A 3-year retrospective study of fresh socket implants: CAD/CAM customized healing abutment vs cover screws.

AIM: To evaluate width loss of the alveolar ridge three years after implant placement in a fresh extraction socket following two different tissue healing methodologies: conventional healing procedure vs CAD/CAM technology for a customized healing abutment. MATERIALS AND METHODS: Post-extraction sockets underwent immediate dental implant placement without the voids being filled between the implant surface and the socket wall. Samples (one implant per patient) were retrospectively enrolled in each group according to the type of healing procedure: implants in the conventional group underwent standard closed healing with a cover screw, while in the customized group the healing abutment was immediately screwed onto the head of the implant, mimicking the look of the extracted tooth fabricated by CAD/CAM technology. The width of the alveolar ridge was measured on 3D radiographs at baseline (before surgery) and three years postsurgery. Nonparametric statistics were performed with a significance level of 0.01. RESULTS: A total of 54 dental implants were selected. An implant survival rate of 100% was reported for all implants after 36 months. Three years after implant placement, loss in bone width was registered for both the conventional and customized groups, being 2.2 (1.1) and 0.2 (0.7) mm, respectively. Changes in the customized group were significantly lower than in the conventional group. Significant differences were again found between the groups for each of the tooth sites. Loss of bone width appeared negligible (from incisor to premolar), with values ranging between 0.2 and 0.4 mm in the customized group, whereas in the conventional group all tooth sites underwent wide shrinkage (with a bone loss ranging from 1.6 to 3.0 mm). CONCLUSION: The CAD/CAM procedure might provide the following advantages: 1) Stabilization of the gingival setting and bone volume in a fresh socket implant; 2) Maintaining the same emergence profile of teeth for restorative crowns, avoiding laboratory approximation of the emergence profile of the definitive restoration; and 3) Optimal prosthetic-surgical planning and minimally invasive extraction to preserve the integrity of the supporting tissue.

Nonsurgical Treatment of Peri-implantitis Without Eliminating Granulation Tissue: A 3-Year Study.

OBJECTIVES: The purpose of this study was to evaluate a nonsurgical approach toward peri-implantitis by means of mechanical debridement and local detoxification leaving granulation tissue into the peri-implant pockets. MATERIALS AND METHODS: An analysis was performed on the outcomes of 2 nonsurgical protocols: mechanical debridement plus chemical detoxification with 0.2% chlorhexidine and chlortetracycline hydrochloride (test), and mechanical debridement alone (control). Measures were collected at baseline, 3, 24, and 36 months after treatment. RESULTS: Seventy-five implants with peri-implantitis were included. At a 36-month evaluation, mean pocket probing depth was 3.15 ± 0.32 mm for the test group and 5.97 ± 0.90 mm for the control group, the difference being significant. An improvement of marginal bone level was recorded for the test group, whether the control group showed a further marginal bone loss. Treatment success was 100% in the test group and 31.4% in the control group. CONCLUSION: Nonsurgical implant debridement alone seemed not efficient in the treatment of peri-implantitis. Further longitudinal studies are required to evaluate the efficacy of mechanical debridement with chemical detoxification and removal of granulation tissues against mechanical debridement with chemical detoxification alone.

Surgical Treatment of Oroantral Communications.

