Severe Resorption (severe + resorption)

Distribution by Scientific Domains

Selected Abstracts

The Marius Implant Bridge: Surgical and Prosthetic Rehabilitation for the Completely Edentulous Upper Jaw with Moderate to Severe Resorption: A 5-Year Retrospective Clinical Study

Yvan Fortin DDS
ABSTRACT Background: Patients seeking replacement of their upper denture with an implant-supported restoration are most interested in a fixed restoration. Accompanying the loss of supporting alveolar structure due to resorption is the necessity for lip support, often provided by a denture flange. Attempts to provide a fixed restoration can result in compromises to oral hygiene based on designs with ridge laps. An alternative has been an overdenture prosthesis, which provides lip support but has extensions on to the palate and considerations of patient acceptance. The Marius bridge was developed as a fixed bridge alternative offering lip support that is removable by the patient for hygiene purposes, with no palatal extension beyond normal crown-alveolar contours. Purpose: Implant-supported restorative treatment of completely edentulous upper jaws, as an alternative to a complete denture, is frequently an elective preference, and it requires significant patient acceptance beyond the functional improvement of chewing. Patients with moderate to severe bone resorption and thin ridges present additional challenges for adequate bone volume and soft-tissue contours. The purpose of this investigation was to develop a surgical and prosthetic implant treatment protocol for completely edentulous maxillae in which optimal lip support and phonetics is achieved in combination with substantial implant anchorage without bone grafting. Materials and Methods: The Marius bridge is a complete-arch, double-structure prosthesis for maxillae that is removable by the patient for oral hygiene. The first 45 consecutive patients treated by one person (YF) in one center with this concept are reported, with 245 implants followed for up to 5 years after prostheses connection. Results: The cumulative fixture survival rate for this 5-year retrospective clinical study was 97%. Five fixtures failed before loading, in five different patients, and two fixtures in the same patient failed at the 3-year follow-up visit. None of the bridges failed, giving a prostheses survival rate of 100%. The complications were few and mainly prosthetic: nine incidences of attachment component complications, one mesobar fracture, and three reports of gingivitis. All complications were solved or repaired immediately, with minimal or no interruption of prostheses use. Conclusions: Satisfactory medium-term results of survival and patient satisfaction show that the Marius bridge can be recommended for implant dentistry. The technique may reduce the need for grafting, because it allows for longer implants to be placed with improved bone anchorage and prostheses support. [source]

Apical inflammatory root resorption: a correlative radiographic and histological assessment

M. Laux
Abstract Aim To assess the reliability of routine single radiographs in the diagnosis of inflammatory apical root resorption by correlating the radiographic and histological findings. Methodology The material comprised serial and step serial sections of plastic-embedded root-apices with attached apical periodontitis lesions that were prepared for a previous study and the diagnostic radiographs. The histological sections of 114 specimens were analysed by light microscopy and categorized into three groups: (i) those without any resorption (0); (ii) those with moderate resorption (+); and (iii) those with severe resorption (+ +). The radiographs were examined by a separate examiner and graded with a similar categorization of no resorption (0); moderate (+); and severe (+ +) apical resorption. Results Radiographically, 19% of the teeth were diagnosed as having apical inflammatory root resorption, whereas histologically, 81% of the teeth revealed apical inflammatory root resorption. A correlative radiographic and histological assessment (n = 104) revealed a coincidence of diagnosis in 7% of the specimens and noncoincidence of diagnosis in 76% of the specimens. Conclusions The results indicate that routine single radiographs are not sufficiently accurate or sensitive to consistently diagnose apical root resorptive defects developing as a consequence of apical periodontitis. [source]

Long-term Follow-up of Severely Atrophic Edentulous Mandibles Reconstructed with Short Branemark Implants

Bertil Friberg DDS
ABSTRACT Background: Oral implant treatment (Brånemark System) of edentulous mandibles has been presented in numerous studies. However, with regard to the severely atrophic lower jaw, no long-term follow-up studies with solely short implants are available. Purpose: The purpose of the present investigation was to retrospectively follow the long-term treatment outcome of patients with severely resorbed edentulous mandibles being subjected to oral implant placement with short (6,7 mm) Brånemark implants. Materials and Methods: A total of 247 standard (7 mm long, 3.75 mm) and 13 wide (6 mm long, 5 mm) implants were inserted in 49 patients, all of whom exhibited severe resorption of edentate mandibles. Fixed implant-supported prostheses were manufactured for 45 patients, whereas 4 patients received overdentures. The patients were followed for a mean period of 8 years (range, 1,14 yr). Results: Seventeen implants failed during the study period (cumulative implant survival rate 95.5% at 5-yr and 92.3% at 10-yr follow-up). Implant-supported constructions were worn continuously throughout the investigation by all study subjects. Marginal bone loss, measured after 1, 5, and 10 years of function, concurred with studies of Brånemark implants placed in more voluminous mandibles. No major clinical or construction complications occurred in the followed patients. Conclusions: The outcome of the present study showed that placement of short Brånemark implants without the use of bone grafting procedures for reconstruction of severely atrophic edentulous mandibles is a highly predictable treatment procedure. [source]

