International Journal of Periodontics & Restorative Dentistry, 06/2001

The purpose of this study was to evaluate the clinical success of immediate functional loading of immediate implants in edentulous arches. Five maxillary and five mandibular jaws were treated, and a total of 91 implants were placed; 66 of these implants were placed immediately after tooth extraction, and 25 were placed in healed sites. No bone substitutes or barrier membranes were used. Within 24 hours, fixed temporary restorations were inserted in all cases. During the entire 6-month healing time, all fixed temporary restorations were in normal function, after which the final fixed implant-supported restorations were inserted. After 24 months, the overall success rate of the implants was 92.31% (87.50% for the maxillary implants and 97.26% for the mandibular implants). The bone level measured mesially and distally was in 93.40% of all cases between the implant shoulder and the first thread. The present study shows that the immediate functional loading of immediate implants without the use of any bone substitutes or barrier membranes for fixed complete-arch reconstructions can be successful over a 2-year period.

Periodontal plastic surgery enables enhanced esthetics in the anterior maxillary region. Reconstruction of the interdental papilla is one of the most challenging and least predictable of treatments. Several surgical and nonsurgical procedures to rebuild lost papillae have been presented; however, good results have been elusive. The purpose of the present study was to evaluate a novel surgical procedure based on an advanced papillary flap combined with a gingival graft intended to augment the soft tissue in the interdental area. The study comprised 10 consecutive papilla augmentation procedures performed in nine patients. Previous to the surgical procedure and at least 3 months postoperative, papilla contour measurements were carried out based on a papilla index score (PIS). PIS ranged from 0 to 2 preoperative (mean 1.0) and between 1 and 3 postoperative (mean 2.2). In eight procedures, PIS increased. Differences between pre- and postoperative PIS ranged from 0 to 3 PIS units (mean 1.2). Among the 10 procedures, there was an increase of 1 PIS unit in five, an increase of 2 PIS units in two, 3 PIS units in one, and no increase in the remaining two. This procedure is relatively easy to perform and offers a reliable solution to an esthetic problem. However, larger clinical and histologic follow-up studies are necessary before its long-term predictability can be established.

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.

This work describes the author's experience with the treatment of alveolar vertical bone atrophy using the distraction osteogenesis technique. Five patients with localized vertical atrophy of the alveolar ridge (loss of one to four teeth) were treated using two different types of distractor devices. All the patients were operated on under local anesthesia without needing hospitalization. The surgical technique used in one of these cases and the results of all of the cases treated are reported in this study. Distraction osteogenesis may be a valid alternative to guided bone regeneration in selected cases for the treatment of vertical atrophy of the alveolar ridge, with a substantial reduction in implantation time.

The authors evaluated the health of the maxillary sinus in a group of 18 patients who had undergone sinus lift surgery for implantation purposes, using computed tomography and endoscopic imaging as a means of diagnosis. The study was performed after a mean interval of 31 months. All sinus lift operations were carried out using the lateral flap technique. The authors evaluated graft characteristics and intraoperative and postoperative complications and compared the results with computed tomography and endoscopic images. Endoscopy of a maxillary sinus that underwent microlaceration of the mucosa during sinus lifting showed a situation compatible with healthy conditions. In cases complicated by macrolaceration, the endoscopic picture was typical of sinusitis, even where clinical conditions of this type were not present. In the absence of intraoperative complications, the endoscopic appearance of sinus mucosa appears to improve when autologous graft material is used.

The use of the mandibular symphysis as a source of autogenous bone grafting material has been well documented. Currently, no references in the literature describe the intraosseous distribution of the neurovascular complex anterior to the mental nerve with respect to its position buccolingually and apicocoronally. The objective of this study was to evaluate the distribution of the incisive nerve and measure its location buccolingually and apicocoronally in the anterior mandible and determine its possible significance to clinical practice. According to macroscopic dissection, the mandibular incisive nerve is a normal structure that typically extends closer to the midline than previously reported. To reduce postoperative neurovascular morbidity, this should be considered when using the mandibular symphysis as a source of autogenous bone or during placement of implants in the anterior mandible.

Patients who have been partially edentulous in the posterior segments for many years frequently present with reduced alveolar bone and/or enlarged sinuses. The choice of treatment for these patients will depend on the volume of residual bone, morphology of the alveolar crest, and amount of space available for the prosthesis. A new, minimally invasive surgical procedure using Summers osteotomes is described for the treatment of the edentulous posterior maxilla in which the bone thickness below the sinus is limited (¡Ý 5 mm). This suggested modified treatment is based on the use of a combination of osteotomes, drills, and screw-type implants with a rough surface texture.

The purpose of this study was to evaluate the performance of two bone mills (RQuetin Bone Mill and Micro Knochenmühle, Aesculap) for the grinding of autogenous bone (intraoral, cortical) according to the following criteria: (1) loss of bone during the grinding process, (2) particle size of the chips, (3) variability in chip size, (4) technical handling, and (5) cost-benefit ratio. The amount of material loss was determined by harvesting 30 bone cores from the mandibular symphysis of a pig. Each specimen was weighed before and after the grinding procedure on scales with an accuracy of 0.1 mg. The size and variability of the bone particles were determined histomorphometrically. Twenty-seven bone specimens from different patients were analyzed. Eight were ground with the Aesculap and 12 with the Quetin mill. Seven specimens harvested with a Brånemark implant bur served as controls. A histologic section was prepared from each specimen, and 10 bone particles per section were subjected to histomorphometric analysis. The Quetin mill was superior in all points to the Aesculap mill for the requirements of a periodontal practice.

With the help of new support technology, oral implants can be planned and carried out in altogether new dimensions. The clinician is no longer restricted to his or her experience and the use of two-dimensional image-based procedures. The Stryker Leibinger navigation system now enables surgical planning based on three-dimensional models that can be endlessly manipulated; it produces an intraoperative view of the surgical field (online in real time). The aim of this study was to test a new surgical procedure with the use of a modified system that promises to be safer, more finely controlled, less complicated, and more valid in terms of predictive success than conventional procedures. In this preliminary investigation, the comprehensive system specifications are presented and a critical assessment of the procedural performance and potential is made.