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Bone Height (bone + height)
Selected AbstractsWhich region of the median palate is a suitable location of temporary orthodontic anchorage devices?CLINICAL ORAL IMPLANTS RESEARCH, Issue 3 200920 years, A histomorphometric study on human cadavers aged 1 Abstract Introduction: Endosseus implants can provide a reliable anchorage during orthodontic treatment. The midpalatal structures around the sutura palatina mediana (SPM) are of special interest due to increasing placement of orthodontic implants in this area. Knowledge about the osseous conditions at this site is necessary to predict the expected degree of implant osseointegration. Methods: The upper jaws of 10 human cadavers, aged 15,20 years, were decalcified, and cross-sectional specimens were obtained from four anterior-to-posterior palatal regions for histomorphometric analysis. The analyses focused on the amount of bone and the width of the SPM to determine the anatomical requirements for reliable insertion of palatal implants. Results: Bone density [bone-volume (BV)/ tissue-volume (TV)] in all measured areas was 40,60%. The maximum density was measured at the level of the first premolars (54.9±5.9%) and the least values (44.2±9.6%) were measured at the level of the interconnecting line of the canines. The mean width of the SPM varies from 1.2 to 0.3 mm in different sections of the palate. In the median sagittal plane, the mean values of bone height to nasal cavity reached >5 mm as far as the level distal of the second premolars. Bone height 2 mm paramedian to the SPM decreased consistently from anterior (4.3±0.9 mm) to posterior (2.5±0.8 mm). Conclusions: Our results indicate that the amount and quality of bone along the anterior palatal midline in 15-to-20-year olds is sufficient for orthodontic implantation. Even implantation posterior to the recommended first premolar level, at which orthodontic implants are most often placed, may be suitable. There are some limitations, however, due to small number of samples and variations of anatomical structures. [source] Classification and sequelae of arrested eruption of primary molarsINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 1 2008INGER KJÆR Aim., The aim of this study was to classify early arrested eruption of primary molars and to analyse and explain the sequelae for the surrounding alveolar bone and the succeeding premolar. Design., The position of the arrested primary molars in the mandible, the height of the local alveolar bone, and the morphology and location of the succeeding premolar were evaluated on radiographs from 29 children. Results., Four groups of arrest from mild to severe with regards to infra-position were categorized (Groups I,IV). Mean ages at the time of referral decreased from Groups I (8 years, 10 months) to Group IV (5 years, 9 months). Sequelae., (i) Reduction of alveolar bone height (Groups I,III); (ii) delayed maturity of the succeeding premolar (two-thirds of the cases); (iii) malformation of the succeeding premolar (mainly Groups III and IV); and (iv) ectopically located premolar occlusal to the retained molar (Group IV). Conclusions., The deeper in the alveolar process a primary molar is retained, the earlier the disturbance in the eruption has occurred, and the greater is the risk of the permanent tooth germ being malformed and malpositioned. It is estimated that the earliest occurrences of arrested eruption of primary molars supposedly occur before the age of 3. [source] Alveolar ridge augmentation using implants coated with recombinant human growth/differentiation factor-5: histologic observationsJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 8 2010Giuseppe Polimeni Polimeni G, Wikesjö UME, Susin C, Qahash M, Shanaman RH, Prasad HS, Rohrer MD, Hall J. Alveolar ridge augmentation using implants coated with recombinant human growth/differentiation factor-5: histologic observations. J Clin Periodontol 2010; 37: 759-768 doi: 10.1111/j.1600-051X.2010.01579.x. Abstract Objectives: In vitro and in vivo preclinical studies suggest that growth/differentiation factor-5 (GDF-5) may induce local bone formation. The objective of this study was to evaluate the potential of recombinant human GDF-5 (rhGDF-5) coated onto an oral implant with a purpose-designed titanium porous oxide surface to stimulate local bone formation including osseointegration and vertical augmentation of the alveolar ridge. Materials and Methods: Bilateral, critical-size, 5 mm, supraalveolar peri-implant defects were created in 12 young adult Hound Labrador mongrel dogs. Six animals received implants coated with 30 or 60 ,g rhGDF-5, and six animals received implants coated with 120 ,g rhGDF-5 or left uncoated (control). Treatments were alternated between jaw quadrants. The mucoperiosteal flaps were advanced, adapted, and sutured to submerge the implants for primary intention healing. The animals received fluorescent bone markers at weeks 3, 4, 7, and 8 post-surgery when they were euthanized for histologic evaluation. Results: The clinical examination showed no noteworthy differences between implants coated with rhGDF-5. The cover screw and implant body were visible/palpable through the alveolar mucosa for both rhGDF-5-coated and control implants. There was a small increase in induced bone height for implants coated with rhGDF-5 compared with the control, induced bone height averaging (±SD) 1.6±0.6 mm for implants coated with 120 ,g rhGDF-5 versus 1.2±0.5, 1.2±0.6, and 0.6±0.2 mm for implants coated with 60 ,g rhGDF-5, 30 ,g rhGDF-5, or left uncoated, respectively (p<0.05). Bone formation was predominant at the lingual aspect of the implants. Narrow yellow and orange fluorescent markers throughout the newly formed bone indicate relatively slow new bone formation within 3,4 weeks. Implants coated with rhGDF-5 displayed limited peri-implant bone remodelling in the resident bone; the 120 ,g dose exhibiting more advanced remodelling than the 60 and 30 ,g doses. All treatment groups exhibited clinically relevant osseointegration. Conclusions: rhGDF-5-coated oral implants display a dose-dependent osteoinductive and/or osteoconductive effect, bone formation apparently benefiting from local factors. Application of rhGDF-5 appears to be safe as it is associated with limited, if any, adverse effects. [source] An economic evaluation of different sinus lift techniquesJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 8 2010Stefan