BACKGROUND: Oroantral communication (OAC) can be defined as a pathologic space created between the maxillary sinus and the oral cavity.This communication and subsequent formation of a chronic oroantral fistula is a common complication often encountered by oral and maxillofacial surgeons.Although various techniques have been proposed in published studies, long-term successful closure of oroantral fistulas is still one of the most difficult problems confronting the surgeon working in the oral and maxillofacial region.The decision of which treatment modality to use is influenced by many factors, such as the amount and condition of tissue available for repair, the size and location of the defect, the presence of infection, the time to the diagnosis of the fistula. OBJECTIVE: To evaluate an alternative technique for the treatment of oro-antral fistula, using a combined therapeutic ear nose and throat/intraoral approach. METHODS: Twelve consecutive patients affected by complicated OAC were included in this study.The protocol consisted of: clinical, endoscopic, and radiological preoperative evaluation (panoramic tomogram and computed tomography); systemic antibiotic and steroid therapy for 2 weeks before surgery; one-stage surgical procedure consisting of Functional Endoscopic Sinus Surgery technique associated with the closure of the OAC by a titanium mesh and a mucoperiosteal flap; postoperative antibiotic and cortisone-based therapy.A titanium mesh was used to obtain an optimal support and stabilization of soft tissues.Follow-up consisted of weekly clinical evaluation during the first month, a clinical evaluation at 1, 3, 6, 12, 24 months and a nasal endoscopy at 3, 8, 24 weeks after surgery. A second surgical step took place to remove the mesh, after a period of healing, which went from 6 to 18 months. Samples were harvested from the surgical site after mesh removal for histological analysis. RESULTS: At 1 month follow-up, in 10 patients of 12, the Valsalva manoeuvre was negative, same result at the 3rd month follow-up, although in 11 of 12 patients. In 5 of 12 patients, the mesh was exposed. The histological analysis confirmed the formation of a pseudo-periosteum layer.One patient failed because the mesh lost its stability. The patient was operated again 8 months later and new mesh was fixed into place. CONCLUSION: The current study showed that one-stage, combined endoscopic and intraoral approach represents a feasible and minimally invasive procedure for the long-term effective treatment of chronic complicated OACs.The main advantage of the use of a titanium mesh to guide the regeneration is that it assures a predictable healing, mechanic scaffold, tissues stability and allows a possible following oral rehabilitation.

Specific use of the implant stability quotient as a guide to improve healing for patients who had undergone rehabilitation with fixed implant-supported dental prostheses.

PURPOSES: to develop a clinical approach to evaluating osteointegration around bone implants and try to determining which was the correct time of implant loading in different edentulous indications, that is, either properly positioned implants or implants "at risk", generally referred to as implants having increased probability of failure (namely those for which primary stability had been achieved via a time-consuming surgery). MATERIALS: Several implant-supported rehabilitation strategies, with or without bone augmentation procedures, were performed in the upper and lower arches: From 2 to 5 months following implant placement, the prosthetic restorations were performed. A resonance frequency analyzer allowed clinicians to measure intraoperative and postoperative implant stability, then the values of the implant stability quotient, ISQ, ranging from 0 to 100, were registered. ISQs were ranked into 3 levels: Green (ISQ ≥ 70), Yellow (60 ≤ ISQ < 70), and Red (ISQ < 60). Groups were subjected to Pearson's χ2 analysis, with YATES correction when necessary, with a significance level of 0.05. RESULTS: A total of 213 implants had been included. When the distribution of normalized values of ISQ registered for implants inserted in native bone and loaded at 2-3 months (5 Red, 19 Yellow, and 51 Green) was compared to that of native implants loaded after 4-5 months (4 Red, 20 Yellow, and 11 Green), a significative difference was found (p-value = 0.0037). At the time of loading, significance was lost. Significant clinical improvements on the distribution of normalized values of ISQ were apparent for both the implants placed in pristine and those placed in lifted sinuses; no significant differences were registered between the two groups. CONCLUSION: At the loading time, implants considered to be at risk behaved similarly to the native sites for which the overall prosthetic workflow took about few; results confirmed that the mandibular implants appeared to have higher stabilities when compared to maxillary implants at both the intraoperative and the postoperative surveys.

Changes in Alveolar Bone Width Following Immediate Implant and Fresh Socket Preservation with Xenogeneic Gap-Filling Material Versus Guided Tissue Healing with Anatomical Tooth-Shaped Caps: A 3-Year Retrospective Case-Control Study.

This study aimed to calculate the 3-year dimensional change in crestal bone width when dental implants placed in postextraction sockets underwent two alternative techniques for alveolar preservation. Fresh sockets that had undergone immediate implant placement were categorized into one of two groups depending on the procedure type. For the xenogeneic biomaterial grafted (BG) group, the gaps between the metallic implant surfaces and the bony walls were filled with corticocancellous porcine bone; in the anatomical cap group, in which patients were treated with guided tissue healing (GTH), cross-linkable acrylic resin caps were immediately screwed on the implants. Absolute measurements of the alveolar width were performed on 3D images acquired before tooth extraction (thereby ensuring correct surgical treatment) and 3 years after surgery. Nonparametric statistics were performed, with the level of significance set at 1%. The results of 46 implants (placed in 36 patients) were analyzed, and 100% survival rates were reported for both groups at 3 years postsurgery. Minor swelling of treated areas was observed the first few days of healing, but neither mucositides, dehiscence events, nor suppurations occurred. At 3 years postsurgery, loss in alveolar ridge width was higher for the BG group (-1.1 ± 0.6 mm) than for the GTH group (0.0 ± 0.3 mm); moreover, these changes were significantly different (P < .0001). This clinical and radiographic data analysis suggests that the implant sites that received a xenogeneic filling material were less effective in maintaining the preoperative alveolar bone width than sites that underwent GTH with immediate implants and anatomical tooth-shaped caps.

