Transcrestal sinus lift and implant placementusing the sinus balloon technique

Objective: A description is made of transcrestal sinus lift using the sinus balloon technique, evaluating the bone height achieved and implant success one year after prosthetic loading. Material and method: Between January and July 2007, transcrestal sinus lift using the sinus balloon technique for dental implant placement was carried out in 6 patients. A panoramic X-ray study and maxillary computed tomography scan were carried out before the operation, in order to discard possible sinus pathology. During the intervention, the integrity of the sinus membrane was evaluated using a Medi Pack Pal endoscope (Farol Store and Co., Tuttlingen, Germany), and the intraoperative complications were analyzed. The dental implants were placed in the same surgical step in the presence of 3 mm or more of residual bone. Following the operation, panoramic X-rays were used to assess the bone height gained. One year after prosthetic loading, the implant success rate was determined based on the criteria of Buser. Results: One patient was excluded due to Schneider’s membrane perforation as confirmed by endoscopy. Transcrestalsinus lift was carried out in 5 males with a mean age of 41.6 years (range 27-51), without antecedents of sinus disease. There were no intraoperative complications. In four patients the implants were placed simultaneous to sinus lift, while in another case implant placement was postponed due to insufficient remaining bone height. The mean gain in height after the operation was 8.7 mm. One year after prosthetic loading, the implant success rate was 100% (AU)

Rehabilitation of atrophic posterior maxilla with zygomatic implants: review.

The objective of this study was to review the published literature to evaluate treatment success with zygomatic implants in patients with atrophic posterior maxilla. Studies from 1987 to 2010 were reviewed. In each study, the following were assessed: indications for treatment, number of patients, number of implants, length and diameter of the implants, surgical technique, prosthetic rehabilitation, success rate, complications, and patient satisfaction. Sixteen studies were included, with a total of 941 zygomatic implants placed in 486 patients. The follow-up periods ranged from 12 to 120 months. Three different surgical techniques were used to place zygomatic implants: intrasinus implants with the classic sinus window technique, the sinus slot technique, and extrasinus zygomatic implants. The most common restoration used was fixed prosthesis, with either delayed loading after 3-6 months (89%-100% success) or immediate loading (96.37%-100% success). The weighted average success rate was 97.05%, and the most frequent complication was maxillary sinusitis. The general level of patient satisfaction was high. Zygomatic implants have a high success rate and constitute a suitable alternative to treat severe posterior maxillary atrophy.

Transcrestal sinus lift and implant placement using the sinus balloon technique.

OBJECTIVE: A description is made of transcrestal sinus lift using the sinus balloon technique, evaluating the bone height achieved and implant success one year after prosthetic loading. MATERIAL AND METHOD: Between January and July 2007, transcrestal sinus lift using the sinus balloon technique for dental implant placement was carried out in 6 patients. A panoramic X-ray study and maxillary computed tomography scan were carried out before the operation, in order to discard possible sinus pathology. During the intervention, the integrity of the sinus membrane was evaluated using a Medi Pack Pal endoscope (Farol Store and Co., Tuttlingen, Germany), and the intraoperative complications were analyzed. The dental implants were placed in the same surgical step in the presence of 3 mm or more of residual bone. Following the operation, panoramic X-rays were used to assess the bone height gained. One year after prosthetic loading, the implant success rate was determined based on the criteria of Buser. RESULTS: One patient was excluded due to Schneider's membrane perforation as confirmed by endoscopy. Transcrestal sinus lift was carried out in 5 males with a mean age of 41.6 years (range 27-51), without antecedents of sinus disease. There were no intraoperative complications. In four patients the implants were placed simultaneous to sinus lift, while in another case implant placement was postponed due to insufficient remaining bone height. The mean gain in height after the operation was 8.7 mm. One year after prosthetic loading, the implant success rate was 100%. CONCLUSIONS: Transcrestal sinus lift using the sinus balloon technique is a minimally invasive procedure. In 5 patients the bone height gained proved sufficient to allow implant placement even in the presence of 3 mm of residual bone.

Radiographic findings in the maxillary sinus: comparison of panoramic radiography with computed tomography.