Listl Listl S, Faggion CM. An economic evaluation of different sinus lift techniques. J Clin Periodontol 2010; 37: 777-787 doi: 10.1111/j.1600-051X.2010.01577.x. Abstract Purpose: To identify the most cost-effective approach to sinus lifting on the basis of currently available evidence. Methods: We incorporate the costs and clinical outcomes of nine different sinus lift techniques within a decision tree model in which costs are based on insurance regulations in Germany and health outcomes follow two recent meta-analyses. The most cost-effective treatment option is identified on the basis of the maximum net benefit criterion. Uncertainties regarding health outcomes are incorporated via probabilistic sensitivity analysis based on Monte-Carlo simulation. Results: When there are no financial restrictions, the optimum treatment strategy is the lateral approach with autogenous particulate bone and a resorbable membrane. When, however, monetary resources for sinus-floor elevation are scarce, the most cost-effective option is the transalveolar technique without bone grafting. Only if relatively high costs can be afforded or if initial bone height at implant site is below 5 mm is the maximum net benefit achieved by lateral approaches. Conclusions: On the basis of currently available evidence, the transalveolar technique is advisable when monetary resources for sinus-floor elevation are scarce and initial bone height is sufficiently high. Lateral approaches are primarily recommended for lower pre-operative bone heights. [source] Evaluation of implants coated with rhBMP-2 using two different coating strategies: a critical-size supraalveolar peri-implant defect study in dogsJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 6 2010Jaebum Lee Lee J, Decker JF, Polimeni G, Cortella CA, Rohrer MD, Wozney JM, Hall J, Susin C, Wikesjö UME. Evaluation of implants coated with rhBMP-2 using two different coating strategies: a critical-size supraalveolar peri-implant defect study in dogs. J Clin Periodontol 2010; 37: 582,590. doi: 10.1111/j.1600-051X.2010.01557.x. Abstract Background: Implants coated with recombinant human bone morphogenetic protein-2 (rhBMP-2) induce relevant bone formation but also resident bone remodelling. Objectives: To compare the effect of implants fully or partially coated with rhBMP-2 on new bone formation and resident bone remodelling. Materials and Methods: Twelve, male, adult, Hound Labrador mongrel dogs were used. Critical-size, supraalveolar, peri-implant defects received titanium porous oxide surface implants coated in their most coronal aspect with rhBMP-2 (coronal-load/six animals) or by immersion of the entire implant in an rhBMP-2 solution (soak-load/six animals) for a total of 30 ,g rhBMP-2/implant. All implants were air-dried. The animals were euthanized at 8 weeks for histometric evaluation. Results: Clinical healing was uneventful. Supraalveolar bone formation was not significantly affected by the rhBMP-2 application protocol. New bone height and area averaged (± SE) 3.4 ± 0.2 versus 3.5 ± 0.4 mm and 2.6 ± 0.4 versus 2.5 ± 0.7 mm2 for coronal-load and soak-load implants, respectively (p>0.05). The corresponding bone density and bone,implant contact (BIC) recordings averaged 38.0 ± 3.8%versus 34.4 ± 5.6% and 25.0 ± 3.8%versus 31.2 ± 3.3% (p>0.05). In contrast, resident bone remodelling was significantly influenced by the rhBMP-2 application protocol. Bone density outside the implants threads averaged 74.7 ± 3.8% and 50.8 ± 4.1% for coronal-load and soak-load implants, respectively (p<0.05); bone density within the thread area averaged 51.8 ± 1.2% and 37.8 ± 2.9%, and BIC 70.1 ± 6.7% and 43.3 ± 3.9% (p<0.05). Conclusion: Local application of rhBMP-2 appears to be a viable technology to support local bone formation and osseointegration. Coronal-load implants obviate resident bone remodelling without compromising new bone formation. [source] Bone regeneration in dehiscence-type defects at chemically modified (SLActive®) and conventional SLA titanium implants: a pilot study in dogsJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 1 2007Frank Schwarz Abstract Objectives: The aim of the present study was to evaluate bone regeneration in dehiscence-type defects at titanium implants with chemically modified (mod) and conventional sand-blasted/acid-etched (SLA) surfaces. Material and Methods: Standardized buccal dehiscence defects (height: 3 mm, width: 3 mm) were surgically created following implant site preparation in both the upper and lower jaws of four beagle dogs. modSLA and SLA implants were inserted bilaterally according to a split-mouth design. The animals were sacrificed after 2 and 12 weeks (n=2 animals each). Dissected blocks were processed for histomorphometrical analysis: defect length, new bone height (NBH), percent linear fill (PLF), percent of bone-to-implant contact (BIC-D) and area of new bone fill (BF). Results: Wound healing at SLA implants was predominantly characterized by the formation of a dense connective tissue at 2 and 12 weeks, without significant increases in mean NBH, PLF, BIC-D or BF values. In contrast, modSLA implants exhibited a complete defect fill at 12 weeks following implant placement. In particular, histomorphometrical analysis revealed the following mean values at 12 weeks: NBH (3.2±0.3 mm), PLF (98%), BIC-D (82%) and BF (2.3±0.4 mm2). Conclusion: Within the limits of the present study, it was concluded that modSLA titanium surfaces may promote bone regeneration in acute-type buccal dehiscence defects at submerged implants. [source] Tobacco smoking and periodontal bone height in a Saudi Arabian populationJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 9 2005Suzan Natto Abstract Aim: To study the association between tobacco smoking, in particular water pipe smoking, and periodontal bone height. Methods: A study sample of 355 individuals in the age range 17,60 years was recruited from Jeddah, Saudi Arabia. The smoking behavior was registered through a questionnaire during interview. Participants were stratified into water pipe smokers (33%), cigarette smokers (20%), mixed smokers (19%) and non-smokers (28%). The periodontal bone height was measured from digital panoramic radiographs mesially and distally to each tooth and expressed as a percentage of the root length. Results: The mean periodontal bone height was 76.2% for water pipe smokers, 75.8% for cigarette smokers, 80.2% for mixed smokers and 80.9% for non-smokers. The