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Biomedical subjects

Michael S Block

Publications and source records attributed to Michael S Block.

At least 19 recordsLinked to original sources
PubMed2007

Resorbable plates for the fixation of mandibular fractures: a prospective study.

PURPOSE: The hypothesis for this prospective evaluation is that resorbable plates are equal to the performance of titanium 2-mm plates, regarding healing of the fracture with bone union and restoration of function. To prove this hypothesis, specific end points will be compared with literature norms for titanium 2-mm miniplate rigid fixation. The primary end point variable for this analysis is the union of the fracture and return to normal function. Secondary end point variables included the incidence of complications such as infection, malunion with malocclusion, soft tissue dehiscence, the need for revision surgery, specific technical challenges, operative time, and the learning curve for the surgeon. PATIENTS AND METHODS: This prospective study consisted of a sequential enrollment of 50 fractures that met the inclusion criteria of having a fracture of the mandibular body, symphysis, angle, or ramus, and required an open reduction and internal fixation for stabilization and repair. The resorbable plates and screws used consisted of an amorphous injection molded copolymer of L-lactide/D-lactide/trimethylene carbonate (Inion CPS system, Tampere, Finland). Data were collated and compared with literature norms for titanium plates and also compared with nonrigid fixation data from a prospective study performed on a similar population in the same institution. RESULTS: Clinical and radiographic evaluation indicated union of all fractures at the eighth follow-up visit. Three sites (6%) noted to have clinical signs of infection were treated immediately upon presentation, with fracture union by 8 weeks. There was no need for revision surgery in this series of patients; 12 screw heads fractured during screw placement and were immediately replaced without significant fracture sequelae. CONCLUSION: Based on this limited series of patients, the hypothesis formulated for this study was validated.

Absorbable Implants↗
PubMed2005

Reconstruction of severe anterior maxillary defects using distraction osteogenesis, bone grafts, and implants.

PURPOSE: The purpose of this article is to describe the method for reconstructing patients with severe anterior maxillary defects, using a combination of distraction osteogenesis, onlay bone grafts, and implants to support either fixed or fixed/removable prostheses. MATERIALS AND METHODS: The surgical technique involves placement of an extraosseous distraction device followed by greater than 10 mm of distraction of the alveolus. A corticocancellous graft is harvested from the hip to establish sufficient horizontal bone for implant placement. Implants are placed after graft consolidation followed by fabrication of a fixed or fixed/removable prosthesis depending on the needs of the individual patient. RESULTS: Five patients have been prospectively followed using this technique, with completion of their prosthetic reconstruction, with follow-up ranging from 1 to 4 years. CONCLUSION: The combination of distraction, onlay bone grafting, and implant placement has been able to reconstruct patients with severe maxillary defects.

Bone Transplantation↗
PubMed2005

Correlation of papilla to crestal bone levels around single tooth implants in immediate or delayed crown protocols.

PURPOSE: The purposes of this study are to determine if there is a difference in the papilla fill between implant and teeth comparing immediate provisionalized and delayed single tooth implant restorations, and to determine the relationships between the vertical and horizontal bone levels to papilla filling the inter-dental region with single implant restorations. PATIENTS AND METHODS: Two groups of patients treated with single tooth implant restorations were prospectively followed. One group had immediate provisionalization of their implants, and the second group a delayed approach. Serial radiographs and photographs were used to collect bone level measurements for the vertical distance between contact point to bone level on the adjacent tooth, implant, and the midcrestal region. The horizontal distances were also recorded. Papilla morphology was scored 1 through 4. Univariate analysis was used to evaluate the relationships between bone levels and papilla morphology. RESULTS: There were no differences between papilla or bone levels comparing immediate provisionalization to delayed approaches. There were significant ( P < .05) relationships between the vertical distance from contact point to bone levels, with the distance from the contain point to the adjacent tooth the distance most critical to papilla maintenance. There were no significant relationships between horizontal distance and papilla maintenance. CONCLUSION: As the distance from the contact point to the implant increased, there was a significant chance of loss of papilla. There was no difference between delayed or immediate provisionalization and papilla scores. The horizontal distance from adjacent tooth bone level did not correlate to papilla score within the range of clinically relevant distances.

