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PubMed2003

Autogenous free tooth transplantation with a two-stage operation technique.

If tooth transplantation is to succeed, it is crucial to preserve the vitality of the cells on the root surface of the tooth transplant. Insufficient postoperative nutrition to the cells on the root surface of the tooth transplant was thought to contribute to their devitalization of these cells. Impaired nutrition may be a result of poor contact between the recipient bed and the root surface of the transplanted tooth, and development of an interposed blood clot. To improve postoperative nutrition to the root surface cells, teeth were transplanted to the recipient beds in which the tissues were regenerated during a 14 day period, i.e., using the two-stage transplantation technique. In a clinical study of this technique, a total of 95 autogenous teeth with fully developed roots were transplanted in 84 patients, and examined both clinically and radiographically for up to 13 years after the transplantation. In a dog model, a comparative experimental study was made between teeth transplanted to beds left to heal for 5 days and teeth transplanted to beds prepared immediately before the transplantation. The clinical study showed a low prevalence of tooth graft loss and root resorption even when infection of the root canal occurred. Periodontal attachment loss of less than 3 mm was found in 97% of 6 defined surfaces around the transplanted teeth. Transplanted teeth which were later extracted were often hypermobile, and signalled pain when provoked with heavy loading. Excessive extraction trauma, fixation failure, and excessive plaque accumulation after transplantation were all shown to be detrimental to tooth transplant. Transplanted teeth were used as abutments for fixed partial dentures and provided the necessary dental support for crowns and bridges even in patients with atrophic alveolar bone. The experimental histological study showed no differences between test and control teeth in terms of the prevalence of root resorption, which was suspected to be caused by traumatic injuries to the roots during extraction and non-rigid fixation of the transplanted teeth.

Age Factors↗
PubMedDate not supplied

Immediate implant placement and provisionalization using implants with an internal connection.

Single-tooth implant restoration has evolved from traditional two-stage surgical procedures to techniques that allow implant placement and provisionalization immediately following tooth extraction. Restorative success using an immediately provisionalized implant system is based upon adherence to several clinical and biological parameters. This article will discuss the clinical and restorative considerations that must be addressed when immediately loading single-tooth implants. Four cases are presented demonstrating the clinical versatility of an immediate implant system for predictable and aesthetic restoration of the posterior region.

Adult↗
PubMedDate not supplied

Contemporary implant concepts in aesthetic dentistry--Part 2: Immediate single-tooth implants.

Immediate implant placement and provisionalization in the aesthetic region has demonstrated predictable long-term results. Use of the immediate loading protocol significantly reduces the need for a second surgical intervention following implant placement. Based on the patient's preoperative condition, this technique can also be incorporated in select cases without the need for complicated bone grafting and augmentation procedures in compromised ridges. This article discusses the placement of single-tooth implants in the anterior region and presents the advantages and limitations of the immediate placement protocol.

Adult↗
PubMed2004

Sinus floor augmentation through a rotated palatal flap at the time of tooth extraction.

Rapid crestal bone resorption following maxillary tooth loss is further accentuated in the posterior regions because of pneumatization and enlargement of the maxillary sinuses. A treatment rationale that allows preservation and/or augmentation of vertical available bone at the time of posterior maxillary tooth extraction may offer numerous therapeutic benefits. The present study comprised 14 patients in whom 18 posterior maxillary teeth with no evident bone between the tooth apex and sinus floor, as estimated through preoperative radiographic analysis, were carefully extracted using a palatal approach. The empty alveolus was thoroughly debrided and incrementally filled with tricalcium phosphate. The graft material was gently pushed beyond the empty alveolus to elevate the sinus membrane using an osteotome. Primary soft tissue closure over the grafted sites was achieved by a rotated palatal flap. The distance between bone crest and sinus floor was radiographically estimated 6 to 7 months after the first procedure. Another procedure was then carried out to place the 10- to 14-mm implants, together with a bone-added osteotome sinus floor elevation. At uncovering, all implants were clinically stable, with no signs of infection. The presented surgical procedure performed at the time of extraction of posterior maxillary teeth in close proximity to the sinus floor allowed placement of implants of proper length and width, together with a bone-added osteotome sinus floor elevation during a second procedure.

Adult↗
PubMed2004

Dental implants in the esthetic zone. Considerations for form and function.

Successful esthetic results of dental implant placement in the esthetic zone require knowledge of various concepts and techniques. Careful preoperative treatment planning, augmentation of hard and soft tissues, and attention to the details of implant surgical and prosthetic techniques are areas that must be addressed when treating the anterior maxilla. This article will address the fundamental considerations related to implant treatment in the anterior maxillary esthetic zone, using both theory and case examples.

Bone Transplantation↗
PubMed2000

Bone healing under experimental anemia in rats.