association between smoking and mean bone height was statistically significant controlling for age (p<0.001). The association between life-time smoking exposure and mean bone height controlling for age was statistically significant in water pipe smokers and cigarette smokers (p<0.01). The prevalence of bone loss in excess of 30% of the bone height was 27% in water pipe smokers, 24% in cigarette smokers, 9% in mixed smokers and 6% in non-smokers. The prevalence was significantly greater in water pipe smokers and cigarette smokers compared with non-smokers (p<0.001). The relative risk of periodontal bone loss associated with water pipe and cigarette smoking after adjustment for age was 3.5-fold and 4.3-fold elevated, respectively, compared with non-smoking (p<0.01). Conclusion: An association between tobacco smoking and periodontal bone height reduction is observed. The impact of water pipe smoking is of the same magnitude as that of cigarette smoking. [source] Recombinant human bone morphogenetic protein-7 in maxillary sinus floor elevation surgery in 3 patients compared to autogenous bone graftsJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 9 2000A clinical pilot study Abstract Background/Aims: This pilot study was designed to determine the clinical bone formation ability of a human recombinant DNA bone morphogenetic protein-7, also referred to as Osteogenic Protein-1 [OP-1] combined with a collagen carrier, implanted in the maxillary sinus of 3 patients. The results were compared with a group of 3 patients treated with sinus floor elevation and autogenous bonegrafts. Methods: 6 consecutive patients, 4 female and 2 male, between 48 and 57 years of age were treated by means of sinus floor elevation for insufficient bone height in the posterior maxilla for implant surgery. 3 patients, 2 female and 1 male, were treated with OP-1 attached to a collagen device. In these patients, 4 maxillary sinus grafting procedures according to Tatum's method were carried out. 1 g of collagen carrier containing 2.5 mg rhOP-1 mixed with 3 ml of saline was placed between the bony floor and the elevated mucosal lining of the most caudal part of the maxillary sinus, in order to increase the vertical bone dimension to place dental implants of a sufficient length. The 3 other patients, also 2 female and 1 male, with a total of 5 sinus sites, were treated with sinus floor elevation and autogenous iliac crest bonegrafts. After 6 months, during dental implant preparation, bone cores were taken for histology. Thus, clinical, radiological and histological results of the 2 groups of 3 patients were compared. Results: 6 months after sinus grafting with OP-1, in 1 male, well-vascularized bonelike tissue of good quality was observed clinically. This could be confirmed by histology. In the second, female, patient no bone formation was observed at all. A cyst-like granular tissue mass, without purulent content, was removed. In the 3rd, female, patient, who received bilateral sinus grafts, some bonelike formation was seen, however it showed flexible tissue which led to the decision that at 6 months after the sinus grafting, the implant placement had to be postponed. In all 5 autogenous grafted sinuses a bone appearance similar to normal maxillary bone was observed clinically as well as histologically and dental implants could be placed six months after sinus floor elevation surgery. Conclusions: These findings indicate that the OP-1 device has the potential for initiating bone formation in the human maxillary sinus within 6 months after a sinus floor elevation operation. However, the various findings in these 3 patients indicate that the behaviour of the material is at this moment insufficiently predictable, in this indication area. Further investigation is indicated before OP-1 can be successfully used instead of the "gold standard" autogenous bone graft. [source] Topical administration of simvastatin recovers alveolar bone loss in ratsJOURNAL OF PERIODONTAL RESEARCH, Issue 3 2008H. Seto Background and Objective:, Simvastatin, a cholesterol-lowering drug, has been reported to show anabolic effects on bone metabolism. We examined the effects of simvastatin in vitro using cultured rat calvaria cells and in vivo using periodontitis-induced rats. Material and Methods:, Alkaline phosphatase activity and bone nodule formation were measured in cultured rat calvaria cells. Nylon ligature was placed around the maxillary molars of Fischer male rats for 20 d to induce alveolar bone resorption. After ligature removal, simvastatin was topically injected into the buccal gingivae for 70 d and then microcomputed tomography and histological examinations were performed. Results:, Simvastatin maintained high alkaline phosphatase activity and increased bone nodule formation in rat calvaria cells in a dose-dependent manner, showing that simvastatin increased and maintained a high level of osteoblastic function. Microcomputed tomography images revealed that treatment with simvastatin recovered the ligature-induced alveolar bone resorption, showing a 46% reversal of bone height. Histological examination clarified that low-mineralized alveolar bone was formed in simvastatin-treated rats. Conclusion:, These findings demonstrate that simvastatin has the potential to stimulate osteoblastic function and that topical administration of simvastatin may be effective for the recovery of alveolar bone loss in rats. [source] Minimally Invasive Antral Membrane Balloon Elevation , Results of a Multicenter RegistryCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2009Efraim Kfir DMD ABSTRACT Background and Purpose: Frequently, the posterior maxilla lacks sufficient bone mass to support dental implants. This multiphysician registry assessed the feasibility and safety of minimally invasive antral membrane balloon elevation (MIAMBE), followed by bone augmentation and implant fixation. Materials and Methods: One hundred twelve consecutive patients were referred for MIAMBE. Following pre-procedural assessment and informed consent, patients underwent alveolar crest exposure, and 3 mm osteotomy followed by MIAMBE. Platelet-rich fibrin and bone substitutes were injected under the antral membrane; implant placement and primary closure were executed at the same sitting. Implant loading was carried out 6 to 9 months later. Results: One hundred nine (97.3%) patients successfully concluded the initial procedure. Three patients had membrane tear requiring procedure