Socket Preservation Following Tooth Extraction Using Polilactide-Poliglicolide Acid Scaffold: Radiological and Histological Evaluation.

PURPOSE: Following tooth extraction, the healing process comprises bone resorption and soft tissue contraction, which have the potential to obstruct the optimal placement of implants, causing both functional and aesthetic limitations. This study is aimed at assessing the healing process of the extraction socket and the dimensional changes that occur after alveolar ridge preservation, utilizing a polylactide-co-glycolide scaffold (PLGA). MATERIALS AND METHOD: The present study involved the extraction of 28 teeth from 14 patients. The total number of sockets was 28, which were divided into two groups consisting of 14 study and 14 control sockets. The study group (SG) was subjected to socket preservation with PLGA scaffold while the control group (CG) was left for spontaneous healing. Measurements were taken before and after the operation, with cone beam computed tomographies (CBCT) being conducted at both the baseline and 4-month intervals. Samples for histological examination were obtained via trephine core biopsy and the implants were subsequently placed. RESULTS: According to the histologic analyses, the PLGA scaffold was resorbed within four months. CBCT imaging revealed a decrease in the horizontal dimension of the crest at three distinct coronoapical levels in the SG, measuring 2.05±1.05 mm at -1 mm, 1.51±0.89 mm at -3 mm, and 0.92±0.7 mm at -5 mm level. The CG showed readings of 1.22±1 at -1 mm, 0.92±0.67 at -3 mm, and 0.73±0.69 at -5 mm levels. In comparison to CG, SG showed a significant reduction in horizontal losses at the -1 mm level. Vertical dimension of the crest decreased by 1.64±1.11 mm on the buccal bone height, 1.56±1.08 mm on lingual bone height in SG; in the CG, the buccal and lingual bone height had mean values of 2.08±1.44 mm and 1.73±1.27 mm, respectively. There was no significant statistical difference observed in the vertical losses between the groups. CONCLUSIONS: Following a period of 4 months, it can be concluded that the PLGA scaffold was completely resorbed. Based on CBCT measurements, it was observed that horizontal resorption was lower than CG at the -1 mm coronal level.

Evaluating risk factors and complications in mandibular ramus block grafting: a retrospective cohort study.

OBJECTIVES: This retrospective cohort study aimed to identify the complications and risk factors associated with alveolar grafting using autologous mandibular ramus grafts, guided by the research question: What are the complications encountered in patients undergoing alveolar bone grafting using autologous mandibular ramus block and what are the risk factors associated with the development of these complications? MATERIALS AND METHODS: The study included 70 patients who underwent alveolar crest augmentation with autologous mandibular ramus block grafting. Intraoperative, early postoperative, and late postoperative complications were analyzed, as were various risk factors. RESULTS: The results showed that the majority of patients had successful outcomes with minimal complications. Sex was found to significantly influence the visibility of the inferior alveolar nerve (IAN). Early postoperative complications were associated with IAN visibility and the use of a single screw for graft fixation. Late postoperative complications were significantly associated with the presence of infection. CONCLUSION: The findings emphasize the importance of careful surgical techniques, infection prevention, and patient selection in minimizing complications. CLINICAL RELEVANCE: This article may contribute to clinicians' and so patients' understanding of potential risk factors associated with over all ramus block grafting procedure. Based on this information, clinicians can also improve their ability to manage risk factors and associated complications and compare ramus block grafting with other alternatives to determine the best treatment approach for that particular patient.

The Clinical and Radiologic Outcomes of Early Loaded Implants After 5 Years of Service.

