Augmentation procedures for deficient edentulous ridges, using onlayautologous grafts: An update

The purpose of this review was to analyze publications related to augmentation procedures using autologous onlaygrafts and to evaluate the survival/success rates of implants placed in the augmented areas. An automated searchwas made in Medline, of clinical publications from 2002 to 2007, including at least 5 patients and with a minimumfollow-up of 6 months. Ten papers were included. These suggested that grafts are indicated when the height of thealveolar crest is less than 5mm, or the width less than 4mm. The surface resorption of grafts protected by guidedbone regeneration membranes was less than for unprotected grafts. Calvarial grafts suffered less resorption thandid iliac grafts. The healing period of the graft until implant placement was, in most cases, 4-6 months. The mostfrequent complications in the recipient site were wound dehiscences. Prosthetic loading time was, in almost allpatients, 3 months after implant placement. Implant survival rate ranged from 97.1% to 100%. Although , due tothe difficulty in finding homogenous studies, the sample is small, we can conclude that autologous onlay blockbone grafts are an effective procedure for alveolar crest augmentation; graft surface resorption is reduced whenthe grafts are protected by regeneration membranes; few complications arise from the procedure; and the successrate for implants placed in the reconstructed area is between 89.5 and 95.7% (AU)

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Oral rehabilitation with bone graft and simultaneous dental implants in a patient with epidermolysis bullosa: a clinical case report.

Epidermolysis bullosa (EB) represents a group of mainly hereditary skin disorders, manifested by an exceptional tendency of the skin and mucosa to form bullae and vesicles after minor friction and trauma. Oral features include repeated blistering, scar formation, elimination of buccal and vestibular sulci, and alveolar bone resorption. The use of endosseous implants in the fixed prosthetic rehabilitation of patients with recessive dystrophic EB might provide a considerably better outcome than conventional removable prosthetic methods. This clinical report describes the fixed rehabilitation with 2 implants placed simultaneously with bone graft in a partially edentulous patient diagnosed with recessive dystrophic EB. The implants, with simultaneous bone graft, were placed to decrease the number of surgical operations required, avoiding soft tissue ulcerations and discomfort in the patient. This treatment option appears to be favorable for recessive dystrophic EB patients compared with other options involving removable prostheses, which irritate the oral mucosa.

Augmentation procedures for deficient edentulous ridges, using onlay autologous grafts: an update.

The purpose of this review was to analyze publications related to augmentation procedures using autologous onlay grafts and to evaluate the survival/success rates of implants placed in the augmented areas. An automated search was made in Medline, of clinical publications from 2002 to 2007, including at least 5 patients and with a minimum follow-up of 6 months. Ten papers were included. These suggested that grafts are indicated when the height of the alveolar crest is less than 5mm, or the width less than 4mm. The surface resorption of grafts protected by guided bone regeneration membranes was less than for unprotected grafts. Calvarial grafts suffered less resorption than did iliac grafts. The healing period of the graft until implant placement was, in most cases, 4-6 months. The most frequent complications in the recipient site were wound dehiscences. Prosthetic loading time was, in almost all patients, 3 months after implant placement. Implant survival rate ranged from 97.1% to 100%. Although , due to the difficulty in finding homogenous studies, the sample is small, we can conclude that autologous onlay block bone grafts are an effective procedure for alveolar crest augmentation; graft surface resorption is reduced when the grafts are protected by regeneration membranes; few complications arise from the procedure; and the success rate for implants placed in the reconstructed area is between 89.5 and 95.7%.

Inflammatory implant periapical lesion: etiology, diagnosis, and treatment--presentation of 7 cases.

PURPOSE: To investigate implant periapical lesions, and to describe their treatment. The hypothesis of this evaluation is that implant periapical lesions are disorders of the area surrounding the apex of a dental implant, and that their etiology can be multifactorial (ie, vascular impairment, vascular ischemia, overheating of bone during drilling, and implant surface contamination). The diagnosis is based on the clinical manifestations and x-ray findings. The x-ray findings usually involve a periapical radiotransparency. MATERIALS AND METHODS: Seven patients with implant periapical lesions (3 in the upper jaw, and 4 in the mandible) after implant placement are described. All patients reported pain, and 3 suffered from inflammation. Upon percussion, the 3 nonsubmerged implants produced a dull sound, with no mobility. A panoramic x-ray study showed periapical transparencies around 5 implants, whereas in 1 case, computed tomography showed a maxillary sinus reaction. The diagnosis was acute apical peri-implantitis (nonsuppurative in 2 cases, and suppurative in 5 cases). RESULTS: The clinical manifestations did not subside with antibiotics. In all cases, treatment consisted of implant periapical surgery, after which the symptoms disappeared. The radiotransparencies showed progressive resolution. CONCLUSION: The possibility of implant periapical lesions must be taken into account. A rapid diagnosis should be established to treat the lesions at an early stage, hence preventing the need for implant extraction.

