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1.
Int J Mol Sci ; 21(17)2020 Aug 22.
Artículo en Inglés | MEDLINE | ID: mdl-32842709

RESUMEN

The health of peri-implant soft tissues is important for the long-term success rate of dental implants and the surface topography is pivotal in influencing it. Thus, the aim of this study was to evaluate, in human patients, the inflammatory mucosal microenvironment in the tissue surrounding a new, nanoscale, laser-treated healing abutment characterized by engineered nanopores versus a standard machined-surface. Analyses of anti- and pro-inflammatory markers, cytokeratins, desmosomal proteins and scanning electron microscopy were performed in 30 soft-tissue biopsies retrieved during second-stage surgery. The results demonstrate that the soft tissue surrounding the laser-treated surface was characterized by a lower grade of inflammation than the one facing the machined-surface, which, in turn, showed a disrupted epithelium and altered desmosomes. Moreover, higher adhesion of the epithelial cells on the laser-treated surface was detected compared to the machined one. In conclusion, the laser-treated surface topography seems to play an important role not only in cell adhesion, but also on the inflammatory makers' expression of the soft tissue microenvironment. Thus, from a clinical point of view, the use of this kind of topography may be of crucial importance not only on healing abutments but also on prosthetic ones.

2.
Materials (Basel) ; 13(9)2020 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-32397597

RESUMEN

Marginal bone loss (MBL) is a key factor in long-term implant success rate. Among the different factors that influence MBL, it is the different implant shoulder designs, such as scalloped or non-scalloped, which have been widely studied on screw retained but not on cemented retained implants. Thus, the aim of the present study was to evaluate the MBL around scalloped and non-scalloped cemented retained dental implants after 4 years of loading, in humans. A total of 15 patients were enrolled in the present study. A radiographic and clinical examination was performed after implant placement (T0) and after 4 years from it (T1). The results demonstrated a differential MBL (T1-T0) of 2.436 ± 1.103 mm and 1.923 ± 1.021 mm, respectively for test (scalloped) and control (non-scalloped) groups with a statistically significant difference between them. On the other hand, no statistically significant differences were found between the groups in terms of prosthetic complication and abutment decementation, whilst ceramic crowns chipping was shown in both groups. In conclusion, the use of a scalloped platform did not provide better results on the maintenance of MBL after 4 years follow-up. In this study, this probably was determined by multiple factors, among which was the subcrestal insertion of scalloped implants.

3.
J Clin Med ; 9(4)2020 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-32252463

RESUMEN

Although, the high success rate of implant rehabilitation treatment, the biological complications such as bone loss and peri-implantitis are still present. The creation of a coronal biological seal between the implant and the oral tissues seems to be a crucial point on preserving dental implants. The objective of this study was to immunohistochemically analyze the behavior of peri-implant soft tissues around a new implant healing-abutment surface on humans. A total of 30 soft tissue biopsies were collected after a healing period of 30 (±7) days, to analyze the expression of inflammatory (cluster of differentiation 63 (CD63), human neutrophil peptides 1-3 (HPN1-3)) and junctional (E-cadherin, occludin, and ß-catenin) markers, on soft tissues around laser treated and machined alternated healing abutments. The evaluation demonstrated the whole area of the soft tissues adherent to the laser treated surface with a regular morphology. While several stress hallmarks in correspondence of machined surfaces were shown such as: a) An irregular, disrupted, and discontinued basal membrane with an increased inflammation evident both the epithelial and connective tissues; b) the absence or defective proper keratinization process of the external layer, and c) damages in the cell to cell interaction. In conclusion, the laser treated surface is preferable to maintain the integrity and functionality of the gingiva epithelium.

4.
J Oral Implantol ; 46(1): 13-17, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-31580759

RESUMEN

The loosening of an abutment screw is one of the most frequent complications in implant-prosthetic rehabilitation, especially for single-crown cemented prostheses. This complication is due to several mechanical factors including type of connection, abutment-screw geometry, settling effects, and cyclical load. The purpose of the present in vitro study was to compare and associate different times of retightening with reductions in preload losses. We evaluated 40 internal hexagon dental implants and 40 external hexagon dental implants, with their related abutment screws. The implants were embedded in acrylic resin in cylindrical polyvinyl chloride tubes (26 mm diameter, 20 mm height). The abutments were fixed to the implants with screws to an initial torque of 35 Ncm using a digital torque meter with decimal precision. Two different types of connection were randomly divided in 4 subgroups of 10 samples each. One subgroup was used as control. The test groups underwent retightening to the same initial torque at increasing times from initial torque application for tightening of the abutment screws, to their retightening at 2 minutes, 5 minutes, and 10 minutes. The retightening time of 2 minutes shows significantly reduced preload loss. Randomized clinical trials are strongly required to provide clinicians with a beneficial standardized protocol of retightening that can be applied in routine clinical practice.


Asunto(s)
Implantes Dentales , Coronas , Pilares Dentales , Diseño de Implante Dental-Pilar , Análisis del Estrés Dental , Torque
5.
Int J Oral Implantol (Berl) ; 12(1): 39-54, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31116187