The effects of anemia on different physiological parameters have been the object of permanent study. There are no studies in the literature on the effects of this disorder on the process on bone healing. The aim of the present study was to evaluate, histologically and histomorphometrically, the process of osteogenesis in the post-extraction alvcolus of the lower molar, and in the peri-implant environment of rats. Twenty male Wistar rats (body weight (b.w.): 60 +/- 7 g) were grouped into two experimental sets. The control group (n:10) was given 0.5 mL saline solution i.p. The anemic group (n:10) was injected with 6 mg/100 g of b.w. or 3 mg/100 g b.w. phenylhidrazine, a well known hemolytic agent. Under ketamine-xylazine anesthesia the rats were submitted to extraction of the first lower molars, and to implantation in the tibia in keeping with the "laminar test" procedure. Other parameters, i.e. body weight (b.w.), food intake (FI), hematocrit (Htc), and hemoglobinemia (Hb) were monitored every 48 hs. The results showed a reduction in b.w., FI, Htc and Hb in the experimental group. The histological and histomorphometrical data show that the condition of anemia affects osteogenesis quali-quantitatively in the post-extraction alveolus and peri-implant microenvironment. Both bone reparative situations showed that ostegenesis is "sensitive" to anemia and/or the associated conditions, causing a delay in bone healing.

Anemia↗
PubMedDate not supplied

Retrospective analysis of implant survival and the influence of periodontal disease and immediate placement on long-term results.

PURPOSE: The purpose of this study was to investigate the cumulative survival rates of dental implants placed in a private periodontal practice and the effects of periodontal disease and immediate placement on implant survival. MATERIALS AND METHODS: A retrospective chart review was conducted on 149 consecutive patients. Each patient had a single implant placed. For the purpose of analysis, patients were divided into 2 groups: those who were periodontally healthy and those who had periodontal disease. Implants were placed into available bone either immediately or after a healing period. All failed implants were removed and recorded. The effects of periodontal status and placement time on implant survival were evaluated using Cox proportional hazards regression and log-rank tests. RESULTS: Of the 149 implants in the study, 22 failed during the observation period. The 127 censored cases (i.e., implants that had not failed at the end of the observational period) were observed for a mean of 943 days (SD 932, range 35 to 4,030). Failed implants were observed for a mean of 722 days (SD 1,026, range 18 to 3,548). The presence of periodontal disease appeared to be associated with a greater failure rate, but there was no observed effect associated with time of placement. The percentages of censored immediate placement cases and delayed placement cases were nearly identical. Among the 77 implants associated with periodontal disease, placement time was not strongly associated with percentage censored. Forty-three of the 55 immediately placed implants (78.18%) and 18 of the 22 implants (81.18%) whose placement was delayed were censored. Both Cox proportional hazards regression and log-rank tests established that survival was adversely affected by periodontal disease (P < .05) but unaffected by time of placement (P > .50). The lower 1-sided 95% confidence limit for median survival time was 3,548 days for patients without periodontal disease and 1,799 days for patients with disease. DISCUSSION AND CONCLUSION: Implant survival was compromised by a history of periodontitis but not affected by immediate or delayed placement.

Dental Implantation, Endosseous↗
PubMed2004

Modified approach to the Bio-Col ridge preservation technique: a case report.

With today's esthetic conscious population, the day of simply extracting a tooth and replacing it at a later date is unacceptable to many patients. It is vital to preserve and maintain the edentulous ridge and normal gingival architecture, which often collapses after tooth extraction. As clinicians, we must have multiple techniques available to preserve or restore the function and esthetics when teeth are unrestorable. This case report describes a modified approach to the "Bio-Col Technique." This modification simplifies the procedure without compromising the esthetic result.

Adult↗
PubMedDate not supplied

Comparison of an allograft in an experimental putty carrier and a bovine-derived xenograft used in ridge preservation: a clinical and histologic study in humans.

PURPOSE: The aim of this randomized, controlled, blinded clinical study was to compare ridge dimensions and histologic characteristics of ridges preserved with 2 different graft materials. MATERIALS AND METHODS: Twenty-four subjects, each requiring a nonmolar extraction and delayed implant placement, were randomly selected to receive ridge preservation treatment with either an allograft in an experimental putty carrier plus a calcium sulfate barrier (PUT) or a bovine-derived xenograft (BDX) plus a collagen membrane. Horizontal and vertical ridge dimensions were determined using a digital caliper and a template. At 4 months postextraction, a trephine core was obtained for histologic analysis. RESULTS: The average ridge width decreased by 0.50 mm for both groups (P < .05). The midbuccal vertical change for the PUT group was a loss of 0.3+/-0.7 mm versus a gain of 0.7+/-1.2 mm for the BDX group, a difference of 1.0 mm (P > .05). Histologic analysis revealed vital bone in the PUT group of about 61%+/-9% versus 26%+/-20% for the BDX group (P < .05). DISCUSSION: Greater vital bone fill in the PUT group may be attributable to earlier and greater vascular invasion of the carrier material. The putty material was characterized by ease of handling, simple placement, and enhanced graft particle containment. CONCLUSIONS: Allograft mixed with an experimental putty carrier produced significantly more vital bone fill than did the use of a xenograft with no carrier material. Ridge width and height dimensions were similarly preserved with both graft materials.

