Use of subepithelial connective tissue graft as a biological barrier: a human clinical and histologic case report.

The aim of the present study was to develop a method to study the healing process after gingival grafting and to observe the histologic results after use of the modified edentulous ridge expansion technique. A 47-year-old nonsmoking woman with a noncontributory past medical history affected by edentulism associated with a horizontal alveolar ridge defect was referred to the authors for surgical correction of the deficit to improve implant support and the final esthetics of an implant-borne prosthesis. At the 4-month follow-up visit, a biopsy was performed by a punch technique in the same sites of healing abutment connection. The tissue was elevated from the attached gingival. Clinically, the grafted tissues seemed to be attached to the bone surfaces. The histologic findings revealed dense grafted tissues, providing long-term stability to the area. No ligament or bone, characteristic for periodontal regeneration, were observed. The presence of thick attached keratinized tissue around implants may constitute a protective factor against marginal inflammation or trauma.

A modified edentulous ridge expansion technique for immediate placement of implants: a case report.

This case report is focused on the possibility of treating atrophic ridge with a reduced number of surgical procedures and a reduced healing time. A 43-year-old female patient affected by edentulism associated with horizontal resorption of the ridge was treated by means of a sagittal osteotomy and expansion of the ridge with the new modified edentulous ridge expansion (MERE) technique to obtain a wider bony base for ideal implant placement. In the same procedure 2 implants were placed and connective tissue graft, covering the bony wound, was placed to achieve keratinized mucosa. The implants were placed immediately after the split crest of the ridge and covered by a connective tissue graft. Postoperative recovery was uneventful. Within the limits of this case report, the MERE technique appeared to be reliable and simple, and it reduced morbidity compared with other techniques such as autogenous bone grafts and guided bone regeneration.

Immediate loading of dental implant after sinus floor elevation with osteotome technique: a clinical report and preliminary radiographic results.

Edentulous ridges in the posterior maxilla are often compromised by reduced bone volume. This anatomic condition often limits dental implant placement of 10 mm in length without prior or simultaneous sinus augmentation. The osteotome technique is an alternative and conservative technique for sinus floor augmentation and immediate implant placement in the posterior region of the maxillary jaw. According to the relevant literature, the osteotome technique appears to be a predictable and safe method for augmenting bone at the sinus floor and to improve bone density and quality of the implant site sufficiently so that immediate loading is possible. A 46-year-old male patient was referred to the authors to replace the single upper premolar with an implant-supported crown restoration without interfering with the integrity and topography of the adjacent gingival tissues. Only one clinical study analyzed minimally invasive implant and sinus lift surgery with immediate loading. In that case report, the osteotomy was widened to its final diameter using a series of incrementally larger twist drills. In our clinical case, a series of incrementally larger diameter osteotomes improved bone density. This simplified treatment modality can make single tooth implant rehabilitation of the atrophic premolar maxilla region more accessible, and immediate loading is facilitated by improved bone density.

A modified crestal ridge expansion technique for immediate placement of implants: a report of three cases.

Atrophic edentulous jaws can pose a significant challenge to successful oral rehabilitation with endosseous dental implants. Although ridge augmentation can help to restore ridge volume, grafting procedures can significantly increase patient morbidity, costs, and treatment time, depending on the case, before dental implants can be placed. This article reports on an alternative technique used in 3 patients to expand ridge volume and place dental implants in a single procedure. A partial-thickness flap was elevated to expose the alveolar crest, and conventional implant osteotomies were partially prepared. Along the crest of the ridge, a furrow with terminal vertical releases 1 to 3 mm deep were created, and a bone chisel was used to deepen the furrow. Osteotomes were used to complete preparation of the implant receptor sites, and the implants were placed. Bony plates were stabilized through the use of resorbable sutures. Furrows more than 2 mm deep between the plates were augmented with a xenograft. Collegen membranes were placed over the sites, and soft tissue was sutured. Healing was unremarkable, and all implants were successfully restored. For these patients, the ridge expansion technique resulted in substantial bone reconstruction with little or no grafting. Long-term, prospective studies on this procedure are required before definitive conclusions can be drawn.