Immediately restored dental implants for partial-arch applications: a study of 12 cases.

PURPOSE: To study the success of immediate loading in partial-arch applications and to evaluate the level of patient satisfaction. MATERIALS AND METHODS: We treated 12 partially edentulous patients, placing 36 implants and rehabilitating them with screw-retained bridges on the same day. The level of satisfaction with the provisional prosthesis was evaluated on a visual analog scale. RESULTS: One implant failed during the osteointegration period, yielding a success rate of 97.2%. Of the 12 provisional prostheses, 1 was removed as a result of this loss. The patients' assessment of functional and esthetic levels was high (mean scores on visual analog scale, 7.1 and 8.3, respectively). CONCLUSION: Immediate restoration of teeth in partial-arch applications provides an esthetic and functional solution with a high success rate.

Comparative study of wide-diameter implants placed after dental extraction and implants positioned in mature bone for molar replacement.

OBJECTIVE: The aim of this study was to compare wide-diameter implants placed in mature bone versus implants inserted in postextraction bone. MATERIAL AND METHODS: A retrospective case study was made; the sample was composed of subjects who had had wide implants placed in the molar area between 2003 and 2005. Two groups were formed: implants placed in mature bone and implants in postextraction bone. A protocol was prepared in which patient age, sex, oral hygiene, implant length, type of prosthesis, and antagonist dentition were collected. After 12 months, data relating to the clinical and radiologic conditions of the implants and the success rate (criteria of Buser et al) were recorded. A statistical analysis of the variables was made (t test, Pearson correlation coefficient, analysis of variance, chi-square). RESULTS: The study examined 162 implants placed in 100 patients. Of the 162 implants, 130 were placed in mature bone and 32 in postextraction bone. Four implants placed in mature bone failed in 4 patients (success rate of 96.9%). None of the implants placed in postextraction bone failed. CONCLUSIONS: The placement of wide-diameter implants in recent molar extraction sites has been shown to achieve similar results to implants placed in healed mature bone after 12 months of follow-up, within the limitations of this study.

Immediately restored dental implants for partial-arch applications. A literature update.

This article carries out a literature update on immediately restored dental implants in partially edentulous patients. A search was made in Medline of all articles published between the year 2000 and February 2007, including all articles published in both English and Spanish, in which immediate restoration of implants was made of partially edentulous areas with a minimum of 12 implants and six months follow-up. Certain decisive factors exist for the success of this technique in partially edentulous patients, such as primary stability, a roughened implant surface, and the absence of parafunctional habits in patients acceptable for this type of treatment. Following the analysis of these studies of immediate restoration of teeth in partially edentulous areas, a weighted mean survival of 95.39% was observed. In spite of the high success rate, major controversy still exists on this subject resulting in few studies and short follow-up periods, making the routine use of this technique questionable.

Immediately restored dental implants for partial-arch applications. A literature update

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This article carries out a literature update on immediately restored dental implants in partially edentulous patients. A search was made in Medline of all articles published between the year 2000 and February 2007, including all articles published in both English and Spanish, in which immediate restoration of implants was made of partially edentulous areas with a minimum of 12 implants and six months follow-up.Certain decisive factors exist for the success of this technique in partially edentulous patients, such as primary stability, a roughened implant surface, and the absence of parafunctional habits in patients acceptable for this type of treatment.Following the analysis of these studies of immediate restoration of teeth in partially edentulous areas, a weighted mean survival of 95.39% was observed. In spite of the high success rate, major controversy still exists on this subject resulting in few studies and short follow-up periods, making the routine use of this technique questionable (AU)

Resonance frequency analysis of dental implant stability during the healing period.

