The impact of anatomic, patient and surgical factors on membrane perforation during lateral wall sinus floor elevation.

OBJECTIVES: This retrospective study aimed to evaluate the influence of anatomical, patient and surgical factors on the occurrence of membrane perforation (MP) during lateral window sinus floor elevation (LWSFE). MATERIAL AND METHODS: A review of LWSFE patient records between 2014 and 2019 accounted for MP occurrence, window surface area (WSA), intravenous sedation use, osteotomy instrument type and clinician experience. Preoperative cone beam computed tomography (CBCT) scans were analyzed for lateral wall thickness (LWT), LFM and LAM angles formed between lateral and medial walls at the floor and anterior wall, respectively, sinus width at 5-, 10- and 15-mm (LM-5, LM-10 and LM-15) from the floor, residual bone height (RBH), sinus pathologies, septa and arterial anastomoses. The generalized estimating equation (GEE) approach with a sandwich variance-covariance estimator was used to evaluate the associations with MP. RESULTS: MP occurred in 25.74% of 202 LWSFE procedures (166 patients). Mean 1.6 mm-LWT, 3.2 mm-RBH, 95°-LFM, 75.5°-LAM, 12 mm-LM-5, 20.79% septa, 16.83% arterial anastomosis, 37.62% sinus pathology and 29.21% intravenous sedations, 85.24% WSA ≥ 40 mm2 and 57% >10 procedures/clinician were reported. Greater MP rates were encountered as follows: 38.3% (LWT ≥ 1.5 mm), 38% (LFM < 90°), 59.6% (LAM < 70°), 45.4% (LM-5 < 10 mm) and 36.4% (WSA ranged > 80 mm2 ), with statistically significant associations with all these outcomes (p < .05). The presence of pathologies was also associated with MP (p = .013). Associations between MP and the presence of septa and arterial anastomoses, age/gender, right/left sinus, RBH, clinician's experience, instrument type and intravenous sedation use could not be demonstrated. CONCLUSIONS: MP is significantly associated with thicker lateral walls, narrower sinuses, larger windows and existing sinus pathology.

Patient-reported outcomes of palatal donor site healing using four different wound dressing modalities following free epithelialized mucosal grafts: A four-arm randomized controlled clinical trial.

BACKGROUND: The aim of this study was to compare the effects of four different commonly used wound dressings in improving patient reported outcomes (PROMS) after free epithelialized mucosal grafts (FEGs) harvesting. METHODS: Following 72 FEGs harvesting from 72 patients, patients were assigned into four groups. CONTROL: collagen plug + sutures (CPS); test: collagen plug with cyano-acrylate (CPC), platelet rich fibrin (PRF) + sutures, or palatal stent only (PS). Patients were observed for 14 days, with evaluation of pain level utilizing the visual analog scale, number of analgesics consumed, need for additional analgesics, amount of swelling, amount of bleeding, activity tolerance, and willingness for retreatment. RESULTS: Compared to the control group all test groups indicated significant lower pain perception (P < 0.0001), lower analgesic consumption (P < 0.0001), and higher willingness for retreatment (P < 0.0001), while no statistically significant differences among test groups were observed. There were no statistically significant differences in amount of day-by-day swelling, bleeding, and activity tolerance among four groups. Compared to other groups, the PS had the lowest overall pain scores (over the 14-day period). Palatal thickness, graft length, graft width, and graft thickness did not appear to affect patient morbidity (P > 0.05). CONCLUSIONS: All interventions significantly decreased pain perception compared to a hemostatic collagen sponge alone over the palatal donor site after FEG surgery. In the first few days after surgery, the use of a palatal stent seemed to be associated with less overall pain, pain pills consumed, and higher willingness of doing the same procedure again.

The effect of bone particle size on the histomorphometric and clinical outcomes following lateral ridge augmentation procedures: A randomized double-blinded controlled trial.

BACKGROUND: The aim of this randomized clinical trial was to clinically and histologically compare the amount and quality of bone gained after lateral ridge augmentation (LRA) procedures performed using small-particle (SP)-size (250-1000 µm) versus large-particle (LP)-size (1000-2000 µm) size corticocancellous bone allografts at 6 months following surgical intervention. METHODS: Twenty-two patients, each presenting with ridge width <5 mm were enrolled. Patients were randomly allocated to SP- and LP-size graft. The gain in ridge width at the level of the crest and 4 mm apical to the crest was assessed via a standardized procedure before grafting and at time of implant placement, using a surgical caliper and a novel digital technique using cone-beam computed tomography (CBCT). Six months following the procedure, trephine bone cores were taken from 19 augmented sites of 17 patients (14/19 sites were in the posterior mandible) who completed the study for clinical, histologic, and histomorphometric analysis. RESULTS: Seventeen patients (19 sites) completed the study. An LP-size graft resulted in greater ridge width gain at the level of the crest (LP 5.1 ± 1.7; SP 3.7 ± 1.3 mm; p = 0.0642) and 4 mm apical to the crest (LP 5.9 ± 2.2; SP 5.1 ± 1.8 mm; p = 0.4480) compared with the SP. No statistical significance for the bone density at the time of implant placement (p = 1.00) was found. Vital bone formation was more extensive in the SP compared with the LP (41.0 ± 10.1% vs. 31.4 ± 14.8%, respectively; p = 0.05). CONCLUSION: The results of the present study show a trend of higher ridge gain using LP during the bone augmentation procedure. Future research with bigger sample size should confirm the results of the present research.