RESUMEN

PURPOSE: To evaluate whether 5 × 5 mm dental implants with a novel nanostructured calcium-incorporated titanium surface could be an alternative to implants at least 10-mm long placed in bone augmented with bone substitutes in posterior atrophic jaws. MATERIALS AND METHODS: Forty patients with atrophic posterior (premolar and molar areas) mandibles having 5- to 7-mm bone height above the mandibular canal, and 40 patients with atrophic maxillae having 4- to 6-mm bone height below the maxillary sinus, were randomised according to a parallel-group design to receive one to three 5-mm implants or one to three at least 10-mm long implants in augmented bone at two centres. All implants had a diameter of 5 mm. Mandibles were vertically augmented with interpositional bovine bone blocks covered with resorbable barriers. Implants were placed after 4 months. Maxillary sinuses were augmented with particulated porcine bone via a lateral window covered with resorbable barriers and implants were placed simultaneously. All implants were submerged and loaded after 4 months with provisional prostheses. Four months later, definitive screw-retained or provisionally cemented metal-ceramic or zirconia prostheses were delivered. Patients were followed to 5 years post-loading and the outcome measures were: prosthesis and implant failures, any complication and peri-implant marginal bone level changes. RESULTS: Sixteen patients dropped out before the 5-year evaluation (four short mandibles, three short maxillae, six augmented mandibles and three augmented maxillae). In mandibles, two grafted patients were not prosthetically rehabilitated because of multiple complications, and three implants failed in the same patient (one was a replacement implant) versus one patient who lost his short implant and crown 2 years after loading. In maxillae one short implant failed with its provisional crown 3 months post-loading. There were no statistically significant differences in prostheses (difference in proportion = -0.003; 95% CI: -0.14 to 0.13; P = 1.000) and implant failures (difference in proportion = -0.03; 95% CI: -0.17 to 0.09; P = 0.609) up to 5 years after loading. Significantly more complications occurred at mandibular grafted sites: 17 augmented patients were affected by complications versus nine patients treated with short implants in mandibles (difference in proportion = 0.39; 95% CI: 0.10 to 0.62; P = 0.013). In the maxilla seven sinus-elevated patients versus two patients treated with short implants were affected by complications, the difference not being statistically significant (difference in proportion = 0.25; 95% CI: -0.04 to 0.49; P = 0.128). Patients with mandibular short implants lost on average 1.22 mm of peri-implant bone at 5 years and patients with 10-mm or longer mandibular implants lost 1.70 mm. Patients with maxillary short implants lost on average 1.25 mm of peri-implant bone at 5 years and patients with 10-mm or longer maxillary implants lost 1.73 mm. Longer implants showed a greater bone loss up to 5 years after loading than short implants both in maxillae (mean difference: -0.48 mm; 95% CI: -0.89 to -0.07 mm; P = 0.024) and in mandibles (mean difference: -0.48 mm; 95% CI: -0.79 to -0.18 mm; P = 0.004). CONCLUSIONS: Five years after loading, 5 × 5 mm implants achieved similar results to longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation especially in posterior mandibles since the treatment is faster, cheaper and associated with less morbidity; however, 10-year post-loading data are necessary before making reliable recommendations.


Asunto(s)
Aumento de la Cresta Alveolar , Titanio , Animales , Bovinos , Implantación Dental Endoósea , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Humanos
6.
Int J Oral Implantol (Berl) ; 12(1): 57-72, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31116188

RESUMEN

PURPOSE: To evaluate whether 6-mm-long by 4-mm-wide dental implants could be an alternative to implants at least 10-mm long placed in bone augmented with bone substitutes in posterior atrophic jaws. MATERIALS AND METHODS: A total of 20 patients with bilateral atrophic mandibles and 20 patients with bilateral atrophic maxillae, having 5 to 7 mm of bone height below the maxillary sinus or 6 to 8 mm above the mandibular canal, had their sides of the jaws randomly allocated according to a split-mouth design. They were allocated to receive one to three 6-mm-long and 4-mm-wide implants, or implants at least 10-mm long in augmented bone by two different surgeons in different centres. Mandibles were vertically augmented with interpositional equine bone blocks and resorbable barriers, and implants were placed 3 months later. Maxillary sinuses were augmented with particulated porcine bone via a lateral window and implants were placed simultaneously. All implants were submerged and loaded, after 4 months, with provisional prostheses. Four months later, definitive prostheses were delivered. Outcome measures were prosthesis and implant failures, any complication and radiographic peri-implant marginal bone level changes. The follow-up was 5 years after loading for all patients. RESULTS: Eight patients (five treated in mandibles and three in maxillae) dropped out before the 5-year post-loading follow-up. Four short implants (two maxillary and two mandibular) affected by peri-implantitis failed together with their prostheses versus three mandibular prostheses which could not be placed on implants at least 10-mm long due to graft failures; one was associated with the loss of three implants because of infection. There were no statistically significant differences in implant (P = 1.0) and prosthesis failures (P = 1.0). In total, 19 complications occurred in 14 patients at augmented sites versus five complications in four patients with 6-mm-long implants (P = 0.118). More complications occurred at grafted sites both in mandibles (P = 0.727), and maxillae (P = 0.063), although the differences were not statistically significant. In mandibles, patients with 6-mm-long implants lost an average of 1.34 ± 0.35 mm of peri-implant bone at 5 years versus 2.11 ± 0.59 mm in patients with implants at least 10-mm long. The difference was statistically significant (mean difference = 0.77 ± 0.70 mm; 95% CI: 0.32 to 1.21 mm; P = 0.003). In maxillae, patients with 6-mm-long implants lost an average of 1.52 ± 0.47 mm of peri-implant bone at 5 years versus 1.85 ± 0.51 mm in patients with implants at least 10-mm long. The difference was statistically significant (mean difference = 0.33 ± 0.36 mm; 95% CI: 0.14 to 0.53 mm; P = 0.002). CONCLUSIONS: Results at 5 years after loading indicate that 6-mm-long implants with a conventional diameter of 4 mm achieved similar results to longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation, especially in posterior mandibles since the treatment was faster, cheaper and associated with less morbidity. However, 10-year post-loading data are necessary before making reliable recommendations.


Asunto(s)
Aumento de la Cresta Alveolar , Implantación Dental Endoósea , Animales , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Caballos , Humanos
7.
Mult Scler Relat Disord ; 24: 120-122, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-29982109

RESUMEN

BACKGROUND: Teriflunomide is a once-daily oral immunomodulator approved for the treatment of relapsing-remitting multiple sclerosis (RRMS) with a consistent safety profile in clinical trials. We report three cases of multiple teeth loss during teriflunomide treatment. CASE REPORTS: Case 1: a 39 year-old woman started teriflunomide for RRMS, switching from interferon beta. Four months later she complained about mandibular pain followed by the sudden loss of 4 teeth, in the absence of bleeding or trauma. Suspecting a causal role, we discontinued teriflunomide and started the accelerated elimination procedure with cholestyramine. Orthopantomography and a subsequent dental CT scan showed diffuse alveolar atrophy and periapical bone loss in several residual roots. Investigating retrospectively the patient's dental history, and revising previous orthopantomographies dating from 2009, we highlighted a chronic and progressive dental pathology with several cavities and teeth loss. Case 2: A 52-year-old woman affected by multiple sclerosis (MS) since 1988, switched from interferon beta to teriflunomide treatment due to poor tolerability. One year later she experienced the sudden loss of five teeth in the absence of traumatic events. Dental assessment and orthopantomography confirmed moderate chronic periodontitis. Teriflunomide was discontinued and the accelerated elimination procedure with cholestyramine was performed. Case 3: A 56-year-old woman affected by MS for thirty years. She switched from interferon beta to teriflunomide due to injection site reactions. After eighteen months she experienced hypermobility of several teeth without gum inflammation or pain, followed by sudden loss of twelve teeth. No dental examination is available. Teriflunomide was discontinued without accelerated elimination procedure. DISCUSSION: Odontogenic infections (periodontal disease and dental caries) are common and can cause teeth loss if left untreated as in case 1. It is conceivable that local infections favoured by teriflunomide accelerated pulpitis, endodontic infections and periapical reactions followed by teeth loss in predisposed subjects. Poor oral hygiene is common in MS patients and might favour dental infections. CONCLUSIONS: We underline the importance to assess concomitant teeth morbidity and to recommend accurate oral hygiene before and during teriflunomide treatment.