PURPOSE: To assess the prevalence of radiographic signs of maxillary sinus pathology in patients undergoing dental implant treatment and to compare the efficacy of panoramic radiography, computed tomography (CT), and three-dimensional (3D) CT with Implametric software in the diagnosis of sinus pathology. MATERIALS AND METHODS: Thirty patients were selected at random from those being treatment-planned to receive implant-supported restorations in the maxilla and who had a panoramic radiograph, a conventional CT scan in acetate, and a 3D CT scan in digital format. The radiographic maxillary sinus findings were categorized as: (1) no sign of pathology, (2) mucosal thickening, (3) mucous cyst, or (4) occupation of the entire sinus. RESULTS: Seventeen women and 13 men were included, with a mean age of 50.9 years. There was a 38.3% prevalence of radiographic abnormalities (23.3% mucosal thickenings, 10% mucous cysts, and 5% occupation of the entire sinus). Of the 23 sinuses that displayed radiographic signs of pathology, only 1 (4.3%) was correctly diagnosed by the panoramic radiograph. CONCLUSIONS: The most common radiographic maxillary sinus finding was mucosal thickening, followed by mucous cysts and occupation of the whole sinus. Conventional CT can be considered a reliable method for the diagnosis of maxillary sinus pathology.

Prevalence, location, and size of maxillary sinus septa: panoramic radiograph versus computed tomography scan.

PURPOSE: To determine the prevalence, location, and size of maxillary sinus septa, and to compare the results of panoramic radiographs and computed tomography (CT) scans. MATERIALS AND METHODS: This study included 30 patients, 17 women and 13 men, with a mean age of 50.9 years (range, 28-73 years), undergoing treatment planning for implant-supported restorations in the maxilla. Three observers analyzed the panoramic radiographs, the conventional CT scans in acetate, and the Implametric 3-dimensional CT (3Dent, Valencia, Spain). The maxillary sinus septa of each patient and the type of septa, as well as its location and size, were recorded. RESULTS: In 60 maxillary sinuses, panoramic radiographs showed 32 septa (53.3%); CT in acetate showed 42 septa (70%); and Implametric 3-dimensional CT showed 40 septa (66.7%). Most septa (60%) were located in the middle region of the maxillary sinus, 22.5% in the posterior region, and 17.5% in the anterior region. The mean height of the septa was 4.78 ± 1.76 mm. Panoramic radiographs led to an erroneous diagnosis in 46.5% of the cases. CONCLUSIONS: Maxillary sinus septa are a frequent anatomic variation. They can be found in any of the maxillary sinus regions independently of patient edentulism. The panoramic radiograph can lead to false-positive and false-negative findings in the visualization of septa in almost half of cases. Therefore, whenever a maxillary sinus lift is planned, a thorough study of the affected sinus should be made using CT.

Clinical characteristics, treatment, and evolution of 89 mucoceles in children.

PURPOSE: The present study was undertaken to evaluate mucoceles in the oral cavity of pediatric patients, including the clinical characteristics, treatment, and progress of the lesions. PATIENTS AND METHODS: A retrospective study was performed from the medical records of patients (0-14 years old) treated for oral mucoceles between 1998 and 2008 in a reference children's hospital. All subjects with mucoceles on lips, mouth, buccal mucosa, and palate were included. The following data were recorded: age, gender, history of trauma, location, size, progression, time before diagnosis, treatment, histologic type, follow-up time, and recurrence. RESULTS: A total of 89 patients (mean age, 6.1 years) participated in this study. There were 89 mucoceles: 4 were congenital; 79.8% were located on the lower lip; and 69% were larger than 5 mm in diameter. Average progression time was 5.7 months (range, 1-24 months). It was observed that older patients developed more mucoceles on the tongue and lips and younger patients developed more mucoceles on the buccal mucosa and palate. The lesions of 39 subjects resolved spontaneously; 50 were removed but 4 reappeared afterward. Histologically, all lesions were extravasation mucoceles. CONCLUSION: Mucoceles were more commonly located on the lower lip; 43.8% resolved spontaneously and 8% of the surgically removed mucoceles reappeared.

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)

The post-endodontic periapical lesion: Histologic and etiopathogenic aspects

Apical periodontitis is produced in the majority of cases by intraradicular infection. Treatment consists in the elimination of the infectious agents by endodontia. Even when carrying out a correct cleansing and filling of canals, it is possible that periapical periodontitis will persist in the form of an asymptomatic radiolucency, giving rise to the post-endodonticperiapical lesion.The chronic inflammatory periapical lesion is the most common pathology found in relation to alveolar bone of the jaw. From the histological point of view, it can be classified as chronic periapical periodontitis (periapical granuloma), radicular cyst, and as scar tissue. The most frequent is the periapical granuloma, constituted by a mass of chronic inflammatorytissue, in which isolated nests of epithelium can be found. The radicular cyst is characterized by the presence of a cavity, partially or wholly lined by epithelium. Scar tissue is a reparative response by the body, producing fibrousconnective tissue.The aim of this study is to review and update the etiopathogenic and histological aspects of chronic post-endodontic periapical lesions