Maintenance of soft tissue closure following guided bone regeneration: technical considerations and report of 723 cases.

The purpose of this paper is to present simple clinical techniques which have been utilized in a significant number of consecutive cases to maintain primary closure throughout the course of regeneration. The maintenance of soft tissue primary closure following guided bone regeneration (GBR) therapy, while considered a considerable challenge, is recognized as contributing to the maximization of therapeutic results. A retrospective analysis of the maintenance of such soft tissue primary closure following the utilization of specific mucoperiosteal flap designs during GBR surgery in 723 consecutively treated cases was carried out. Soft tissue closure was maintained over the membranes for the course of regeneration (a minimum of 6 months) in 695 cases (96.1%). The maintenance of soft tissue primary closure following GBR therapy may be predictably attained through proper surgical planning, technical care, and appropriate postoperative management.

Bone regeneration over a poorly-positioned implant to correct an esthetic deformity: a case report.

Guided tissue regeneration was employed to effect regeneration of a disfigured edentulous ridge, with a poorly positioned implant in place. Demineralized freeze dried bone and an expanded polytetrafluoroethylene membrane were utilized and resulted in growth of new, bone-like material in both a bucco-lingual and apico-occlusal dimension, totally submerging the unusable implant.

A comparison of the success of root resected molars and molar position implants in function in a private practice: results of up to 15-plus years.

BACKGROUND: When faced with a furcated molar, today's clinician must decide between a number of treatment options, including root resection, tooth removal, and implant placement. This paper assesses the results in one private clinical practice of root resection and subsequent restoration or molar implant placement and subsequent restoration. Clinical considerations in treatment selection are discussed. METHODS: A retrospective analysis of treated patients was carried out by examining active and inactive patient charts. When patients had discontinued therapy, every effort was made to determine the reason for leaving the private practice, so as to assess the impact of previously undocumented treatment failure on the statistics in question. RESULTS: A total 701 root resected molars and 1,472 molar implants were evaluated after > or = 15 and 13 years in function, respectively. Resection of the distal root of a mandibular molar demonstrated the lowest success rate (75%). All other success rates for various root resected molars in function ranged from 95.2% to 100%. Lone standing implants in second molar positions demonstrated the lowest success rate (85%). All other implant use in molar positions demonstrated a success rate ranging from 97.0% to 98.6%. Root resected molars and molar implants demonstrated the highest degree of failure when they were lone standing terminal abutments. Seven out of 23 (30.4%) root resected molar failures, and 17 of 45 (37.8%) of the molar implant failures were associated with untreated parafunction. Cumulative success rates were 96.8% for root resected molars and 97.0% for molar implants. Success and failure are discussed by tooth and/or implant position, and resected root, where applicable. Possible ramifications of these findings upon treatment planning are also reviewed. CONCLUSIONS: Both molar root resection and appropriate restoration and molar implant placement and restoration demonstrated a high degree of success in function. However, this success rate is markedly affected when either the root resected molar or molar implant is a lone standing terminal abutment. Care must be taken to choose the appropriate treatment modality for a given patient scenario.

A classification system for sinus membrane perforations during augmentation procedures with options for repair.

A classification system for sinus membrane perforations encountered during a sinus augmentation procedure is presented. Five of the perforations are discussed, as are the therapeutic options for their repair. Class I and Class II perforations are most easily repaired, while Class IV is the most difficult to successfully treat. In addition, the effect of the sinus membrane perforation on the course of proposed therapy is discussed. When classified and managed appropriately, sinus membrane perforations are not an absolute indication for aborting the augmentation procedure which is in progress. This paper provides a system of classification that can be used by clinicians to collect data on membrane perforations and repair results.

Success and failure rates of cylinder implants in type IV bone.

It is well documented that implant success rates are much lower in Type IV bone than in Types I, II, and III. However, all of these studies have reported on the use of screw type implants. The present study demonstrates the efficacy of cylinder implant use in Type IV bone. A total of 513 cylinders were placed in Type IV bone and were followed for 0 to 60+ months in function. The absolute success rate was 95.7%. Of the 22 fixture failures encountered, 8 were discovered at the time of second stage surgery, 3 during the first year following uncovering, and 11 occurred after 24 to 36 months in function. A possible rationale for the higher success rate of cylinders as compared to that reported for screw type implants in Type IV bone is presented. Further well-controlled studies directly comparing various implant designs in a range of bony sites are needed to better understand and to fully document the differences suggested by the present study.

Success and failure rates of osseointegrated implants in function in regenerated bone for 6 to 51 months: a preliminary report.