Asunto(s)
Crotonatos/efectos adversos , Inmunosupresores/efectos adversos , Toluidinas/efectos adversos , Pérdida de Diente/etiología , Adulto , Crotonatos/uso terapéutico , Femenino , Humanos , Inmunosupresores/uso terapéutico , Persona de Mediana Edad , Esclerosis Múltiple Recurrente-Remitente/tratamiento farmacológico , Toluidinas/uso terapéutico
8.
Eur J Oral Implantol ; 11(2): 175-187, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29806665

RESUMEN

PURPOSE: To evaluate whether 6 mm long × 4 mm wide dental implants could be an alternative to implants of at least 10 mm long placed in bone augmented with bone substitutes in posterior atrophic jaws. MATERIALS AND METHODS: A total of 20 patients with bilateral atrophic mandibles, and 20 patients with bilateral atrophic maxillae, having 5 mm to 7 mm of bone height below the maxillary sinus or 6 mm to 8 mm above the mandibular canal, had their side of the jaws randomly allocated according to a split-mouth design. They were allocated to receive one to three 6 mm long × 4 mm wide implants, or implants of at least 10 mm long in augmented bone by two different surgeons at different centres. Mandibles were vertically augmented with interpositional equine bone blocks and resorbable barriers, and implants were placed 3 months later. Maxillary sinuses were augmented with particulated porcine bone via a lateral window and implants were placed simultaneously. After 4 months, all implants were submerged and loaded with provisional prostheses. Four months later, definitive prostheses were delivered. Outcome measures were prosthesis and implant failures, any complication and radiographic peri-implant marginal bone level changes. RESULTS: Five patients (three treated in mandibles and two in maxillae) dropped out before the 3-year post-loading follow-up. Two short maxillary implants affected by peri-implantitis failed together with their prosthesis vs three mandibular prostheses that could not be placed on implants at least 10 mm long due to graft failures; one was associated with the loss of three implants because of infection. There were no statistically significant differences in implant (difference in proportions = 0.000; 95% CI: -0.140 to 0.140; P = 1.000) and prosthesis failures (difference in proportions = 0.057; 95% CI: -0.094 to 0.216; P = 0.625). In total, 18 complications occurred in 13 patients at augmented sites vs four complications in three patients with 6 mm long implants. Significantly more complications occurred at grafted sites in mandibles (difference in proportions = 0.353; 95% CI: 0.005 to 0.616; P = 0.031), but not in maxillae (difference in proportions = 0.222; 95% CI: -0.071 to 0.486; P = 0.219). In mandibles, patients with 6 mm long implants lost an average of 1.25 mm of peri-implant bone at 3 years vs 1.54 mm in patients with implants of at least 10 mm long. The difference was statistically significant (mean difference = 0.29 mm; 95% CI: 0.08 to 0.51 mm; P = 0.010). In maxillas, patients with 6 mm-long implants lost an average of 1.28 mm of peri-implant bone at 3 years vs 1.50 mm in patients with implants of at least 10 mm long. The difference was statistically significant (mean difference = 0.22 mm; 95% CI: 0.08 to 0.35 mm; P = 0.003). CONCLUSIONS: Results at 3 years after loading indicate that 6 mm long implants with a conventional diameter of 4 mm achieved similar, if not better, results than longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation, especially in posterior mandibles, since the treatment is faster, cheaper and associated with less morbidity. However, data obtained 5 to 10 years after loading are necessary before making reliable recommendations.


Asunto(s)
Pérdida de Hueso Alveolar/rehabilitación , Pérdida de Hueso Alveolar/cirugía , Aumento de la Cresta Alveolar , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Adulto , Anciano , Anciano de 80 o más Años , Diseño de Prótesis Dental , Femenino , Humanos , Masculino , Persona de Mediana Edad
9.
Eur J Oral Implantol ; 10(3): 263-278, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28944355