Volume assessment of the external contour around immediate implant with or without immediate tooth-like crown provisionalization: A digital intraoral scans study.

PURPOSES: To examine differences between immediate and delayed dental implant loading in maxillary aesthetic areas. METHODS: In this retrospective controlled analysis, 43 subjects who underwent immediate placement of the dental implant in a post-extraction socket were ranked into either immediate (24 implants loaded with non-occlusal tooth-like profile provisional prostheses fabricated by virtual diagnostic impressions and an in-office dental milling machine) or delayed group (19 implants loaded with conventional cover screws and secondary intention healing). Intraoperatively and then four months later, scans of the external layers were acquired with an optical scanner. The width of the alveolar crest and Jemt papilla index were acquired. Non-parametric tests were applied with a level of significance set at p < 0.01. RESULTS: In both groups, the volumes and areas showed significant reductions from the baseline to the 4-month survey. Reductions in volume appeared to be statistically different between the two groups (-39±31 mm3 for the immediate and 89 ± 30 mm3 for the delayed group). The final Jemt papilla index appeared significantly different between the immediate (mesial, 2.5 and, distal, 3) and delayed groups (2 for both aspects). CONCLUSIONS: Immediate provisionalization significantly reduced volume loss and area shrinkage at the external layer when data were compared to a delayed rehabilitation strategy.

Assessment of the alveolar bone loss in fresh socket implant procedures with immediate implant loading via temporary preformed anatomical healing caps: Comparison of two different lengths of the implant collar.

PURPOSES: The aim of the present clinical and radiologic retrospective study was to evaluate alveolar bone remodeling, in terms of alveolar width and peri­implant bone level, two years after immediate implant positioning (with two different collar lengths, 0.8 mm and 2.0 mm) and loading of preformed healing cap. The Null hypothesis, H0 is: there was no difference between the two groups of implants. METHODS: Patients suffering from single-tooth edentulous areas in premolar, cuspid, and incisive areas were treated with fresh-socket implants and immediate preformed anatomical healing caps. Each final crown restoration was fabricated 3 months later. Primary outcomes (related to loss of the alveolar width and peri­implant bone level) and secondary outcomes (testing adverse events, and measuring implant/prosthesis survival) were acquired and analyzed. RESULTS: A two-year retrospective analysis was conducted on 31 patients (19 female and 12 male), who underwent dental implant placement with implants having two different lengths of the collar: group A, 0.8 mm, and group B, 2.0 mm. As for the width of the alveolar crest, there was a negligible loss (less than half a millimeter) reported for both the groups, anyway reaching a statistical significance. Preoperative alveolar widths (9.50±0.67 mm and 9.45±0.90 mm, respectively for groups A and B) were different from the two-year alveolar widths (9.20±0.74 mm and 8.93±0.99 mm, respectively for groups A and B) with p-values ≤ 0.0049. When the marginal bone loss was assessed, significant differences were registered between the two procedure groups (-1.42±0.34 mm for group A and -0.11±0.15 mm for group B with a p-value < 0.0001). CONCLUSIONS: The proper design of a healing abutment was very important to preserve the emergence profile immediately after extraction and implant placement. The length of the implant collar used with an immediate healing abutment appeared to affect the preservation of the alveolar crest with predictable final results.

Bone assessment around the delayed dental implant with and without preformed anatomical caps: A 1-year retrospective case-control study.

