Long-term assessment (5 to 71 months) of endosseous dental implants placed in the augmented maxillary sinus.

BACKGROUND: It is not uncommon for the placement of endosseous dental implants in the maxillary posterior jaw region to be complicated by the pneumatization of the maxillary sinus. When this occurs, the residual bone between the floor of the sinus and the crestal ridge is inadequate for the placement of implants. The sinus lift procedure provides a way to increase the amount of available bone and the placement of longer implants. METHODS: One hundred twenty (120) implants were placed in 45 augmented maxillary sinuses. Patients ranged in age from 34 to 78 years. The implant design included a limited number of non-hydroxyapatite (HA)-coated titanium screws, with the majority of the implants being HA-coated cylinders, grooved cylinders, and screws. The augmentation materials were autogenous bone, allogenic bone (demineralized freeze-dried bone allograft, DFDBA), alloplastic bone (HA), combination grafts of HA and DFDBA, and combination grafts of autogenous bone and DFDBA. All the cases were successfully restored with implant-supported, bar-retained overdentures or fixed partial dentures. The follow-up began at Stage 2 uncovering and ranged from 5 to 71 months, with a mean of 38.2 and standard deviation of 14.6 months. RESULTS: Three (2.5%) of the 120 implants failed between the period of implant placement and 36 months. Failures appeared to be associated with a history of smoking. Other complications encountered during the study are presented. Implant survival was higher in those placed in grafted sinuses (97.5%) than in those placed in the posterior maxilla without sinus grafting (90.3%). CONCLUSION: These findings support the use of implants placed in augmented sinuses to support dental prostheses.

The influence of preoperative antibiotics on success of endosseous implants at 36 months.

The benefits of prophylactic antibiotics are well recognized in dentistry. However, their routine use in the placement of endosseous dental implants remains controversial. As part of the comprehensive Dental Implant Clinical Research Group (DICRG) clinical implant study, the preoperative or postoperative use of antibiotics, the type used, and the duration of coverage were left to the discretion of the surgeon. These data for 2,973 implants were recorded and correlated with failure of osseointegration during healing (Stage 1), at surgical uncovering (Stage 2), before loading the prosthesis (Stage 3), and from prosthesis loading to 36 months (Stage 4). The results showed a significantly higher survival rate at each stage of treatment in patients who had received preoperative antibiotics.

Dental and medical considerations of patients with renal disease.

Often a dentist will have a patient with a complicated medical condition that needs to be considered when providing treatment. Following is an in-depth discussion of the medical and dental considerations of patients with renal disease.

The influence of preoperative antibiotics on success of endosseous implants up to and including stage II surgery: a study of 2,641 implants.

According to the American College of Surgeons, complex oral surgical procedures, including the transoral placement of endosseous implants, are of the type that may require prophylactic antibiotics. However, the routine use of prophylactic antibiotics in the field of dental implantology continues to be controversial, and their utilization varies widely. No data from a randomized prospective clinical study of the prophylactic use of antibiotics in implant surgery have been previously published. As part of the comprehensive Dental Implant Clinical Research Group clinical implant study, the preoperative or postoperative use of antibiotics, the type used, and the duration of coverage was left to the discretion of the surgeon. These data were recorded and correlated with failure of osseointegration during healing (stage I) and at stage II surgery (uncovering). The results showed that significantly fewer failures occurred when preoperative antibiotics were used.

Large mucous retention phenomenon (mucocele) of the upper lip. Case report and review of the literature.

An unusual presentation of a mucocele of the upper lip has been described. Differential diagnosis, clinical presentation, histology, and treatment were discussed.

The influence of maxillary sinus augmentation on the success of dental implants through second-stage surgery.

An interim evaluation of the status of 102 implants placed in 42 augmented sinuses in 27 patients involved in an alternate category of the Dental Implant Clinical Research Group's long-term, randomized, prospective clinical investigation is presented. Autogeneic, allogeneic, and alloplastic sinus grafts were used, individually or mixed. Through second-stage surgery, 101 implants were found to be integrated. The mean Periotest value at uncovering was -3.36, with a standard deviation of 4.19. The results suggest that root form implants placed in augmented sinuses are successful through second-stage surgery, regardless of the augmentation material or implant design used.

Corrected cast for implant-supported prosthesis: segmental matrix pickup.

A modification of a segmental framework matrix technique for fabrication of an implant-supported prosthesis is presented. A direct "pickup" procedure creates a master cast with intraorally verified accuracy. Proximal contacts and interocclusal relationships are also recorded.

Small cell carcinoma of the lung metastatic to the wall of a radicular cyst.

This case report details the unusual presentation of small cell carcinoma at the periapex of a maxillary left lateral incisor. The initial clinical presentation was that of a symptomatic, nonhealing, well-circumscribed radiolucency about the periapex of the tooth. The biopsy specimen submitted by the endodontist was diagnosed as small cell carcinoma. This report stresses the need for submission of all tissue removed from the oral cavity for histopathological examination.

Proliferative myositis of the head and neck. Report of a case and review of the literature.

A case of proliferative myositis arising in the tongue is described. Light and electron micrographs revealed the characteristic infiltrative growth pattern and cellular pleomorphism of this lesion. A review of the literature disclosed 50 reported cases of proliferative myositis, including 10 that originated in the head and neck. The rapid growth rate and unusual gross and histologic appearance of this infiltrative lesion have contributed to its relatively frequent misdiagnosis and inappropriate treatment. Consequently it is hoped that this report will help clarify its benign nature.

Rapidly enlarging ulcerated lesion of the maxilla.

This report describes a mixed tumor of the left maxilla. The lesion showed rapid growth, 5 years after excision of a mixed tumor from the left side of the hard palate. The extent of the lesion indicates an aggressive tumor that requires close follow-up.

Bilateral redundant mucosal tissue of the upper lip.

A case of a double lip malformation, an uncommon oral anomaly, has been presented. Differential diagnosis and indications for treatment were discussed. This case represents a congenital form of double lip that became of esthetic and functional concern to the patient after the loss of his remaining teeth.

Bilateral gingival swellings in the mandibular canine-premolar areas.

A bilateral occurrence of gingival cyst of the adult has been presented. A comparison of the gingival cyst and lateral periodontal cyst indicates that these lesions may represent intraosseous and extraosseous counterparts. Criteria for differentiation of the two similar lesions were presented. Because not all lesions are clinically apparent, the frequency of occurrence of this cyst may be underestimated.

Rapidly enlarging gingival mass.

A case of small cell carcinoma metastatic to the mandible has been detailed. The lesion involved both hard and soft tissues and it was impossible to determine the site to which it first spread. Because of the histological similarity to the primary lung lesion and evidence of metastatic spread to other body organs, this lesion was considered to be metastatic rather than a primary tumor. The importance of accurate diagnosis was discussed, and treatment options were presented.

Slow-growing, ulcerated mass of the left posterior hard palate.

The importance of a thorough oral and paraoral examination of all patients, with appropriate follow-up of abnormalities, cannot be overstated. The prognosis of any malignant lesion is improved if diagnosis and treatment are rendered early. This patient had an obvious lesion of the hard palate, 4 1/2 years before definitive diagnosis. When the lesion was first noted, prompt diagnostic evaluation may have discovered the malignant process. The lengthy delay in appropriate treatment for this patient has resulted in a potentially tragic outcome.

Slowly enlarging, asymptomatic mass in the upper lip.

A case of monomorphic adenoma, basal cell variant, is described. The clinician should be aware of this tumor and its histological differential diagnosis so that patients may be treated appropriately.