Retrospective Study of Maxillary Sinus Augmentation Using Demineralized Tooth Block Bone for Dental Implant.

(1) Background: When placing implants in the maxillary posterior region with insufficient alveolar bone, a maxillary sinus elevation is necessary. Autogenous bone, though biologically ideal, poses risks and discomfort due to donor site harvesting. Block-type autogenous tooth bone graft material, made from the patient's own extracted tooth, offers similar biological stability without these drawbacks. (2) Methods: This study observed the progress of 19 implant patients who were treated with maxillary sinus elevation procedures using block-type autogenous tooth bone graft material at the Daegu Catholic University Medical Center. Extracted teeth were processed into demineralized tooth block bone. After elevating the sinus membrane, implants and the tooth bone graft material were placed in the space, and the bony window was repositioned. Postoperative evaluations through clinical observation and radiographic imaging assessed sinus membrane elevation, alveolar bone height increase, and implant osseointegration. (3) Results: Results showed proportional increases in alveolar bone height to the graft material size, with long-term stability. No postoperative complications occurred, even with sinus membrane perforation, and implants remained stable. (4) Conclusions: The study concludes that maxillary sinus lifts using block-type autogenous tooth bone graft material provide excellent bone induction and biocompatibility, making this a highly beneficial method for both dentists and patients.

Utilization of Tenting Pole Abutments for the Reconstruction of Severely Resorbed Alveolar Bone: Technical Considerations and Case Series Reports.

INTRODUCTION: Although various surgical techniques have been utilized in the reconstruction of severely resorbed alveolar bone, its regeneration is still regarded as a major challenge. Most of the surgical techniques used in advanced ridge augmentation have the disadvantages of prolonging the patient's edentulous healing and increasing the need for surgical revisits because simultaneous implant placement is not allowed. This report presents a new and simplified method for advanced ridge augmentation, which utilizes a vertical tenting device. CASE PRESENTATION: The first case presented the reconstruction of the mandibular posterior region with severely resorbed alveolar bone due to peri-implantitis using tenting pole abutment for ridge augmentation. The second and third cases presented three-dimensional ridge augmentations in severely resorbed ridges due to periodontitis. The last case presented horizontal ridge augmentation using a vertical tenting device. All cases were performed under local anesthesia. Implants were simultaneously placed in the bone defect area. A vertical tensioning device was then connected to the implant platform to minimize the collapse of the bone graft during the bone regeneration period due to the contraction of the soft tissue matrix. A sticky bone graft was transplanted onto the exposed surface of the implant and on top of the vertical tensioning device. After covering with an absorbable barrier membrane, the soft tissues were sutured without tension. CONCLUSIONS: In all cases, prosthetic restorations were provided to patients after a bone grafting period of 5-6 months, leading to a rapid restoration of masticatory function. Results tracked for up to 6 years revealed observed stable reconstruction of the alveolar bone. The use of a vertical tenting device can prevent the collapse of biomaterials in the augmented ridge during the healing period, leading to predictable outcomes when achieving three-dimensional ridge augmentation.

Comparative Histomorphometric Analysis of Bone Regeneration According to Bone Graft Type.

PURPOSE: To use histomorphometric analysis to evaluate bone reconstruction in rabbit calvaria with autogenous bone, anorganic bovine bone, undecalcified human tooth bone (UdTB), and decalcified human tooth bone (dTB) grafts. MATERIALS AND METHODS: Extracted human teeth were crushed, and tooth bone with and without decalcification was prepared. Bony defects were made in 10 rabbit calvaria and allocated to one of the following four groups: group 1, in which UdTB was grafted; group 2, in which dTB was grafted; group 3, in which anorganic bovine bone was grafted; group 4, in which autogenous bone was grafted. The rabbits were sacrificed at 2 or 8 weeks postoperatively, and histomorphometric comparison was performed. RESULTS: Histologically, new bone formation was observed at the defect margin and around all graft materials. The dTB group revealed significantly greater new bone areas at 2 and 8 weeks compared to the UdTB group and the anorganic bovine bone group (P < .05). The dTB group revealed no significant difference in the new bone area at 2 weeks but revealed significantly less new bone area at 8 weeks compared to the autogenous bone group (P < .05). The dTB group also revealed significantly less graft material area compared to the anorganic bovine bone group at 8 weeks (P < .05). The autogenous bone group revealed significantly less graft material area and significantly greater bone marrow area compared to other groups at 8 weeks (P < .05). CONCLUSIONS: Grafting with dTB resulted in better bone regeneration than UdTB and anorganic bovine bone grafting at 8 weeks and addresses the potential disadvantages of autogenous bone grafting.