PURPOSES: To investigate the amount of first-year peri­implant bone loss and the development of the papillae when delayed dental implants loaded with anatomic cover screw and those underwent conventional healing protocol were compared. METHODS: Edentulous healed sites had undergone delayed implants placement. In the anatomical cap group, patients were treated with a guided tissue healing, tooth-like cross-linkable acrylic resin caps had been immediately screwed on dental implants. The marginal loss of the alveolar bone height 1 year after surgery and Jemt's papillae index were obtained. Non-parametric statistics were performed with a level of significance of 1% RESULTS: Forty patients were included in the present retrospective analysis. After a follow-up of 1 year, none of the 40 included implants showed a failure. The Jemt's papilla index was 1.76±0.44 and 1.34±0.50 respectively for guided tissue healing and conventional healing group, without any significant difference. Within the first year of survey a bone loss of -1.27±0.26 mm for conventional healing treatment showed a statistically significant difference (p-value<0.0001) when it was compared to the negligible of the other group (-0.06±0.31 mm). CONCLUSIONS: A guided healing procedure with preformed caps seemed to give better outcomes regarding marginal bone loss and papilla index than those of conventional abutments.

Immediate Implant and Customized Healing Abutment for a Periodontally Compromised Socket: 1-Year Follow-Up Retrospective Evaluation.

Immediate dental implant placement with or without immediate loading is reported in daily dentistry and implantology, but these procedures are not common in the case of periradicular and periapical lesions around the tooth needed to be replaced. In the following retrospective evaluation, 10 cases with a 1-year follow-up were selected to propose the technique of an immediate provisional non-loading prosthesis being delivered on the same day of the post-extraction implant placement in multiradicular teeth affected by chronic periradicular and periapical lesions. Post-extractive sockets underwent immediate dental implant placement by filling the empty space with sterile, re-absorbable gelatin sponges. The widths of the alveolar ridge were measured on three-dimensional radiographs before and after the operation, 4 and 12 months later. Non-parametric statistics were performed to compare the outcomes over time with a level of significance of 0.05. Comparing the preoperative cross-sectional images of cone beam computerized tomography (CBCT) scans to the postoperative ones, it was noted that changes in the crestal ridge width, ΔCW, (compared to baseline) were negligible and not clinically appreciable. However, while ΔCW at 4 months appeared to be negative (-0.17 ± 045 mm), crestal width at 12 months was at the same level as the baseline (ΔCW = 0.02 ± 0.48 mm), with a significant difference between 4 and 12 months (p-value = 0.0494). Immediate implant placement with an immediate non-loading provisional customized healing abutment of polyether-ether-ketone placed into the post-extractive sockets with asymptomatic and large chronic periapical and periradicular lesions could represent a further treatment strategy for patients' rehabilitation and soft tissue preservation to replace a hopeless tooth.

Clinical and radiographic evaluation of transalveolar two-step osteotome-mediated sinus floor elevation versus sinus augmentation with displacement of the palatal wall in lateral direction coupled to alveolar ridge split technique: A 3-year retrospective study.

INTRODUCTION: The present study aimed to examine the middle-term effects of transcrestal double-sinus elevation (TSFE) versus alveolar/palatal split expansion technique (APS) and simultaneous implant placement in the augmented sinus. NULL HYPOTHESIS: there were no differences between groups. MATERIAL & METHODS: Magnetoelectric device was used for bone augmentation and expansion techniques in long-standing edentulous patients with a deficiency in vertical height in the posterior maxilla (3mm to 4mm residual bone height): TSFE group, or two-stage process with a first transcrestal sinus floor augmentation and a second sinus floor elevation with immediate implant placement; APS group, or "dual split and dislocation" of the two cortical bony plates towards the sinus and palatal side. Volumetric and linear analyses were performed on the superimposed preoperative and postoperative 3-year computed tomography scans. The level of significance was set at 0.05. RESULTS: Thirty patients were selected for the present analysis. For both groups significant differences were found in the volume outcomes between baseline and 3-year follow-up, showing a gain of about +0.28±0.06cm3 for the TSFE group, and +0.43±0.12cm3 for the APS group, with p-values < 0.0001. However, an effective increase of the volume of the alveolar crest was registered just in the APS group (+0.22±0.09cm3). A significant increase in bone width was found in the APS group (+1.45±0.56mm with p-value < 0.0001); on the contrary, a slight width reduction of the alveolar crest was observed in the TSFE group (-0.63±0.21mm). DISCUSSION: TSFE procedure seemed to not affect the shape of the alveolar crest. APS procedures led to a higher increase of the volume available for dental implant placement and could be used in horizontal bone defects too.