Six hundred twenty-six titanium plasma-sprayed cylindrical implants that had been functioning in regenerated bone for a period of up to 51 months were evaluated according to Albrektsson's criteria. These implants had been placed either with concomitant guided bone regeneration procedures or in bony ridges that had previously been augmented. According to Albrektsson's criteria, absolute success rates of 97.6% overall, 98.8% in the maxilla, and 98.2% in the mandible were recorded, as were cumulative success rates of 94.9% in the maxilla and 91.9% in the mandible. The overall cumulative success rate was 93.8%. One patient, who underwent protracted chemotherapy 14 months after implant function began, accounted for 33% (3 of 9) of the total implant loss in the study. If this patient is excluded from the study, the cumulative success rates are 94.9% (maxilla), 96.7% (mandible), and 95.8% (overall). These findings support the theory that regenerated bone will achieve osseointegration with titanium plasma-sprayed cylindrical implants, and that this osseointegration can be maintained under function over time.

The use of demineralized laminar bone sheets in guided bone regeneration procedures: report of three cases.

Demineralized laminar bone sheets were utilized as membranes to affect guided bone regeneration around five implants in two patients and to perform a ridge augmentation procedure in one patient. In all cases, significant regeneration of hard tissues occurred, and no complications were encountered. The regenerated hard tissues have been in function for up to 32 months with no clinical signs of breakdown.

Report of 302 consecutive ridge augmentation procedures: technical considerations and clinical results.

Three hundred two consecutive ridge augmentation procedures (289 in a buccolingual and 13 in an apico-occlusal direction) were performed in 284 patients. Gore-Tex membranes of various configurations were used in conjunction with various nonautogenous particulate materials. Two hundred ninety-one of the augmented ridges (279 buccolingual and 12 apico-occlusal augmentations) demonstrated sufficient regenerated hard tissues for implant placement in ideal prosthetic positions. This represents an overall "success" rate of 96%, 97% for horizontally augmented ridges and 92% for vertically augmented ridges. A total of 574 implants were placed in the augmented ridges; 346 of these implants have subsequently been uncovered and restored. Seven implants failed to achieve osseointegration, and three implants (in one patient) were lost in function, for an overall survival rate of 97% for the uncovered implants.

Sinus floor augmentation at the time of maxillary molar extraction: technique and report of preliminary results.

A technique is described for accomplishing both localized sinus augmentation and guided bone regeneration at the time of maxillary molar extraction. One hundred nine sites were treated in 92 patients. Of these, 102 procedures (94.0%) were successful and 7 (6.0%) were partially successful. Success was defined as the ability to ideally position an implant at least 10 mm in length and 4.8 mm in width without perforating the floor of the sinus or generating an implant fenestration or dehiscence. Partially successful procedures required an additional osteotome sinus lift at the time of implant placement.

Ridge augmentation with titanium screws and guided tissue regeneration: technique and report of a case.

A technique is described for augmenting an edentulous ridge buccally with a mixture of freeze-dried bone and resorbable tricalcium phosphate covered with a Gore-Tex membrane. Titanium screws are used to prevent the collapse of the regenerative materials. In the patient described, the buccolingual dimensions of the edentulous mandibular ridge more than doubled, thus allowing the placement of two implant cylinders. The rationale for such a procedure is discussed.

Maintenance of regenerated bone beneath pontics: preliminary clinical report of 43 sites.

Ridge augmentation was achieved through the use of guided bone regeneration procedures in pontic areas of 43 planned fixed prostheses. Measurements taken through templates, which fit over the final fixed prostheses, at the time of prosthetic placement and a mean of 123 weeks after prosthesis placement demonstrated a change of less than 0.1 mm in buccopalatal dimensions of the regenerated hard tissues.

Long-term success of sinus augmentation using various surgical approaches and grafting materials.

Two hundred twenty-two sinus augmentation procedures were performed using one of three techniques: crestal approach; lateral approach; or lateral approach with simultaneous implant placement. Forty-one of these sinus augmentation procedures were performed in conjunction with buccolingual ridge augmentation. Of the 222 procedures, 217 (97.7%) were successful. Of 510 implants placed in augmented sinus areas, 495 (97.0%) were deemed successful by the criteria of Albrektsson et al for up to 73 months in function. Clinical considerations in the execution of such therapy are discussed.

Implant/tooth-connected restorations utilizing screw-fixed attachments: a survey of 3,096 sites in function for 3 to 14 years.

Numerous problems have been reported following various therapies used to attach natural teeth to implants beneath a fixed prosthesis. This study documents the results of 843 consecutive patients treated with 1,206 natural tooth/implant-supported prostheses utilizing 3,096 screw-fixed attachments. After 3 to 14 years in function, only 9 intrusion problems were noted. All problems were associated with fractured or lost screws. This report demonstrates the efficacy of such a treatment approach when a natural tooth/implant-supported fixed prosthesis is contemplated.

The use of IMZ osseointegrated implants in partially and completely edentulous patients: success and failure rates of 2,023 implant cylinders up to 60+ months in function.