Simplified Free Gingival Graft Around Implants Using Medical Grade Tissue Cyanoacrylate: A Case Series Report.

The free gingival graft (FGG) procedure using suturing techniques has been widely utilized to effectively increase the amount of attached keratinized gingiva. However, conventional suturing procedures are time-consuming and technique-sensitive. Simplified FGG procedure around teeth and dental implants using medical grade tissue adhesive (cyanoacrylate) is known to overcome drawbacks of traditional suture techniques. However, the clinical application of cyanoacrylate as a means of stabilizing the graft has not been a common practice. The aim of this report demonstrates simplified FGG procedures around dental implants using cyanoacrylate with follow-up results.

"Sticky Bone" Preparation Device: A Pilot Study on the Release of Cytokines and Growth Factors.

Sticky bone, a growth factor-enriched bone graft matrix, is a promising autologous material for bone tissue regeneration. However, its production is strongly dependent on manual handling steps. In this sense, a new device was developed to simplify the confection of the sticky bone, named Sticky Bone Preparation Device (SBPD®). The purpose of this pilot study was to investigate the suitability of the SBPD® to prepare biomaterials for bone regeneration with autologous platelet concentrates. The SBPD® allows the blending of particulate samples from synthetic, xenograft, or autogenous bone with autologous platelet concentrates, making it easy to use and avoiding the need of further manipulations for the combination of the materials. The protocol for the preparation of sticky bone samples using the SBPD® is described, and the resulting product is compared with hand-mixed SB preparations regarding in vitro parameters such as cell content and the ability to release growth factors and cytokines relevant to tissue regeneration. The entrapped cell content was estimated, and the ability to release biological mediators was assessed after 7 days of incubation in culture medium. Both preparations increased the leukocyte and platelet concentrations compared to whole-blood samples (p < 0.05), without significant differences between SB and SBPD®. SBPD® samples released several growth factors, including VEGF, FGFb, and PDGF, at concentrations physiologically equivalent to those released by SB preparations. Therefore, the use of SBPD® results in a similar product to the standard protocol, but with more straightforward and shorter preparation times and less manipulation. These preliminary results suggest this device as a suitable alternative for combining bone substitute materials with platelet concentrates for bone tissue regeneration.

Comparison of immunohistochemical analysis on sinus augmentation using demineralized tooth graft and bovine bone.

OBJECTIVES: The purpose of this animal research was to compare bone regeneration in augmented rabbit maxillary sinuses treated with demineralized particulate human-tooth graft and anorganic bovine bone by immunohistochemical analysis. MATERIALS AND METHODS: Piezoelectric bilateral sinus augmentation was performed in eight adult rabbits. In the control group, anorganic bovine was grafted in the maxillary sinus following elevation of the sinus membrane. In the experimental group, demineralized human particulate tooth bone was grafted in the sinus. Bone regeneration in augmented sinuses was evaluated by immunohistochemical analysis using various markers of osteoprogenitor cells. RESULTS: The number of bromodeoxyuridine-labeled cells was significantly higher in the experimental group than in the control group at eight weeks. The immunoreactivity of proliferating-cell nuclear antigen was increased slightly in the experimental group relative to the control group at eight weeks. Other bone markers were expressed equally in the two groups. CONCLUSION: In the rabbit maxillary sinus, higher osteoinduction was correlated with demineralized human particulate tooth bone grafting than with anorganic bovine grafting.

Comparative Histomorphometric Evaluation of Bone Regeneration with Different Preparations of Xenogeneic Tooth Block Bone.