Conventional avulsion versus less traumatic extraction of ankylosed roots with a magnetoelectric device in anterior maxillary areas.

The analysis aimed to compare two different single-tooth extraction surgical approaches in anterior maxillary areas of the ankylosed teeth: less traumatic magneto-electrical (mag) versus conventional tooth extraction (con) in minimizing the adverse effects on post-extractive sockets. Parameters of clinical interest such as intra-surgical fracture of the buccal bone plate, presence of postoperative inflammation, and application of stitches were acquired from medical records. The data were subjected to Pearson's χ2 analysis or to Fisher's exact test with significance at 0.05. Sixty-six hopeless maxillary permanent ankylotic teeth were extracted in the same number of patients. In the mag group 2 incisors suffered a fracture. Two patients out of 40 had signs and symptoms of inflammation that resolved completely within 3 days. In the con group 18 out of 26 patients suffered from buccal alveolar fracture. Six of these patients experienced signs of inflamed tissue. The two groups showed significant differences with p-values ≤0.0009 with regards to fracture (2/38 vs. 18/8) and tissue inflammation variables (2/38 vs. 10/16). A significantly different distribution about the presence of sutures was registered between the mag (4/36) and the con (18/8) group with a p-value <0.0001. Mag group seemed to have reduced frequency of fractured and infected post-extractive sites.

A Retrospective Digital Analysis of Contour Changing after Tooth Extraction with or without Using Less Traumatic Surgical Procedures.

BACKGROUND: The present retrospective analysis aimed to compare two different single tooth extraction surgical approaches in both premolar and molar areas: less traumatic magneto-electrical versus conventional tooth extraction in minimizing the edentulous ridge volume loss. METHODS: In the present retrospective control trial, 48 patients who underwent one-tooth extraction, were allocated either to control (28 sites treated with conventional tooth extraction procedures) or test group (20 subjects treated with less traumatic tooth extraction procedures by tooth sectioning and magnetoelectric roots subluxation). Intraoperatively (during tooth extraction surgery just after the subsequent filling of the alveolar socket with the sterile fast re-absorbable gelatin sponge), and then four months later, contours of the sockets were acquired through a laser intra-oral scanner. The digitally superimposed models were converted to dicom (Digital Imaging and Communications in Medicine) format first, then volumetric and area evaluations were performed with a DentaScan tool package. Non-parametric tests were applied with a level of significance set at p < 0.01. RESULTS: significant reductions of anatomical features were observed four months later in all the groups (p-values < 0.001) with volume losses leading to a final alveolar ridge volume of 0.87 ± 0.34 cm3 for atraumatic extractions and 0.66 ± 0.19 cm3 for conventional extractions. No significant differences were registered for outcomes related to the basal surface variables. When just molar tooth were considered, the outcomes relating to volume loss between baseline and four months (ΔV) and its percentage (ΔV%) showed a better behavior in the less traumatic procedure (ΔV = -0.30 ± 0.10 cm3 and ΔV% = -22.3 ± 8.4%) compared to the conventional extractions (ΔV = -0.59 ± 0.10 cm3 and ΔV% = -44.3 ± 5.8%) with p-values < 0.0001. CONCLUSIONS: at four months, the less traumatic tooth extraction procedures by tooth sectioning and magnetoelectric root subluxation seemed to be able to better preserve the volume of the alveolar crest (reduction close to 22% with less traumatic extraction in molar sites) when compared to subjects treated with the conventional tooth extraction techniques.

Guided Tissue Healing by Preformed Anatomical Healing Caps in the Edentulous Ridge: A 2-Year Retrospective Case-Control Study.