abortion. One case of infection was documented at 4 weeks. Procedure time was 58 ± 23 minutes. Incremental bone height consistently exceeded 10 mm, and implant survival of 95% was observed at 6 to 9 months. Conclusion: MIAMBE can be applied to all patients in need of posterior maxilla bone augmentation with high procedural success, low complication rate, and satisfactory bone augmentation and implant survival. As it is minimally invasive and associated with minimal discomfort, MIAMBE should be an alternative to the currently employed methods of maxillary bone augmentation. [source] Accuracy of Linear Measurement Provided by Cone Beam Computed Tomography to Assess Bone Quantity in the Posterior Maxilla: A Human Cadaver StudyCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 4 2008Sophie Veyre-Goulet DDS ABSTRACT Purpose: The aim of this study was to assess, for implant placement in the posterior maxilla, the accuracy of linear measurements provided by cone beam computed tomography (CBCT) using an image intensifier tube and television (TV) chain as an X-ray detector despite a loss of contrast resolution. The NewTom® 9000 (Quantitative Radiology, Verona, Italy) was used to explore the posterior maxilla. Materials and Methods: Fourteen measurements were taken in three dry maxillaries. On every anatomical site, three fiducial markers were placed on the bony crest to define a plane. Dry maxillaries were submitted to CBCT imaging examination. The maxillaries were then sawn according to the previously defined planes, and bone height and width were assessed using a caliper. The same measurements were taken on images. Results: Clinical analysis demonstrated no difference between real measurements and image measurements. Conclusions: Although cadaver bone density may not correspond to the density of vital bone, this in vitro study indicates that CBCT images provided by technique using image intensifier tube and TV chain as an X-ray detector are reliable to define the bone volume of the posterior maxilla for the purpose of planning the implant axis. [source] Five-Year Survival Distributions of Short-Length (10 mm or less) Machined-Surfaced and Osseotite® ImplantsCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 1 2004Sylvan Feldman DDS ABSTRACT Background: In cases of reduced alveolar bone height, implants of short length (10 mm or less) may be employed although there is a perceived risk that because of their small stature they will be unable to tolerate occlusal loads and will fail to osseointegrate. Purpose: This report describes an analysis of prospective multicenter clinical studies evaluating the risk for failure of short-length implants, comparing dual acid-etched (DAE) Osseotite® implants (Implant Innovations, Inc., Palm Beach Gardens, FL, USA) to machined-surfaced implants. Materials and Methods: Admission criteria were the same for both data sets. Baseline variables of demographics including age, gender and smoking status, bone quality, location, implant dimensions, and types of prostheses were compared to ensure balance among groups. Cumulative survival rates (CSRs) were calculated with the Kaplan-Meier estimator. Results: The implant data included 2,294 implants for the DAE series and 2,597 implants for the machined-surfaced series. Patient demographics showed similar percentages of occurrence for all variables. The distributions of implants between short- and standard-length data sets for baseline variables including width, location, and restorative type were similar, qualifying these data sets for comparison of the independent variable of length. Overall, there was a 2.2% difference in 5-year CSRs between the machined-surfaced short- and the standard-length implants. For these implants a 7.1% difference was observed in the posterior maxilla and an 8.5% difference in the anterior maxilla. For DAE implants the overall difference between "standards" and "shorts" was 0.7%, which is not statistically significant. Conclusion: In this analysis the difference in CSRs between short- and standard-length implants was greater for machined-surfaced implants than for DAE implants. [source] Maxillary Implants Loaded at 3 Months after Insertion: Results with Astra Tech Implants after up to 5 YearsCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 3 2001Helmut Steveling DMD ABSTRACT Background: To date, clinical studies have mainly focused on early loading of mandibular implants. Recently, there has also been considerable interest in early loading of maxillary implants. Purpose: The purpose of this article is to report the outcome of maxillary implants loaded after a 3-month healing period and followed up to 5 years. Materials and Methods: Seventeen patients (11 males and 6 females) received 44 Astra Tech implants (Molndal, Sweden) for treatment of single-tooth (13 cases) and partial edentulism (9 cases). The patients were followed up to 5 years after implant placement:50% of the implants were followed for 3 years and 16% have been followed throughout the observation period. Preoperatively, bone height and width were assessed on radiographs. Marginal bone loss was recorded on intraoral radiographs annually. Results: No implant was lost during the observation period. The average marginal bone loss was 0.5 ± 0.7 mm after 1 year, 0.6 ± 0.7 mm after 3 years, and 0.9 ± 1.6 mm after 5 years. There were no soft-tissue or prosthetic failures recorded during the observation period. Conclusion: Early loading of Astra Tech implants was highly successful in maxillary partial and single-tooth cases followed up to 5 years in function. [source] Marginal Bone Level around Implants Assessed in Digital and Film Radiographs: In Vivo Study in the DogCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 1 2000Eva Borg DDS ABSTRACT Background: One of the objectives of postoperative radiographic examinations of implants is to evaluate the marginal bone height and its changes over time. Purpose: The purpose of this study was to assess the influence of digital image processing on measurements of the marginal bone level around implants. Material and Methods: Implants in beagle dogs, used to study the development of peri-implantitis and subsequent healing following treatment, were monitored with conventional radiography and a digital image plate system. Five observers measured the distance between a reference point and the bone level. Measurements in conventional radiographs were made with the use of an x-ray viewer (2X) and a magnifying lens (7X). For the digital images, the system's built-in measuring function was used together with five image processing techniques: edge enhancement (matrixes set on 5 and 25), inverted grey scale, single color highlight, and color intensity mapping together with the brightness and contrast control. From the time of maximum breakdown and the end of the experiment, histologic values were available. Results: Differences between techniques and observers increased toward the end of the healing period. Measurements made at maximum breakdown did not differ significantly from the histologic value. Measurements made after healing all methods, except that using edge enhancement and a 25 × 25 kernel, differed significantly from the histologic value by underestimating the bone level. Conclusions: Measurements of bone level around implants from digital radiographs are as accurate and precise as those from film images. In particular cases, the use of specific image processing algorithms may improve both accuracy and precision. After healing, the histologic specimens showed an incomplete bone fill in the crater with a remaining thin layer of connective tissue in contact with the fixture, and in such situations, the morphology of the bone will give a more complicated diagnostic task. [source] Alveolar ridge preservation with guided bone regeneration and a synthetic bone substitute or a bovine-derived xenograft: a randomized, controlled clinical trialCLINICAL ORAL IMPLANTS RESEARCH, Issue 7 2010Nikos Mardas Abstract Objectives: The aim of this randomized, controlled clinical trial was to compare the potential of a synthetic bone substitute or a bovine-derived xenograft combined with a collagen membrane to preserve the alveolar ridge dimensions following tooth extraction. Methods: Twenty-seven patients were randomized into two treatment groups following single tooth extraction in the incisor, canine and premolar area. In the test group, the alveolar socket was grafted with Straumann Bone Ceramic® (SBC), while in the control group, Bio-Oss® deproteinized bovine bone mineral (DBBM) was applied. In both groups, a collagen barrier was used to cover the grafting material. Complete soft tissue coverage of the barriers was not achieved. After 8 months, during re-entry procedures and before implant placement, the horizontal and vertical dimensions of the residual ridge were re-evaluated and trephine biopsies were performed for histological analysis in all patients. Results: Twenty-six patients completed the study. The bucco-lingual dimension of the alveolar ridge decreased by 1.1±1 mm in the SBC group and by 2.1±1 in the DBBM group (P<0.05). Both materials preserved the mesio-distal bone height of the ridge. No differences in the width of buccal and palatal bone plate were observed between the two groups. The histological analysis showed new bone formation in the apical part of the biopsies, which, in some instances, was in direct contact with both SBC and DBBM particles. The coronal part of the biopsies was occupied by a dense fibrous connective tissue surrounding the SBC and DBBM particles. Conclusion: Both biomaterials partially preserved the width and the interproximal bone height of the alveolar ridge. To cite this article: Mardas N, Chadha V, Donos N. Alveolar ridge preservation with guided bone regeneration and a synthetic bone substitute or a bovine-derived xenograft: a randomized, controlled clinical trial. Clin. Oral Impl. Res. 21, 2010; 688,698. [source] Maxillary sinus floor elevation using the (transalveolar) osteotome technique with or without grafting material.CLINICAL ORAL IMPLANTS RESEARCH, Issue 7 2009Part I: implant survival, patients' perception Abstract Objectives: To analyze the survival and success rates of implants installed utilizing the (transalveolar) osteotome technique, to compare peri-implant soft tissue parameters and marginal bone levels of osteotome-installed implants with implants placed using standard surgical procedures, and to evaluate patient-centered outcomes. Material and methods: During 2000 to 2005, 252 Straumann® dental implants were inserted in 181 patients. The surgical technique was a modification of the original osteotome technique presented by Summers. In addition to the clinical examination, the patients were asked to give their perception of the surgical procedure, utilizing a visual analogue scale. Results: The cumulative survival rate of the osteotome-installed implants after a mean follow-up time of 3.2 years, was 97.4% (95% confidence intervals: 94.4,98.8%). From the 252 implants inserted, three were lost before loading and another three were lost in the first and second year. According to residual bone height the survival was 91.3% for implant sites with ,4 mm residual bone height, and 90% for sites with 4 mm and 5 mm, when compared with that of 100% in sites with bone height of above 5 mm. According to implant length the survival rates were 100% for 12 mm, 98.7% for 10 mm, 98.7% for 8 mm and only 47.6% for 6 mm implants. Soft tissue parameters (pocket probing depth, probing attachment level, bleeding on probing and marginal bone levels) did not yield any differences between the osteotome-installed and the conventionally placed implants. More than 90% of the patients were satisfied with the implant therapy and would undergo similar therapy again if necessary. The cost associated with implant therapy was considered to be justified. Conclusion: In conclusion, the osteotome technique was a reliable method for implant insertion in the posterior maxilla, especially at sites with 5 mm or more of preoperative residual bone height and a relatively flat sinus floor. [source] Which region of the median palate is a suitable location of temporary orthodontic anchorage devices?CLINICAL ORAL IMPLANTS RESEARCH, Issue 3 200920 years, A histomorphometric study on human cadavers aged 1 Abstract Introduction: Endosseus implants can provide a reliable anchorage during orthodontic treatment. The midpalatal structures around the sutura palatina mediana (SPM) are of special interest due to increasing placement of orthodontic implants in this area. Knowledge about the osseous conditions at this site is necessary to predict the expected degree of implant osseointegration. Methods: The upper jaws of 10 human cadavers, aged 15,20 years, were decalcified, and cross-sectional specimens were obtained from four anterior-to-posterior palatal regions for histomorphometric