Single-tooth replacement in the esthetic zone with ridge expansion osteotomy: a clinical report and radiographic results.

Maxillary alveolar atrophy often limits the placement of dental implants. The bone splitting and bone widening by osteotome technique is a more obvious method for the immediate placement of implants in those cases in which the dimensions of the residual ridge are reduced by only a small degree. Few studies have been performed that are aimed at the radiographic results shown after the osteotome technique by a low-dose computed tomography scan and assessment of objective improvement of the bone density using Misch's classification. The aim of this clinical case was to analyze the radiographic data of the osteotome technique on the change of bone density and to demonstrate efficacy of the ridge expansion crest to bypass bone fenestrations of the buccal plate in the esthetic zone. The advantages of this technique for patients include less surgical trauma and a shorter treatment time.

Modified edentulous ridge expansion technique and immediate implant placement: a 3-year follow-up.

Restoration of the edentulous alveolar ridge with implants often requires the ridge width to be augmented to allow its placement. The aim of this study was to evaluate the split-crest technique, with subepithelial connective tissue graft used as biological barrier, in patients with narrow ridges, focusing on the status of soft and hard tissues and on implant success rate, at 36 months after implant loading. Thirteen patients (6 males and 7 females), ages 32-68 years (mean 49.4 years) with an atrophic maxillary jaw underwent modified edentulous ridge expansion technique for implant placement. A total of 33 Laser-Lok tapered internal implant, were placed in the maxilla. The following parameters were evaluated: (1) initial ridge width (time t0); (2) ridge width at the time of abutment connection (time t1); four months after implants placement, healing abutments were connected and the prosthetic rehabilitation was initiated, and all patients were evaluated clinically and radiographically with periapical radiograph at intervals of 3-6 months for the first year and annually thereafter for 3 years. The ridge width was measured with a cone beam computed tomography. The initial ridge width ranged from 3.5 mm to 7 mm (mean: 4.67 mm), while at the end of the expansion procedure the width ranged from 6.3 mm to 11.0 mm (mean: 8.2 mm). The width gain of the edentulous ridge ranged from 1.45-4.9 mm (mean: 3.5 mm). Two implants became exposed 1 month after surgery. One implant was lost before loading (3%). The diameter of failed implant was 5.8 mm and length was 10.5 mm. The remaining 32 implants were stable and free of complications at the end of the study. Thus, the implant survival rate was 97%. Because no implant failed after loading, the cumulative survival rate of loaded implants was 100%. The minimally invasive regenerative technique presented here avoids the use of bone graft, secondary surgery for soft tissue augmentation, and mechanical expansion devices. However, the follow-up period for outcome evaluation and exiguous patient's number in this series was limited.

Augmentation of atrophic posterior maxilla by short implants and osteotome technique.

UNLABELLED: INTRODUCTION. Edentulous ridge in the posterior maxilla is often compromised by reduced bone volume. This anatomical condition limits the implant placement of 10 mm in length without sinus augmentation. The use of shorter implants with osteotome technique minimizes the need of more extensive sinus floor elevation, thus reducing the duration and morbidity of the treatment. MATERIALS AND METHODS. A prospective study was conducted of all patients treated between Nov 2007 and Nov 2008 who received endosseous implants that were less than 10 mm in length. Patient age, gender, height bone residual of posterior maxilla, location of implants, number and type of implants and Albrektsson criteria for success were assessed. RESULTS: A total of 25 implants of 8 mm in length were placed with primary stability in 11 patients. Cumulative survival rates for implants were 100%. CONCLUSION. This simplified treatment modality can make implant rehabilitation of the atrophic posterior maxilla more accessible.