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Implant Insertion (implant + insertion)
Selected AbstractsEffects of maxillary sinus floor elevation surgery on maxillary sinus physiologyEUROPEAN JOURNAL OF ORAL SCIENCES, Issue 3 2003Nicolaas M. Timmenga In a prospective study, the effects of elevation surgery of the maxillary sinus floor on maxillary sinus physiology were assessed. Seventeen consecutive patients without preoperative anamnestic, clinical and radiological signs of maxillary sinusitis underwent sinus floor elevation surgery with iliac crest bone grafts. All patients were subjected to unilateral endoscopic examination of the maxillary sinus, taking of a biopsy specimen from the sinus floor mucosa, and collection of a sinus lavage-fluid aspirate. This triad of evaluations was performed immediately preceding the elevation procedure, and 3 months (at implant insertion) and 9 months (at uncovering of implants) postoperatively. All procedures were performed under general anesthesia. Preoperatively, three out of 17 patients showed pre-existing mucosal pathology endoscopically, while the 3- and 9-month results revealed the presence of mucosal pathology in four and two patients, respectively. The 3-month microbiological evaluation showed a significant increase in cultures with bacterial growth, while the 9-month culture results were comparable to the preoperative status of the maxillary sinus. Morphologically, neither fibrosis nor an altered inflammatory response or thickening of the epithelium and lamina propria was observed postoperatively. The number of goblet cells in the epithelial layer was increased. From this study it is concluded that the effect of maxillary sinus floor elevation surgery with autogenous bone grafts does not appear to have clinical consequences in patients without signs of pre-existing maxillary sinusitis. [source] A biomechanical assessment of the relation between the oral implant stability at insertion and subjective bone quality assessmentJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 4 2007Ghada Alsaadi Abstract Aim: The study was set to evaluate the validity of subjective jaw bone quality assessment. Materials and Methods: A total of 298 patients (198 females, mean age 56.4) were treated with oral implants at the Periodontology Department at the University Hospital of KUL. A total of 761 TiUniteÔ implants have been installed. Subjective bone quality assessment was performed on radiographs and by the surgeon's tactile sensation and was compared with torque measurements. In a subset of patients, implant stability was also assessed by implant stability quotient and/or periotest values. Results: Subjective assessment of bone quality was related to the PTV, ISQ and placement torque [in the crestal, the second and the apical third (N cm)], respectively; in grade 1: ,5.3, 73.3 (4.2, 9.6, 15.2), and grade 3 or 4: ,1.6, 55 (3.3, 5.5, 8.4). For the surgeon's tactile sensation, a good correlation was noted for the presence of a thick cortex: ,4.6, 70.3 (4.2, 9.7, 15.1), or a thin one: ,0.3, 65.9 (3.6, 6.9, 10.1). For dense trabecular bone, the values were ,2.8, 69.4 (4.4, 9.7,14.8), while for poor trabecular bone, the values were,1.7, 66.4 (3.6, 6.4, 9.8). Conclusions: Subjective assessment of bone quality is related to PTV, ISQ and placement torque measurements at implant insertion. [source] Enamel matrix derivative and titanium implantsJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 4 2003An experimental pilot study in the rabbit Aim: The aim of present study was to evaluate if an enamel matrix derivative (Emdogain®) may enhance bone formation and osseointegration of titanium implants, using a well-documented rabbit model. Material and methods: Thirty-six threaded commercially pure titanium (cp.ti.) implants were inserted in six New Zealand white rabbits. One implant was placed in each femur and two in each tibia. Prior to implant insertion approximately 0.5 mL of Emdogain (EMD) (test) or the vehicle gel (PGA: propylene glycol alginate) (control) was injected into the surgically prepared implant site. The follow-up time was 6 weeks. Biomechanical evaluations by resonance frequency analysis (RFA) and removal torque measurements (RTQ) were performed. Histomorphometrical quantifications were made on ground sections by measurements of the percentage of bone-to-metal contact, bone area inside the threads as well as outside the threads (mirror image). Bone lengths along the implant surface were also measured