analysis. The analyses focused on the amount of bone and the width of the SPM to determine the anatomical requirements for reliable insertion of palatal implants. Results: Bone density [bone-volume (BV)/ tissue-volume (TV)] in all measured areas was 40,60%. The maximum density was measured at the level of the first premolars (54.9±5.9%) and the least values (44.2±9.6%) were measured at the level of the interconnecting line of the canines. The mean width of the SPM varies from 1.2 to 0.3 mm in different sections of the palate. In the median sagittal plane, the mean values of bone height to nasal cavity reached >5 mm as far as the level distal of the second premolars. Bone height 2 mm paramedian to the SPM decreased consistently from anterior (4.3±0.9 mm) to posterior (2.5±0.8 mm). Conclusions: Our results indicate that the amount and quality of bone along the anterior palatal midline in 15-to-20-year olds is sufficient for orthodontic implantation. Even implantation posterior to the recommended first premolar level, at which orthodontic implants are most often placed, may be suitable. There are some limitations, however, due to small number of samples and variations of anatomical structures. [source] Osteotome sinus floor elevation without grafting material: a 1-year prospective pilot study with ITI implantsCLINICAL ORAL IMPLANTS RESEARCH, Issue 6 2006Rabah Nedir Abstract Objective: The aim of the present pilot study was to evaluate: (1) the predictability of an osteotome sinus floor elevation procedure with ITI-SLA implants without placing a bone grafting material, and (2) the possibility to gain bone height without filling the created space with a bone grafting material. Material and methods: Seventeen patients received 25 implants protruding in the sinus. Most implants (21/25) were 10 mm long, eight were inserted in type 2 bone, 12 in type 3 and five in type 4 bone. At implant placement, the mean residual bone height (RBH) under the maxillary sinus was 5.4±2.3 mm; it was 5.7±2.6 mm on the mesial side and 5.1±1.9 mm on the distal side. Nineteen implants had less than 6 mm of bone on at least one side and six implants had less than 6 mm on both sides. A healing period of 3,4 months was allowed before abutment tightening at 35 Ncm. The percentage of stable implants at abutment tightening and at the 1-year control was calculated. The endo-sinus bone gain and the crestal bone loss (CBL) at the mesial and distal sides were measured. Results: Abutments were tightened after 3.1±0.4 months. All implants but one (96%) resisted the applied 35 Ncm torque. At the 1-year control, all implants were clinically stable and supported the definitive prosthesis. All showed endo-sinus bone gain; the mean gain was 2.5±1.2 mm. The mean CBL was 1.2±0.7 mm. Endo-sinus bone gain and RBH showed a strong negative correlation (r=,0.78 on the mesial side and ,0.80 on the distal side). A good correlation (r=0.73) was found between implant penetration in the sinus and endo-sinus bone gain. Conclusion: Elevation of the sinus membrane alone without addition of bone grafting material can lead to bone formation beyond the original limits of the sinus floor. Despite a limited RBH at implant placement, a healing period of 3 months was sufficient to resist a torque of 35 N cm and to lead to a predictable implant function at the 1-year control. [source] A 7-year life table analysis from a prospective study on ITI implants with special emphasis on the use of short implantsCLINICAL ORAL IMPLANTS RESEARCH, Issue 2 2004Results from a private practice Abstract: This paper reports on a 7-year life table analysis on ITI titanium plasma-sprayed (TPS) and sandblasted and etched (SLA) implants placed in a private practice and loaded for at least 1 year. In 236 patients, 528 (264 TPS and 264 SLA) implants were placed, 351 (66.5%) implants rehabilitated the posterior region and 71.1% implants were ,11 mm. In the posterior mandible and maxilla, the mean implant length was 9.90 and 9.74 mm respectively. Implant length was determined through standard radiographs only. Increase of the number of implants or reduction of the width or the length of the rehabilitations was not specifically sought for the shorter implants. One hundred and twenty-two SLA implants were loaded within 63 days. All early loaded SLA implants resisted the applied 35 N cm without rotation or pain. Three implants failed, one early and two late failures, all were SLA implants placed in the mandible. Shorter implants did not fail more than longer ones. The cumulative success rate was 99.40%. The predictable use of short implants supporting single crowns and small fixed partial dentures of 2,4 units supported by two to three implants permitted (1) restricting the need for sophisticated and expensive presurgical procedures aimed to determine precisely the available bone height by computerized radiographic methods, (2) the placement of prosthetically driven restoration instead of surgically driven ones, (3) reducing the indications span for complex invasive procedures like sinus lift and bone grafting procedures, (4) facilitating the surgery, without attempting to place the longest implant and (5) avoiding the occurrence of sensation disturbance. The safe use of short implants in a private practice should make implant therapy simpler and accessible to a higher number of patients and practitioners. Résumé Ce manuscript rapporte une analyse sur sept ans d'implants ITI® TPS et SLA placés dans un cabinet privé et chargés pendant au moins une année. Chez 236 patients, 528 implants (264 TPS et 264 SLA) ont été placés, 351 (66,5%) d'entre eux pour reconstruire la région postérieure et 71,1 étaient ,11 mm. Dans les parties postérieures de la mandibule et du maxillaire la longueur implantaire moyenne était respectivement de 9,90 et 9,74 mm. La longueur de l'implant était déterminée à partir uniquement de radiographies standards. L'augmentation du nombre d'implants ou la réduction de la largeur ou la longueur des reconstructions n'étaient pas spécifiquement recherchées pour les implants les plus courts. Cent vingt-deux implants SLA ont été mis en charge avant 63 jours. Tous les implants SLA avec mise en charge précoce ont resistéà la force de 35 Ncm appliquée sans rotation ni douleur. Trois implants ont échoué: 1) de manière précoce et 2) plus tard, tous étaient des implants SLA placés dans la mandibule. Les implants les plus courts n'avaient pas davantage d'échec que les plus