Flapless Piezotome Crest Split Achieves Comparable Outcomes to Autologous Onlay Grafts With Significant Less Patient Morbidity and Complications-A Randomized Clinical Study.

PURPOSE: In the management of the narrow alveolar ridge, the flapless piezotome crest split (FPCS) technique with horizontal distraction was introduced as an alternative to lateral alveolar ridge augmentation using autologous bone block grafting (ABBG). The study purpose was to measure and compare the alveolar crest width and complications between FPCS and ABBG. MATERIALS AND METHODS: We implemented a nonblinded, randomized clinical trial. The sample included patients requiring lateral alveolar ridge augmentation before implant insertion. The predictor variable was lateral alveolar ridge augmentation performed using ABBG (control group) or FPCS using an ultrasonic surgical device (Piezotome II or Piezotome CUBE; Acteon, Norwich, UK) and specific crest split working tips (test group). The primary outcome variable was the overall coronal crest width achieved after completed healing measured at 6 months using 3-dimensional imaging studies. Other study variables included the postoperative morbidity, staged using the Universal Pain Assessment Scale, complications, and surgery duration. Descriptive and bivariate statistics were computed using SPSS, version 22.0 (IBM Corp, Armonk, NY), and P ≤ .05 was considered to indicate statistical significance. RESULTS: The sample included 567 patients treated with ABBG (56.1% female; age, 64.1 ± 20.2 years) and 562 treated with FPCS (57.2% female; age, 62.3 ± 18.2 years). The baseline crest width in the control and test groups was 2.1 ± 0.5 mm and 1.9 ± 0.4 mm, respectively. The final crest width achieved with ABBG and FPCS was 5.8 ± 0.8 mm and 6.5 ± 0.7 mm, respectively (P > .05). Statistically significant differences (P < .05) were found between the ABBG and FPCS groups in the postoperative complication rate, morbidity, and operative time, all in favor of FPCS. CONCLUSIONS: FPCS seems to be a significantly less traumatic alternative to buccal onlay grafting with autologous bone blocks, providing a comparable or better net gain in the alveolar crest width with a significantly shorter operative time and less postoperative morbidity.

Descriptive retrospective study analyzing relevant factors related to dental implant failure

BACKGROUND: The objective of this retrospective descriptive study was to analyze the characteristics of incident reports provided by dentists while using a specific brand of dental implants. MATERIAL AND METHODS: The study was carried out in collaboration with Oxtein Iberia S.L.(R), with the company providing access to the incident database in order to evaluate the characteristics of incidents from January 2014 to December 2017 (a total of 917 over four years). The data sheet recorded different variables during each of the stages of implant treatment, from initial implant placement to subsequent prosthetic rehabilitation. These variables included age, sex, systemic pathologies, smoking habits, bone quality, implant type, prosthesis type, and type of load applied, among others. SPSS Statistics was used to perform statistical analysis of the qualitative variables (univariate logistic regressions, χ2 test, Haberman's adjusted standardized residuals). RESULTS: The total study sample consisted of 44,415 implants shipped from Oxtein (R) warehouses on the dates indicated, of which 917 implants (2.1%) were flagged due to reports of lack of primary stability, failed osseointegration, or implant failure within one year of placement. When analyzing incident reports, it was observed that 61.6% of incidents occurred in male patients, compared to 38.4% in female patients. The average age of patients in the reported cases was 56.12 ± 12.15 years. A statistically significant correlation was discovered between incidents of implant failure and tobacco use, diabetes, heart disease, poor oral hygiene, previous infection, poor bone quality, and bruxism (p < 0.05). A (statistically significant) higher rate of incidents was also observed in tapered, internal connection, Grade IV titanium, narrow, and short implants. CONCLUSIONS: Analysis of these implants reveals a higher rate of complication in short, tapered, internal connection and narrow-diameter implants. These data can help and encourage clinicians to use the utmost surgical precautions when placing these implants

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Histological and histomorphometric study using an ultrasonic crestal sinus grafting procedure. A multicenter case study

BACKGROUND: The aim of this study was to evaluate the efficacy of a hydrodynamic ultrasonic driven transcrestal sinus grafting procedure (Intralift (R), Acteon Company, Bordeaux, France) and the use of a bovine high temperature sintered grafting material in sinus sites with less than 5 mm remaining bone height with no additional autogenous bone in order to create a sufficient recipient site for implants. MATERIAL AND METHODS: 12 patients (16 sinus) in this multicenter case study were included. Using a crestal approach, bone under the sinus was prepared with ultrasonic tips until the Schneiderian membrane was reached. With a trumpet shaped instrument, the Schneiderian membrane was elevated. In the new created subantral space a high temperature sintered bovine grafting material was introduced (Bego Oss, BEGO Implant Systems GmbH & Co. KG, Bremen, Germany). After 6 months biopsies were taken with a trephine bur and histologies were generated following histomorphometric analysis. RESULTS: The results showed new vital bone in average of 33.4% ± 17.05%, and 43.6% ± 16.70 of bone substitute material. No signs of abnormal inflammation were observed. CONCLUSIONS: This procedure (Intralift (R)) allows, using a bovine material with no additional autogenous bone, new bone formation in the sinus in order to allow place implant subantraly

Primary implant stability in augmented sinuslift-sites after completed bone regeneration: a randomized controlled clinical study comparing four subantrally inserted biomaterials.