Choosing the Ideal Implant-Supported Prosthesis for an Edentulous Maxilla: Three Key Prosthetic Parameters.

Assessment of patient- and prosthetic-specific factors in identifying the ideal implant-supported prosthesis helps enable the delivery of a dental restoration that can meet the esthetic, functional, physiologic, psychologic, financial, and time goals of the patient. For practitioners, determining the relative risks and benefits of removable and fixed implant-supported prostheses for restoration of an edentulous maxilla can be challenging. Proper treatment selection requires thorough examination, diagnosis, and a systematic approach to treatment planning. Consideration of both prosthetic and surgical outcomes is necessary to ensure the restoration of facial structures and oral function. This article discusses three prosthetic parameters essential to determining whether a patient's needs can be best met with a fixed or removable prosthesis: prosthetic space, lip support, and transition line. Standardized treatment planning considerations are presented to facilitate the clinician's step-by-step diagnostic and decision-making processes.

Is the degree of physiological bone remodeling a predictive factor for peri-implantitis?

BACKGROUND: The amount of initial physiological bone remodeling (IPBR) after implant placement varies and the ways it may play a role in peri-implantitis development remains unknown. The aim of this retrospective study was to investigate the association between the amount of IPBR during the first year of implant placement and incidence of peri-implantitis as well as the pattern of progressive bone loss. METHODS: Clinical and radiographic documentation of implants at the time of implant placement (T0), 1 year ± 6 months after crown placement (T1), and at a ≥2-year follow-up from implant placement (T2) were retrospectively collected. IPBR was defined as the bone loss occurring from implant placement to the end of the bone remodeling (T1). Cases were grouped into those diagnosed with (test) or without peri-implantitis (PIm) (control). Linear regression model under generalized estimation equation approach was estimated to assess correlation between marginal bone loss (MBL) rates in both periods (T1-T0) and (T2-T1). Receiver operating characteristics curve was estimated to explore an optimal cut-off point of T1-T0 MBL to discriminate between PIm and no-PIm implants. RESULTS: A total of 45 patients receiving 57 implants without PIm and 40 with PIm were included. There were no associations between PIm and IPBR (p > 0.05), nor between BML of (T2-T1) and (T1-T0). However, arch and total follow-up showed significant influence on the probability of PIm. Splinted implants showed an MBL rate of 0.60-mm/year higher than non-splinted implants (p < 0.001) from T1 to T2. CONCLUSION: No statistically significant association was found between IPBR and incidence of peri-implantitis.

Management of a Large Artery During Maxillary Sinus Bone Grafting: A Case Report.

INTRODUCTION: Branches of the posterior superior artery (PSA) are often found within the lateral wall of the maxillary sinus. Most vessels are small and laceration of the blood vessel during sinus augmentation is not uncommon. Such lacerations can result in intra-surgical bleeding complicating the augmentation procedure, otherwise they are typically non-life threatening. The purpose of the present case report is to document a maxillary sinus floor augmentation procedure involving displacement of large artery from its bony canal using a piezoelectric device. CASE PRESENTATION: A maxillary sinus floor augmentation procedure was performed in a 58-year-old healthy female planned for a future implant supported fixed prosthesis. The preoperative computed tomography scan revealed a bony canal within the lateral maxillary sinus wall of the alveolar ridge. The artery tracing obvious on the lateral wall was elevated along with the Schneiderian membrane without any complication or hemorrhage using a piezoelectric device system. The postoperative healing was uneventful. CONCLUSION: Elevation of a large diameter PSA branch with the Schneiderian membrane significantly minimizes the risk of vessel laceration and hemorrhagic complications.

Extraction Socket Grafting and Ridge Augmentation Failures Associated with Clindamycin Antibiotic Therapy: A Retrospective Study.

PURPOSE: The aim of this retrospective study was to determine if penicillin allergy and/or clindamycin therapy may contribute to a higher incidence of postsurgical infections after bone augmentation. MATERIALS AND METHODS: This retrospective study analyzed patients between 2014 and 2019 who received bone augmentation procedures (socket grafting [SG]; ridge augmentation [RA]) prior to placement of dental implants. All the grafting procedures were performed under preoperative and postoperative oral antibiotic coverage with either amoxicillin or clindamycin for patients who reported penicillin allergy. Infections associated with the bone augmentation procedures were recorded. RESULTS: In this study, 1,814 patients received 2,961 bone augmentation procedures (2,530 SG, 431 RA). In the 2,530 SG procedures, 270 (10.7%) were associated with a penicillin allergy. Infections occurred in 91 of the 2,530 SG sites (3.6%). However, the infection rate was 10.7% (29 SG sites) for clindamycin and only 2.7% (62 SG sites) for amoxicillin (P < .02). In the 431 RA procedures, 71 (16.5%) were associated with a penicillin allergy. Overall infections occurred in 31 of the 431 sites (7.2%). However, the infection rate was 22.5% (16 RA sites) for clindamycin and only 4.2% for amoxicillin (15 RA sites; P < .01). Penicillin-allergic patients taking clindamycin demonstrated a higher risk of infection with a risk ratio of 6.9 (95% CI) and 4.5 (95% CI) compared with nonallergic patients taking amoxicillin for RA and SG, respectively. CONCLUSION: Penicillin allergy and the use of clindamycin following SG and RA procedures was associated with a higher rate of infection and may be a risk factor for bone augmentation complications.