PURPOSE: To evaluate the 5-year results of the clinical and radiographic outcomes of three types of early loaded implants. MATERIALS AND METHODS: Seventy-five implants were placed in the posterior mandible or maxilla in 30 patients. Three types of implants (Straumann SLActive, Astra OsseoSpeed, and Thommen Implant System) were used. Definitive restorations were made after 8 weeks of implant placement. The radiographs were taken at the placement of the prosthesis, at 6 months, and at 1- and 5-year follow-ups. Clinical and radiologic data were evaluated for all types of implants. The Wilcoxon signed rank test, least significant differences, and Mann-Whitney U were used to test for statistically significant differences (P < .005). RESULTS: Twenty-four patients and 62 implants were evaluated after 5 years. The mean marginal bone loss was 0.20 ± 0.40 mm, 0.21 ± 0.05 mm, and 0.25 ± 0.36 mm after 1 year and 0.32 ± 0.22 mm, 0.31 ± 0.26 mm, and 0.42 ± 0.36 mm after 5 years for the Straumann, Astra, and Thommen groups, respectively. After 5 years, the mean peri-implant probing depth level was 1.75 ± 0.49 mm, 1.87 ± 0.48 mm, and 1.92 ± 0.57 mm for the Straumann, Astra, and Thommen groups, respectively. No peri-implantitis was detected after 5 years of loading. CONCLUSION: All groups of implants showed a stable peri-implant probing depth and marginal bone level. The survival rate was high and bone loss was low at 5 years; thus, early loading may be a useful procedure that allows reduction in treatment time.

Clinical and Radiographic Evaluation of Early Loaded Maxillary Anterior Implants: Three-Year Follow-up.

The aim of this study was to evaluate clinical and radiologic results up to 3 years in patients treated with early loading of anterior implants supporting single-tooth all-ceramic restorations. Twenty-four patients were treated with 29 screw-type implants in the anterior maxilla. The implants were evaluated by clinical and radiographic parameters. Clinical parameters Plaque Index (PI), Sulcus Bleeding Index (BI), peri-implant probing depth (PD), and marginal bone loss (MBL) were recorded. At the recall examinations, all implants were successfully integrated, demonstrating healthy peri-implant soft tissues as documented by standard clinical parameters. No biologic complications were observed. There was no statistically significant increase in MBL between the baseline and recall stages (P > .05). Early loaded maxillary anterior implants supporting single-tooth restorations reveal successful clinical and radiographic outcomes when treatment steps were performed.

Comparison of the Efficacy of Local Infiltration and Mandibular Block Anesthesia With Articaine for Harvesting Ramus Grafts.

PURPOSE: We compared the efficacy of local infiltrative anesthesia and regional mandibular block anesthesia using articaine to harvest ramus grafts and the postoperative sequelae. MATERIALS AND METHODS: A total of 20 patients with alveolar bone deficiency participated in the present comparative, prospective, randomized study. The first group received regional anesthesia with the mandibular block technique (group A; n = 10), and those in the second group received local infiltration anesthesia (group B; n = 10). Intraoperative pain and bleeding were evaluated as the primary outcome variables. The visual analog scale (VAS) scores were compared at 0.5, 1, 2, and 4 hours postoperatively. The maximal interincisal mouth opening (MIO) (on days 3 and 7) and VAS scores (at 6, 12, 24, and 48 hours and on days 3 and 7) were compared as secondary outcome variables. The correlation between pain (VAS scores) and trismus (MIO) were also compared. RESULTS: A painless procedure was performed in both groups. The VAS score, MIO, and intraoperative bleeding were not significantly different between the 2 groups. Paresthesia was not observed in either group postoperatively. No statistically significant correlations were found between the VAS scores and MIO. CONCLUSIONS: Local infiltrative anesthesia preserves almost the same depth of anesthesia as mandibular block anesthesia. No differences were found between these techniques in terms of efficacy and postoperative sequelae during and after ramus graft harvest. Thus, using articaine with a local infiltration technique is an alternative to mandibular block anesthesia during ramus graft harvesting and results in a reduced risk of inferior alveolar nerve damage.

Comparison of ultrasound-guided and conventional arthrocentesis of the temporomandibular joint.

Arthrocentesis of the temporomandibular joint (TMJ) can be done either conventionally or under ultrasonographic guidance, and we have compared the effectiveness of the two techniques. Twenty patients who required arthrocentesis of the TMJ were randomly assigned to ultrasonographically guided (US-guided) and conservative arthrocentesis (n=10 in each group). The number of relocations of the first and second punctures, pain experienced during each procedure measured using a visual analogue scale (VAS), and the duration of the procedure were the main outcome variables. The pain score compared with the maximal interincisal mouth opening measured preoperatively, immediately after operation, at 1 week, and 1 and 3 months, were secondary outcome variables. No patient in either group developed a complication, and there was no significant difference between the two groups, except that US-guided arthrocentesis took significantly longer than the conventional technique (p=0.000). US-guided arthrocentesis of the TMJ was no more successful than the conventional technique, and took longer. Further studies with more patients are required to validate these findings.

