de Paoli, Sergio

This investigation was designed to evaluate crestal bone stability and soft tissue maintenance to Laser-Lok tapered tissue-level implants. Twelve patients presenting with an edentulous site adequate for the placement of two implants were recruited from four dental offices (2 to 4 patients per office). Each patient received two Laser-Lok tissue-level implants placed with a 3-mm interimplant distance according to a surgical stent. The implants were placed so that the Laser-Lok zone sat at the junction between hard and soft tissues. A total of 24 implants were placed, and all achieved satisfactory crestal bone stability and soft tissue maintenance 1 year after receiving the final prosthetic restoration.

A technique for restoration of decayed and fractured teeth with composite inlays or onlays is presented. This approach conserves the tooth structure, requires less preprosthetic periodontal surgical intervention, and provides excellent functional results, while minimizing the incidence of post-therapeutic endodontic involvement. Two thousand seven teeth were restored using this technique over a period of 120 months, with a mean time of 59.6 months in function. The technique is described, and the advantages of this treatment modality are discussed.

Four partially edentulous patients received particulate autogenous bone and platelet-rich plasma (PRP) in one sinus and particulate autogenous bone alone in the contralateral sinus. After 6 months of healing, two or three Osseotite implants were inserted, and an additional Osseotite mini-implant was placed into the graft through the lateral wall of the sinus. At abutment connection, the mini-implants were retrieved for histologic examination. Despite similar clinical and radiographic healing patterns, a higher bone-to-implant contact rate was observed on the implants placed in bone and PRP than on those placed in bone only (46.75% ± 13.6% versus 20.5% ± 5.57%, respectively).

The purpose of this study was to report on the tunnel technique, an approach to alveolar ridge augmentation in partially edentulous patients that uses bone blocks immobilized with titanium screws prior to implant placement. Twenty patients (7 men and 13 women) between the ages of 35 and 65 years were treated during a 2-year period with the tunnel technique. The technique consists of creating the tunnel, exposing the crestal defect, harvesting the graft, and final adaptation and stabilization of the graft in the defect site. Nineteen of the 20 patients treated had an adequate level of bone postoperatively to place implants 3.75 or 4 mm in diameter and at least 10 mm in length. None of the patients reported temporary or permanent lower lip paresthesia. There were also no infections reported in the donor sites. This method eliminates the need for a membrane because the integrity of the periosteum is preserved, and it greatly reduces patient discomfort since only one surgical field is needed. The learning curve for this procedure is relatively short.

The objective of this investigation was to determine the fate of thin buccal bone encasing the prominent roots of maxillary anterior teeth following extraction. Resorption of the buccal plate compromises the morphology of the localized edentulous ridge and makes it challenging to place an implant in the optimal position for prosthetic restoration. In addition, the use of Bio-Oss as a bone filler to maintain the form of the edentulous ridge was evaluated. Nine patients were selected for the extraction of 36 maxillary anterior teeth. Nineteen extraction sockets received Bio-Oss, and seventeen sockets received no osteogenic material. All sites were completely covered with soft tissue at the conclusion of surgery. Computerized tomographic scans were made immediately following extraction and then at 30 to 90 days after healing so as to assess the fate of the buccal plates and resultant form of the edentulous sites. The results were assessed by an independent radiologist, with a crest width of 6 mm regarded as sufficient to place an implant. Those sockets treated with Bio-Oss demonstrated a loss of less than 20% of the buccal plate in 15 of 19 test sites (79%). In contrast, 12 of 17 control sockets (71%) demonstrated a loss of more than 20% of the buccal plate. In conclusion, the Bio-Oss test sites outperformed the control sites by a significant margin. No investigator was able to predict which site would be successful without the grafting material even though all were experienced clinicians. This leads to the conclusion that a patient has a significant benefit from receiving grafting materials at the time of extraction.

All of the surgical techniques to elevate the maxillary sinus present the possibility of perforating the schneiderian membrane. This complication can occur during the osteotomy, which is performed with burs, or during the elevation of the membrane using manual elevators. The purpose of this article is to present a new surgical technique that radically simplifies maxillary sinus surgery, thus avoiding perforating the membrane. The piezoelectric bony window osteotomy easily cuts mineralized tissue without damaging the soft tissue, and the piezoelectric sinus membrane elevation separates the schneiderian membrane without causing perforations. The elevation of the membrane from the sinus floor is performed using both piezoelectric elevators and the force of a physiologic solution subjected to piezoelectric cavitation. Twenty-one piezoelectric bony window osteotomy and piezoelectric sinus membrane elevations were performed on 15 patients using the appropriate surgical device (Mectron Piezosurgery System). Only one perforation occurred during the osteotomy at the site of an underwood septa, resulting in a 95% success rate. The average length of the window was 14 mm; its height was 6 mm, and its thickness was 1.4 mm. The average time necessary for the piezoelectric bony window osteotomy was approximately 3 minutes, while the piezoelectric sinus membrane elevation required approximately 5 minutes.