Retrospective radiographic analysis of sinus graft and implant placement procedures from the Academy of Osseointegration Consensus Conference on Sinus Grafts.

A retrospective quantitative radiographic analysis determined the effect of graft material and smoking status on the maintenance of graft height over 3 years. Analysis of variance models with planned comparison were constructed to compare mean graft change by (1) graft material and (2) smoking status. Maintenance of bone height was significantly greater in intraoral autogenous grafts versus allografts (P < .05). The effect of smoking on implant loss revealed a significant difference in implant survival (P < .05). Autogenous bone generally resulted in a more favorable outcome over a 3-year period. Smoking adversely impacted implant survival in sinus grafts.

Report of the Sinus Consensus Conference of 1996.

Retrospective data from sinus floor augmentation bone grafts were collected from 38 surgeons for 1007 sinus grafts that involved the placement of 2997 implants over a 10-year period, with the majority of the implants followed for 3 years or more postrestoration. There were 229 implant failures reported. Various root-form implants and grafting modalities were used. A consensus conference was organized to evaluate the data and reach a consensus on optimal treatment protocols. The complete database demonstrated a 90.0% success rate for implants placed in sinus grafts with at least 3 years of function. Differences in grafting materials, implant surfaces, and timing protocols were statistically analyzed. However, the database was so multivariate and multifactorial that it was difficult to draw definitive conclusions; these must await controlled prospective studies. The consensus conference therefore developed and voted on multiple consensus statements derived by committee review for bone graft materials, type of implants, timing for implant placement, failure analysis, radiographic analysis, indications/contraindications, prosthetics, and nomenclature. Several consensus statements were obtained, the most significant being that the sinus graft should now be considered a highly predictable and effective therapeutic modality.

Dental implant infections.

Dental implants provide a restorative tool to support crowns, bridge abutments, and removable dentures. Osseointegrated implants are titanium posts that are surgically implanted in alveolar bone. A tight immobile bond (osseointegration) forms between bone and titanium, and prosthetic and restorative fixtures are attached to the implants. Titanium implants differ from natural teeth, which may make them more susceptible to mechanical stress. A small proportion of implants are not successful and may fail due to infection. The microbiota of implants is similar to that of teeth in similar clinical states. Implants that fail because of mechanical stress are colonized by species associated with healthy teeth. Infected implants are colonized by subgingival species, including Porphyromonas gingivalis, Bacteroides forsythus, Fusobacterium nucleatum, Campylobacter gracilis, Streptococcus intermedius, and Peptostreptococcus micros. Different patients may be colonized by different microbial complexes, indicating that optimal treatment should be directed to the specific infection.

Surgical considerations in implant dentistry.

Standardized prospective clinical trials are uncommon in implant dentistry. Aside from the Brånemark and staple trials; both restricted to edentulous jaws, and two blade trials in their early and as yet inconclusive stages, most implant studies are retrospective. As such, they lack uniformity in patient selection, methodology, evaluation, and definitions of success and do not yield the information needed for critical clinical decisions. There are data to compare treatments for edentulous jaws, but virtually none for the partially edentulous patient. Decisions, out of necessity, involve retrospection and interpolation. In the absence of a definitive data base, added attention must be paid to patient safety and informed consent. Patient selection, implant selection, site selection, and surgical and prosthetic management--all of which influence implant efficacy and safety--are highlighted. It is the opinion of this author, based upon the benefit/risk information reviewed, that osseointegrated root forms are the implants of choice when adequate bone is available, and that blade implants and subperiosteal implants are indicated when bone space is restricted. Prospective clinical trials must be given the highest priority in planning for implant research.

Evaluation in reconstructive implantology.

Acceptance of implants by dentist, readiness for use, and general indications are described. Individual evaluation for implants is detailed and success of implants defined. Indications for removal are cited and appropriate statistic methodology presented.

Immobilization of baboons (Papio anubis) using ketamine and diazepam.

Ketamine (10mg/kg body weight) was administered intramuscularly in 10 baboons (Papio anubis). Subsequently, a combination of ketamine (10mg/kg body weight) and diazepam (7.5 mg) was administered intramuscularly. Results indicated that using diazepam concurrently with ketamine suppressed or eliminated the epileptoid movements characteristic of anesthesia with ketamine used alone.

Bone maintenance: implant versus transplant.

Bone maintenance based on various attachment mechanisms is the key to tooth-root replacement safety and efficacy. The dental implant has broad applicability based on design, but demonstrates progressive peri-implant bone loss. The allogeneic tooth transplant, significantly less applicable because of size, is antigenic and rejected by bone-replacement root resorption. Since the predictability and survival times of these implant and transplant modalities are similar and there is less residual bone loss with the transplant, it is suggested that for clinical situations such as the fresh extraction socket, where there is room, the allotransplant, rather than implant, is the root-replacement of choice.