RESUMEN

PURPOSE: To compare the effectiveness of 6.0 to 8.0 mm-wide diameter implants, placed immediately after tooth extraction, with conventional 4.0 or 5.0 mm diameter implants placed in a preserved socket after a 4-month period of healing in the molar region. MATERIALS AND METHODS: Just after extraction of one or two molar teeth, and with no vertical loss of the buccal bone in relation to the palatal wall, 100 patients requiring immediate post-extractive implants were randomly allocated to immediate placement of one or two 6.0 to 8.0 mm-wide diameter implants (immediate group; 50 patients) or for socket preservation using a porcine bone substitute covered by a resorbable collagen barrier (delayed group; 50 patients), according to a parallel group design in one centre. Bone-to-implant gaps were filled with autogenous bone retrieved with a trephine drill used to prepare the implant sites for the immediate wide diameter post-extractive implants. Four months after socket preservation, one to two 4.0 or 5.0 mm-wide delayed implants were placed. Implants were loaded 4 months after placement with fixed provisional restorations in acrylic, and replaced after 4 months by fixed, definitive, metal-ceramic restorations. Patients were followed to 1 year after loading. Outcome measures were: implant failures, complications, aesthetics assessed using the pink esthetic score (PES), peri-implant marginal bone level changes, patient satisfaction, number of appointments and surgical interventions recorded, when possible, by blinded assessors. RESULTS: Three patients dropped out 1 year after loading from the immediate group vs six from the delayed group. Five implants out of 47 failed in the immediate group (10.6%) vs two out 44 (4.6%) in the delayed group, the difference being not statistically significant (difference in proportion = 6.0%, 95% CI: -8.8% to 20.8%, P = 0.436). In the immediate group 10 patients were affected by 10 complications, while in the delayed group four patients were affected by four complications. The difference was not statistically significant (difference in proportion = 12%, 95% CI: -2% to 26%, P = 0.084). At delivery of the definitive prostheses, 4 months after loading, the mean total PES score was 9.65 ± 1.62 and 10.44 ± 1.47 in the immediate and delayed groups, respectively. At 1 year after loading, the mean total PES score was 9.71 ± 2.71 and 10.86 ± 1.37 in the immediate and delayed groups, respectively. The Total PES score was statistically significantly better at delayed implants both at 4 months (mean difference = 0.79; 95% CI: 0.05 to 1.53; P = 0.03) and at 1 year (mean difference = 1.15; 95% CI: 0.13 to 2.17; P = 0.02). Marginal bone levels at implant insertion (after bone grafting) were 0.04 mm for immediate and 0.11 mm for delayed implants, which was statistically significantly different (mean difference = 0.07; 95% CI: 0.02 to 0.12; P < 0.0001). One year after loading, patients in the immediate group lost on average 1.06 mm and those from the delayed group 0.63 mm, the difference being statistically significant (mean difference = 0.43 mm; 95% CI: 0.15 to 0.61; P < 0.0001). All patients were fully or partially satisfied both for function and aesthetics, and would undergo the same procedure again both at 4 months and 1 year after loading. Patients from the immediate group required on average 7.48 ± 1.45 visits to the clinician and 2.14 ± 0.49 surgical interventions and to have their definitive prostheses delivered vs 10.30 ± 0.99 visits and 3.08 ± 0.40 surgical interventions for the delayed group, the difference being statistically significant (P < 0.001 for visits, and P < 0.001 for surgical interventions). CONCLUSIONS: Preliminary 1 year follow-up data suggest that immediate placement of 6.0 to 8.0 mm wide diameter implants in molar extraction sockets yielded inferior aesthetic outcomes than ridge preservation and delayed placement of conventional 4.0 to 5.0 mm diameter implants.


Asunto(s)
Implantación Dental , Implantes Dentales de Diente Único , Carga Inmediata del Implante Dental , Diente Molar/cirugía , Extracción Dental , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del Tratamiento
10.
Artículo en Inglés | MEDLINE | ID: mdl-28609491

RESUMEN

The aim of this retrospective study was to compare clinical and radiographic outcomes of the interpositional (inlay) augmentation technique in atrophic posterior partially edentulous mandibles using three different types of block bone grafts: autogenous bone block harvested from the iliac crest, deproteinized bovine bone mineral block, and collagenated equine bone block. A total of 115 patients were included with a 4.2-year mean after-loading follow-up. Data seem to suggest that heterologous bone blocks are similar in results to autogenous bone blocks, so they might be considered preferable as they avoid invasive harvesting surgeries.


Asunto(s)
Aumento de la Cresta Alveolar/métodos , Trasplante Óseo/métodos , Implantación Dental Endoósea/métodos , Implantes Dentales , Ilion/trasplante , Mandíbula/cirugía , Animales , Atrofia , Placas Óseas , Bovinos , Colágeno , Prótesis Dental de Soporte Implantado , Femenino , Estudios de Seguimiento , Caballos , Humanos , Italia , Masculino , Mandíbula/diagnóstico por imagen , Mandíbula/patología , Persona de Mediana Edad , Osteotomía , Estudios Retrospectivos , Colgajos Quirúrgicos , Resultado del Tratamiento
11.
Eur J Oral Implantol ; 7(1): 65-75, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24892114

RESUMEN

PURPOSE: To compare the efficacy of 1-stage versus 2-stage lateral maxillary sinus lift procedures. MATERIALS AND METHODS: Sixty partially edentulous patients requiring 1 to 3 implants and having 1 to 3 mm of residual bone height and at least 5 mm bone width below the maxillary sinus, as measured on CT scans were selected. They were randomised according to a parallel group study design into two equal arms to receive either a 1-stage lateral window sinus lift with simultaneous implant placement or a 2-stage procedure with implant placement delayed by 4 months, using a bone substitute in three different centres. Implants were submerged for 4 months, loaded with reinforced provisional prostheses, which were replaced, after 4 months, by definitive prostheses. Outcome measures, assessed by masked assessors, were: augmentation procedure failures; prosthesis failures and implant failures; complications; and marginal peri-implant bone level changes. Patients were followed up to 1 year after loading. Only data of implants placed in 1 to 3 mm of bone height were reported. RESULTS: Two patients dropped out from the 1-stage group and none from the 2-stage group. No sinus lift procedure failed in the 1-stage group but one failed in the 2-stage group, the difference being not statistically significant (P = 1.00). Two prostheses failed or could not be placed in the planned time in the 1-stage group and one in the 2-stage group, the difference being not statistically significant (P = 0.51). Three implants failed in three patients of the 1-stage group, versus one implant in the 2-stage group, the difference being not statistically significant (P = 0.28). Two complications occurred in the 1-stage group and one in the 2-stage group, the difference being not statistically significant (P = 0.61). One year after loading, 1-stage treated patients lost an average of -1.01 mm (SD: 0.56) of peri-implant bone and 2-stage sites about -0.93 mm (SD: 0.40). There were no statistically significant differences in bone level change between groups 1 year after loading (-0.08 mm 95%CI: -0.33 to 0.18 P = 0.56). CONCLUSION: No statistically significant differences were observed between implants placed according to 1- or 2-stage sinus lift procedures. However this study may suggest that in patients having residual bone height between 1 to 3 mm below the maxillary sinus, there might be a slightly higher risk for implant failures when performing a 1-stage lateral sinus lift procedure.