PURPOSE: The aim of this animal study was to evaluate new bone formation in human dentin block grafted on rabbit calvaria according to a comparison of histologic analysis. MATERIALS AND METHODS: Human teeth were prepared according to four different types of dentin blocks: group 1, demineralized and microperforated dentin block; group 2, demineralized dentin block; group 3, undemineralized and microperforated dentin block; group 4, undemineralized dentin block. These four different dentin blocks were grafted on nine rabbit calvaria, and animals were sacrificed at 2, 4, and 8 weeks after the surgical procedure for histologic evaluation. RESULTS: In group 1, histologically, new bone formation was initiated at the interface between demineralized and microperforated dentin block and host bone and microholes at 2 weeks, and mature bone was observed at 8 weeks. In group 3, new bone formation was observed at 8 weeks in the undemineralized and microperforated dentin block bottom and microholes. The bone formation ratio of group 1 was significantly higher at 2, 4, and 8 weeks compared with groups 2, 3, and 4 (P < .05). The bone formation ratio in microholes at 2 and 8 weeks in group 1 was significantly greater than in group 3 (P < .05). CONCLUSION: New bone formation of the demineralized dentin block began more rapidly than the undemineralized dentin block, and perforated dentin block was more effective in bone formation than dentin block without microholes.

Comparative Histomorphometric Analysis of Maxillary Sinus Augmentation With Deproteinized Bovine Bone and Demineralized Particulate Human Tooth Graft: An Experimental Study in Rabbits.

PURPOSE: The aim of this animal study is to evaluate, by histomorphometric analysis, new bone formation in rabbit maxillary sinuses with Bio-Oss and demineralized particulate human tooth graft. MATERIALS AND METHODS: Bilateral sinus augmentation procedures were performed in 8 adult male rabbits. After preparation of replaceable bony windows on the lateral wall of the nasal cavity with a piezoelectric surgical device, deproteinized bovine graft (Bio-Oss) was grafted in the new compartment of the maxillary sinus after elevation of the sinus membrane in the control group. In the experimental group, the demineralized human particulate tooth bone was grafted in the sinus. The replaceable bony window was repositioned over the bone graft in both groups. Animals were killed at 2 and 8 weeks after the surgical procedure. The augmented sinuses were evaluated by histomorphometric analysis using hematoxylin-eosin and Masson trichrome stains. RESULTS: Histologically, new bone was revealed along the elevated sinus membrane and both bone grafts. In the control group, the new bone area at 8 weeks was not significantly different than that at 2 weeks. In the experimental group, the new bone area at 8 weeks was significantly greater than that at 2 weeks. CONCLUSION: Significant higher new bone formation was revealed in the experimental group than in the control group.

Histomorphometric study of rabbit's maxillary sinus augmentation with various graft materials.

The purpose of this animal study is to evaluate, by histomorphometric analysis, bone regeneration in rabbit's maxillary sinuses with blood clots alone, Bio-Oss, ß-tricalcium phosphate (ß-TCP), and demineralized tooth dentin (DTD) grafting. Bilateral sinus augmentation procedures were performed in 18 adult male rabbits. Rectangular replaceable bony windows were made with a piezoelectric thin saw insert. In the group 1, blood clots were filled; group 2, anorganic bovine graft (Bio-Oss) was grafted; group 3, ß-TCP was grafted; group 4, DTD was grafted, and covered by replaceable bony windows. Animals were sacrificed at 2, 4, and 8 weeks after surgical procedure. The augmented sinuses were evaluated by histomorphometric analysis using hematoxylin and eosin and Masson's trichrome stains. Histologically, new bone formation was revealed along the elevated sinus membrane and all graft materials. The new bone area of the group 2 was significantly greater than the group 1, and of the group 3 was significantly greater than the group 2, and of the group 4 was significantly greater than the group 3 at 8 weeks with P<0.05. The bone marrow area of group 1 was significantly greater than other groups at 8 weeks. The DTD area was significantly lesser than Bio-Oss or ß-TCP particles area at 8 weeks. This present study suggests that DTD can be effective graft materials for bone regeneration of the maxillary sinus augmentation.

A digital approach to fabricating an abutment replica to control cement volume in a cement-retained implant prosthesis.

If a cement-retained implant prosthesis is placed on an abutment, excess cement should be minimized or removed to prevent periimplant inflammation. Various methods for fabricating an abutment replica have been introduced to maintain tissue health and reduce clean-up time. The purpose of this article is to present an alternative technique for fabricating an abutment replica with computer-aided design/computer-aided manufacturing (CAD/CAM) technology.