Adult↗
PubMed2005

Indications for splinting implant restorations.

PURPOSE: The purpose of this article was to review the literature concerning the need to splint implants together when restoring them with a provisional restoration immediately after implant placement. METHODS: The literature is reviewed concerning the rationale for splinting teeth and reports concerning the efficacy of splinting implants together. Based on this team's experience with a prospective series of consecutive 2 to 5 unit provisionalization cases, guidelines are included with case examples for understanding the technique. CONCLUSION: As long as canine guidance is present, and occlusion is stable, multiunit single quadrant restorations do not need to be splinted when provisionalized.

Dental Abutments↗
PubMed2005

Implant restoration of external resorption teeth in the esthetic zone.

PURPOSE: The purposes of this article were to review the literature for treatment of teeth with external resorption secondary to avulsive injuries and to illustrate treatment of patients with teeth following different clinical scenarios to develop a predictable course of therapy. MATERIALS AND METHODS: Cases that demonstrate treatment of teeth with external resorption following injury during the growing period, external resorption treated with a delayed approach after tooth extraction, immediate grafting of the extraction site to repair labial bone loss, and immediate implant placement with provisionalization are shown. CONCLUSION: Based on a review of the literature, the decision to place dental implants to replace teeth with external resorption can be timed depending on the location and type of the resorption, with excellent esthetic results.

Adolescent↗
PubMed2005

Techniques to facilitate provisionalization of implant restorations.

PURPOSE: The aim of this article was to review current methods for immediate provisionalization of single unit implant restorations. METHODS: Four methods are discussed and illustrated in detail, including: preoperative preparation of an abutment and provisional crown using diagnostic models; abutment placement and modification at the time of implant placement; the use of 1-piece or non-prepable abutments; and methods of indexing. Material characteristics for indexing are presented to provide the clinician with an understanding of material handling in relation to accuracy of indexing. CONCLUSION: Depending on clinician and patient case specific criteria, immediate provisionalization of implant restorations can be performed in an efficient manner.

Dental Abutments↗
PubMed2005

Treatment planning for multiunit restorations--the use of diagnostic planning to predict implant and esthetic results in patients with congenitally missing teeth.

Patients afflicted with congenitally missing teeth are a unique patient population for consideration of treatment with osseointegrated implants. Frequently, these patients have limited development of the alveolar process and differences in spatial position relative to the opposing arch, which places emphasis on ancillary treatment with orthodontics and oral surgery. A thorough diagnostic workup should include an interdisciplinary approach to ensure optimal treatment and timing of treatment in those who are developing. This article outlines considerations for treating these types of patients and scenarios of treatment paths frequently taken to restore the partially dentate and edentulous to esthetics and function.

Anodontia↗
PubMed2004

Single-implant restorations: a contemporary approach for achieving a predictable outcome.

The replacement and restoration of missing single teeth with dental implants are routine procedures. However, because of the relatively short clinical history of this procedure in dentistry, custom-tailored protocols for this procedure do not exist. This article will outline the various surgical and restorative steps involved in the treatment planning, fabrication, and delivery of single-implant restoration, and will critically analyze the existing clinical concepts and provide recommendations based on a contemporary approach. As data for and experience with this procedure increase the same general guidelines for all types of implant restorations may not apply. Emphasis will be placed on differentiating between the various types of single-implant restorations, comparing and contrasting the differences between the different types of single-implant restorations, and revising some of the existing concepts of this treatment modality.

Anodontia↗
PubMed2004

Horizontal ridge augmentation using human mineralized particulate bone: preliminary results.