and used for shear strength calculations. Results: The results demonstrated no beneficial effects from the EMD treatment on bone formation around titanium implants in any of the tested parameters. Significant differences were demonstrated with removal torque test and shear force calculations for the control implants. No other parameter demonstrated a statistically significant difference. Conclusion: The results of the present study may indicate that EMD does not contribute to bone formation around titanium implants. This observation may indicate that the bone formation that occurs after EMD treatment in periodontal defects is the result of functional adaptation. However, further research is required to evaluate the effect of EMD treatment on bone formation. Zusammenfassung Schmelzmatrixprotein und Titanimplantate. Eine experimentelle Pilotstudie beim Kaninchen Zielsetzung: Untersuchung im gut dokumentierten Kaninchenmodell, ob Schmelzmatrixprotein (Emdogain®) die Knochenbildung und Osseointegration von Titanimplantaten verbessert. Material und Methoden: 36 kommerziell erhältliche Schraubenimplantate aus reinem Titan (cp.ti.) wurden bei 6 weißen Neuseeländischen Kaninchen inseriert. Ein Implantat wurde in jeden Femur und 2 in jede Tibia gesetzt. Vor Implantatinsertion wurden etwa 0,5 ml Emdogain (EMD) (Test) oder das Trägergel (PGA: Propylenglykolalginat) (Kontrolle) in die chirurgisch vorbereitete Insertionsstelle gespritzt. Die Nachuntersuchungszeit betrug 6 Wochen. Die biomechanischen Untersuchungen umfassten eine Resonanzfrequenzanalyse (RFA) und die Messung des Drehmoments, das zur Entfernung der Implantate nötig war (RTQ). Folgende histomorphometrische Messungen wurden auf Schliffpräparaten durchgeführt: Messung des prozentualen Knochen-zu-Metall-Kontaktes, Knochenbereich innerhalb und außerhalb der Schraubengewinde (Spiegelbild). Die Knochenlänge entlang der Implantate wurde ausgemessen und für Scherkraftberechnungen genutzt. Ergebnisse: Es konnten für keinen der untersuchten Parameter günstige Auswirkungen der Anwendung von EMD auf die Knochenbildung um Titanimplantate beobachtet werden. Signifikante Unterschiede konnten für RTQ und Scherkraftberechnungen für die Kontrollimplantate gezeigt werden. Für keinen anderen Parameter konnten statistisch signifikante Unterschiede gefunden werden. Schlussfolgerungen: Die Ergebnisse dieser Studie zeigen, dass der Einsatz von EMD nicht zur Knochenbildung um Titanimplantate beiträgt. Diese Beobachtung kann darauf hinweisen, dass die Knochenbildung, die nach Gabe von EMD in parodontalen Defekten stattfindet, das Ergebnis funktioneller Adaptation ist. Allerdings sind weitere Untersuchungen erforderlich, um die Auswirkung von EMD auf die Knochenbildung zu verstehen. Résumé Dérivés de la matrice amellaire et implants en titane. Une étude pilote expérimentale sur le lapin. But: Le but de cette étude était d'évaluer si un dérivé de la matrice amellaire (Emdogain®) pouvait augmenter la formation osseuse et l'ostéo-intégration d'implants en titane en utilisant un modèle éprouvé de lapin. Matériel et méthodes: 36 implants en titane commercialement purs (cp.ti.) ont été vissés chez 6 lapins blancs de Nouvelle Zélande. 1 implant fut placé dans chaque fémur et 2 dans chaque tibia. Préalablement à l'insertion, environ 0.5 mL d' Emdogain (EMD) (test) ou du gel vecteur (PGA: propylene glycol alginate) (control) fut injecté dans le site implantaire préparé chirurgicalement. Le suivi était réalisé sur 6 semaines. Des évaluations biomécaniques par analyse de la fréquence de résonance (RFA) et des mesures de torque de retrait (RTQ) furent utilisées. Les quantifications histo-morphométriques furent réalisées sur des coupes en mesurant le pourcentage de contact os-métal, les surfaces osseuses à l'intérieur ainsi qu'à l'extérieur des spires (Image miroir). Les longueurs d'os le long des surfaces implantaires furent aussi mesurées et utilisées pour calculer les forces de cisaillement. Résultats: Les résultats n'ont montré aucun effet bénéfique du traitement à l'EMD sur la formation osseuse autour des implants en titane pour aucun des paramètres test. De significatives différences furent trouvées avec le test de torque et les calculs de force de cisaillement pour les implants contrôles. Aucun autre paramètre ne montrait de différences statistiquement significatives. Conclusion: Les résultats de cette étude pourrait indiquer que l'EMD ne contribue pas à la formation osseuse autour des implants en titane. Cette observation peut