Angled dental implant placement into the vomer/nasal crest of atrophic maxillae for All-on-Four immediate function: a 2-year clinical study of 100 consecutive patients.

PURPOSE: To report on the use of angled implants placed into the vomer/nasal crest to support a complete-arch maxillary prosthesis. MATERIALS AND METHODS: Consecutive patients were treated with the All-on-Four concept to restore the maxillary dentition. When bone volume in the subnasal region was inadequate, angled implants were placed into the vomer/nasal crest area to support the restoration. All implants were loaded immediately. RESULTS: One hundred consecutive maxillary All-on-Four patients were treated over a period of 2 years. Four hundred six implants were placed; 12 were inserted into the vomer/nasal crest area. One year later, at definitive restoration, the 12 vomer implants were found to be osseointegrated without bone loss or instability. CONCLUSIONS: Midline maxillary bone volume at the nasal crest appeared to be a viable alternative to the lateral nasal rim when subnasal bone was deficient. Vomer implants allowed for immediate function or were sometimes used as a rescue implant when an anterior implant failed.

Recombinant human bone morphogenetic protein-2 confined by an imperforate titanium shell over high-profile dental implants in rabbit tibiae: a pilot bone augmentation study.

PURPOSE: To evaluate the use of a nonperforated titanium occlusive device over a bone morphogenetic protein-2 in an absorbable collagen sponge (BMP-2/ACS) in grafting the bone around high-profile (ie, supracrestal) dental implants in rabbit tibiae. MATERIALS AND METHODS: Eight New Zealand white rabbits were used for the experiment. Two implants were placed in the right tibia of each rabbit, with 4 mm of each implant placed supracrestally ("high-profile" placement) in four groups of two rabbits each: control, titanium shell only, titanium shell over buffered collagen, and titanium shell over BMP-2/ACS. The animals were sacrificed after 3 or 6 weeks. Calcified and nondecalcified histologic preparation was carried out to evaluate bone formation and degree of osseointegration. RESULTS: Three of the eight animals developed tibial fractures. The two BMP-2 test animal tibiae remained intact, with the 3-week specimen showing very little bone formation inside or outside of the titanium chamber and the 6-week specimen showing bone mostly outside of the chamber. CONCLUSION: The placement of BMP-2 beneath an occlusive nonperforated titanium shell next to a high-profile implant did not result in significant bone formation. .

Posterior maxillary sandwich osteotomy combined with sinus grafting with bone morphogenetic protein-2 for alveolar reconstruction for dental implants: report of four cases.

Four patients underwent posterior sandwich osteotomy combined with sinus floor grafting using bone morphogenetic protein-2 and other grafting materials. The patients were treated over a period of 4 years. Two to four implants were placed in each site subsequently. Of the 12 implants placed, none failed. Alveolar crest bone levels appeared to be stable over time, with an average vertical gain of about 5 mm. Overall vertical gain, including the sinus graft, exceeded 13 mm in all patients. The procedure appears to hold promise for combined vertical alveolar defects and prominent pneumatization of the posterior maxilla.

Experience with bone morphogenetic protein-2 and interpositional grafting of edentulous maxillae: a comparison of Le Fort I downfracture to full-arch (horseshoe) segmental osteotomy done in conjunction with sinus floor grafting.

This paper is a retrospective report of the treatment of six patients with severely resorbed maxillae. Patients were treated, based on the amount of maxillary retrognathia, with either a Le Fort I downfracture or a "horseshoe" interpositional sandwich osteotomy, along with sinus elevation. Recombinant human bone morphogenetic protein-2 in an absorbable collagen sponge carrier was used for grafting in all patients, either alone or in combination with other grafting materials. Implants were placed and the patients were restored with fixed prostheses. Both grafting techniques are described, and the treated patients are presented.

Occult peri-implant oroantral fistulae: posterior maxillary peri-implantitis/sinusitis of zygomatic or dental implant origin. Treatment and prevention with bone morphogenetic protein-2/absorbable collagen sponge sinus grafting.

Sinus floor grafting with bone morphogenetic protein-2 for transsinus implant placement or as a salvage technique for sinus-involved peri-implantitis has been found to be successful. Transsinus implants for All-on-Four treatment, zygomatic implants including quad zygomatics, and infected transsinus implants underwent peri-implant grafting, which was found to seal off the sinus cavity from the oral cavity in an effort to prevent or treat sinusitis/peri-implantitis.

Closure of 1.5-cm alveolar oral antral fistula with intra-alveolar sinus membrane elevation and bone morphogenetic protein-2/collagen graft followed by dental implant restoration: case report.

Closure of a 1.5-cm oral antral fistula was done in combination with sinus floor and extraction socket grafting using recombinant human bone morphogenetic protein-2 within a collagen sponge matrix. The approach to the sinus was transalveolar, with elevation of the sinus membrane done through a molar extraction socket. Following graft placement, soft tissue repair was done with a buccal advancement flap. A dental implant was subsequently placed and restored. Peri-implant bone and implant stability were well maintained at the 1-year follow up examination.