PURPOSE: We evaluated the hypothesis that particulate human mineralized bone can be used to augment the thin mandibular ridge followed by implant placement 4 months after augmentation. The thin ridge prevents implant placement without grafting. PATIENTS AND METHODS: Eleven consecutive patients with thin posterior mandibular ridges had approximately 1 cc of particulate human mineralized bone placed through a tunneling approach to augment the ridge width. Thirty-five implants were placed into 13 ridges after graft consolidation, with 1 implant failure. RESULTS: All grafted ridges were able to have at least a 3.25 mm diameter implant placed. One implant failed to integrate. One-year follow-up indicates stability of the augmentation. CONCLUSION: This preliminary report indicates the potential for this technique to substitute for more invasive procedures.

Alveolar Ridge Augmentation↗
PubMed2004

Fixed partial denture or single-tooth implant restoration? Statistical considerations for sequencing and treatment.

The choice to replace a single missing tooth can be based on the primary decision that the restorability of the tooth is in doubt. Many teeth are decimated by incipient or recurrent caries, trauma, endodontic complications, or periodontal disease which requires extraction. It is our objective to familiarize the participant with literature comparing success rates of fixed partial dentures and single-tooth implant restorations and a repertoire of prosthodontic techniques used in replacement of single missing teeth with osseointegrated dental implants. The fixed partial denture (FPD) has been regarded as the standard of care for some time in replacement of single and multiple missing teeth. Many studies surveying long term survival have been compiled and analyzed to arrive at a generalized outcome. Most of these studies arrive at common conclusions. Studies surveying success of single-tooth implant-supported restorations are not comparably abundant nor survey for comparable time as those for FPDs. Although, many of the outcomes are statistical survival estimates such as Kaplan-Meier survival tables, implant restorations in partially dentate patients are a predictable means of tooth replacement. There are certain factors which make FPD more appropriate and conversely factors which make an implant restoration more appropriate. Indications and contraindications for each treatment scenario will also be reviewed based on the literature and clinical experience. It is hoped that the practitioner will be able to appropriately identify those cases in which either an FPD or an implant restoration is the appropriate treatment option.

Contraindications↗
PubMed2004

Immediate loading of the edentulous mandible: delivery of the final restoration or a provisional restoration--which method to use?

PURPOSE: Edentulous patients desire restoration of their chewing ability as soon as possible after placement of dental implants. The purpose of this article is to provide clinicians with evidence that immediate loading of implants placed into the anterior mandible can predictably provide the patient with early functional rehabilitation. Two methods are presented that illustrate delivery of the final restoration or a provisional implant-borne prosthesis immediately after implant placement. MATERIALS AND METHODS: A literature search was performed which produced 14 articles in the English literature that provided sufficient evidence that immediate loading is now not experimental and can be recommended as an acceptable treatment alternative. RESULTS: Two practical methods to achieve immediate function are presented in a step-wise manner to illustrate how to deliver this service to the patient. CONCLUSION: Based on our literature review, immediate loading of the edentulous mandible with an implant-borne restoration is an acceptable and predictable method to deliver efficient return of function for the edentulous patient.

Dental Abutments↗
PubMed2004

Immediate loading of dental implants in the edentulous mandible.

BACKGROUND: The authors review the literature regarding immediate implant loading in the anterior edentulous mandible, demonstrate the technique they currently use, review preliminary results and present an illustrative case. MATERIALS AND METHODS: The authors conducted a literature search using PUBMED and Ovid databases. They considered for review 31 articles in English from 1969 to 2003 that pertained to immediate loading of the anterior mandible. The authors developed a technique to provide a bar-supported prosthesis on the day of surgery. They treated five patients and followed them up for at least six months. The preliminary results are presented. RESULTS: This literature review demonstrated that immediate loading of anterior mandibular implants is an acceptable method, with predictable results. This case series demonstrates the potential for delivering a final bar on the day of surgery, based on the current evidence and clinical application. CONCLUSIONS AND PRACTICE IMPLICATIONS: The method described provides patients with immediate prosthetic restorations and a decreased treatment time compared with that for the traditional two-stage implant approach.