Clinical and radiographic evaluation of early loaded maxillary anterior single-tooth bone-level implants.

PURPOSE: The aim of this study was to evaluate the clinical and radiographic outcomes of early loaded platform-switched implants in the anterior maxilla. MATERIALS AND METHODS: In this study, patients were treated with implants that supported all-ceramic single-tooth crowns and were followed for 2 to 4 years. Implants were evaluated on the basis of clinical and radiographic parameters, including Plaque Index, Sulcus Bleeding Index, peri-implant probing depths (PDs), Papilla Index, soft tissue recession, and marginal bone levels. Statistical analyses were performed. RESULTS: Fifty-five implants were placed in 47 patients. At the recall examinations, all implants had successfully integrated, demonstrating healthy peri-implant soft tissues as documented by standard clinical parameters. At the time of recall, 7 implants had been followed for 4 years, 30 implants for 3 years, and 18 implants for 2 years. Plaque accumulation scores of 2 and 3 were not noted at any point during the study. At baseline, the mean PD was 2.1 ± 0.6 mm, at 2 years it was 2.2 ± 0.6 mm, at 3 years it was 2.2 ± 0.6 mm, and at 4 years (7 implants), the mean PD was 1.9 ± 0.4 mm. There were no statistically significant differences between time intervals. Complete papilla fill was seen for 49 implants. All implants showed less than 0.5 mm of marginal bone loss; mean bone loss at the time of final recall was 0.12 ± 0.22 mm. Seven implants showed an increase in the level of bone contact. There were no statistically significant differences over time. CONCLUSION: Bone-level implants with a platform-switched design are a successful treatment modality for anterior single-tooth implants.

Esthetic outcome evaluation of maxillary anterior single-tooth bone-level implants with metal or ceramic abutments and ceramic crowns.

PURPOSE: The aim of this study was to evaluate the treatment outcome of implants placed in the maxillary anterior segment. MATERIALS AND METHODS: Patients were treated with bone-level implants (Straumann Bone Level Implant, Institut Straumann) that supported all-ceramic single crowns and were followed for 2 to 4 years. Titanium or ceramic abutments were used according to the quality of the soft tissue at each site. Esthetic parameters were recorded to assess treatment outcomes. Pink esthetic scores (PES) and white esthetic scores (WES) were used to evaluate the esthetic outcome of anterior single-tooth implant-supported crowns. Patient satisfaction was also evaluated by means of a questionnaire. RESULTS: Fifty-five implants were placed in 47 patients. At the recall examinations, all implants were confirmed to have successfully integrated and demonstrated healthy peri-implant soft tissues, as documented by generally accepted clinical parameters. Overall, the esthetic results were considered favorable, and there were no significant differences between restorations with ceramic or titanium abutments. WES values were slightly superior to PES values. None of the implants had mucosal recession. CONCLUSION: Objective and subjective evaluation of maxillary bone-level implants in the esthetic zone yielded satisfactory results. Pleasing esthetic outcomes and stable facial soft tissues were achieved.

Retrospective analysis of prosthetic complications of implant-supported fixed partial dentures after an observation period of 5 to 10 years.