indiquer que la formation osseuse qui survient après traitement à l'EMD dans les lésions parodontales serait le résultat d'une adaptation fonctionnelle. Cependant, de futures recherches sont nécessaires pour évaluer l'effet du traitement à l'EMD sur la formation osseuse. [source] Vancomycin covalently bonded to titanium alloy prevents bacterial colonizationJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 7 2007Valentin Antoci Jr. Abstract Periprosthetic infection is a devastating consequence of implant insertion and can arise from hematogenous sources or surgical contamination. Microbes can preferentially colonize the implant surface and, by forming a biofilm, escape immune surveillance. We hypothesized that if an antibiotic can be tethered to a titanium alloy (Ti) surface, it will inhibit bacterial colonization, prevent biofilm formation, and avert late-stage infection. To test this hypothesis, a Ti rod was covalently derivatized with vancomycin. Reaction efficiencies were evaluated by colorimetric and spectrophotometric measurements. The vancomycin-modified surface was stable in aqueous solutions over extended time periods and maintained antibiotic coverage, even after press-fit insertion into a cadaverous rat femora. When evaluated using fluorescently labeled bacteria, or by direct colony counts, the surface-bound antibiotic prevented bacterial colonization in vitro after: (1) exposure to high levels of S. aureus; (2) extended incubation in physiological buffers; and (3) repeated bacterial challenges. Importantly, whereas the vancomycin-derivitized pins prevented bacterial colonization, S. aureus adhered to control pins, even in the presence of concentrations of vancomycin that exceeded the strain MIC. These results demonstrate that we have effectively engineered a stable, bactericidal Ti surface. This new surface holds great promise in terms of mitigating or preventing periprosthetic infection. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:858,866, 2007 [source] Local alendronate increases fixation of implants inserted with bone compaction: 12-week canine studyJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 4 2007Thomas Jakobsen Abstract Bone compaction has been shown to increase initial implant fixation. Furthermore, bone compaction creates a peri-implant zone of autograft that exerts osteoconductive properties. We have previously shown that locally applied bisphosphonate (alendronate) at 4-week observation can preserve the autograft generated by bone compaction. We now investigate whether the increased amount of autograft, seen at 4 weeks, can increase implant osseointegration and biomechanical fixation. Porous-coated titanium implants were bilaterally inserted with bone compaction into the proximal part of tibia of 10 dogs. On the right side, local bisphosphonate was injected into the bone cavity prior to bone compaction immediately prior to implant insertion. On the left side, saline was used as control. Observation period was 12 weeks. Locally applied bisphosphonate significantly increased biomechanical implant fixation (approximately twofold), bone-to-implant contact (1.2-fold), and peri-implant bone volume fraction (2.3-fold). This study indicates that local alendronate treatment can increase early implant osseointegration and biomechanical fixation of implants inserted by use of bone compaction. Long term effects remain unknown. © 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:432,441, 2007 [source] Age as compromising factor for implant insertionPERIODONTOLOGY 2000, Issue 1 2003Danny G Op Heij No abstract is available for this article. [source] Chronic cystic ovarian disease in a Holstein cowAUSTRALIAN VETERINARY JOURNAL, Issue 1-2 2005AM PADULA Cystic ovarian follicles are commonly found during rectal examination of early postpartum dairy cows, usually presenting with anoestrus and occasionally nymphomania. Most cases self cure with time, or respond to exogenous hormonal treatment. This case report describes a refractory case in a Holstein cow in which a novel treatment approach was used. A gonadotrophin releasing hormone agonist implant was inserted for 180 d in an attempt to suppress pituitary gonadotrophin output, arrest abnormal ovarian follicle growth and prevent steroidogenesis. Frequent serial blood samples were collected before and after implant insertion to monitor changes in pulse release of luteinising hormone. Follow up ultrasound scans and blood samples were done to monitor ovarian