The present study evaluated the 2-year changes in soft tissue width after implant placement in healed sites, using two different methodologies to obtain tissue healing: preformed and anatomical abutment caps for customized healing (test) vs conventional healing abutments (control). The null hypothesis was that there would be no difference between the test group and the control group. Patients who suffered from a single-tooth edentulous area in the premolar/molar region were included. Both the standard abutments and the preformed and anatomical abutment caps were immediately screwed on the implants. The final crown restoration was fabricated 3 months later. Primary outcomes (changes in the alveolar soft tissue ridge) and secondary outcomes (testing adverse events and measuring implant/prosthesis survival) were evaluated. Thirty-nine patients (24 women) with a mean age of 57.7 ± 7.1 years (range: 42.6 to 72.8 years) were included. Alveolar widths in both groups showed significant increases from baseline to the 3-month follow-up, with augmentations of 3.6 ± 0.7 mm for the test group and 1.1 ± 0.9 mm for the control group. The gain in soft tissue appeared to be statistically different between the two groups (P < .0001). Contrarily, any subsequent change in width from 3 months to 2 years was negligible and insignificant (< 0.33 mm for both groups). The technique described in the present study encourages the potential for alternative healing based on the guided soft tissue concept, as it either eliminated the need for second-stage surgery or it reduced step-by-step peri-implant soft tissue conditioning, obtaining a tissue contour immediately very similar to that of a final prosthesis.

Lateral Displacement of Maxillary Sinus Palatal Wall: A 1-Year Retrospective Computerized Tomography Study.

PURPOSE: To examine the short-term outcomes of maxillary sinus augmentations consisting of laterally and apically displacing the palatal wall through a transcrestal approach. MATERIALS AND METHODS: The maxillary sinus floor was fractured in its palatal aspect by allowing a displacement in the buccal and apical direction with a magnetoelectric system. A medial displacement of the alveolar crest in its palatal bony plate was performed at the same time. Crestal bone change was investigated using superimposed preoperative and postsurgical computed tomography scans. Clinical and radiologic outcomes over 1 year were evaluated. RESULTS: A total of 18 implants were selected for retrospective volumetric and linear analyses. Sinus floor and alveolar bone augmentation surgery led to a significant increase in the bone volume (P = .0002) from 0.134 ± 0.060 cm3 to 0.639 ± 0.166 cm3, with an overall gain of +0.504 ± 0.139 cm3. No part of the implant apices appeared to protrude into the maxillary sinus at the 1-year follow-up. The width of the alveolar crest changed from 5.1 ± 0.5 mm to 6.5 ± 0.7 mm, with a significant increase of +1.4 ± 0.6 mm registered at 1 year. However, a marginal bone loss of 1.0 ± 0.8 mm was observed. When tooth positions were investigated, no significant differences between the two groups (premolars versus molars) were found. CONCLUSION: Significant and effective bone gains allowed proper placement of the dental implants but with a minimal loss of peri-implant bone volume.

Effectiveness of a Water Disinfection Method Based on Osmosis and Chlorine Dioxide for the Prevention of Microbial Contamination in Dental Practices.

In dental clinics, the infections may be acquired through contaminated devices, air, and water. Aerosolized water may contain bacteria, grown into the biofilm of dental unit waterlines (DUWLs). We evaluated a disinfection method based on water osmosis and chlorination with chlorine dioxide (O-CD), applied to DUWL of five dental clinics. Municipal water was chlorinated with O-CD device before feeding all DUWLs. Samplings were performed on water/air samples in order to research total microbial counts at 22-37 °C, Pseudomonas aeruginosa, Legionella spp., and chlorine values. Water was collected from the taps, spittoons, and air/water syringes. Air was sampled before, during, and after 15 min of aerosolizing procedure. Legionella and P. aeruginosa resulted as absent in all water samples, which presented total microbial counts almost always at 0 CFU/mL. Mean values of total chlorine ranged from 0.18-0.23 mg/L. Air samples resulted as free from Legionella spp. and Pseudomonas aeruginosa. Total microbial counts decreased from the pre-aerosolizing (mean 2.1 × 102 CFU/m3) to the post-aerosolizing samples (mean 1.5 × 10 CFU/m3), while chlorine values increased from 0 to 0.06 mg/L. O-CD resulted as effective against the biofilm formation in DUWLs. The presence of residual activity of chlorine dioxide also allowed the bacteria reduction from air, at least at one meter from the aerosolizing source.

Maxillary and Mandibular Split Crest Technique with Immediate Implant Placement: A 5-Year Cone Beam Retrospective Study.