PURPOSE: The purpose of this study was to evaluate the incidence of the most common technical problems with implant-supported fixed partial dentures (FPDs) and to assess the survival and success rates (event-free survival) after 5 to 10 years of function. MATERIALS AND METHODS: All of the implants evaluated in this study were from a single manufacturer (Institut Straumann). Follow-up examinations were scheduled 1 week after suprastructure placement, 6 months later, and annually thereafter. Prosthesis-based data on survival/failure rates and technical complications were analyzed. RESULTS: In 95 partially edentulous patients, 231 Straumann implants were placed and restored with 177 implant-supported prostheses (125 single crowns, 18 splinted crowns on two adjacent implants, and 34 three-unit FPDs). One hundred thirty one solid abutments and 100 synOcta abutments were inserted. The survival rate of prostheses supported by implants was 97.7%. The prosthetic success rate (event-free survival) was 96.05%. After an observation period of 5 years, the cumulative incidence of screw loosening was 0%. Fracture of the veneering porcelain occurred in 3.95% of all restorations. Fractures of the superstructure framework were not observed. The overall incidence of complications after 5 years was highest for splinted crowns, which showed the lowest success rate (94.4%), followed by three-unit FPDs (96%) and single crowns (98.4%). CONCLUSIONS: Single-unit restorations or short-span FPDs supported by both synOcta and solid abutments on Straumann implants showed low rates of technical complications, the most common being fracture of the veneering porcelain.

Experimental custom-made zirconia abutments for narrow implants in esthetically demanding regions: a 5-year follow-up.

PURPOSE: This prospective clinical study evaluated an experimental custom-made zirconia abutment with respect to peri-implant hard and soft tissue reaction in narrow implants. MATERIALS AND METHODS: Patients were treated with prefabricated titanium implants and custom-made zirconia abutments. All-ceramic crowns were fabricated and cemented with resin cement. Clinical parameters such as Plaque Index, Sulcus Bleeding Index, peri-implant probing depth, and radiographic marginal bone loss levels were recorded, along with any biologic and mechanical complications, at baseline and up to 5 years. RESULTS: Twelve patients with missing maxillary lateral incisors treated with a total of 23 implants were evaluated. Thirteen Straumann Narrow Neck Solid Screw implants with a diameter of 3.3 mm and 10 Astra MicroThread implants with a diameter of 3.5 mm were used. Six patients with 11 implants were treated with custom-made zirconia abutments and prefabricated metal abutments were used in the control group. Implant and abutment success at 5 years was 100%. No abutment fractures occurred. Abutment screw loosening was reported for one restoration at the 1-year recall. Mean marginal bone loss measured 0.21 mm after 5 years of functional loading. CONCLUSION: Custom-made zirconia abutments offered sufficient stability to support all-ceramic restorations over narrow implants in anterior regions over a 5-year period. The soft and hard tissue reactions to zirconia were favorable.

Effects of thermocycling on the retention of various cements of one-unit and three-unit fixed implant-supported restorations.

PURPOSE: To investigate the physical retention of different cements on one-unit and three-unit implant-supported restorations before and after thermocycling. MATERIALS AND METHODS: Twenty acrylic resin maxilla models with a single missing tooth and three missing teeth were fabricated and implants were placed. Cast partial denture copings were cemented to Straumann solid abutments with seven different cements. Specimens were placed in a humidifier at 37°C for 24 hours; half of them were then subjected to thermocycling. The tensile force was measured using a universal testing machine with a crosshead speed of 0.5 mm/min. The retention force required to remove the specimens was recorded and the data were submitted to statistical analyses. RESULTS: The retentive strength of the cements was highest for Multilink Implant, followed in descending order by Kavitan Cem, Adhesor Carbofine, Premier Implant, Adhesor, RelyX Temp, and Cavex before and after thermocycling for both one- and three-unit restorations. The bond strength was statistically significantly higher for three-unit than for one-unit restorations before and after thermocycling, and there were statistically significant differences between cements for all groups before and after thermocycling. Both groups showed a statistically significant decrease in bond strength after thermocycling, and the largest differences were seen for Cavex and RelyX Temp for one-unit restorations and Cavex, RelyX Temp, and Kavitan Cem for three-unit restorations. CONCLUSIONS: The bond strength value was higher for three-unit than for one-unit restorations, and thermocycling reduced the bond strength of cements, especially Cavex, RelyX Temp, and Kavitan Cem.

Stability and marginal bone loss with three types of early loaded implants during the first year after loading.