PURPOSE: The objective of the present study was to measure the implant stability quotient (ISQ) values during the osseointegration period, and determine the factors that affect implant stability. MATERIALS AND METHODS: To measure implant stability, resonance frequency analysis (RFA) was performed in 24 patients (12 women, 12 men) with a total 64 Defcon implants (10 anterior maxilla, 12 posterior maxilla, 18 anterior mandible, 24 posterior mandible). Bone type was classified according to the Lekholm and Zarb index (52 type II bone, 12 type III). RFA was used for direct measurement of implant stability on the day of implant placement and consecutively once a week for 8 weeks and at week 10. RESULTS: The mean ISQ of all measured implants was 62.6. The lowest mean stability measurement was at 4 weeks for all bone types (60.9). Gender was found to be significant (p<0.05); women showed higher implant stability than men. In relation to location within the dental arch, statistical analysis showed higher ISQ values for anterior implants than posterior fixtures (p<0.05).

Resonance frequency analysis of dental implant stability during the healing period

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Purpose: The objective of the present study was to measure the implant stability quotient (ISQ) values during the osseointegration period, and determine the factors that affect implant stability. Materials and Methods: To measure implant stability, resonance frequency analysis (RFA) was performed in 24 patients (12 women, 12 men) with a total 64 Defcon® implants (10 anterior maxilla, 12 posterior maxilla, 18 anterior mandible, 24 posterior mandible). Bone type was classified according to the Lekholm and Zarb index (52 type II bone, 12 type III). RFA was used for directmeasurement of implant stability on the day of implant placement and consecutively once a week for 8 weeks and at week 10. Results: The mean ISQ of all measured implants was 62.6. The lowest mean stability measurement was at 4 weeks for all bone types (60.9). Gender was found to be significant (p<0.05); women showed higher implant stability than men. In relation to location within the dental arch, statistical analysis showed higher ISQ values for anterior implants than posterior fixtures (p<0.05) (AU)

Failure of locoregional anesthesia in dental practice. Review of the literature.

Correct identification of the causes of dental anesthetic failure is essential in order to adopt the required measures for successful anesthesia. A review is made of the factors implicated in locoregional anesthesia failure, such as a bifid inferior alveolar nerve, retromolar foramen associated to accessory innervation, double or accessory mental foramen, the relation between the infiltration technique and bone density, accessory innervation in the case of the mylohyoid nerve and first cervical branches, cross innervation of the incisors, inactivity in the presence of tissue inflammation, inactive anesthetic solutions, an incorrect technique, and subjective perception on the part of particularly anxious patients. The therapeutic options available in the event such problems are encountered in routine clinical practice are commented.

Update in dental implant periapical surgery.

Implant periapical lesions are infectious-inflammatory alterations surrounding an implant apex, and can be caused by a number of situations--including contamination at instrumentation, overheating of bone, and the prior existence of bone pathology. The diagnosis is based on the clinical manifestations and radiological findings, where a radiotransparency can be seen at periapical level. The lesions are classified according to their evolutive stage as either acute (non-suppurated and suppurated) or chronic (or periapical abscess). The management of implant periapical lesions comprises periapical surgery with curettage and irrigation in the acute phase, or implant extraction when the bone surface is affected and/or primary fixation is lost (chronic phase).

Actualización de la cirugía periapical en los implantes dentales / Update in dental implant periapical surgery

La lesión periapical implantaria es una patología infecciosa-inflamatoria localizada alrededor del ápice del implante. Puede ser provocada por diversas causas, entre ellas: la contaminación en el momento de la instrumentación, el sobrecalentamientoóseo y la presencia de una patología preexistente en el hueso. Su diagnóstico es sintomático y radiográfico, y puede observarse una imagen radiolúcida alrededor del periápice. Clasificamos las lesiones según el momento evolutivo en lesión aguda (no supurada y supurada) y crónica o absceso periapical. El tratamiento de esta patología es la cirugía periapical con legrado e irrigación en la fase aguda; y la extracción del implante cuando se involucre la superficie ósea y/o se pierda la fijación primaria (fase crónica)

Implant periapical lesions are infectious-inflammatory alterations surrounding an implant apex, and can be caused by a number of situations – including contamination at instrumentation, overheating of bone, and the prior existence of bone pathology. The diagnosis is based on the clinical manifestations and radiological findings, where a radiotransparency can be seen at periapical level. The lesions are classified according to their evolutive stage as either acute (non-suppurated and suppurated) or chronic (or periapical abscess). The management of implant periapical lesions comprises periapical surgery with curettage and irrigation in the acute phase, or implant extraction when the bone surface is affected and/or primary fixation is lost (chronic phase)