structures; progesterone and oestradiol were collected at various times over the 180 d period. A normal, cycling herdmate was enrolled as a control. Prior to implant insertion, high frequency and low amplitude luteinising hormone pulses were detected in the cystic cow. Insertion was followed by a sustained surge in the release of luteinising hormone in both cows, but ovulation was not induced in the cystic cow. Plasma oestradiol levels remained consistently elevated and signs of oestrous behaviour were observed. Long term gonadotrophin releasing hormone agonist treatment failed to suppress either ovarian steroid production or cause regression of the cysts by 180 d. [source] Implant Placement in Patients with Oral Bisphosphonate Therapy: A Case SeriesCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 3 2010Ghasem Omati Shabestari DDS ABSTRACT Background: Although the effect of bisphosphonates on dental implant osseointegration is not clear, dental implant failures attributable to oral bisphosphonate therapy have been reported in patients with osteoporosis. Purpose: The aim of this study was to evaluate implant survival in patients with a history of bisphosphonate therapy in a retrospective survey. Materials and Methods: A total of 46 ITI implants placed in 21 osteoporotic patients (females; average age 53 years, range 42,79 years) were evaluated with regard to probing depth, mobility, thread exposure, and bleeding on probing. All patients were under oral bisphosphonate therapy. Results: None of implants showed mobility and all patients could be considered free from peri-implantitis. Time of bisphosphonate therapy before and after implant insertion showed no statistically significant influence on PD, BOP, and TE. Likewise, implant location, prosthetic type, and opposing dentition had no statistically significant influence on the clinical and radiological parameters of implants. Conclusion: Within the limitations of this study, it could be concluded that neither being on oral bisphosphonate treatment before implant placement nor starting bisphosphonate therapy after implant installation might jeopardize the successful osseointegration and clinical and radiographic condition of the implants. [source] RFA Values of Implants Placed in Sinus Grafted and Nongrafted Sites after 6 and 12 MonthsCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 3 2009Marco Degidi MD ABSTRACT Background: Maxillary sinus floor elevation surgery is widely used as a preimplantology method to permit implant insertion. Nevertheless, very few data are available about long-term stability of dental implants inserted in grafted sites. Purpose: The aims of the present study were to evaluate the evolution of resonance frequency analysis (RFA) values at 6 and 12 months from the implant insertion in sinus grafted sites and nongrafted sites. Materials and Methods: In 14 patients, 80 Xive implants (Dentsply Friadent GmbH, Mannheim, Germany) were inserted. Sixty-three implants were inserted in a site previously treated with a sinus lift; 17 implants were inserted in healed or postextraction sites. For each implant diameter, length, bone density, insertion torque, and percentage of implant fixed to a nongrafted bone were recorded. RFA values at implant insertion after 6 and 12 months were recorded. Results: After 6 and 12 months, grafted sites showed higher RFA values than the control sites; after 12 months, the difference was statistically significant (.007). A statistically significant positive correlation was found between resonance frequency values and bone quality after 12 months (.05). No statistically significant correlation between RFA values and all the other variables considered was found. Conclusions: Sites treated with sinus lift can offer good long-term stability. After 6 and 12 months, the geometric characteristics of the implant are no longer important to obtain high RFA values, and the bone,implant interface seems to be determinant. [source] Accuracy of a newly developed integrated system for dental implant planningCLINICAL ORAL IMPLANTS RESEARCH, Issue 11 2009Timo Dreiseidler Abstract Objectives: To evaluate the accuracy of the first integrated system for cone-beam CT (CBCT) imaging, dental implant planning and surgical template-aided implant placement. Materials and methods: On the basis of CBCT scans, a total of 54 implant positions were planned for 10 partially edentulous anatomical patient-equivalent models. Surgical guides were ordered from the manufacturer (SICAT). Two