A total of 974 patients were treated with 2,023 IMZ implants. A variety of prosthodontic designs were utilized. These included replacement of single teeth, use as pier abutments, and for totally implant-supported prostheses. The implants were followed in function for 6 to 60+ months. Absolute success rates were 96.4% and 98.4% in the maxilla and mandible, respectively. Cumulative success rates at the end of the study were 92.9% and 95.8% in the maxilla and mandible, respectively. The use of an intramobile element is also discussed.

The bone-added osteotome sinus floor elevation technique: multicenter retrospective report of consecutively treated patients.

A retrospective clinical evaluation of patients consecutively treated from multiple centers was performed. The treatment of these patients utilized the bone-added osteotome sinus floor elevation (BAOSFE) procedure with immediate implant fixation. The BAOSFE method employs a specific set of osteotome instruments to tent the sinus membrane with bone graft material placed through the osteotomy site. A total of 174 implants was placed in 101 patients. Implants were of both screw and cylinder shapes with machined, titanium plasma-sprayed, and hydroxyapatite surfaces from various manufacturers. The 9 participating clinicians used autografts, allografts, and xenografts alone or in various combinations, and the type of graft was selected by the individual clinicians. The choice of graft material did not appear to influence survival rates. Loading periods varied from 6 to 66 months. The survival rate was 96% or higher when pretreatment bone height was 5 mm or more and dropped to 85.7% when pretreatment bone height was 4 mm or less. The most important factor influencing implant survival with the BAOSFE was the preexisting bone height between the sinus floor and crest. This short-term retrospective investigation suggests that the BAOSFE can be a successful procedure with a wide variety of implant types and grafting procedures.

Periodontal restorative interrelationships: the isolated restoration.

Only by controlling plaque early and consistently, before periodontal and restorative problems require intervention in the form of a full prosthetic and periodontal reconstruction, the continued maintenance of a full dentition is assured. Plaque control is not merely continued prophylaxes, but a striving for a healthy biologic situation with the placement of every restoration. This is attainable only through ensuring a normal attachment apparatus and establishing that all restorative margins be accessible to plaque control measures. Deep, subgingival restorations are not only difficult to place and finish correctly, but, by providing an environment conducive to microbial plaque retention and proliferation, also lead to inflammatory periodontal destruction and recurrent carious lesions. Early detection, although difficult, is essential to avoid excessive destruction of the tooth and its supporting structures. A deterrent to early detection may be the response of the patient's tissue. Paradoxically, if the patient's periodontal tissues respond in a fibrotic manner to early gingival inflammation, rather than in a dramatic, edematous manner, the situation may appear clinically healthy. Waerhaug discussed "submarginal gingivitis," a situation in which the tissue will appear pink and firm, elicit to exudate or bleeding on probing, and mimic healthy to the casual examiner. When this is coupled with the difficulty inherent in detecting early recurrent carious lesions, resulting from the radiographic superimposition of the existing restoration or the deep subgingival extent of the restoration, the situation becomes all the more demanding of the practitioner's efforts.

Immediate implant placement and GBR in humans: a case report and histologic evaluation.

An IMZ titanium plasma-sprayed implant was placed at the time of removal of a fractured mandibular left first premolar. Porous hydroxyapatite (Interpore 200) was placed on one side of the residual defect around the implant, and the entire defect was covered with a Gore-Tex membrane. The implant, with surrounding newly reformed hard tissues, was removed in a block section 13 months postoperative. Histologic examination demonstrated regeneration of living bone tissues, the attainment of osseointegration, and incorporation of the Interpore 200 into surrounding bone.

Maxillary sinus grafting with and without simultaneous implant placement: technical considerations and case reports.

Maxillary sinus grafting with demineralized freeze-dried human cortical bone and resorbable tricalcium phosphate is discussed in three different situations: when minimal bone remains coronal to the sinus (crestal approach); when between 1 and 4 mm of bone remains coronal to the sinus (lateral approach); and when greater than 4 mm of bone remains coronal to the sinus (lateral approach with simultaneous implant placement). Cases that demonstrate all three situations are presented.

Guided bone regeneration around titanium implants: report of the treatment of 1,503 sites with clinical reentries.

Guided bone regeneration procedures were carried out around 1,503 implants, including 237 that were noted in a previous publication, using Gore-Tex membranes over demineralized freeze-dried bone allograft, freeze-dried bone allograft, an equal combination of these, or demineralized freeze-dried bone allograft combined with equal parts of resorbable tricalcium phosphate. Comparison of findings at the time of clinical reentry and preoperative photographs and measurements yielded an overall success rate of 97.0% in the treatment of dehisced or fenestrated implants or fixtures placed in immediate extraction sockets. Success was defined as the presence of regenerated hard tissue covering all previously exposed implant surfaces (complete success) or as the presence of two threads or 2 mm or less of residual dehiscence (partial success).