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Treatment of complications in sinus augmentation surgery: a clinical study
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21st ICOMS 2013—Abstracts: Oral Papers
Key words: failed implant; implant removal technique; minimal invasive removal technique. Disclosure: This work was not supported by manufacturer/supplier of any commercial products or services related to the work. http://dx.doi.org/10.1016/j.ijom.2013.07.313 T17.OR014 Biomechanics and periimplantitis: the effect of a subcrestal wing-thread to decrease alveolar crestal bone strain: theory, finite element analysis and clinical experience Z. Laster Poriya Hospital, The Galilee Medical School, Israel Purpose: This study used finite element analysis and a clinical case example to support a hypothesis that a wing-thread placed 4 mm below the top of the implant would decrease crestal bone loss in function. Materials and methods: A finite element analysis was done comparing a straight and winged implant using axial and off-axis forces based on a hypothesis that decreasing bone strain at the alveolar crestal margin influences periimplant bone stability. A clinical case example of the wing-thread implant is followed for 30 months. Results: Stress concentration was diminished at the crest when a wing-thread was used compared to a straight implant body. 90 degree lateral forces were diminished by a factor of ten in the wingthread implant. A case report with 30 months follow-up showed stable bone levels around the implants. Conclusion: A wing-thread hypothesis appears to have some support for increasing bode stability based on finite element analysis.
3 implants failed to osseointegrate at the first try and were replaced successfully 8 weeks later. No complications were observed 18–30 months after prosthetic treatment. Conclusions: Crest widening by distraction may be a better alternative to bone augmentation in cases of narrow crest with sufficient height. The advantages of the new technique are; early implant placement, simple procedure, no painful donor site, no post-op bone resorbtion, the technique can be easily performed in the private office. A long term and multi center trial is needed. http://dx.doi.org/10.1016/j.ijom.2013.07.315 T17.OR016 Biomechanics of periimplantitis—winged implant, the ultimate solution for post extraction immediate loading and D5 bone type Z. Laster Poriya Hospital, Isreal
Crest Expander-the use of distraction osteogenesis as an alternative technique to bone augmentation
The desire for immediate load restoration of dental implants, particularly in the anterior esthetic zone, requires specific implant design strategies to enhance primary stability. In the presence of extraction sites, often with compromised bone, implant fixation is obtained apically and palatally. Surface roughness is a factor in early osseointegration (Alberktsson et al.). However, it is the macro-architectural design of the implant that establishes initial mechanical fixation, which is crucial in minimizing implant mobility in the first 3–4 weeks of function. In the search of a new macro-architectural design, an idea of adding a wing to the implant for extra primary stability was raised. Finite element analysis of the ‘winged’ implant, in comparison to a regular implant, revealed that when a 20 kg force is applied at an off-axis angle of 20◦ , the amount of maximal displacement at the neck of a regular implant is 60% higher than observed with the ‘winged’. In order to determine the clinical efficacy of this new implant, a study was undertaken to evaluate the implant in both jaws under conditions of immediate function. This implant will be presented with finite elements analysis and animal experiments with explanation of the biomechanics of pri-implantitis.
Z. Laster
http://dx.doi.org/10.1016/j.ijom.2013.07.316
Poriya Hospital, The Galilee Medical School, Israel
T17.OR017
Aim: To introduce a new device and technique to widen a narrow alveolar crest prior to implantation. Materials and methods: A new distractor was used to widen a narrow alveolar crest. Under local anesthesia, 3 mucoperiosteal incisions were performed; One along the crestal ridge and two vertical incisions at the anterior and posterior buccal aspects. Through these incisions, bone cuts were made without stripping the mucoperiosteum. The bone transport was fractured by an osteotome and the distractor was inserted into the crestal bone cut. Distraction started 7 days post-op and was stopped when adequate width was achieved. Consolidation period was 1 week and than removed under local anesthesia. Implants inserted at the same session. Results: 35 patients who suffered from a narrow alveolar crest were treated over 2 1/2 years. Amount of crest expansion was 4–8 mm. 1 case failed due to partial denture placement by the patient against the instructions. 33 patients had 79 implants placed. 28 patients prosthesis completed. 1 complications of bone loss and implant neck exposure (The only case that the bone was stripped).