different types of guidance were assessed: for assessment of the SICAT system inherent accuracy vendor's titanium sleeves of 2 mm internal diameter and 5 mm length were utilized for pilot drills. The guide sleeves of the NobelGuide system were implemented for fully guided surgery and implant insertion. Deviations perpendicular to the implant axes at the crestal and apical end, as well as the angle deviations between the virtual planning data and the surgical results, were measured utilizing a follow-up CBCT investigation and referential marker-based registration. Results: The SICAT system inherent mean deviation rates for the drilled pilot osteotomies were determined to be smaller than 500 ,m even at the apical end. Mean angle deviations of 1.18° were determined. Utilizing the NobelGuide sleeve-in-sleeve system for fully guided implant insertion in combination with the investigated template technology enabled to insert dental implants with the same accuracy. Crestal deviations, in general, were significantly lower than the apical deviations. Conclusion: Although hardly comparable due to different study designs and measurement strategies, the investigated SICAT system's inherent accuracy corresponds to the most favourable results for computer-aided surgery systems published so far. In combination with the NobelGuide surgical set for fully guided insertion, the same accuracy level could be maintained for implant positioning. [source] Accuracy of a computerized tomography-guided template-assisted implant placement system: an in vitro studyCLINICAL ORAL IMPLANTS RESEARCH, Issue 10 2009Jacob Horwitz Abstract Objectives: To evaluate the accuracy of computer-assisted 3D planning and implant insertion using computerized tomography (CT). Materials and methods: Nine implants were planned on pre-operative CTs of six resin models, which were acquired with radiographic templates, using a planning software (E implants). Each resin model contained three pre-existing control implants (C implants). Radiographic templates were converted into operative guides containing 4.8-mm-diameter titanium sleeves. A single set of insertable sleeves was used for consecutively drilling the six models, followed by implant insertion through the guide sleeves. Models were further divided into group A (the first three models) and group B (the last three models). Post-operative CTs were used to compare implant positions with pre-operative planned positions. Statistical analysis included the Mann,Whitney U test for E and C implants and the Wilcoxon's signed ranks test for groups A and B. Results: The mean apex depth deviations for E and C implants [0.49 mm±0.36 standard deviation (SD) and 0.32 mm±0.21 SD, respectively], and the mean apex radial deviations (0.63 mm±0.38 SD and 0.49 mm±0.17 SD, respectively) were similar (P>0.05). The mean angulation deviations for E and C implants were 2.17±1.06°SD and 1.33±0.69°SD, P<0.05. E implant deviations of all the parameters in group A were significantly smaller than E implant deviations in group B. Conclusions: Computer-assisted implant planning and insertion provides good accuracy. Deviations are mainly related to system and reproducibility errors. Multiple use of drills and titanium sleeves significantly reduces system accuracy. [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] CAD/CAM fabrication and clinical application of surgical template and bone model in oral implant surgeryCLINICAL ORAL IMPLANTS RESEARCH, Issue 1 2009Taiji Sohmura Abstract Objectives: A novel implant surgery support system with computer simulation for implant insertion and fabrication of a surgical template that helps in drilling bone was developed. A virtual reality haptic device that gives the sense of touch was used for simulation and a surgical template was fabricated by CAD/CAM method. Surgical guides were applied for two clinical cases. Material and methods: Three-dimensional (3D) jaw bone images transferred from DICOM data filmed by CT scanner were fed to the software and manipulated using the haptic device. The site for implant insertion was determined after evaluating the quality of bone and position of the mandibular canal. The surgical template was designed with ease using the free design CAD function of haptic device. The surgical template and bone model were fabricated by a fused deposit modeling machine. Two clinical cases were applied using the present system. Results: Simulation to determine the site of implant insertion and fabrication of the surgical