Asunto(s)
Elevación del Piso del Seno Maxilar/métodos , Adulto , Anciano , Pérdida de Hueso Alveolar/etiología , Sustitutos de Huesos/uso terapéutico , Colágeno , Implantación Dental Endoósea/métodos , Implantes Dentales , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Femenino , Estudios de Seguimiento , Humanos , Arcada Parcialmente Edéntula/cirugía , Masculino , Maxilar/diagnóstico por imagen , Maxilar/cirugía , Membranas Artificiales , Persona de Mediana Edad , Minerales/uso terapéutico , Oseointegración/fisiología , Complicaciones Posoperatorias , Método Simple Ciego , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
12.
Eur J Oral Implantol ; 6(2): 153-65, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23926587

RESUMEN

PURPOSE: To compare the efficacy of 1-stage versus 2-stage lateral maxillary sinus lift procedures. MATERIALS AND METHODS: Sixty partially edentulous patients requiring 1 to 3 implants and having 1 to 3 mm of residual bone height and at least 5 mm of bone width below the maxillary sinus, as measured on CT scans, were randomised into two equal groups to receive either a 1-stage lateral window sinus lift with simultaneous implant placement or a 2-stage procedure with implant placement delayed by 4 months using a bone substitute in 3 different centres. Implants were submerged for 4 months and loaded with reinforced provisional prostheses, which were replaced, after 4 months, by definitive prostheses. Outcome measures were augmentation procedure failures, prosthesis failures, implant failures, complications and marginal peri-implant bone loss assessed by a blinded outcome assessor. Patients were followed up to 4 months after loading. Only data of implants placed in 1 to 3 mm of bone height were reported. RESULTS: Two patients dropped out from the 1-stage group and none from the 2-stage group. No sinus lift procedure failed in the 1-stage group but 1 failed in the 2-stage group, the difference was not statistically significant (P = 1.00). Two prostheses failed or could not be placed in the planned time in the 1-stage group and 1 in the 2-stage group, the difference was not statistically significant (P = 0.51). Three implants failed in 3 patients of the 1-stage group versus 1 implant in the 2-stage group, the difference was not statistically significant (P = 0.28). Two complications occurred in the 1-stage group and 1 in the 2-stage group, the difference was not statistically significant (P = 0.61). There were no statistically significant differences in bone loss between groups at loading (0.05 mm). Sites treated in 1 stage lost an average of 0.56 mm (SD: 0.36; 95% CI: -0.70 to -0.42; P < 0.001) of peri-implant bone and 2-stage sites approximately 0.61 mm (SD: 0.34; 95% CI: -0.74 to -0.48; P < 0.001). CONCLUSIONS: No statistically significant differences were observed between implants placed according to 1- or 2-stage sinus lift procedures. However, this study may suggest that in patients having a residual bone height between 1 and 3 mm below the maxillary sinus there might be a slightly higher risk for implant failures when performing a 1-stage lateral sinus lift procedure.


Asunto(s)
Elevación del Piso del Seno Maxilar/métodos , Adulto , Anciano , Pérdida de Hueso Alveolar/etiología , Densidad Ósea , Matriz Ósea/trasplante , Sustitutos de Huesos/uso terapéutico , Colágeno , Diseño de Implante Dental-Pilar , Implantación Dental Endoósea/métodos , Implantes Dentales , Fracaso de la Restauración Dental , Femenino , Estudios de Seguimiento , Humanos , Arcada Parcialmente Edéntula/rehabilitación , Arcada Parcialmente Edéntula/cirugía , Masculino , Maxilar/cirugía , Membranas Artificiales , Persona de Mediana Edad , Minerales/uso terapéutico , Oseointegración/fisiología , Piezocirugía/instrumentación , Complicaciones Posoperatorias , Elevación del Piso del Seno Maxilar/efectos adversos , Resultado del Tratamiento , Cicatrización de Heridas/fisiología
13.
Artículo en Inglés | MEDLINE | ID: mdl-23484171

RESUMEN

This report describes a successful implant prosthetic rehabilitation in an atrophic left posterior mandible in a 62-year-old man using a cancellous equine bone block as grafting material. Four months later, two bone specimens were retrieved for histologic evaluation and two dental implants were placed. Computed tomography and conventional radiography showed a 5-mm mean vertical bone gain. The biopsies showed new bone formation within the cancellous portion of the blocks and no foreign body reaction. Cancellous equine bone grafts may be an effective alternative to autogenous bone and inorganic bovine bone grafting for reconstruction of the posterior mandible using the inlay technique.


Asunto(s)
Aumento de la Cresta Alveolar/métodos , Trasplante Óseo/métodos , Xenoinjertos/trasplante , Mandíbula/cirugía , Pérdida de Hueso Alveolar/cirugía , Animales , Atrofia , Biopsia , Bovinos , Implantación Dental Endoósea/métodos , Implantes Dentales , Diseño de Prótesis Dental , Estudios de Seguimiento , Xenoinjertos/patología , Caballos , Humanos , Masculino , Mandíbula/patología , Reconstrucción Mandibular/métodos , Persona de Mediana Edad , Osteogénesis/fisiología , Osteotomía/instrumentación , Piezocirugía/instrumentación , Tomografía Computarizada por Rayos X/métodos
14.
J Periodontol ; 84(10): e40-7, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23517509

RESUMEN

BACKGROUND: Chemical and physical properties of an implant surface have a major influence on the structure of peri-implant bone and thus may influence the clinical performance of the implant. This study aims to evaluate the bone microstructure around implants with and without added nanometer-sized calcium phosphate particles. METHODS: An implant with dual acid-etched surface (control) and an implant with dual acid-etched surface and CaP nanoparticles (test) were placed in the posterior maxilla of 15 patients. Bone microstructure was evaluated for osteocyte density (OD), bone vessel volume density (BVVD), and bone mineral density (BMD). RESULTS: BVVD was 1.806 ± 0.05 for test implants and 1.533 ± 0.10 for control implants (P <0.001). BMDlow was 17.4 × 10(4) µm(2) for test implants and 15.0 × 10(4) µm(2) for control implants (P = 0.025). Results from the BMDhigh comparison, test versus control, were not statistically significant (P >0.05). OD was 575.6 ± 63.7 mm(2) for test implants and 471.2 ± 61.9 mm(2) for control implants (P <0.001). CONCLUSIONS: After 8 weeks of healing, the bone microstructure around test implants appeared to be significantly more organized. Clinical implications of these results include shortened healing time and indication for earlier loading protocols.