PURPOSE: To determine the change in stability of three different implant systems using resonance frequency analysis (RFA) and to correlate RFA measurements with factors related to implant design, length, and diameter, patient gender, and dental arch. Clinical and radiologic evaluations were performed up to 1 year after loading. MATERIALS AND METHODS: Three different types of implants from three different manufacturers were inserted in the posterior maxilla and mandible. RFA measurements were performed at implant placement and weekly up to 8 weeks postoperatively and were compared with respect to implant type, length, and diameter and dental arch. The implants were loaded after 8 weeks. All implants were examined radiographically at baseline and at 6 and 12 months. Plaque Index, Sulcus Bleeding Index, peri-implant probing depths, and marginal bone loss were recorded. Repeated-measurements analysis of variance, two-tailed mixed-model analysis of variance, the Least Significant Differences and Mann-Whitney U tests were used for statistical analyses. RESULTS: All the groups showed high stability values at all time points (above 71). There were statistically significant differences between groups at all time points except 1 and 2 weeks. Mandibular implants showed statistically higher stability values than maxillary implants. Wide implants showed statistically higher stability values than narrow implants. Mean marginal bone loss was 0.22 ± 0.47 mm after 1 year. CONCLUSIONS: All three implant systems showed clinically acceptable stability values prior to early loading. The success rates and bone loss were similar to the values reported in the literature.

The effect of different attachment systems with implant-retained overdentures on maximum bite force and EMG.

OBJECTIVE: To compare the effect of different attachment systems with implant-retained overdentures on maximum bite force and muscle activity using electromyography (EMG). BACKGROUND: Denture retention and stability is of considerable interest in prosthetic dentistry. MATERIALS AND METHODS: Thirty-five patients were examined: 15 edentulous patients treated with mandibular implant-retained overdentures (MIRO) and maxillary dentures (MCD) (two implant-ball attachment) (BC); 10 edentulous patients treated with MIRO and MCD (four implants-bar attachments) (BRC); 10 patients with edentulous mandibular treated with MIRO and maxillary fixed partial dentures (MFPD) (two implant-ball attachments) (BF). Before implant placement all patients received new dentures. After using these dentures for 3 months the maximum bite force and electrical activity of masseter muscle were measured. Two or four implants were then inserted into the intraforaminal region. After osseointegration periods, patients were treated with MIRO which duplicated their dentures and after three months the measurements were repeated. The data were collected and statistically analysed. RESULTS: Muscle activity and chewing ability increased in the second period of measurements. Also chewing time was significantly decreased at the first measurements. The highest muscle activity was observed in the group of patients treated with group BF. CONCLUSION: The EMG values of the masseter muscle significantly increased when an implant attachments was used in the overdenture.

Maxillary sinus floor augmentation using bovine bone grafts with simultaneous implant placement: a 5-year prospective follow-up study.

PURPOSE: The aim of this study was to evaluate the 5 year clinical results of maxillary sinus floor augmentation using bovine bone grafts with simultaneous implant placement. MATERIAL AND METHODS: A total of 28 patients were enrolled in the study, and a total of 84 implants were placed into the grafted sites. Unilateral or bilateral sinus augmentation was performed, and implants were inserted into the augmented sinuses. After osseointegration and insertion of the prosthesis, the implants were evaluated by clinical and radiographic parameters. RESULTS: The cumulative implant survival rate after 60 months of loading was 100%. Periimplant bone loss was at clinically acceptable levels (0.146 and 0.34 mm after 1 and 5 years, respectively). CONCLUSIONS: Bovine bone grafts used in 1-stage sinus augmentation yields sufficient quality and volume of bone for predictable simultaneous implant placement.

Five-year treatment outcomes with four types of implants in the posterior maxilla and mandible in partially edentulous patients: a retrospective study.