Accelerated Peri-Implant Soft Tissue Conditioning With Computer-Aided Design and Computer-Aided Manufacturing Technology and Surgical Intervention: A Case Report.

The conventional soft tissue conditioning technique around implant demands time and effort for optimizing soft tissue contour. This article describes an alternative technique for achieving proper emergence profile with a custom-milled titanium abutment, interim restoration, and surgical intervention. With this technique, peri-implant soft tissue is conditioned and healed against a correct designed interim restoration without composite resin addition.

Histomorphometric analysis of maxillary sinus augmentation with calcium phosphate nanocrystal-coated xenograft.

OBJECTIVE: The purpose of this study was to evaluate the histomorphometric result from maxillary sinus augmentation with calcium phosphate nanocrystal-coated bovine bone (Biocera). STUDY DESIGN: Maxillary sinus augmentations were performed on 10 patients with the delayed placement of implants. The lateral bony window was created using a piezoelectric saw, and the sinus membrane was elevated to make a new compartment. Biocera was grafted. The bony window was repositioned over the bone graft. In all cases, samples were taken for biopsy at the time of implant placement, 6 to 8 months after the grafting procedure. RESULTS: None of the 10 patients had complications, and there were no clinical and radiographic signs of infection. Histomorphometrically, 25.94% (± 11.24%) of newly formed bone, 52.67% (± 12.60%) of soft tissue, and 21.38% (± 10.76%) of residual grafts were shown. Histologic findings showed newly formed bone surrounding the residual grafted particles, without inflammation. Newly formed bone along inner surface of the repositioned bony window area showed more mature and dense bone structure than new bone formed along bone graft. CONCLUSION: The present study revealed that calcium phosphate nanocystal-coated xenograft was considered to be a suitable bone graft material for maxillary sinus augmentation.

Comparison of two kinds of bovine bone in maxillary sinus augmentation: a histomorphometric study.

PURPOSE: The purpose of this study was to compare the histomorphometric from sinus augmentation with calcium-phosphate nanocrystal-coated bovine bone (Biocera) and anorganic bovine bone matrix (Bio-Oss). MATERIALS AND METHODS: Bilateral maxillary sinus augmentations were performed on 5 patients with delayed placement of implants. The lateral bony window was created using a piezoelectric saw, and the sinus membrane was elevated to make a new compartment. Bio-Oss was grafted in one sinus as the control group and Biocera was grafted in the opposite sinus as the test group. The bony window was repositioned over the bone graft. In all cases, samples were taken for biopsy at the time of implant placement, 6 to 8 months after the grafting procedure. Independent t tests were used to examine between-group differences. RESULTS: None of the 5 patients had complications during healing period. Histomorphometrically, the Bio-Oss group showed 28.46% (±5.28%) of newly formed bone. Biocera group showed 29.94% (±8.72%) of newly formed bone. Newly formed bone along inner surface of repositioned bony window area showed more mature and dense bone structure than new bone formed along bone graft. CONCLUSIONS: This study revealed that both bovine bone grafts were considered as suitable bone graft materials for maxillary sinus augmentation.

Retrospective study of sintered porous-surfaced dental implants placed in the augmented sinus.

The purpose of this study was to analyze clinical and radiographic outcomes of sintered porous-surfaced dental implants placed in partially edentulous posterior maxillae. The study group consisted of 42 partially edentulous patients who received sinus augmentation using the lateral window technique or crestal approach at Catholic University Hospital of Daegu and one private clinic. The 42 patients received a total of 92 sintered porous-surfaced dental implants in the edentulous posterior maxillae. All implants were restored with fixed prostheses. Of the 92 implants, 17 implants were restored with individual (nonsplinted) crowns, while 75 implants were splinted to other implants. Panoramic views and periapical radiographs using the standardized long-cone paralleling technique were taken at the first visit, postoperatively, at the time of prosthesis seating, and at a follow-up visit. Survival rates of implants in relation to location, length, diameter, crown-to-implant (C/I) ratio, and type of prosthesis were investigated. Statistical data were analyzed using software with the chi-square test. Of the 92 implants, 8 (8.7%) were removed, and the cumulative survival rate was 91.3% after a maximum 9-year functional period (mean: 72.8 months; range: 11 to 107 months). There were no statistical differences in relation to the location of implants, C/I ratio, or type of prosthesis. However, there were statistical differences in relation to the length and diameter of implants. Average crestal bone loss was 0.68 mm at 1-year follow-up and 1.13 mm at final examination. All implants were inserted in the augmented maxillary sites. The cumulative survival rate of sintered porous-surfaced implants in posterior maxillae was 91.3%. Sintered porous-surfaced implants showed satisfactory results in the edentulous posterior maxillae.