Asunto(s)
Densidad Ósea/fisiología , Fosfatos de Calcio/química , Implantes Dentales , Materiales Dentales/química , Maxilar/patología , Nanopartículas/química , Osteocitos/patología , Titanio/química , Grabado Ácido Dental/métodos , Adulto , Anciano , Diseño de Prótesis Dental , Método Doble Ciego , Femenino , Estudios de Seguimiento , Fractales , Humanos , Masculino , Maxilar/irrigación sanguínea , Microscopía Confocal , Microscopía Electrónica de Rastreo , Microvasos/patología , Persona de Mediana Edad , Imagen Óptica , Estudios Prospectivos , Propiedades de Superficie
15.
Eur J Oral Implantol ; 6(4): 343-57, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24570980

RESUMEN

PURPOSE: To evaluate whether 5 × 5 mm dental implants with a novel nanostructured calciumincorporated titanium surface could be an alternative to implants at least 10 mm long placed in bone augmented with bone substitutes in posterior atrophic jaws. MATERIALS AND METHODS: A total of 40 patients with atrophic posterior (premolar and molar areas) mandibles having 5 to 7 mm of bone height above the mandibular canal and 40 patients with atrophic maxillae having 4 to 6 mm below the maxillary sinus, were randomised according to a parallel group design to receive one to three 5 mm implants or one to three at least 10 mm-long implants in augmented bone at two centres. All implants had a diameter of 5 mm. Mandibles were vertically augmented with interpositional bovine bone blocks and resorbable barriers. Implants were placed after 4 months. Maxillary sinuses were augmented with particulated porcine bone via a lateral window covered with resorbable barriers and implants were placed simultaneously. All implants were submerged and loaded after 4 months with provisional prostheses. Four months later, definitive screw-retained or provisionally cemented metal-ceramic or zirconia prostheses were delivered. Patients were followed up to 1 year post-loading and the outcome measures were prosthesis and implant failures, any complications and peri-implant marginal bone level changes. RESULTS: One maxillary grafted patient dropped out before the 1-year evaluation. In mandibles, 1 grafted patient did not want to go ahead with the treatment because of multiple complications and graft failure, and another grafted patient did not receive his prostheses due the loss of 2 implants. In maxillae, one 5 × 5 mm implant failed with its provisional crown 3 months post-loading. There were no statistically significant differences in prostheses and implant failures. Significantly more complications occurred at both mandibular and maxillary grafted sites: 17 augmented patients were affected by complications versus 8 patients treated with short implants in the mandible (P = 0.0079; difference in proportion = -0.45; 95% CI -0.67 to -0.15), and 5 sinus-lift patients versus none treated with maxillary short implants (P = 0.047; difference in proportion = -0.25; 95% CI -0.44 to -0.06). Patients with mandibular short implants lost on average 0.94 mm of peri-implant bone at 1 year and patients with 10 mm or longer mandibular implants lost 1.03 mm. Patients with maxillary short implants lost on average 0.87 mm of peri-implant bone at 1 year and patients with 10 mm or longer maxillary implants lost 1.15 mm. There were no statistically significant differences in bone level changes up to 1 year between short and longer implants in maxillae (mean difference -0.28 mm, 95% CI -0.56 to 0.01, P = 0.051) and in mandibles (mean difference -0.09 mm, 95% CI -0.26 to 0.08, P = 0.295). CONCLUSIONS: One year after loading, 5 × 5 mm implants achieved similar results compared to longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation especially in posterior mandibles since the treatment is faster, cheaper and associated with less morbidity, however 5 to 10 years of post-loading data are necessary before making reliable recommendations. CONFLICT-OF-INTEREST STATEMENT: MegaGen partially supported this trial and donated implants and prosthetic components used in this study, whereas Tecnoss donated the biomaterials. The data belonged to the authors and by no means did the manufacturers interfere with the conduct of the trial or the publication of its results.


Asunto(s)
Pérdida de Hueso Alveolar/cirugía , Aumento de la Cresta Alveolar/métodos , Implantes Dentales , Materiales Dentales/química , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Implantes Absorbibles , Adulto , Anciano , Anciano de 80 o más Años , Sustitutos de Huesos/uso terapéutico , Calcio/química , Implantación Dental Endoósea/métodos , Fracaso de la Restauración Dental , Retención de Dentadura , Dentadura Parcial Provisoria , Femenino , Estudios de Seguimiento , Humanos , Masculino , Membranas Artificiales , Aleaciones de Cerámica y Metal/química , Persona de Mediana Edad , Nanoestructuras/química , Complicaciones Posoperatorias , Propiedades de Superficie , Titanio/química , Resultado del Tratamiento , Circonio/química
16.
Eur J Oral Implantol ; 5(2): 149-61, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22866291

RESUMEN

PURPOSE: To evaluate whether 5 × 5 mm dental implants with a novel nanostructured calcium-incorporated titanium surface could be an alternative to at least 5 × 10 mm-long implants placed in bone augmented with bone substitutes in posterior atrophic jaws. MATERIALS AND METHODS: Forty patients with atrophic posterior (premolar and molar areas) mandibles having 5 to 7 mm of bone height above the mandibular canal and 40 patients with atrophic maxillae having 4 to 6 mm below the maxillary sinus, were randomised according to a parallel group design to receive one to three 5 × 5 mm implants or one to three at least 5 × 10 mm-long implants in augmented bone at two centres. Mandibles were vertically augmented with interpositional bovine bone blocks and resorbable barriers and implants were placed after 4 months. Maxillary sinuses were augmented with particulated porcine bone via a lateral window covered with resorbable barriers and implants were placed simultaneously. All implants were submerged and loaded after 4 months with provisional prostheses. Four months later, definitive screw-retained or provisionally cemented metal-ceramic or zirconia prostheses were delivered. Outcome measures were prosthesis and implant failures as well as any complication. RESULTS: Patients were followed to 4 months post-loading with the exception of one patient who underwent mandibular augmentation and had multiple complications at and after grafting, and subsequent graft failure, who did not want to go ahead with the treatment. This case was considered a complete failure. There were no statistically significant differences in prosthesis and implant failures. In mandibles, apart from the complete graft failure, one 5 × 10 mm implant failed at placement of the provisional prosthesis. In maxillae, one 5 × 5 mm implant failed with its provisional crown 3 months after loading. All complications occurred before loading. Significantly more intra- and postoperative complications occurred at both mandibular and maxillary grafted sites: 16 augmented patients were affected by complications versus 8 patients treated with short implants in the mandible (P = 0.022; difference in proportion = 0.40; CI 95% 0.12 to 0.68), and 5 sinus-lifted patients versus none treated with maxillary short implants (P = 0.047; difference in proportion = 0.25; CI 95% 0.06 to 0.44). CONCLUSIONS: Short-term data (4 months after loading) indicate that 5 × 5 mm implants achieved similar results compared to longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation especially in posterior mandibles since the treatment is faster, cheaper and associated with less morbidity. However, 5 to 10 years of post-loading data are necessary before making reliable recommendations.