bone templates were successfully done in two clinical cases, one for three implant insertion in lower right jaw and the other is for seven implant insertion in lower edentulous jaw, respectively. During surgery, the templates could be firmly adapted on the bone and drilling was successfully performed in both cases. Conclusion: The present simulation and drilling support using the surgical template may help to perform safe and accurate implant surgery. [source] Effect of platelet-rich plasma on the early bone formation around Ca-P-coated and non-coated oral implants in cortical boneCLINICAL ORAL IMPLANTS RESEARCH, Issue 2 2008Dimitris Nikolidakis Abstract Objectives: The purpose of the present study was to investigate the effect of local application of platelet-rich plasma (PRP) on the early healing of cortical bone around Ti implants with two different surface configurations. Material and methods: Six goats were used in this study. PRP fractions were obtained from a venous blood sample of the goats and administered immediately before implant insertion. PRP was applied via gel preparation and installation of the gel into the implant site, or via dipping of the implants in PRP fraction before insertion. A total of 36 implants (18 non-coated and 18 Ca-P-coated) were placed into the tibial cortical bone. The animals were sacrificed at 6 weeks after implantation and implants with surrounding tissue were prepared for histological examination. Histomorphometrical variables like the percentage of implant surface with direct bone,implant contact and the percentage of new and old bone adjacent to the implant were evaluated. Results: More interfacial bone-to-implant contact was observed for all the three groups of Ca-P-coated implants and the Ti/PRP liquid group. All groups revealed similar percentages of old and new bone adjacent to the implant. Conclusions: It was concluded that the additional use of PRP did not have any effect on the early cortical bone response to the Ca-P-coated implants, while PRP in a liquid form showed a tendency to increase bone apposition to roughened titanium implants. [source] Surgical advantages with ITI TE® implants placement in conjunction with split crest techniqueCLINICAL ORAL IMPLANTS RESEARCH, Issue 2 200518-month results of an ongoing prospective study Abstract: Implant rehabilitation of the edentulous maxilla may be somewhat problematic because of anatomic situations involving insufficient bone thickness. One approach in this situation is localized ridge augmentation with the split crest technique. This surgical approach allows the external cortical plate of the maxilla to be moved in a labial direction to gain an increase in width to introduce implants of appropriate diameter. This ongoing prospective study evaluated: (i) the surgical advantages that the new ITI TE® implants have showed compared with the ITI standard solid-screw implants when placed in conjunction with the split crest technique and (ii) the implant success rate associated with 42 ITI TE® implants and 40 ITI standard solid-screw implants placed in 40 patients in conjunction with the split crest technique. ITI TE® implants have shown direct and indirect advantages in reducing the risk of fracture of the labial cortical plate during all the three fundamental surgical steps of this technique: (a) the ridge expansion with osteotomes; (b) implant site preparation with drills and (c) implant insertion. The overall success rates of ITI TE® implants and standard screw implants were 100% and 95%, respectively. Based on the preliminary results of the present study, it can be concluded that ITI TE® implants inserted in conjunction with split crest technique seem to be a promising surgical procedure to treat selected anatomic situations involving insufficient maxillary bone thickness. Résumé La réhabilitation implantaire du maxillaire édenté peut être problèmatique à cause des situations anatomiques comportant une insuffisance de l'épaisseur osseuse. Une approche de cette situation est d'effectuer un épaississement du rebord localisé avec la technique du rebord osseux fendu. Cette approche chirurgicale permet au plateau cortical externe du maxillaire d'être déplacé en une direction linguale pour augmenter la largeur afin de pouvoir ensuite placer des implants d'un diamètre approprié. Cette étude prospective encore en cours a évalué 1) les avantages chirurgicaux des nouveaux implants ITI TE comparés aux implants ITI en vis solide ITI standard lorsqu'ils étaient