Treatment of complications in sinus augmentation surgery: a clinical study
http://dx.doi.org/10.1016/j.ijom.2013.07.314 T17.OR015
E.J. Moraes ∗ , L.E. Moraes, N. Moraes Unifeso, Brazil Background: The maxillary sinus augmentation procedure, is an excellent alternative to oral implantology and present a 90% of success level. However, the complications of sinus lift surgery sometimes perform consequences with very difficult management and solutions. Perforations of the Schneiderian membrane represent the major intraoperative complication and procedures of sinus with irregular mucosal thickening or presence of antral pathology are controversial. Purpose: The present study is to evaluate retrospectively the treatment options of large perforations in schneiderian membrane during the sinus graft procedure in cases with mucosal thickening >10 mm.
21st ICOMS 2013—Abstracts: Oral Papers Patients and methods: Patients of author clinic that were submitted to sinus augmentation surgery and presented sinus membrane perforation > 10 mm with implants placed simultaneously or in a second stage surgery after 6 months. The surgical techniques used were: iliac autogenous blocks, mandibular autogenous blocks and biomaterials graft mixed with platelet rich plasma (PRP) combined with a buccal fat pad flap. Results: From March 2001 to December 2009, 18 patients (12 men and 6 women) were studied, on whom 25 sinus floor augmentation with a total of 54 dental implants were placed under repaired membrane perforations Eighteen sinuses presented mucosal thickening > 10 mm and seven mucosal thickening < 5 mm previously detected in a CT scan. In eleven sinuses were used iliac blocks, in five mandibular blocks and in nine biomaterials mixed with PRP combined to buccal fat pad flap. Three sinuses with iliac blocks presented complications and the blocks were removed and a total of three implants presented fail. Patients were followed up in a period of 120–20 months. Conclusions: Sinus augmentation procedures with large membrane perforations in a presence or not of antral pathology may be adequately reconstructed and covered, and therefore are not an absolute contraindication. http://dx.doi.org/10.1016/j.ijom.2013.07.317 T17.OR018 Rehabilitation of maxillae defects with zygomatic implants: report of three cases E.J. Moraes ∗ , L.E. Moraes, N. Moraes Unifeso, Brazil Objective: The authors present a clinical report of three complex cases with patients with defects in maxilla. One patient with oroantral fistulae promoted by implants and extraoral graft complications. The other patient with a secondary oroantral communication after failure of iliac bone reconstruction associated to a Lefort I advanced. The last one presented a nasal and oroantral communication by postmaxillectomy sequelae. All patients were treated with zygomatic implants. One patient was rehabilitated with fixed prostheses and the other patients with obturator prostheses. A total of 10 zygomatic implants were placed. In two patients quad zygomatic implants technique was used and in the other two zygomatic implants associated to standard implants were performed. The patients were followed up for a period of 5 years. Conclusion: The rehabilitation of atrophic maxillae with zygomatic implants is a predictable treatment option for rehabilitation of complex cases. http://dx.doi.org/10.1016/j.ijom.2013.07.318 T17.OR019 Simultaneous implant placement with ridge augmentation using bone ring transplant M. Omara ∗ , N. Abdelwahed, M. Ahmed, A. Hendi Faculty of Oral and Dental Medicine, Egypt Background and objectives: Root-form endoosseous immediate implants are considered the best teeth replacement alternative as they preserve bone integrity. Sufficient bone at the desired implant location is important factor for implant placement. Defective sockets limit the quantity and quality of bone necessary for
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successful implant placement. A new technique was introduced in a case report by Stevens et al. (2010) to augment the defective socket three-dimensionally with autologous ‘bone rings’ and immediate implant placement in a one-stage procedure. This study aims to evaluate the Bone Ring transplant clinically and radiographically as a technique for augmentation of defective fresh extraction socket with immediate implant placement. Methods: Ten patients were selected with fresh extraction sockets. The extraction sockets were defective due to periodontal disease or traumatic extraction. Twelve defective sockets were prepared using a trephine bur. Bone rings were outlined by a larger trephine bur at the mandibular symphysial area and a central osteotomy for implant placement was done before their removal. The rings were then removed bicortically and then snugly fitted in the prepared defect. This was followed by screwing the implant through the ring and basal bone. Patients were radiographically examined pre- and postoperatively using cone beam computed tomography (CBCT). Crestal bone changes around the implants were measured and statistically evaluated. Results: Based on the clinical and radiographic findings, the twelve implants showed criteria of success including: no implant loss, absence of infection or graft dehiscence and alveolar bone healing with no significant amount of crestal bone loss. Conclusion: The examined technique for augmentation of localized alveolar bone defects proved to be reliable with high rate of success. Key words: ridge augmentation; bone ring; immediate implant. Disclosure: There is no any financial relationships between the authors and any manufacturer/supplier of any commercial products or services related to the work. http://dx.doi.org/10.1016/j.ijom.2013.07.319 T17.OR020 Effect of platelet-rich fibrin on osseointegration E. Öncü 1,∗ , E. Alaaddinoðlu 2 1