PURPOSE: The aim of this retrospective study was to evaluate the outcomes, after 5 years of functional loading, of four different types of implants supporting prostheses in the posterior maxilla and mandible. MATERIALS AND METHODS: Patients missing posterior teeth were treated with implants between 1998 and 2004. The implants were evaluated by clinical and radiographic parameters and Plaque Index, Sulcus Bleeding Index (BI), peri-implant probing depths (PD), and marginal bone loss (MBL) were recorded. Repeated-measures analysis of variance, Kruskal-Wallis, and Wilcoxon signed rank tests were used for statistical analysis. RESULTS: In all, 244 implants were placed in 83 patients: 86 Straumann implants, 35 Swiss Plus implants, 90 Camlog implants, and 33 Frialit implants. Patients received 93 single crowns and 71 fixed partial dentures (FPDs). Nine FPDs were cemented to both implants and natural teeth, and 62 FPDs were supported by implants only. At the 5-year recall, plaque accumulation was significantly higher than at baseline for all groups (P = .01). Mean PD was 1.8 mm in the maxilla and 1.6 mm in the mandible. The mean PD values were 1.77 ± 0.52 mm for Straumann, 1.87 ± 0.64 mm for Swiss Plus, 2.33 ± 0.58 mm for Camlog, and 2.29 ± 0.46 mm for Frialit. MBL was 0.19 ± 0.07 mm for Straumann, 0.27 ± 0.06 mm for Camlog, 0.26 ± 0.07 mm for Swiss Plus, and 0.24 ± 0.07 mm for Frialit. The mean MBL of Straumann implants was significantly lower than that seen in the other groups (P = .001). CONCLUSION: The four types of implants resulted in similar clinical success after 5 years.

Five-year treatment outcomes with three brands of implants supporting mandibular overdentures.

PURPOSE: The purpose of this study was to evaluate clinical outcomes, posttreatment care, and patient satisfaction with overdenture treatment in the severely resorbed mandible. MATERIALS AND METHODS: Two implants were inserted in the intraforaminal region of 36 edentulous patients. Seventy-two implants were placed: 24 ITI (Institut Straumann), 24 SwissPlus (Zimmer Dental), and 24 Astra (Astra Tech). Implants were not loaded until osseointegration was complete. Following osseointegration and insertion of the prosthesis, the implants were evaluated by clinical and radiographic parameters. Clinical parameters, including Plaque Index, Sulcus Bleeding Index, peri-implant probing depth (PD), and marginal bone loss (MBL), were recorded, and any biologic and mechanical complications at baseline and recall evaluations were noted. Patient satisfaction with mastication, phonetics, retention, oral hygiene, and esthetics was also evaluated by means of a questionnaire. The results were analyzed statistically. RESULTS: The cumulative implant survival rate after 5 years of loading was 100%. There were significant differences in mean PD values between the three implant groups at baseline and recall evaluations. Mean PD values for the Astra group were significantly higher than those for the ITI and SwissPlus groups. Although the mean MBL was within clinically acceptable levels for all groups, there were significant differences among the three groups for MBL scores between baseline and 5 years. The mean MBL for the ITI group was significantly lower than the MBL values seen for the Astra and SwissPlus groups. Over the 60-month evaluation period, the most common prosthetic complications were mandibular denture fracture and dislodgement of the female attachment. CONCLUSIONS: Mandibular implant overdenture treatment is a successful treatment modality for the severely resorbed mandible.

General health, dental status and perceived dental treatment needs of an elderly population in Istanbul.

BACKGROUND: Comprehensive data on the oral health status and dental treatment needs of the elderly population in Turkey are deficient. OBJECTIVES: This pilot study determined the general and dental health status, perceived medical and dental treatment needs of an elderly population dwelling in residential homes in Istanbul. METHOD: Subjects at three different residential homes, namely one belonging to the state and two supported by foundations in Istanbul (N=121, female: 63 and male: 58) were involved in this study. A detailed questionnaire was prepared and dental examinations were conducted. Information was collected related to age, education levels, financial status, current physical functional status, general health, mental health, previous dental history, current dental status, oral hygiene practices and denture hygiene of these elderly people. The prevalence of edentulism, the presence and type of dental prostheses, dental and denture status and denture cleanliness were further evaluated. RESULTS: The three most prevalent reported general health problems were associated with genito-urinary problems (24%) followed by cardiovascular (18%) and respiratory problems (14%) varying significantly between genders, with males suffering more from cardiovascular problems than females (p < 0.05). Females showed significantly higher gastrointestinal and orthopaedic problems than males (p < 0.05). Females were more frequently edentulous than males but denture hygiene was significantly better in females than in males (p < 0.05). Brushing frequency did not significantly increase denture hygiene (p = 0.6). More than one-third of the subjects had not been to the dentist within the previous 5-10 years, mainly due to lack of demand, followed by the cost of the dental care and fear. More than two-thirds of denture-wearing subjects wore their dentures only during eating. CONCLUSIONS: There was significant perceived dental treatment and care need for the sample population of elderly studied.