placés en association avec cette technique de rebord osseux fendu et 2) le taux de succès implantaire associé avec 42 implants ITI TE et 40 implants vis solides ITI standard placés chez 40 patients en association avec cette technique de rebord osseux fendu. Les implants ITI TE ont montré des avantages directs et indirects en réduisant le risque de fracture de la corticale linguale durant les trois étapes chirurgicales fondamentales de cette technique : a) l'expansion du rebord alvéolaire avec les ostétomes, b) la préparation des sites implantaires avec les forets et c) l'insertion implantaire. Les taux de succès généraux des implants ITI TE et des implants vis standards étaient respectivement de 100 % et 95%. Basé sur le résultat préléminaire de cette étude, il peut être conclu que les implants ITI TE insérés en association avec la technique du rebord osseux fendu semble être un processus chirurgical prometteur pour traiter des situations anatomiques sélectionnées qui comportent une épaisseur osseuse insuffisante du maxillaire. Zusammenfassung Die Rekonstruktion einer zahnlosen Situation im Oberkiefer ist dann etwas problematischer, wenn anatomisch ungünstige Gegebenheiten wie zum Beispiel eine ungenügende vertikale Breite des Alveolarknochens besteht. Eine mögliche Vorgehensweise in dieser Situation ist die lokale Knochenaugmentation mittels Spaltung und Spreizung der Knochenkortikalis. Diese chirurgische Methode erlaubt uns, die äussere Kortikalis des Oberkiefers in labialer Richtung abzuspreizen und somit ein genügend breites Knochenbett zu erhalten, um Implantate mit dem geeigneten Durchmesser setzen zu können. Diese noch weiterverfolgte Langzeitstudie untersuchte: (i) die chirurgischen Vorteile, die uns das neue ITI TE-Implantat verglichen mit der Vollschraube des ITI-Standardimplantates in Verbindung mit der Kortikalisspreiztechnik bringt und (ii) die Implantaterfolgsrate von 42 ITI TE-Implantaten und 40 Vollschrauben der ITI-Standartimplantate, die man bei 40 Patienten in Verbindung mit der Kortikalisspreiztechnik gesetzt hat. Die ITI TE-Implantate zeigten direkte und indirekte Vorteile bei der Verminderung des Frakturrisikos in der labialen Kortikalisplatte während den drei grundlegenden Schritten dieser Technik: (a) Spreizung des Knochenkamms mit Osteotomen; (b) Vorbohren des Implantatbettes und (c) Eindrehen der Implantate. Die Erfolgsrate lag bei den ITI TE-Implantaten bei 100% und bei den Standartschraubenimplantaten bei 95%. Basierend auf diesen ersten Resultaten der Studie kann man schliessen, dass es sich bei ITI TE-Implantate, die in Verbindung mit der Kortikalisspreiztechnik eingesetzt worden waren, um eine vielversprechende chirugische Technik handelt, um ausgewählte anatomische Situationen, wie zu Beispiel eine ungenügende vertikale Breite des Alveolarknochens im Oberkiefer, zu behandeln. Resumen La rehabilitación con implantes del maxilar edéntulo puede ser un tanto problemática debido a situaciones anatómicas que comprenden situaciones de grosor óseo insuficiente. Un enfoque en esta situación, es el aumento localizado de la cresta con la técnica de cresta dividida. Este enfoque quirúrgico permite mover la placa cortical externa del maxilar en dirección labial para ganar un aumento en anchura para introducir implantes del diámetro apropiado. Este estudio prospectivo continuado evaluó: i) los avances quirúrgicos que los nuevos implantes ITI TE han mostrado en comparación con los implantes macizos roscados ITI estándar al colocarse en combinación con la técnica de cresta dividida y ii) el índice de éxito del implante asociado con 42 implantes ITI TE y 40 implantes macizos roscados estándar colocados en 40 pacientes en combinación con la técnica de cresta dividida. Los implantes ITI TE han mostrado ventajas directas e indirectas en reducir el riesgo de fractura de la placa cortical labial durante los tres pasos quirúrgicos fundamentales de esta técnica: a) expansión de la cresta con osteotomos; b) preparación del lecho implantario con fresas y c) inserción del implante. El índice total de éxito de los implantes ITI TE y de los implantes estándar roscados fue del 100% y del 95% respectivamente. Basado en los resultados preliminares del presente estudio, se puede concluir que los implantes ITI TE insertados en combinación con la técnica de cresta dividida parece ser un procedimiento quirúrgico prometedor para tratar situaciones anatómicas determinadas que conllevan un grosor óseo maxilar insuficiente. [source] | ||||||||||||||||||||||