Alveolar Bone Loss↗
PubMedDate not supplied

Immediate provisional restoration of Osseotite implants: a clinical report of 18-month results.

PURPOSE: The purpose of this study was to assess the survival rates and interproximal bone levels for Osseotite implants that were restored with fixed provisional crowns without occlusion immediately after implant placement. MATERIALS AND METHODS: Ninety-three implants were placed in 38 partially edentulous patients. All implants were immediately restored with prefabricated abutments and cement-retained provisional crowns without centric or eccentric occlusal contacts. The implants were restored with definitive restorations approximately 8 to 12 weeks after implant placement. All patients included in the study were followed for at least 18 months after implant placement (average 20.3 months). RESULTS: Seventy-seven of the 93 implants satisfied the inclusion criteria. Seventy-five implants became osseointegrated. The overall survival rate was 97.4%. Radiographic bone loss 18 months after implant placement (the mean of both interproximal surfaces) was 0.76 mm. The exact binomial confidence interval was 0.32% to 9.07%. For the exact binomial test with the null hypothesis proportion = .05, P was .3334 and was not statistically significant. DISCUSSION: Immediate nonocclusal loading of single-unit dental implants differs from immediate loading of multiple, splinted implants. Unsplinted, restored implants without occlusal loading may still be subject to lateral and occlusal loads secondary to the proximate location of the food bolus. Immediate restoration of dental implants significantly reduces treatment time and may be beneficial in reducing the morbidity associated with loss of teeth, contraction of the alveolus, and loss of interdental papillae associated with the traditional method of treatment following tooth loss. CONCLUSIONS: The results of this study suggest that immediate restoration of Osseotite implants can be accomplished with results that are similar to the results obtained with the traditional 1- or 2-stage surgical, unloaded healing protocols.

Adolescent↗
PubMedDate not supplied

Soft tissue healing around implants placed immediately after tooth extraction without incision: a clinical report.

PURPOSE: The purposes of the present study were to evaluate implants placed immediately after tooth extraction without incision or primary flap closure and to observe the peri-implant soft tissue healing. MATERIALS AND METHODS: Fifteen patients (9 men and 6 women) aged 31 to 54 years were included in this study. Each patient had a tooth that required extraction, and each had at least 4 mm of bone beyond the root apex. Teeth with multiple roots were excluded from this study. After tooth extraction, the implants were immediately placed without incision or flap elevation. Implant sites showing bone fenestrations, bone dehiscences, or peri-implant bone defects exceeding 2 mm were excluded from this study. In these cases, a standard guided bone regeneration procedure with a surgical flap elevation was used. The second-stage surgical procedure was performed 6 months after the first procedure. The following clinical parameters were evaluated at the time of implant placement and at second-stage surgery: levels of mesial and distal papillae, width of keratinized mucosa, position of mucogingival junction relating to the surrounding tissues, and peri-implant radiolucency and marginal bone loss, which were evaluated radiographically. RESULTS: The postsurgical healing period was uneventful for all patients. Soft tissue closure over the implant sites was achieved in 1 to 3 weeks after surgery at all sites. At second-stage surgery, no peri-implant bone defects were observed or detected by probing around all the experimental implants. The soft tissue anatomy was considered clinically acceptable in all patients. DISCUSSION AND CONCLUSION: Successful osseointegration and complete bone healing were observed for all patients. The soft tissue healing and morphology were satisfactory; additional mucogingival surgery was not required before definitive prosthetic rehabilitation.

Adult↗
PubMed2004

[Alveolar bone regeneration stimulated by a combination of platelet-rich plasma and Cerasorb graft in Beagle dogs. Histological and histomorphometric studies].

Healing of extraction wounds was examined in an animal experiment model on Beagle dogs. After bilateral extraction of the premolars of 12 dogs the alveoli were filled up with a combination of beta-tricalcium phosphate (Cerasorb) graft and platelet rich plasma (PRP) on the experimental side, and with Cerasorb alone on the control side. Biopsy specimens were taken from the regenerating bone at 6, 12 and 24 weeks after surgery for histological study. Results of the histologic and histomorphometric examinations revealed that after 6 weeks the newly formed bone was significantly denser on the experimental side. After 12 weeks this difference became moderate, and after 24 weeks the bone forming activity was nearly equal on the two sides. These results suggest that local administration of Cerasorb and PRP results in more intense bone regeneration, especially in the early phase.

Alveolar Process↗