Rehabilitation of maxillary anterior esthetics by alveolar distraction osteogenesis with immediate implant placement: a case report.

Esthetic reconstruction of severe soft and hard tissue deficiencies is the utmost challenge in implant dentistry. To prevent postoperative bone resorption and to control the amount of hard and soft tissue volume, distraction osteogenesis followed by immediate implant placement has been proven to be a promising combined technique. The aim of this report is to introduce a treatment strategy to maintain anterior esthetics and to control hard and soft tissue volume in a case, treated with the combined technique of vertical alveolar distraction and immediate implant placement. An osteotomy was performed by the use of an oscillating saw. Cut alveolar segment was mobilized, and a distractor device was inserted in between the segments. During the activation and consolidation periods of distraction, anterior esthetics was provided with removable acrylic provisional crowns placed on the distractor's rod. In 2 weeks of distraction period, vertically 10 mm of new bony segment was obtained, and 2 weeks after the removal of distractor, maxillary incisors were extracted. Four dental implants were placed according to the immediate placement protocol. In osseointegration period, provisional restorations were fabricated on abutments to form harmonious gingival contours and to maintain maxillary anterior esthetics until the fabrication of final restorations.

Surgical and prosthodontic treatment using alveolar distraction osteogenesis and implant placement for a patient with mandibular prognathism: a clinical report.

A 49-year-old patient presented with an Angle Class III malocclusion with a partially edentulous mandible, as diagnosed by orofacial examination and radiographic and cephalometric analyses. The patient refused orthognathic surgery; therefore, the treatment plan included the preparation of all teeth and fabrication of provisional restorations to reestablish optimal occlusion. To allow for the placement of 3 implants, the edentulous posterior mandibular ridge was improved via alveolar distraction. The patient was recalled 3, 6, 12, and 24 months after prosthodontic treatment. The oral situation was stable and patient satisfaction was reported as high.

Resonance frequency analysis assessment of implant stability in labial onlay grafted posterior mandibles: a pilot clinical study.

PURPOSE: The objectives of this study were (1) to compare the stability, evaluated by means of resonance frequency analysis (RFA), of implants placed posterior mandibles augmented with autogenous bone harvested from the mandibular symphysis with that of implants placed in nongrafted edentulous posterior mandibles and (2) to compare peri-implant marginal bone height changes and implant failure for the 2 groups. MATERIALS AND METHODS: Eight patients with thin posterior mandibular ridges (buccolingual crestal width less than 4 mm) underwent labial onlay alveolar grafting with symphyseal bone blocks 4 months prior to placement of 17 implants. Seven nongrafted patients received 18 implants in the edentulous posterior mandible; these patients served as a control group. RFA was performed the day of implant placement (baseline), 1 month postplacement, 4 months postplacement (after prosthesis delivery), and 12 months postloading. Peri-implant bone height changes at a level of 0.01 mm were assessed using periapical radiographs at baseline, the 1-month follow-up, and the 4-month follow-up. Analysis of variance was used to evaluate statistical differences within the groups, and t test was used to make comparisons between groups. RESULTS: None of the patients presented postoperative complications or implant failure. Mean implant stability quotient (ISQ) was 63.0+/-6.0 to 70.2 +/-3.5 for the grafted group and 64.1+/-4.1 ISQ to 70.1+/-3.9 for the nongrafted group. No significant difference was found in mean ISQ between the grafted and nongrafted groups at baseline, the 1-month follow-up, 4 months postplacement, or 12 months postloading (P = .211, P = .873, P = .925, P = .735, respectively). Mean peri-implant bone loss was 0.16 +/- 0.04 mm mesially and 0.16 +/- 0.05 mm distally. CONCLUSION: RFA revealed no difference in implant stability between mandibular ridges augmented with autologous bone grafts at baseline or after loading.