Alveolar sandwich osteotomy in resorbed alveolar ridge for dental implants: a 4-year prospective study.

PURPOSE: To answer whether severe vertical alveolar defects can be resolved using the sandwich osteotomy technique with xenograft material as filler and to evaluate the predictability of this procedure. MATERIALS AND METHODS: Ten graft sites (5 mandibular and 5 maxillary) in 9 patients treated at the Department of Oral and Maxillofacial Surgery, Hadassah Medical Center, were included in the present study. The patients underwent vertical bone augmentation using the sandwich osteotomy technique filled with xenograft material. The degree of bone augmentation was analyzed clinically at surgery and 4 to 6 months later from the computed tomography images taken just before the sites had been rehabilitated using dental implant insertion. A trephine histologic analysis was performed during implantation at 1 maxillary site. RESULTS: The mean vertical bone gain in the interval between the sandwich osteotomy and implementation was 6 mm (range 4 to 10), and it remained stable after 4 to 6 months. In 2 cases, additional horizontal bone augmentation was needed. All graft sites were rehabilitated using dental implants with satisfactory results. In 3 cases, gingival porcelain was required for the final prosthesis. Histologic examination revealed vital segmentized bone and remodeling of the filled gap. CONCLUSIONS: The interpositional alveolar bone graft using xenograft filler appears to be a viable and predictable alternative to block grafting or guided bone regeneration, resulting in good final results, with substantial vertical bone gain, even for challenging cases.

Evaluation of a navigation system for dental implantation as a tool to train novice dental practitioners.

PURPOSE: This study evaluated the benefits of a virtual reality navigation system for teaching the surgical stage of dental implantation to final-year dental students. The study aimed to assess the students' performance in dental implantation assignments by comparing freehand protocols with virtual reality navigation. MATERIALS AND METHODS: Forty final-year dentistry students without previous experience in dental implantation surgery were given an implantation assignment comprising 3 tasks. Marking, drilling, and widening of implant holes were executed by a freehand protocol on the 2 mandibular sides by 1 group and by virtual reality navigation on 1 side and contralaterally with the freehand protocol by the other group. Subjective and objective assessments of the students' performance were graded. RESULTS: Marking with the navigation system was more accurate than with the standard protocol. The 2 groups performed similarly in the 2-mm drilling on the 2 mandibular sides. Widening of the 2 mesial holes to 3 mm was significantly better with the second execution in the standard protocol group, but not in the navigation group. The navigation group's second-site freehand drilling of the molar was significantly worse than the first. The execution of all assignments was significantly faster in the freehand group than in the navigation group (60.75 vs 77.25 minutes, P = .02). Self-assessment only partly matched the objective measurements and was more realistic in the standard protocol group. CONCLUSIONS: Despite the improved performance with the navigation system, the added value of training in dental implantation surgery with virtual reality navigation was minimal.

Immediate placement of dental implants into debrided infected dentoalveolar sockets.

PURPOSE: To describe a protocol for the immediate placement of endosseous implants into debrided infected dentoalveolar sockets. PATIENTS AND METHODS: A total of 30 implants were immediately placed into debrided infected sites in 20 patients. The pathology at the receptacle dentoalveolar sockets varied, and included subacute periodontal infection, perio-endo infection, chronic periodontal infection, chronic periapical lesion, and a periodontal cyst. The immediate placement protocol emphasized the meticulous debridement of the infected tissues in combination with peripheral ostectomy of the alveoli. Guided bone regeneration was accomplished to support bony healing of alveolar defects surrounding the implantation site. Pre- and postsurgical antibiotic therapy was administered. RESULTS: All implants but 1 were osseointegrated and functional when followed up after 12 to 72 months. One implant was mobile after its immediate restoration and was removed. Complications were related to the use of guided bone regeneration. Deficiency of the attached gingiva was noted in 1 case. The treatment approach is illustrated in 2 anterior maxilla cases with 3-year follow-up. CONCLUSIONS: Successful immediate implantation in debrided infected alveoli depends on the complete removal of all contaminated tissue and the controlled regeneration of the alveolar defect. With this proposed clinical approach, experienced clinicians may consider immediate implants as a viable treatment option in patients presenting with dentoalveolar infections.

Application of a surgical navigation system for implant surgery in a deficient alveolar ridge postexcision of an odontogenic myxoma.

PURPOSE: The study's purpose was to describe the application of a surgical navigation system for the treatment-planning and subsequent precise placement of dental implants in a patient, 2 years postexcision of a mandibular odontogenic myxoma. PATIENTS AND METHODS: A 25-year-old male patient presented for rehabilitation of a deficient edentulous ridge at the right mandible following excision of an odontogenic myxoma. The patient was imaged by dental computed tomography while wearing an individually fitted interfacing acrylic splint. Thereafter, computed tomography data were imported to the Image-Guided Implantology system (IGI; DenX Advanced Dental Systems Ltd, Moshav Ora, Israel), and a precise 3-dimensional implant treatment plan was contemplated considering the compromised anatomy and the anticipated prosthesis. RESULTS: Three dental implants were placed using a surgical navigation approach with precise coordination to the presurgical treatment plan and subsequently were restored with a screw-retained fixed prosthesis. At the 1-year follow-up, the implants were osseointegrated and the fixed prosthesis was fully functional. CONCLUSIONS: Computerized navigation is indicated for dental implant surgery in patients with deficient alveolar ridge where coordination of the positioning of the implants to the final prosthesis is difficult.

Intraoperative computerized navigation for flapless implant surgery and immediate loading in the edentulous mandible.

Computerized navigation surgery has evolved to facilitate minimally invasive procedures, the gold standard of surgery today. While flapless implant surgery may be clinically beneficial, it has generally been perceived as a blind procedure limited to straightforward cases that do not pose a risk of cortical plate perforation. The objective of this report is to describe a protocol for flapless implant placement in a completely edentulous mandible using computerized navigation surgery. The Image Guided Implantology system (IGI, DenX Advanced Dental Systems) is described. The IGI system provides real-time imaging of the dental drill and transforms flapless implant surgery into a fully monitored procedure. The highly accurate intraoperative navigation enables precise transfer of the detailed presurgical implant plan to the patient. This is particularly valuable in edentulous jaws lacking any indication of the dental arch. The accurate positioning of the implants, based on the presurgical digital plan, allows fabrication of a provisional fixed prosthesis before the implant surgery for immediate postoperative loading. This innovative protocol can enhance prosthodontic-driven placement of implants in a fully monitored flapless surgery.