Konya Necmettin Erbakan University, Faculty of Dentistry, Department of Periodontology, Konya, Turkey 2 Baþkent University, Faculty of Dentistry, Department of Periodontology, Ankara, Turkey Background and objectives: Platelet-rich fibrin (PRF) is as autogenous source of growth factors that stimulates and accelerates bone formation and soft tissue regeneration. Activated platelets in PRF secrete growth factors resulting cellular proliferation, collagen synthesis and osteoid production. The use of PRF in bone regeneration, both around dental implants and in periodontal treatments, has become particularly appealing. The aim of this study was to compare the stability of dental implants inserted with one-stage surgical protocol with or without PRF application. Methods: 19 healthy patients with adequate alveolar bone, having at a minimum 2 adjacent missing teeth extracted at least 6 months ago were included in this study. After surgical preparation of implant sockets, preoperatively prepared PRF was placed randomly to one of the sockets (PRF+). Acellular plasma portion of PRF was used to wash the implant inserted into this socket while control implants (PRF−) were placed conventionally. Resonance frequency measurements were made by Osstell ISQ intraoperatively, on the post-operative first week, and the following first month. Statistical analysis of the data was performed.
21st ICOMS 2013—Abstracts: Oral Papers
Key words: failed implant; implant removal technique; minimal invasive removal technique. Disclosure: This work was not supported by manufacturer/supplier of any commercial products or services related to the work. http://dx.doi.org/10.1016/j.ijom.2013.07.313 T17.OR014 Biomechanics and periimplantitis: the effect of a subcrestal wing-thread to decrease alveolar crestal bone strain: theory, finite element analysis and clinical experience Z. Laster Poriya Hospital, The Galilee Medical School, Israel Purpose: This study used finite element analysis and a clinical case example to support a hypothesis that a wing-thread placed 4 mm below the top of the implant would decrease crestal bone loss in function. Materials and methods: A finite element analysis was done comparing a straight and winged implant using axial and off-axis forces based on a hypothesis that decreasing bone strain at the alveolar crestal margin influences periimplant bone stability. A clinical case example of the wing-thread implant is followed for 30 months. Results: Stress concentration was diminished at the crest when a wing-thread was used compared to a straight implant body. 90 degree lateral forces were diminished by a factor of ten in the wingthread implant. A case report with 30 months follow-up showed stable bone levels around the implants. Conclusion: A wing-thread hypothesis appears to have some support for increasing bode stability based on finite element analysis.
3 implants failed to osseointegrate at the first try and were replaced successfully 8 weeks later. No complications were observed 18–30 months after prosthetic treatment. Conclusions: Crest widening by distraction may be a better alternative to bone augmentation in cases of narrow crest with sufficient height. The advantages of the new technique are; early implant placement, simple procedure, no painful donor site, no post-op bone resorbtion, the technique can be easily performed in the private office. A long term and multi center trial is needed. http://dx.doi.org/10.1016/j.ijom.2013.07.315 T17.OR016 Biomechanics of periimplantitis—winged implant, the ultimate solution for post extraction immediate loading and D5 bone type Z. Laster Poriya Hospital, Isreal
Crest Expander-the use of distraction osteogenesis as an alternative technique to bone augmentation
The desire for immediate load restoration of dental implants, particularly in the anterior esthetic zone, requires specific implant design strategies to enhance primary stability. In the presence of extraction sites, often with compromised bone, implant fixation is obtained apically and palatally. Surface roughness is a factor in early osseointegration (Alberktsson et al.). However, it is the macro-architectural design of the implant that establishes initial mechanical fixation, which is crucial in minimizing implant mobility in the first 3–4 weeks of function. In the search of a new macro-architectural design, an idea of adding a wing to the implant for extra primary stability was raised. Finite element analysis of the ‘winged’ implant, in comparison to a regular implant, revealed that when a 20 kg force is applied at an off-axis angle of 20◦ , the amount of maximal displacement at the neck of a regular implant is 60% higher than observed with the ‘winged’. In order to determine the clinical efficacy of this new implant, a study was undertaken to evaluate the implant in both jaws under conditions of immediate function. This implant will be presented with finite elements analysis and animal experiments with explanation of the biomechanics of pri-implantitis.