Dental Implantation, Endosseous↗
PubMed2002

Comparison of 3 bone substitutes in canine extraction sites.

PURPOSE: The purpose of this study was to evaluate the healing response with 3 different bone substitute materials in extraction sites in the dog. MATERIALS AND METHODS: Four dogs had their mandibular and maxillary premolars extracted atraumatically. The sites were immediately grafted with anorganic bovine bone (Bio-Oss, Osteohealth, Shirley, NY), Bone Source (Leibinger, Inc, Kalamazoo, MI), or Embarc (Lorenz Surgical, Jacksonville, FL), or left untreated as a control. After 8 weeks, the sites were removed for histologic evaluation of bone fill and the healing response. RESULTS: All sites healed well without signs of infection. No significant differences were noted in the shape of the ridges between groups. The control sites had radiographic bone fill by 8 weeks. The Bio-Oss sites showed bone fill with a similar appearance to the control sites. The Bone Source and Embarc sites showed implant material taking up most of the extraction site. In all sites the control and Bio-Oss sites had significantly more bone formation than the Embarc and Bone Source sites (P <.05). The control sites contained woven bone. The Bio-Oss sites were similar to the control sites, but with remnants of Bio-Oss in the bone. The Bone Source and Embarc sites were filled predominantly with the graft material without evidence of resorption and replacement of the materials, and with minimal bone formation. CONCLUSIONS: Based on this study, the control and Bio-Oss sites were similar, with bone filling most of the extraction site. The other 2 materials did not show replacement with bone.

Alveolar Bone Loss↗
PubMed2002

Determination of subepithelial connective tissue graft thickness in the dog.

PURPOSE: In this study, we determined the tissue thickness of healed subepithelial connective tissue grafts, the type of tissue present after healing, and the percentage of shrinkage of subepithelial connective tissue grafts over time in the facial aspect of the canine maxilla. MATERIALS AND METHODS: Four dogs each received 2 single-thickness subepithelial connective tissue grafts, 2 double-thickness grafts, and 2 sham-operated sites in the facial aspect of the maxilla bilaterally. The subepithelial connective tissue graft was harvested from the palate and included the periosteum. After the creation of a pouch on the facial aspect of the maxilla, the grafts were sutured directly to the maxillary periosteum and additional sutures were placed to secure the overlying mucosal flap to the graft. Thickness measures of the grafts before placement and after surgery with the grafts in place were made biweekly with a calibrated probe using known reference points on the teeth. Thickness measures were analyzed using a random-effects mixed model. All dogs were killed at 12 weeks, and the tissues were fixed, serially sectioned, and stained with hematoxylin and eosin for microscopic examination. RESULTS: Initial measurements of the sites demonstrated a thickness of 1.5 +/- 0.6 mm. Immediate postoperative measures were 7.1 mm (single thickness), 7.0 mm (double thickness), and 4.8 mm (sham operated). Week 6 measures were 3.9 mm (single thickness), 3.6 mm (double thickness), and 2.7 mm (sham operated), and week 12 measures were 3.9 mm (single thickness), 3.4 mm (double thickness), and 2.9 mm (sham operated). The difference between single- and double-thickness grafts was not significant (P =.34). The differences between single thickness and sham operated (P =.0036) and between double thickness and sham operated (P =.0049) were significant. Microscopic evaluation demonstrated that the grafts were indistinguishable from the adjacent subcutaneous tissues of the maxilla. The submucosal graft region contained fat, small blood vessels, nerves, and fibrous connective tissue. CONCLUSIONS: Based on this study in dogs, shrinkage of subepithelial grafts can be expected. The grafts become incorporate into the host tissues and appear similar to the normal connective tissue.

Analysis of Variance↗