Benefit of the replaceable bony window in lateral maxillary sinus augmentation: clinical and histologic study.

PURPOSE: This retrospective study demonstrates, by clinical and histologic evaluation, the benefit of the replaceable bony window as a homologous bony barrier in lateral sinus augmentation. MATERIALS AND METHODS: A total of 103 maxillary sinus augmentations were performed using a piezoelectric device and a Er,Cr:YSGG laser apparatus. The detached bony windows were repositioned over various bone grafts. Sixteen bone biopsy specimens were harvested at the time of uncovering or implant placement. RESULTS: Three sinuses developed postoperative infections (2.91%). After 6 to 8 months of healing, uncovering procedures were carried out. Radiographically, reconstruction of the lateral sinus wall was observed in all cone-beam computed tomogram. Clinically, complete bone healing between the replaceable bony window and the lateral sinus wall was observed in all cases, except for the 3 infected sinuses (100 sinuses, 97.09%). Histologically, favorable new bone formation was observed in all specimens without any fibrous connective tissue invagination. More mature bone was observed along the floor of the replaceable bony window than at the center of the graft site. CONCLUSION: This study demonstrates that the replaceable bony window acts as an osteoinductive homologous barrier membrane over various bone graft materials and accelerates new bone formation in lateral sinus augmentation.

Fabricating a fiber-reinforced post and zirconia core with CAD/CAM technology.

This article describes a technique for overcoming the limitations of dental scanners in imaging post spaces by using a single fiber-reinforced post and computer-aided design and computer-aided manufacturing (CAD/CAM) technology, thereby eliminating the need for a 'Scan Post' and the post and core module in the CAD. This technique produces an anatomically correct core and ensures the correct thickness of crown restorations.

A simplified pocket reduction procedure around a stud attachment without suturing.

Plaque accumulation on the implant titanium surface plays a critical role in the initiation and progression of periimplant disease. Removing plaque and calculus deposits, and reducing the periimplant probing depth, therefore, are important. The reduction of the periimplant probing depth in periimplant disease by using a cord and a surgical dressing pack has not been previously reported. This procedure is useful for periimplant mucositis and mild periimplantitis before a surgical intervention and can maintain a narrow keratinized mucosa with less pain than surgical intervention.

Flapless transcrestal sinus augmentation using hydrodynamic piezoelectric internal sinus elevation with autologous concentrated growth factors alone.

PURPOSE: The purpose of this retrospective study was to evaluate the success rate of implants and the amount of sinus augmentation using the flapless hydrodynamic piezoelectric internal sinus elevation (HPISE) technique with autologous concentrated growth factors (CGF) alone. MATERIALS AND METHODS: A total of 11 maxillary sinuses were augmented using the HPISE technique through the flapless transcrestal approach. Sixteen implants (average 11.38 mm in length and 4.83 mm in diameter), with 2 different surfaces, were placed simultaneously with CGF alone. Plain panoramic radiograms and cone-beam computed tomograms (CBCT) were taken in all patients to evaluate the sinus augmentation preoperatively and postoperatively. RESULTS: The sinus membranes were successfully elevated, averaging 13.95 ± 6.61 mm in immediate postoperative CBCT without any iatrogenic perforation. After an average 23.8 weeks, the average bone gain above the sinus floor was 8.23 ± 2.88 mm in the axial aspect of CBCT. No complications were recorded in any patients during the follow-up period. CONCLUSION: The flapless transcrestal approach to the sinus augmentation using the HPISE technique with autologous CGF alone could be an alternative to the lateral approach, even at severely resorbed edentulous posterior maxilla with insufficient bone height.