Placement of Brånemark implants in the maxillary tuber region: anatomical considerations, surgical technique and long-term results

Arne Ridell
Abstract Background: Fixture placement in the tuber area is one way to overcome the problem of insufficient bone volume for routine implant surgery in the posterior maxilla due to severe resorption of jawbone and an extensive enlargement of the maxillary sinus. However, little is known about the long-term results. Purpose: The aim of this study was to retrospectively evaluate the survival rate and marginal bone conditions at fixtures placed in the tuber region of the maxilla. Material and methods: Twenty-one patients previously treated with at least one implant in the tuber region of the maxilla were included in this retrospective analysis. A total of 23 standard Brånemark System fixtures with a turned surface had been surgically placed in the tuber regions and 71 additional implants in adjacent areas to support fixed dental bridges. All implants were allowed to heal for 6,8 months before abutment connection and following prosthetic treatment. The patients were radiographed after 1,12 years for evaluation of marginal bone levels. In addition, the relation between the apex of the fixture in the tuberosity area and the posterior border of the maxilla was measured. Results: Twenty of the 21 patients representing 22 tuber and 64 additional implants were radiographically evaluated. No implants in the tuber areas were lost during the follow-up whereas two fixtures in the anterior region had to be removed, one before loading and the other after 4 years of loading not interfering with the prosthesis stability. The mean marginal bone level at tuber implants was situated on average 1.6 mm (SD 1.1, n=22) from the abutment-fixture junction, whilst the other implants showed an average bone level of 1.9 mm (SD 0.8, n=64). The results were similar when comparing partially and totally edentulous patients. Conclusion: The present retrospective study shows good clinical outcome with standard Brånemark fixtures placed in the tuber region of the posterior maxilla using a two-stage procedure. In appropriate cases where bone of adequate volume and density is available, our data indicate that the technique can be used as an alternative to more extensive surgery and especially to the sinus lift procedure. However, prospective comparative studies are needed in order to evaluate the efficacy of the described technique for this purpose. [source]

Alveolar ridge augmentation with a prototype trilayer membrane and various bone grafts: a histomorphometric study in baboons