Asunto(s)
Pérdida de Hueso Alveolar/cirugía , Aumento de la Cresta Alveolar/métodos , Sustitutos de Huesos , Implantes Dentales , Diseño de Prótesis Dental , Fracaso de la Restauración Dental , Titanio , Adulto , Anciano , Anciano de 80 o más Años , Pérdida de Hueso Alveolar/rehabilitación , Aumento de la Cresta Alveolar/efectos adversos , Diente Premolar , Calcio , Implantación Dental Endoósea , Implantes Dentales/efectos adversos , Prótesis Dental de Soporte Implantado , Dentadura Parcial Fija , Femenino , Regeneración Tisular Guiada Periodontal , Humanos , Arcada Parcialmente Edéntula/rehabilitación , Arcada Parcialmente Edéntula/cirugía , Masculino , Persona de Mediana Edad , Diente Molar , Nanoestructuras , Elevación del Piso del Seno Maxilar/efectos adversos , Propiedades de Superficie
17.
Eur J Oral Implantol ; 5(1): 19-33, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22518377

RESUMEN

PURPOSE: To evaluate whether 6 mm-long by 4 mm-wide dental implants could be an alternative to at least 10 mm-long implants placed in bone augmented with bone substitutes in posterior atrophic jaws. MATERIALS AND METHODS: Twenty patients with bilateral atrophic mandibles and 20 patients with bilateral atrophic maxillae, having 5 to 7 mm of bone height above the mandibular canal or below the maxillary sinus, were randomised according to a split-mouth design to receive one to three 6 mm-long and 4 mm-wide implants or at least 10-mm long implants in augmented bone at two centres. Mandibles were vertically augmented with interpositional equine bone blocks and resorbable barriers, and implants were placed after 3 months. Maxillary sinuses were augmented with particulated porcine bone via a lateral window and implants were placed simultaneously. All implants were submerged and loaded, after 4 months, with provisional prostheses. Four months later, definitive screw-retained metal-ceramic prostheses were delivered. Outcome measures were prosthesis and implant failures, any complication, time needed to fully recover mental nerve function (only for mandibular implants) and patient preference. RESULTS: All screened patients had sufficient bone width to support 4 mm-diameter implants. Patients were followed up to 5 months post-loading and none dropped out. There were no statistically significant differences in graft, implant or prosthesis failures, though significantly more intra- and postoperative complications occurred at grafted sites. Fourteen complications occurred in 12 patients at augmented sites versus none at short implants. All complications occurred before loading. Three complications were associated with the failure of the mandibular grafts (15%), determining the failures of 3 implants in one patient and 2 prostheses could not be delivered. One patient was re-grafted and 2 patients received short implants instead. Apart from those complications associated with graft failures, there were 4 perforations of the sinus membrane during sinus lifting and 7 temporary lower lip paraesthesiae lasting up to 4 days with no long-term consequences for the patients. All maxillary implants and prostheses were successful. All 20 patients treated with mandibular implants and 15 patients treated with maxillary implants preferred short implants, whereas 5 patients treated with maxillary implants described both procedures as equally acceptable. These differences were statistically significant. CONCLUSIONS: Short-term data (5 months after loading) indicate that 6 mm-long implants with a conventional diameter of 4 mm achieved similar if not better results than longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation, especially in posterior mandibles since the treatment is faster, cheaper and associated with less morbidity. However, 5- to 10-year post-loading data are necessary before making reliable recommendations.


Asunto(s)
Aumento de la Cresta Alveolar/métodos , Implantes Dentales , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Mandíbula/cirugía , Maxilar/cirugía , Implantes Absorbibles , Adulto , Anciano , Anciano de 80 o más Años , Atrofia , Sustitutos de Huesos/uso terapéutico , Coronas , Implantación Dental Endoósea/métodos , Retención de Prótesis Dentales , Fracaso de la Restauración Dental , Femenino , Estudios de Seguimiento , Supervivencia de Injerto , Humanos , Arcada Parcialmente Edéntula/rehabilitación , Arcada Parcialmente Edéntula/cirugía , Masculino , Mandíbula/patología , Maxilar/patología , Aleaciones de Cerámica y Metal/química , Persona de Mediana Edad , Prioridad del Paciente , Proyectos Piloto , Complicaciones Posoperatorias , Elevación del Piso del Seno Maxilar/métodos , Resultado del Tratamiento
18.
Clin Oral Implants Res ; 22(10): 1125-1130, 2011 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-21251081

RESUMEN

BACKGROUND: Rehabilitation of partially or totally edentulous posterior mandible with implant-supported prosthesis has become a common practice in the last few decades, with reliable long-term results. The use of miniscrews and miniplates have been reported to increase the risk of fracture of the osteotomy segments. The purpose of this case series was to use an inlay technique, without the use of miniscrews and miniplates for stabilization of the transported bone fragments. MATERIALS AND METHODS: Nine consecutive patients (six men and three women) aged between 26 and 51 years (mean 44 years) were enrolled in this study. A horizontal osteotomy was performed 2-3 mm above the mandibular canal, and two oblique cuts were made using a piezosurgery device. The final phase of the osteotomy was performed with chisels. The osteotomized segment was then raised in the coronal direction, sparing the lingual periosteum. Two miniblocks of xenograft without miniscrews and miniplates were inserted mesially and distally between the cranial osteotomized segment and the mandibular basal bone. The residual space was filled with particles of cortico-cancellous porcine bone. Four months after surgery, a panoramic X-ray was taken before implant insertion. A bone trephine with an internal diameter of 2 mm was used as the second dental drill to take a bone core biopsy during preparation of the #35 and #37 or #45 and #47 implant sites. RESULTS: The postoperative course was uneventful in seven of the nine patients. No dehiscence of the mucosa was observed at the marginal ridge of the mobilized fragment. Newly formed bone was present near the osteotomized segments, and was observed in the bottom half of the specimens and was identified by its higher affinity toward the staining. Newly formed bone was observed to be in close contact with the particles of biomaterials. No gaps or connective tissue were present at the bone-biomaterial interface. Histomorphometry demonstrated that 44±2.1% of the specimens was composed by newly formed bone, 18±0.8% by marrow spaces, and 33±2.4% by the residual grafted biomaterial. CONCLUSION: The rigidity of the equine collagenated block allowed to eliminate the use of miniscrews and miniplates and simplified the technique. Moreover, the rigidity of the block allowed maintenance of the space.