longs. Le taux de succès cumulatif était de 99,40%. L'utilisation prévisible des implants courts portant des couronnes uniques et des petites prothèses fixées de deux à quatre unités supportées par deux à trois implants permettait 1) de réduire la nécessité de processus préchirurgicaux sophistiqué et cher visant ,a d"terminer précisemnentla hauteur osseuse disponible par des méthodes radiographiques avec ordinateur, 2) le placement de restaurations axées sur la prothèse plutôt que sur la chirurgie, 3) de diminuer la portée des indications des processus invasifs complexes comme l'épaississement du plancher buccal et les processus de greffe osseuse, 4) de faciliter la chirurgie sans essayer de placer l'implant le plus long, 5) d'éviter l'apparition de troubles de sensation. L'utilisation s,re d'implants court dans une pratique privée pourrait rendre la thérapie plus simple et accessible à un polus grand nombre de patients et de praticiens. Zusammenfassung Diese Arbeit berichtet über eine 7 Jahre Life Time Analyse von ITI TPS und SLA Implantaten, welche in einer Privatpraxis gesetzt wurden und für mindestens 1 Jahr unter Belastung standen. Bei 236 Patienten wurden 528 Implantate (264 TPS und 264 SLA) eingesetzt, 351 Implantate (66.5%) dienten der Wiederherstellung der posterioren Region und 71.1% der Implantate waren 11 mm lang. In der posterioren Mandibula bzw. Maxilla betrug die mittlere Implantatlänge 9.9 bzw. 9.74 mm. Die Implantatlänge wurde nur auf Standardröntgenbildern bestimmt. Bei Rekonstruktionen mit kurzen Implantaten wurden nicht speziell mehr Implantate verwendet oder die Breite oder die Länge der Rekonstruktionen reduziert. 122 SLA Implantate wurden innerhalb von 63 Tagen belastet. Alle frühbelasteten SLA Implantate widerstanden den applizierten 35Ncm ohne Rotation oder Schmerzen. 3 Implantate zeigten Misserfolge, einen Früh- und 2 Spätmisserfolge. Es handelte sich dabei ausschliesslich um SLA Implantate, welche im Unterkiefer eingesetzt worden waren. Kurze Implantate zeigten nicht mehr Misserfolge als lange. Die kumulative Erfolgsrate betrug 99.4%. Die Verwendung von kurzen Implantaten, welche Einzelkronen und kleine festsitzende Brücken mit 2,4 Einheiten auf 2,3 Implantanten trugen, erlaubte, 1) die Notwendigkeit von komplizierten und teuren prächirurgischen Abklärungen zur genauen Bestimmung der zur Verfügung stehenden Knochenhöhe durch computerisierte radiologische Methoden zu beschränken, 2) die Platzierung von prothetisch diktierten Rekonstruktionen anstelle von chirurgisch diktierten Rekonstruktionen, 3) eine Reduktion der Indikationsbreite von komplexen invasiven Prozeduren wie Sinuslift und Knochentransplantationen, 4) eine Erleichterung der Chirurgie indem nicht ein möglichst langes Implantat gesetzt werden musste, 5) das Auftreten von Sensibilitätsstörungen zu vermeiden. Die sichere Verwendung von kurzen Implantaten in einer Privatpraxis sollte die Implantattherapie einfacher machen. Dadurch sollte die Behandlung mit Implantaten einer grösseren Anzahl Patienten und Praktikern zugänglich werden. Resumen Este estudio informa sobre un análisis de un cuadro de vida de implantes ITI TPS y SLA colocados en una consulta privada y cargados durante al menos un año. Se colocaron 528 implantes (264 TPS y 264 SLA) en 236 pacientes, 351 implantes (66.5%) rehabilitaron el maxilar posterior y el 71.1% de los implantes fueron ,11 mm. La longitud media de los implantes en la mandíbula posterior y el maxilar fue de 9,90 y 9.74 mm respectivamente. La longitud del implante se determinó solamente a través de radiografías. No se buscaron específicamente incrementos en el número de implantes o reducción en la anchura o longitud de las rehabilitaciones para los implantes cortos. Se cargaron 122 implantes dentro de los 63 días. Todos los implantes SLA cargados tempranamente resistieron la fuerza de 35 Ncm aplicada sin rotación ni dolor. 3 implantes fracasaron, uno tempranamente y 2 tardíos, todos fueron implantes SLA colocados en la mandíbula. Los implantes mas cortos no fracasaron más que los implantes largos. El índice acumulativo de éxito fue del 99.4%. El uso predecible de implantes cortos soportando coronas unitarias y pequeñas prótesis fijas parciales de 2,4 unidades soportadas por 2,3 implantes permitieron, 1) restringir la necesidad de procedimientos quirúrgicos sofisticados y costosos con la intención de determinar con precisión la altura de hueso disponible por medio de métodos de radiografías computarizadas, 2) la colocación de restauraciones orientadas prosteticamente en vez de quirúrgicamente, 3) reducir el abanico de indicaciones para procedimientos complejos invasivos tales como procedimientos de elevación del seno e injertos, 4) facilitar la cirugía, sin intentar colocar el implante mas largo, 5) evitar la aparición de sensación de molestia. El uso seguro de implantes cortos en una consulta privada debería hacer el tratamiento de implantes mas simple y accesible para un mayor número de pacientes y profesionales. [source] Histomorphological evaluation of loaded plate-form and root-form implants in Macaca mulatta monkeysCLINICAL ORAL IMPLANTS RESEARCH, Issue 2 2002Michael McCracken Abstract: As part of a long-term evaluation of endosteal dental implants in primates, this paper describes the histological response to plate-form and root-form implants. Thirty-six primates received 48 mandibular distal abutment implants. After healing, the implants were restored with fixed partial dentures, which remained in function for two years. A subset of the group was ligated at the gingival sulcus to biologically stress tissues supporting the implants. Crestal bone height around implants was quantified using digital subtraction radiographic techniques. The ligated implants lost more crestal bone than non-ligated implants, as shown by ANOVA (P < 0.05). After retrieval, implants were embedded and sectioned for histomorphometric analysis including measurement of per cent osseointegration. Both plate-form and root-form non-ligated implants demonstrated about 60% osseointegration. When ligated, plate-form implants dropped to an average integration of only 34%, while root-form implants maintained 62% integration, a significant difference. These data show that in this primate model, plate-form and root-form implants maintained integration while in function for two years. When stressed with ligation, root-form implants maintained relative amounts of osseointegration, while per cent osseointegration of