Dieter Busenlechner
Abstract: Barrier membranes have become a standard treatment option in alveolar ridge augmentation prior to implant placement. However, non-resorbable membranes require secondary surgery and resorbable membranes show an unfavorable degradation profile. The purpose of this study was to evaluate the potential of a slowly biodegradable/bioresorbable prototype trilayer membrane (PTLM) for supporting bone regeneration in alveolar ridge augmentation. Clinically relevant cavities were made 3 months after the extraction of the first and second molars in each jaw of six baboons. Each animal was treated with four different regimens: (1) autogenous bone block (ABB) alone, (2) ABB+PTLM, (3) deproteinized bovine bone mineral (DBBM)+PTLM and (4) no treatment. After 9 months, the baboons were sacrificed and block sections of the augmented area were subjected to histologic and histomorphometric analyses. Newly formed bone areas were determined at a distance of 1, 3, 7 and 10 mm from crestal. The data showed a well-preserved ridge profile at the membrane-protected sites, whereas non-protected bone blocks and control sites underwent severe resorption resulting in knife-edge ridge profiles. Significant differences were found between ABB+PTLM and ABB (P=0.0137,0.0232). DBBM+PTLM also produced a larger bone area compared with ABB alone (P=0.0396,0.0439). No significant difference in bone area was detectable between ABB+PTLM and DBBM+PTLM (P>0.05). The present study supports the use of the slowly biodegradable/bioresorbable PTLM with autografts and DBBM for lateral ridge augmentation in this type of bone defects. Résumé Les membranes barrière sont devenues une option de traitement standard dans l'épaississement du rebord alvéolaire avant le placement des implants. Cependant, des membranes non-résorbables requièrent une seconde chirurgie et les membranes résorbables montrent un profil de dégradation peu favorable. Le but de cette étude a été d'évaluer le potentiel d'une membrane prototype de trois épaisseurs (PTLM) qui était biodégradable/biorésorbable lentement pour aider la régénération osseuse dans les épaississements de rebord alvéolaire. Des cavités cliniques ont été creusées trois mois après l'avulsion des premières et deuxièmes molaires de chaque mâchoire chez six babouins. Chaque animal a été traité de quatre manières différentes : 1) un bloc osseux autogène (ABB), 2) ABB+PTLM, 3) la partie minérale de l'os bovin déprotéiné (DBBM)+PTLM et 4) pas de traitement. Après neuf mois les babouins ont été euthanasiés et des coupes en blocs de la région épaissie ont été soumises aux analyses histologiques et histomorphométriques. Les zones d'os néoforméétaient déterminées à une distance de 1, 3, 7 et 10 mm du rebord alvéolaire. Les données ont montré un profil bien préservé au niveau des sites protégés par les membranes tandis que les blocs osseux non-protégés et les sites contrôles subissaient une résorption importante en un profil en forme de lame de couteau. Des différences significatives ont été trouvées entre ABB+PTLM et ABB (P=0,0137 àP=0,0232). DBBM+PTLM produisait aussi une aire osseuse plus importante comparéà ABB seul (P=0,0396 àP=0,0439). Aucune différence significative dans l'aire osseuse n'était visible entre ABB+PTLM et DBBM+PTLM (P>0,05). L'étude présente prône l'utilisation de la membrane prototype en trois couches biodégradable/biorésorbable lentement avec du minéral osseux bovin déprotéiné et des autogreffes pour l'augmentation latérale du rebord alvéolaire dans ce type de lésions osseuses. Zusammenfassung Muss vor der Implantation eine Knochenkammaugmentation durchgeführt werden, so ist die GBR mit der Membrantechnik als Standardbehandlung anzuführen. Nichtresorbierbare Membranen erfordern jedoch einen chirurgischen Zweiteingriff, und resorbierbare Membranen zeigen ein ungünstiges Verhalten während der Resorptionsphase. Das Ziel dieser Studie war, bei der GBR die Platzhalterfunktion des Prototyps einer dreischichtig aufgebautenen Membran (PTLM) zu untersuchen, die langsam biologisch abgebaut und resorbiert wird. Drei Monate nach der Extraktion der ersten und zweiten Molaren in jedem Kiefer von sechs Pavianaffen präparierte man klinisch relevante Kavitäten. Jedes Tier erhielt vier verschiedene Behandlungsmodalitäten: (1) nur autologe Knochenblöcke (ABB), (2) ABB+PTLM, (3) entproteinisiertes Knochenmineral vom Rind (DBBM)+PTLM und (4) keine Behandlung. Nach 9 Monaten opferte man die Paviane, entnahm von den aufgebauten Stellen Blockbiopsien und bereitete sie für die histologischen und histomorphometrischen Analysen auf. Auf die Suche nach Regionen mit neu gebildetem Knochen ging man in 1, 3, 7 und 10 mm Entfernung vom crestalen Knochen. Die Daten zeigten bei den mit Membranen abgedeckten und geschützten Stellen ein gut erhaltenes Alveolarkammprofil. Bei den ungeschützten Knochenblöcken und den Kontrollstellen kam es zu ausgedehnten Resorptionen, es resultierten messerscharf auslaufende Kammprofile. Man fand signifikante Unterschiede zwischen ABB+PTLM und ABB (P=0.0137 zu P=0.232). Auch DBBM+PTLM brachte, verglichen mit nur ABB, eine bessere Knochenauffüllung (P=0.0396 zu P=0.0439). Zwischen den Varianten ABB+PTLM und DBBM+PTLM fanden sich im untersuchten Kochen keine signifikanten Unterschiede (P>0.05). Diese Arbeit befürwortet bei der lateralen Knochenkammaugmentation eines solchen Knochendefektes den Einsatz eines Prototyps einer dreischichtigen Membran (PTLM), die langsam biologisch abgebaut und resorbiert wird, sowie von autologen Knochentransplantaten und entproteinisiertem Knochenmineral vom Rind. Resumen Las membranas de barrera se han convertido en una opción estándar de tratamiento en aumento de la cresta alveolar previo a la colocación del implante. De todos modos, las membranas no reabsorbibles requieren de un segundo procedimiento quirúrgico y las membranas reabsorbibles muestran un perfil de degradación desfavorable. El propósito de este estudio fue evaluar el potencial de un prototipo de membrana de tres capas (PTLM) biodegradable/biorreabsorbible para apoyar la regeneración ósea en el aumento de la cresta alveolar. Se realizaron cavidades clínicamente relevantes tres meses después de la extracción del primer y segundo molares de cada mandíbula de seis babuinos. Cada animal se trató con cuatro diferentes regímenes: (1) bloque de hueso autógeno (ABB) únicamente, (2) ABB+ PTLM, (3) hueso mineral bovino desproteinizado (DBBM)+PTLM y (4) sin tratamiento. Tras 9 meses se sacrificó a los babuinos y secciones en bloque del área aumentada se sometieron a análisis histológicos e histomorfométricos. Se determinaron las áreas de hueso neoformado a una distancia de 1, 3, 7, y 10 mm de la cresta. Los datos mostraron un perfil de la cresta bien preservado en los lugares protegidos por la membrana, mientras que los bloques de hueso no protegido y los lugares de control sufrieron una severa reabsorción resultando en unos perfiles de cresta en filo de cuchillo. Se encontraron diferencias significativas entre ABB+PTLM y ABB (P=0.0137 a P=0.0232). DBBM+PTLM también produjeron unas áreas mayores de hueso comparadas con ABB únicamente (P=0.0396 a P=0.0439). No se detectaron diferencias significativas entre ABB+PTLM y DBBM+PTLM (P>0.05). El presente estudio apoya el uso del prototipo de membrana de tres capas lentamente biodegradable/biorreabsorbible con autoinjertos y hueso mineral bovino desproteinizado para aumento lateral de la cresta en este tipo de defectos. [source]