Implant-Insertion-Torque-Value (ITV) proved to be a significant clinical parameter to predict long term implant success-rates and to decide upon immediate loading. The study evaluated ITVs, when four different and commonly used biomaterials were used in sinuslift-procedures compared to natural subantral bone in two-stage-implant-procedures. The tHUCSL-INTRALIFT-method was chosen for sinuslifting in 155 sinuslift-sites for its minimal invasive transcrestal approach and scalable augmentation volume. Four different biomaterials were inserted randomly (easy-graft CRYSTAL n = 38, easy-graft CLASSIC n = 41, NanoBone n = 42, BioOss n = 34), 2 ccm in each case. After a mean healing period of 8,92 months uniform tapered screw Q2-implants were inserted and Drill-Torque-Values (DTV) and ITV were recorded and compared to a group of 36 subantral sites without need of sinuslifting. DTV/ITV were processed for statistics by ANOVA-tests. Mean DTV/ITV obtained in Ncm were: Control Group 10,2/22,2, Bio-Oss 12,7/26,2, NanoBone 17,5/33,3, easy-graft CLASSIC 20,3/45,9, easy-graft CRYSTAL 23,8/56,6 Ncm, significance-level of differences throughout p < 0,05. Within the limits of this study the results suggest self-hardening solid-block-like bone-graft-materials to achieve significantly better DTV/ITV than loose granulate biomaterials for its suspected improvement of vascularization and mineralization of the subantral scaffold by full immobilization of the augmentation site towards pressure changes in the human sinus at normal breathing.

Schneiderian membrane detachment using transcrestal hydrodynamic ultrasonic cavitational sinus lift: a human cadaver head study and histologic analysis.

PURPOSE: Recent studies have suggested the osteogenic layer of the periosteum at the base of the sinus membrane to play a key role in bone regeneration after sinus lift procedures. Thus, atraumatic detachment of the sinus membrane with an intact periosteum seems mandatory. The present histologic study of fresh human cadaver heads investigated the detachment behavior and histologic integrity of the detached periosteum after application of the transcrestal hydrodynamic ultrasonic cavitational sinus lift (tHUCSL-INTRALIFT). MATERIALS AND METHODS: A total of 15 sinuses in 8 fresh human cadaver heads were treated using tHUCSL-INTRALIFT. After surgery, they were checked macroscopically for damage to the sinus membrane and then processed for histologic inspection under light microscopy. A total of 150 histologic specimens, randomly selected from the core surgical sites, were investigated using hematoxylin-eosin (HE), Azan, and trichrome staining. RESULTS: None of the 150 inspected specimens showed any perforation or dissection of the periosteum from the subepithelial connective tissue and respiratory epithelium and were fully detached from the bony antrum floor. The connecting Sharpey fibers revealed to be cleanly separated from the sinus floor in all specimens. CONCLUSIONS: The results of the present study suggest tHUCSL-INTRALIFT should be used to perform predictable and safe detachment of the periosteum from the bony sinus floor as a prerequisite for undisturbed and successful physiologic subantral bone regeneration.

Rupture length of the sinus membrane after 1.2 mm puncture and surgical sinus elevation: an experimental animal cadaver study.

OBJECTIVES: To evaluate the rupture length of the sinus membrane after applying a defined 1.2 mm defect comparing 3 different techniques: Summers lift, balloon-assisted technique (BASL), and hydrodynamic ultrasonic cavitational sinus lift (HUCSL). STUDY DESIGN: Thirty fresh sheep heads (60 maxillary sinuses) were investigated. The sinus membrane was ruptured using a 1.2 mm pilot drill. Then Summers lift, BASL, and HUCSL were each performed on 20 sinuses, creating a 5 mm vertical lift of the sinus membrane. The length of the ruptured sinus membrane was measured before and after the experiment. The results of the different sinus lift techniques were compared using t tests. RESULTS: The t test showed that the Summers lift leads to a significantly higher rupture length (P = .05) than BASL. The comparison between Summers lift and HUCSL showed a significantly higher rupture length with the Summers lift (P < .005). The same significance (P < .005) was found when BASL was compared with HUCSL. Comparing the increasing rupture length of the sinus membrane during the experiment, the t test showed a significantly greater rupture using BASL or the Summers lift compared with HUCSL. CONCLUSIONS: The HUCSL technique yielded the lowest increase of rupture length compared with BASL and Summers lift. The technique therefore shows the lowest risk of a growing rupture of the sinus membrane in case of an iatrogenic puncture during preparation of the transcrestal approach.

Hydrodynamic ultrasonic sinus floor elevation--an experimental study in sheep.

PURPOSE: The aim of the present study was to evaluate the pressure forces appearing to elevate the sinus membrane by comparing the hydraulic and pneumatic pressure. Also, the relation between the time and volume of the applied liquid and the achieved lift-volume were determined. MATERIALS AND METHODS: A total of 190 fresh, half sheep heads were used for the present investigation. An ultrasound surgical device (Piezotome; Acteon, Bordeaux, France) was tested to evaluate the pressure increase at different flow rates. The elevation volume at different flow rates and activation times of the ultrasound hand piece were measured. RESULTS: To detach the sinus membrane pneumatically from the sinus floor, a mean average pressure of 29.54 millibars was required. Using the hydraulic technique, a mean average pressure of 19.8 millibars was determined. Comparing the different flow rates, the elevated volume increased to 0.52 mL when a flow of 60 mL/minute was used. Using an activation time of 20 seconds, a lifted volume of 3.92 mL could be measured on average. If the flow was set to a maximum of 60 mL/minute, the created volume increased to 5.58 mL. A comparison using the chi(2) test showed a significant correlation (P = .03) between the application time and the created sinus lift volume. Even at high flow rates of 60 mL/minute of the activated Piezotome for a 20-second period, no rupture of the sinus membrane of the sheep heads occurred in 190 experiments. CONCLUSION: From these results, we have concluded that hydrodynamic ultrasound could be used as an alternative method for sinus floor elevations of any size and volume with a mere 3-mm-diameter transcrestal approach, if findings from clinical investigations confirm the results of the present animal study.