PURPOSE: This study aimed to test the effectiveness and reliability of the alveolar ridge-splitting technique in atrophic posterior arches, investigating the middle-term volumetric and clinical outcomes. MATERIALS AND METHODS: Atrophic alveolar ridges in the maxillary and mandibular posterior areas were treated with the alveolar ridge-splitting/expansion technique (ARST), immediate implant placement, collagen sponges covering the defect, and healing by secondary intention. Areas were rehabilitated by fixed dental prostheses supported by dental implants. Changes in volume and width of the alveolar ridge were retrospectively calculated by comparing the x-ray tomography scans obtained before and 5 years after surgery. Report of failure in the case sheets was taken into account. Cross-sectional images were also used to assess the thickness of the labial alveolar plates at the implant shoulder. Nonparametric analyses of variance with post hoc and pair-comparison tests were performed with a level of significance of .05. RESULTS: A total of 38 patients were retrospectively selected (23 women and 15 men). Six patients underwent ARST surgeries in both the maxilla and the mandible and were excluded from statistical analysis. Differences between 16 maxillae and 16 mandibles and between 12 single crowns and 20 fixed partial dentures (FPDs) were searched. Episodes of minor swelling occurred within the first 2 days after surgery. Neither mucositis nor flap dehiscence had been registered. The mean values of buccal cortical thickness were 2.46 ± 0.49 mm and 1.15 ± 0.33 mm, respectively, in the maxillary and mandibular areas. After 5 years of survey, maxillary increases in alveolar ridge width and volume were +4.4 ± 0.4 mm and +295 ± 45 mm3, respectively, whereas the same outcome variables (+3.5 ± 0.7 mm and +217 ± 53 mm3) measured in the mandible appeared to be significantly smaller than those in the maxilla (P < .0001). One maxillary single implant failed. Cumulative survival rates at 5 years were 100% for mandibles and 95.5% (95% CI: 86.8% to 100%) for maxillae. CONCLUSION: Posterior areas of the maxilla displayed a higher increase in alveolar width and volume than mandibular areas, and even if it would be premature to draw survival conclusions at this stage without any statistical support, a lower cumulative survival rate was reported for the maxillary single implants.

Clinical and Radiographic Evaluation of Modified Transalveolar Two-Step Osteotome-Mediated Localized Maxillary Sinus Elevation: A Retrospective Computed Tomography Study with a 3-Year Follow-up.

PURPOSE: This study aimed to report a practicable and noninvasive two-stage technique for sinus elevation and delayed implant insertion in the augmented site with residual bone height down to 3 mm or even lower. MATERIALS AND METHODS: The surgical technique employed a two-stage process for rehabilitation of posterior maxillary single-tooth edentulous areas, involving, in the first step, transcrestal maxillary sinus floor augmentation with a collagen sponge to fill the intrabony cavity resulting from the detachment of the sinus membrane; the second step consisted of another indirect sinus floor elevation using magnetoelectric surgery with immediate implant placement and no grafting material. Changes in bone height were evaluated by a comparison of the computed tomography scans acquired before treatment and after surgery (at 3 months and 5 years of the survey). Statistically significant differences between the times and the tooth sites were evaluated by nonparametric statistics (matched and independent), with P < .01. RESULTS: Forty patients were retrospectively selected. The preoperative height of the available alveolar bone was 2.9 ± 0.6 mm. A significant increase in bone height (P < .01) was found for both the first and the second surgery (3.1 ± 0.6 mm and 4.4 ± 0.6 mm, respectively). The overall bone height was measured at 3 years after the first surgery (10.3 ± 0.6 mm). Measurements of the bone height ranked for tooth positions showed no significant difference between premolars and molars. None of the selected patients registered an implant failure. CONCLUSION: Two-stage osteotome-mediated sinus elevation appeared to be a predictable technique that enabled practitioners to increase the bone height and to obtain successful outcomes even if the amount of bone was approximately 3 mm in height.

Effect of Different Timings of Implant Insertion on the Bone Remodeling Volume around Patients' Maxillary Single Implants: A 2-3 Years Follow-Up.

