Assessment of absorbable gelatin sponge for maxillary sinus floor elevation versus anorganic bovine bone minerals: a randomized clinical trial.

PURPOSE: The present study compared the absorbable gelatin sponge as a space-filling material versus anorganic bone bovine mineral (ABBM) in maxillary sinus augmentation with simultaneous endosseous dental implant placement. METHODS: Eighteen maxillary sinus floor elevation cases were randomly allocated into two groups. The first group received ABBM, while the second group received an absorbable gelatin sponge as a space-filling material. For both groups, CBCT scans were obtained immediately postoperatively and six months later to calculate the difference in sinus floor bone gain. Osstell readings were recorded both at the time of implant placement and implant exposure with a total of twenty-three dental implant placements in relation to the eighteen elevated sinus floors. RESULTS: The mean radiographic sinus floor gain in the ABBM group was 10.2 mm (± 2.5), while in the absorbable gelatin sponge group was 5.4 mm (± 2.0), with a mean difference of 4.8, which was statistically significant (p < 0.001). The mean implant stability for the ABBM was 77.3 (± 4.9), while in the absorbable gelatin sponge group was 74.2 (± 3.0), with a mean difference of 3.1, which was statistically insignificant (p = 0.1610). CONCLUSION: The ABBM showed superior results regarding the amount of radiographic sinus floor bone gain. However, the implant stability was invariable between both groups.

Immediate implant placement with platelet rich fibrin as space filling material versus deproteinized bovine bone in maxillary premolars: A randomized clinical trial.

BACKGROUND: Several biomaterials have been suggested to augment the jumping gap during immediate implant placement. PURPOSE: The aim of this study was to compare the effect of xenograft or platelet derived growth factor (PRF) to graft the jumping gap in immediate implant placement in the maxillary premolar region. MATERIALS AND METHODS: Twenty patients underwent atraumatic extraction followed by immediate placement. The patients were equally divided into two groups. The first group received xenograft as a jumping gap filling material. The second group received PRF to graft the jumping gap. All patients received preoperative, immediate postoperative, and 6 months postoperative cone beam CT scan (CBCT). Implant stability quotient ISQ values were taken for the installed implants immediate postoperative and at 6 months. RESULTS: Implants receiving PRF as a jumping gap graft material demonstrated a significantly greater amount of crestal bone loss 1.85 ± 0.89 mm as compared to xenograft group 0.77 ± 0.32 mm (t = 3.52, p = 0.005). PRF group showed significantly greater reduction in buccopalatal direction 1.63 mm as compared to xenograft group 0.59 mm (t = 4014, p <0.001). ISQ values were similar immediately postoperative (t = 0.070, p = 0.945) while the ISQ values were significantly lower in PRF group as compared to xenograft graft at the six-month interval (t = 0.248, p = 0.023). CONCLUSION: The use of xenograft material as a jumping gap filling material resulted in superior results compared to PRF with regards to crestal bone loss, buccolingual socket reduction, and ISQ values.

Socket shield technique vs conventional immediate implant placement with immediate temporization. Randomized clinical trial.

BACKGROUND: Alveolar bone resorption and labial bone plate reduction follow teeth extraction due to the deficiency of blood supply, derived from the loss of periodontal ligaments, and hence the socket shield technique was introduced to preserve the periodontal ligaments related perfusion. PURPOSE: The study aimed to compare the vertical and horizontal changes of the buccal cortical bone plates, encountered after utilizing the socket shield technique with immediate temporization vs an immediate implant placement with immediate temporization, and analyzing the differences of the implant stability and pink esthetic score evaluation between both techniques. MATERIALS AND METHODS: A total of 40 dental implants were placed in the maxillary esthetic zone, 20 implants were placed using the socket shield technique with immediate temporization; the study group and 20 implants were placed immediately with immediate temporization; the control group. All patients received immediate and 6 months postoperative CBCT to assess the dimensional changes in the labial bone plates. Implant stability quotients (ISQs) and pink esthetic scores were measured at the time of implant placement and 6 months postoperatively. RESULTS: The horizontal bone loss; ranged from 0 to0.26 (0.15) mm and 0.03 to0.44 (0.32) mm for the study and control groups, respectively. The vertical bone loss; ranged from 0.11 to 0.55 (0.31) mm and 0.25 to 1.51 (0.7) mm for the study and control groups, respectively. The ISQ for the study group increased from 68.6 ± 3.81 to 76.7 ± 3.49, while in the control group it increased from 66.4 ± 5.64 to 75 ± 4.4. PES for the study group increased from 11 to 12, while in the control group it decreased from 13 to 9. CONCLUSION: The socket shield technique with immediate temporization is a reliable method to reduce the labial bone loss following teeth extraction. However, further studies are required to investigate the effect of grafting the jumping gaps, to evaluate the graft contribution in further reduction of the bone loss.

Horizontal ridge augmentation using native collagen membrane vs titanium mesh in atrophic maxillary ridges: Randomized clinical trial.

BACKGROUND: Several techniques have been proposed to reconstruct deficient alveolar ridges including bone blocks, ridge splitting and guided bone regeneration (GBR). GBR has been successfully established in restoring horizontal bone deficiency. However, yet still there is a debate regarding the ideal barrier for GBR. PURPOSE: To evaluate the quantity and the quality of the bone gained using collagen membrane with 1:1 mixture of autogenous and anoraganic bovine bone mineral compared to titanium mesh with the same mixture of bone for GBR of horizontally deficient maxillary ridges. MATERIALS AND METHODS: Two different grafting techniques were evaluated, 10 patients receiving GBR using native collagen membrane using 1:1 autogenous and anorganic bovine bone mineral (ABBM) bone mixture, and 10 patients receiving GBR using titanium mesh with same mixture of bone. RESULTS: Statistical analysis showed a significant increase in alveolar bone width in both techniques with a mean bone gain of 4.0 mm for Collagen group and 3.7 mm for titanium mesh group. Bone area percent was almost 28% for both groups. For Ti-mesh group, six sites soft tissue healing was uneventfully with no signs of wound dehiscence. However, four cases showed mesh exposure first 3 patients showed this exposure 3 weeks postoperatively while the fourth patient showed exposure 4 months postoperatively. The mean graft resorption in the Collagen and mesh group 6 months postoperative was considered nonsignificant. CONCLUSIONS: GBR with both collagen membrane and titanium mesh using a 1:1 mixture of autogenous and ABBM is a viable technique for horizontal augmentation of deficient maxillary alveolar ridges. Titanium mesh is a more technique sensitive compared to collagen membrane. Soft tissue dehiscence and difficulty during second stage removal should limit its use in augmentation of horizontally deficient maxillary ridges.

Combined bony closure of oroantral fistula and sinus lift with mandibular bone grafts for subsequent dental implant placement.

Sinus lifting and reconstruction of localized alveolar defects are often required after closure of a large oroantral fistula (OAF) to allow for subsequent implant installation. This study describes a combined surgical technique that involves sinus lifting, bony closure, and reconstruction of the alveolar defect at the site of an OAF. The sinus membrane was reconstructed as a continuous layer by combining the residual sinus membrane with a rotated part of oral mucosa around the OAF. Autogenous bone from the chin and/or ramus was grafted into the prepared sinus space and alveolar defect, and the graft was covered by a buccal advancement flap. This technique was used to treat 8 patients who had large OAFs in the posterior maxillary region. The treatment was successful in all cases, and the technique appears to be suitable for large OAFs where implants are subsequently desired.