Trans-sinus dental implants, bone morphogenetic protein 2, and immediate function for all-on-4 treatment of severe maxillary atrophy.

PURPOSE: The aim of this study was to evaluate the clinical outcomes of trans-sinus dental implant placement by use of bone morphogenetic protein 2 (BMP-2) grafting and immediate functional loading by the all-on-4 scheme. PATIENTS AND METHODS: After bone reduction to create the all-on-4 shelf or because of severe maxillary atrophy and prominent sinus anatomy, 10 patients were selected to undergo trans-sinus implant placement and simultaneous BMP-2 sinus floor grafting for immediate provisional loading. Insertion torque was measured upon implant placement. Patients were followed up for at least 1 year after final restoration when either a computed tomography scan or panoramic radiograph was obtained and analyzed for the presence of trans-sinus peri-implant bone. Hounsfield units were recorded mid sinus graft. RESULTS: Of 19 trans-sinus implants, 18 remained integrated at the 1-year follow-up, for a 5.2% failure rate. All sinus grafts formed bone, with a mean of 460 Hounsfield units. Final fixed prostheses were completed for all 10 patients. CONCLUSION: Trans-sinus dental implant placement with BMP-2 grafting to gain anterior-posterior spread for immediate function by use of all-on-4 treatment appears to be a viable alternative to the use of zygomatic implants in the presence of severe maxillary atrophy.

Orthognathic and osteoperiosteal flap augmentation strategies for maxillary dental implant reconstruction.

In this article, five variations in orthognathic surgery procedures used to gain bone mass for implants are discussed: Le Fort I downgrafting, Le Fort I distraction, sub-Le Fort I interpositional sandwich grafting, segmental sandwich grafting, and the island osteoperiosteal flap approach.

Hourglass mandibular anatomic variant incidence and treatment considerations for all-on-four implant therapy: report of 10 cases.

PURPOSE: The purpose of this study was to determine the incidence and treatment of hour glass variant mandibles for All On Four implant placement. MATERIALS AND METHODS: Cone beam CAT scans were analyzed for 719 patients to determine the incidence of alveolar constriction in the mandible. Ten patients with alveolar constriction were treated over a 2-year period and retrospectively studied after 1 year in function. RESULTS: Of 719 mandibles studied, 28 have "hour glass" variants identified for an incidence of 3.89%. Treatment of these cases were variously done including the use of guided bone regeneration, the use of long implants, bone reduction, and angulation strategies. CONCLUSIONS: The hour glass mandibular finding is a developmental or genetic variant that poses a significant anatomic difficulty for dental implant surgery for All On Four immediate function.

Buccal to lingual transalveolar implant placement for all on four immediate function in posterior mandible: report of 10 cases.

PURPOSE: A retrospective study was done to evaluate the use of transalveolar implant placement in the mandible posterior to the mental nerve. MATERIALS AND METHODS: Ten patient charts were reviewed of twenty implants placed transalveolarly with evaluation of function, osseointegration, and bone level for 1 year by unregistered periapical x-rays. RESULTS: Ten patients which received twenty transalveolar implants were followed for 1 year. One implant failed. There were no significant complications encountered from the procedure. CONCLUSION: All On Four treatment of mandibles with relatively anterior mental nerve locations may be successfully treated with transalveolar implant placement posterior to the foramen.

Orthognathic and osteoperiosteal flap augmentation strategies for maxillary dental implant reconstruction.

In this article, 5 variations in orthognathic surgery procedures used to gain bone mass for implants are discussed: Le Fort I downgrafting, Le Fort I distraction, sub-Le Fort I interpositional sandwich grafting, segmental sandwich grafting, and the island osteoperiosteal flap approach.

The all on 4 shelf: mandible.

The use of full arch alveolar reduction as an aide to doing All on 4 implant restoration in the mandible is presented. The osteoplasty is described as a flat "shelf" on which to place the restoration. The shelf approach is used to establish optimal implant position and angulation as well as to define anatomy to maximize implant fixation for immediate load prosthetics.

The All-on-4 shelf: maxilla.

All-on-4 treatment is facilitated by bone reduction to create prosthetic restorative space, establish maximum anterior posterior spread of implants, and to avoid pneumatized sites. Unlike a reduction alveloplasty for denture placement, the All-on-4 shelf enables optimal surgical prosthetic management of implant placement for the fixed hybrid prosthesis.

Osteoperiosteal flaps and local osteotomies for alveolar reconstruction.

This article focuses on the emergence of the small edentulous osteoperiosteal flap.

Island osteoperiosteal flap for alveolar bone reconstruction.

The island osteoperiosteal flap (I-flap) is introduced as a modified alveolar split bone grafting technique used to gain width and modify the facial or buccal bone plate position. Three case examples are shown as well as animal histology indicating the possible development of this new surgical procedure as an adjunct for alveolar augmentation and implant therapy.