Prevalence of maxillary sinus disease and abnormalities in patients scheduled for sinus lift procedures.

BACKGROUND: The purpose of the present study was to determine the prevalence of sinus disease and abnormalities among patients scheduled to undergo direct sinus augmentation. METHODS: Forty-five patients attending a private periodontal practice and consecutively treatment planned for sinus augmentation were referred for otorhinolaryngologic evaluation, which included a medical history and radiographic (computed tomography), clinical, and endoscopic examinations. Pathological findings were recorded and otorhinolaryngologic treatment was provided. Six months later the sinus augmentation procedure was performed and followed by postoperative evaluations for 4 to 6 months. RESULTS: Of the 45 subjects, 98% (44) were diagnosed with chronic periodontitis, 51% were smokers, and 27% reported a history of symptoms indicative of sinus disease. Eighteen subjects were diagnosed with sinus disease and/or abnormalities. The diagnosed conditions included chronic sinusitis, sinus cysts, nasal septum deviation, and ostium stenosis. No significant differences in age, gender, or smoking status between patients with and without sinus conditions were found (P >0.05). There was a significant association between history of symptoms and diagnosis of sinus conditions (P <0.0001). Three subjects (one treated for preoperative sinus conditions) experienced notable intra- or postoperative complications related to the sinus augmentation procedure. CONCLUSIONS: The results indicate that, in a population of patients with chronic periodontitis, presence of sinus conditions is strongly associated with a history of indicative symptoms and is independent of age, gender, and smoking status. The results reinforce the importance of careful detailed history taking and thorough clinical and radiographic evaluation prior to performing sinus augmentation.