plate-form implants decreased. Résumé Ce manuscript décrit la réponse histologique à long terme au niveau des implants-plateau ou racine. Trente-six primates ont reçu 48 implants comme pilier distal au niveau de la mandibule. Après guérison, les implants ont été chargés avec des prothèses partielles fixées qui sont restées en fonction durant deux années. Un sous-groupe a été ligaturé au niveau des sulci gingivaux afin d'augmenter l'accumulation de plaque dentaire au niveau de ces implants. La hauteur osseuse crestale autour des implants a été quantifée en utilisant des techniques de soustraction radiologique. Les implants ligaturés ont perdu davantage d'os crestal que les non-ligaturés (ANOVA: P<0.05). Après leur avulsion les implants ont été enfouis dans des blocs et découpés pour une analyse histomorphométrique évaluant la mesure de l'ostéointégration. Les deux types d'implant avaient une ostéintégration d'environ 60%. Lorsqu'il y avait une ligature, les implants-plateau avaient une diminution de l'intégration allant jusqu'à 34% tandis que ceux en forme racine maintenaient une intégration de 62%. Ces données ont montré que dans ce modèle de primate, les implants-plateau et -racine maintenaient une intégration durant leur mise en fonction de deux années. Lorsqu'une ligature était placée les implants-racine maintenaient une bonne quantité d'ostéo?ntégration tandis que cette dernière était significativement inférieure lorsque les implants-plateau étaient utilisés. Zusammenfassung Diese Arbeit ist Teil einer Langzeitstudie über enossale Zahnimplantaten an Primaten und beschreibt die histologische Antwort auf scheiben- und wurzelförmige ?mplantate. 36 Primaten erhielten 48 seitliche Unterkieferimplantate. Nach der Heilphase wurden die ?mplantate mit festsitzenden Teilprothesen versorgt, die während zwei Jahren in Funktion verblieben. Ein Teil der Gruppe erhielt im den Sulcus eine Ligatur, um die dem ?mplantat angrenzendenden Gewebe einer biologischen Stressituation auszusetzen. Die Höhe des Alveolarknochens um die ?mplantate wurde mit Hilfe der digitalen Subtraktionsradiographie quantitativ erfasst. Die ?mplantate mit einer Ligatur verloren mehr Alveolarknochen als die nichtligierten ?mplantate (ANOVA; P<0.05). Nach der Entnahme wurden die ?mplantate eingebettet und histologische Schnitte angefertigt. Diese dienten der histomorphometrischen Analyse und der Bestimmung des Osseointegrationsgrades in Prozenten. Sowohl die scheiben-, wie auch die wurzelförmigen ?mplantate zeigten ohne Ligaturen eine 60%-ige Osseointegration. Wurden aber Ligaturen angelegt, so reduzierte sich der Grad der Osseointegration bei den scheibenförmigen ?mplantaten auf 34%, bei den wurzelförmigen ?mplantate auf 62%, es handelte sich um einen signifikanten Unterschied. Die Resultate dieses Primatenmodells zeigen, dass die scheiben- und wurzelförmigen ?mplantate während einer Funktionszeit von zwei Jahren ihre Osseointegration beibehalten. Werden die Gewebe aber mit Ligaturen zur experimentellen Entzündung gebracht, können die wurzelförmigen ?mplantate ihren Osseontegrationsgrad beibehalten, bei den scheibenförmigen ?mplantaten nahm er ab. Resumen Como parte de una evaluación a largo plazo de implantes dentales endoóseos en primates, este trabajo describe la respuesta histológica a implantes con forma de placa y con forma de raíz. Treinta y seis primates recibieron 48 implantes distales mandibulares con pilar. Tras la cicatrización, los implates se restauraron con dentaduras parciales fijas, que permanecieron en functión durante 2 años. A un subconjunto del grupo se les colocó una ligadura en el surco gingival para estresar los tejidos que soportan los implantes. Se cuantificó la altura de la cresta ósea alrededor de los implantes usando técnicas radiográficas de sustracción digital. Los implantes ligados perdieron mas hueso crestal que los implantes no ligados, como se muestra en ANOVA (P<0.05). Tras la retirada, los implantes se embebieron y seccionaron para análisis histomorfométrico incluyendo mediciones del porcentaje de osteointegración. Tanto los implantes con forma de placa como los de forma de raíz no ligados mostraron un 60 por ciento de osteointegración. Cuando se ligaron, los implantes con forma de placa bajaron a una media de integración de solo el 34 por ciento, mientras que los implantes con forma de raíz mantuvieron el 62 por ciento de integración, una diferencia significativa. Estos datos muestran que en este modelo de primates, lo implantes con forma de placa y forma de raíz mantuvieron la integración en función durante 2 años. Al estresarse con ligaduras, los implantes con forma de raíz mantuvieron unas cantidades relativas de osteointegración, mientras que el porcentaje de integración de los implantes con forma de placa disminuyó. [source] An economic evaluation of different sinus lift techniquesJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 8 2010Stefan Listl Listl S, Faggion CM. An economic evaluation of different sinus lift techniques. J Clin Periodontol 2010; 37: 777-787 doi: 10.1111/j.1600-051X.2010.01577.x. Abstract Purpose: To identify the most cost-effective approach to sinus lifting on the basis of currently available evidence. Methods: We incorporate the costs and clinical outcomes of nine different sinus lift techniques within a decision tree model in which costs are based on insurance regulations in Germany and health outcomes follow two recent meta-analyses. The most cost-effective treatment option is identified on the basis of the maximum net benefit criterion. Uncertainties regarding health outcomes are incorporated via probabilistic sensitivity analysis based on Monte-Carlo simulation. Results: When there are no financial restrictions, the optimum treatment strategy is the lateral approach with autogenous particulate bone and a resorbable membrane. When, however, monetary resources for sinus-floor elevation are scarce, the most cost-effective option is the transalveolar technique without bone grafting. Only if relatively high costs can be afforded or if initial bone height at implant site is below 5 mm is the maximum net benefit achieved by lateral approaches. Conclusions: On the basis of currently available evidence, the transalveolar technique is advisable when monetary resources for sinus-floor elevation are scarce and initial bone height is sufficiently high. Lateral approaches are primarily recommended for lower pre-operative bone heights. [source] | ||||||||||||||||||||||