Failure of locoregional anesthesia in dental practice. Review of the literature

Una identificación correcta de la causa de los fracasos en la anestesia dental es esencial con el fin de tomar las medidas adecuadas para conseguir el éxito en la anestesia. En este artículo se revisan los factores implicados en un fallo anestésicocomo son el nervio dentario inferior bífido, el agujero retromolar asociado a una inervación accesoria, el agujero mentoniano doble o accesorio, la relación entre técnica infiltrativa y la densidad ósea, las inervaciones accesorias en el caso del nervio milohioideo y primeras ramas cervicales, la inervación cruzada en los incisivos, la inactividad ante la inflamacióntisular, soluciones anestésicas inactivas, una técnica incorrecta y la subjetividad en los pacientes muy ansiosos. Se comentan las opciones terapéuticas a realizar si se nos plantea uno de estos problemas en la práctica habitual

Correct identification of the causes of dental anesthetic failure is essential in order to adopt the required measures for successful anesthesia. A review is made of the factors implicated in locoregional anesthesia failure, such as a bifid inferior alveolar nerve, retromolar foramen associated to accessory innervation, double or accessory mental foramen, the relation between the infiltration technique and bone density, accessory innervation in the case of the mylohyoid nerve and first cervical branches, cross innervation of the incisors, inactivity in the presence of tissue inflammation, inactive anesthetic solutions, an incorrect technique, and subjective perception on the part of particularly anxious patients. The therapeutic options available in the event such problems are encountered in routine clinical practice are commented

Resonance frequency analysis after the placement of 133 dental implants.

INTRODUCTION: The primary stability of dental implants is related to the bone in contact with the latter, and can be evaluated by resonance frequency analysis. MATERIAL AND METHODS: Measurements were made in 133 implants (62 in the upper jaw and 71 in the mandible) of resonance frequency and insertion force to determine implant stability on the day of surgery, with an evaluation of its relationship to different variables. RESULTS: The stability quotient of the implants on the day of surgery was 62.1, with an insertion force of 35.7 N. The insertion force was proportional to the resonance frequency, with an increasing stability quotient with growing insertion force. The stability quotient was greater in the larger diameter implants, shorter implants, in mandibular placement and in areas of more compact bone. CONCLUSIONS: The stability quotient on the day of implant placement is greater in higher bone density areas.

Estudio del análisis de frecuencia de resonancia tras la colocación de 133 implantes dentales / Resonance frequency analysis after the placement of 133 dental implants

Introducción: La estabilidad primaria del implante dental está relacionada con el hueso que se encuentra en contacto con él y se puede medir mediante el análisis de frecuencia de resonancia. Material y métodos: En 133 implantes (62 en maxilar y 71 en mandíbula) se midió la frecuencia de resonancia y la fuerza de inserción para conocer la estabilidad de los implantes el día de la cirugía, y estudiar su relación con distintas variables. Resultados: El cociente de estabilidad del implante obtenido el día de la cirugía fue de 62’1 y el de la fuerza de inserción fue de 35’7 Nw. La fuerza de inserción fue proporcional al análisis de la frecuencia de resonancia, a mayor fuerza de inserción mayor cociente de estabilidad. El cociente de estabilidad fue mayor en los implantes de diámetro mayor, en longitudes más cortas, en las fijaciones colocadas en mandíbula y áreas de hueso más compacto. Conclusiones: El cociente de estabilidad el día de la colocación de los implantes es mayor en zonas óseas de mayor densidad

Introduction: The primary stability of dental implants is related to the bone in contact with the latter, and can be evaluated by resonance frequency analysis. Material and methods: Measurements were made in 133 implants (62 in the upper jaw and 71 in the mandible) of resonance frequency and insertion force to determine implant stability on the day of surgery, with an evaluation of its relationship to different variables. Results: The stability quotient of the implants on the day of surgery was 62.1, with an insertion force of 35.7 N. The insertion force was proportional to the resonance frequency, with an increasing stability quotient with growing insertion force. The stability quotient was greater in the larger diameter implants, shorter implants, in mandibular placement and in areas of more compact bone. Conclusions: The stability quotient on the day of implant placement is greater in higher bone density areas