Asunto(s)
Aumento de la Cresta Alveolar/métodos , Trasplante Óseo/métodos , Arcada Parcialmente Edéntula/rehabilitación , Mandíbula/cirugía , Adulto , Animales , Femenino , Humanos , Arcada Parcialmente Edéntula/diagnóstico por imagen , Masculino , Mandíbula/diagnóstico por imagen , Persona de Mediana Edad , Osteotomía , Radiografía Panorámica , Porcinos , Trasplante Heterólogo , Resultado del Tratamiento
19.
Eur J Oral Implantol ; 4(4): 329-44, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-22282730

RESUMEN

PURPOSE: To compare the effectiveness of immediate post-extractive single implants with delayed implants placed in preserved sockets after 4 months of healing. Implants that achieved an insertion torque of at least 35 Ncm were immediately non-occlusally loaded. MATERIALS AND METHODS: Just after tooth extraction and in the presence of a loss of the buccal plate bone less than 4 mm, compared to the palatal wall, 106 patients requiring a single immediate postextractive implant in the maxilla from second premolar to second premolar were randomly allocated to immediate implant placement (immediate group; 54 patients) or to socket preservation using anorganic bovine bone covered by a resorbable collagen barrier (delayed group; 52 patients) according to a parallel group design at three different centres. Bone-to-implant gaps were to be filled with anorganic bovine bone, however this was not done in 17 patients (corresponding to 40% of those who should have been grafted). Four months after socket preservation, delayed implants were placed. Implants placed with an insertion torque >35 Ncm were immediately loaded with non-occluding provisional single crowns, replaced, after 4 months, by definitive crowns. Outcome measures were implant failures, complications, aesthetics assessed using the pink esthetic score (PES), and patient satisfaction, recorded by blinded assessors. All patients were followed up to 4 months after loading. RESULTS: Nineteen (35%) implants were not immediately loaded in the immediate group versus 39 (75%) implants in the delayed placement group because an insertion torque >35 Ncm could not be obtained. No patient dropped out. Two implants failed in the immediate group (4%) versus none in the delayed group. More minor complications occurred in the immediate group (8) than the in the delayed group (1) and this was statistically significant (P = 0.032). At delivery of definitive crowns, 4 months after loading, aesthetics were scored as 12.8 and 12.6 in the immediate and delayed groups, respectively. There was no statistically significant difference (P = 0.5). Patients of both groups were equally satisfied. CONCLUSIONS: There were more complications at immediate post-extractive implants when compared to delayed implants. The aesthetic outcome appears to be similar for both groups and it seems more difficult to obtain a high insertion torque in sockets preserved with anorganic bovine bone.


Asunto(s)
Implantación Dental Endoósea/métodos , Implantes Dentales de Diente Único , Carga Inmediata del Implante Dental , Maxilar/cirugía , Alveolo Dental/cirugía , Implantes Absorbibles , Adulto , Anciano , Aumento de la Cresta Alveolar/métodos , Matriz Ósea/trasplante , Sustitutos de Huesos/uso terapéutico , Colágeno , Coronas , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Estética Dental , Femenino , Estudios de Seguimiento , Humanos , Masculino , Membranas Artificiales , Persona de Mediana Edad , Minerales/uso terapéutico , Satisfacción del Paciente , Complicaciones Posoperatorias , Extracción Dental , Torque , Resultado del Tratamiento
20.
Eur J Oral Implantol ; 3(4): 297-305, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-21180682

RESUMEN

PURPOSE: To compare the efficacy of two different techniques for maintaining the space beneath a maxillary lining lifted using a lateral window approach: rigid synthetic resorbable barriers versus granular anorganic bovine bone. MATERIALS AND METHODS: Ten partially edentulous patients having bilaterally 1 to 5 mm of residual bone height and at least 5 mm bone width below the maxillary sinuses, were randomised in a split-mouth study design, to receive a rigid Inion GTR Biodegradable Membrane System barrier without any graft on one side and 100% loosely packed granular Bio-Oss on the contralateral side following a lateral window, two-stage, sinus lift procedure. After 6 months, two or three implants were inserted at each side and submerged for 4 months. Implants were loaded with provisional acrylic prostheses and replaced, after 4 months, by definitive metal-ceramic prostheses cemented with provisional cement. Outcome measures were implant and prosthetic failures, any complication and peri-implant marginal bone level changes assessed by a blinded outcome assessor. All patients were followed up to 1 year after loading. RESULTS: One patient dropped out after implant placement. One distal implant failed at the Inion side just before delivery of the definitive prosthesis, which was cut and maintained as a single crown. Four complications occurred in three patients at Inion sites (two sinus lining perforations, one fracture of the ceramic cusp of the definitive prosthesis, one iatrogenic peri-implantitis) versus two complications at Bio-Oss sites (one sinus lining perforation and one iatrogenic peri-implantitis). There were no differences for failures or complications between groups; however, in one of the patients where a perforation occurred at the Inion site, at implant placement, the sinus was filled two-thirds with soft tissue and the site was retreated with Bio-Oss. There were no statistically significant differences in bone loss between groups. One year after loading, Inion sides lost an average of 1.5 mm of periimplant bone and Bio-Oss sides about 1.7 mm. CONCLUSIONS: A bone graft may not be needed to augment atrophic maxillary sinuses since it is sufficient to keep space with a rigid barrier; however, it may be simpler to fill sinuses with a bone substitute than positioning a rigid barrier to maintain space.


Asunto(s)
Aumento de la Cresta Alveolar/métodos , Matriz Ósea/trasplante , Sustitutos de Huesos/uso terapéutico , Regeneración Tisular Guiada Periodontal/métodos , Maxilar/cirugía , Seno Maxilar/cirugía , Implantes Absorbibles , Adulto , Pérdida de Hueso Alveolar/etiología , Implantación Dental Endoósea , Implantes Dentales , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Dentadura Parcial Provisoria , Femenino , Estudios de Seguimiento , Regeneración Tisular Guiada Periodontal/instrumentación , Humanos , Enfermedad Iatrogénica , Arcada Parcialmente Edéntula/rehabilitación , Arcada Parcialmente Edéntula/cirugía , Masculino , Membranas Artificiales , Aleaciones de Cerámica y Metal/química , Persona de Mediana Edad , Minerales/uso terapéutico , Membrana Mucosa/lesiones , Periodontitis/etiología , Proyectos Piloto , Complicaciones Posoperatorias , Resultado del Tratamiento
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