Background: To investigate the middle-term effect on bone remodeling of different timings for different implant placement (immediate versus delayed). Methods: Patients with an anterior maxillary failing tooth were treated by single-crown supported by dental implant. Subjects were retrospectively analyzed for 3 years and assigned to one of two predictor groups: nine immediate versus 10 delayed implant placement (1-2 months after tooth extraction). The crestal bone loss around dental implants was measured with the cone beam computerized tomography by fusing pre-operative and post-operative data. Results: The percentage of volume loss registered at 1-year follow-up (%ΔV) was of 7.5% for the immediate group, which was significantly lower (p-values ≤ 0.0002) than the loss of 24.2% for the delayed group. At 3 years, there was a significant difference (p-values = 0.0291) between the two groups, respectively, with a volume loss of 14.6% and 27.1%. When different times were compared, the percentage of the volume loss for the immediate group was different (p-value = 0.0366) between the first and third year (7.5% and 14.6%, respectively). For the delayed group, no significant difference was registered between the 1- and 3-year follow-up. Conclusions: The bone loss around dental implant-supported single-crown with different timing of insertion appeared higher for the delayed group than the immediate group.

Distal Displacement of Maxillary Sinus Anterior Wall Versus Conventional Sinus Lift with Lateral Access: A 3-Year Retrospective Computerized Tomography Study.

BACKGROUND: The present study is designed to compare the outcomes of two sinus augmentation procedures: distal displacement of the anterior wall versus standard sinus lifting and grafting with a lateral window approach. METHODS: In the displacement group, a localized surgical fracture of the sinus floor achieved through an electromagnetic device results in the distal displacement of the anterior wall. In the filling group, sinus lifting (with lateral access) and grafting with particulate xenogeneic bone substitute was performed. Bone volume beneath the maxillary sinus was investigated with computerized tomography after baseline and postoperative data superimposition. Clinical and radiological outcomes over three years had been evaluated. RESULTS: Forty-three dental implants were selected. The two sinus lift procedures significantly increased the bone volume (p-value ≤ 0.0017) in the displacement group from 1.17 ± 0.34 to 1.53 ± 0.39 cc, with a final bone gain of +0.36 ± 0.17 cc, and in the filling group from 1.24 ± 0.41 to 1.94 ± 0.68 cc, with a bone augmentation of +0.71 ± 0.31 cc. No events of dental implant bulging into the maxillary sinus occurred. Two implants failed early on in the filling group, attesting the 3-year survival rate of 92.6% (CI95%: 82.7-100%). Marginal bone loss at the distal aspect was 1.66 ± 0.72 and 1.25 ± 0.78 mm, respectively, for the displacement and filling groups, with a significant difference (p-value = 0.0497). CONCLUSION: Results showed a significant and effective bone gain around dental implants at a 3-year survey for both sinus augmented by backward displacement of the anterior wall (+34%) and sinus lifting and grafting with a lateral window approach (+57%).

Bone Assessment in Grafted and Ungrafted Sockets After Dental Implant Placement: A 10-year Follow-up Study.

PURPOSE: The purpose of this study was to compare success and outcomes among implants positioned either in grafted or ungrafted alveoli during 10 years of follow-up. MATERIALS AND METHODS: This retrospective analysis was conducted on data of subjects who underwent tooth extraction and alveolar ridge preservation. Sites, one per patient, were ranked into three groups: postextraction ungrafted alveoli, and postextraction grafted alveoli with either synthetic magnesium-enriched hydroxyapatite or porcine bone. An absorbable collagen sheet was used to completely cover all the sockets. A secondary intention healing was sought for all procedures. Data regarding implant survival and marginal bone loss around implants were gathered until the 10-year follow up. Pairwise comparisons were performed with nonparametric tests, and statistical significance was set at .01. RESULTS: Sixty-three subjects were included: 42 implants (19 and 23 in the magnesium-enriched hydroxyapatite and porcine bone groups, respectively) placed in grafted sites and 21 in nongrafted sites. The success rate of the grafted groups was 88.1% (CI: 78.3% to 97.9%) at the 10-year follow-up. On the other hand, in the ungrafted group, the overall success rate was 85.7% (CI: 70.8% to 100%). Peri-implant marginal bone loss at the 10-year follow-up for the magnesium-enriched hydroxyapatite group was 1.2 (0.7) mm, while for the porcine bone group, it was close to 0. The behavior of the ungrafted group appeared to be significantly different compared with both grafted groups; however, marginal bone levels ranging from 0.1 to 0.4 mm were observed from 3 to 10 years. CONCLUSION: A difference in terms of long-term success rates between grafted and ungrafted sites was not revealed. Bone loss was significantly higher in the magnesium-enriched hydroxyapatite grafted group compared with those in the other groups (without or with other bone substitute material).