Z. Laster
http://dx.doi.org/10.1016/j.ijom.2013.07.316
Poriya Hospital, The Galilee Medical School, Israel
T17.OR017
Aim: To introduce a new device and technique to widen a narrow alveolar crest prior to implantation. Materials and methods: A new distractor was used to widen a narrow alveolar crest. Under local anesthesia, 3 mucoperiosteal incisions were performed; One along the crestal ridge and two vertical incisions at the anterior and posterior buccal aspects. Through these incisions, bone cuts were made without stripping the mucoperiosteum. The bone transport was fractured by an osteotome and the distractor was inserted into the crestal bone cut. Distraction started 7 days post-op and was stopped when adequate width was achieved. Consolidation period was 1 week and than removed under local anesthesia. Implants inserted at the same session. Results: 35 patients who suffered from a narrow alveolar crest were treated over 2 1/2 years. Amount of crest expansion was 4–8 mm. 1 case failed due to partial denture placement by the patient against the instructions. 33 patients had 79 implants placed. 28 patients prosthesis completed. 1 complications of bone loss and implant neck exposure (The only case that the bone was stripped).
Treatment of complications in sinus augmentation surgery: a clinical study
http://dx.doi.org/10.1016/j.ijom.2013.07.314 T17.OR015
E.J. Moraes ∗ , L.E. Moraes, N. Moraes Unifeso, Brazil Background: The maxillary sinus augmentation procedure, is an excellent alternative to oral implantology and present a 90% of success level. However, the complications of sinus lift surgery sometimes perform consequences with very difficult management and solutions. Perforations of the Schneiderian membrane represent the major intraoperative complication and procedures of sinus with irregular mucosal thickening or presence of antral pathology are controversial. Purpose: The present study is to evaluate retrospectively the treatment options of large perforations in schneiderian membrane during the sinus graft procedure in cases with mucosal thickening >10 mm.
21st ICOMS 2013—Abstracts: Oral Papers Patients and methods: Patients of author clinic that were submitted to sinus augmentation surgery and presented sinus membrane perforation > 10 mm with implants placed simultaneously or in a second stage surgery after 6 months. The surgical techniques used were: iliac autogenous blocks, mandibular autogenous blocks and biomaterials graft mixed with platelet rich plasma (PRP) combined with a buccal fat pad flap. Results: From March 2001 to December 2009, 18 patients (12 men and 6 women) were studied, on whom 25 sinus floor augmentation with a total of 54 dental implants were placed under repaired membrane perforations Eighteen sinuses presented mucosal thickening > 10 mm and seven mucosal thickening < 5 mm previously detected in a CT scan. In eleven sinuses were used iliac blocks, in five mandibular blocks and in nine biomaterials mixed with PRP combined to buccal fat pad flap. Three sinuses with iliac blocks presented complications and the blocks were removed and a total of three implants presented fail. Patients were followed up in a period of 120–20 months. Conclusions: Sinus augmentation procedures with large membrane perforations in a presence or not of antral pathology may be adequately reconstructed and covered, and therefore are not an absolute contraindication. http://dx.doi.org/10.1016/j.ijom.2013.07.317 T17.OR018 Rehabilitation of maxillae defects with zygomatic implants: report of three cases E.J. Moraes ∗ , L.E. Moraes, N. Moraes Unifeso, Brazil Objective: The authors present a clinical report of three complex cases with patients with defects in maxilla. One patient with oroantral fistulae promoted by implants and extraoral graft complications. The other patient with a secondary oroantral communication after failure of iliac bone reconstruction associated to a Lefort I advanced. The last one presented a nasal and oroantral communication by postmaxillectomy sequelae. All patients were treated with zygomatic implants. One patient was rehabilitated with fixed prostheses and the other patients with obturator prostheses. A total of 10 zygomatic implants were placed. In two patients quad zygomatic implants technique was used and in the other two zygomatic implants associated to standard implants were performed. The patients were followed up for a period of 5 years. Conclusion: The rehabilitation of atrophic maxillae with zygomatic implants is a predictable treatment option for rehabilitation of complex cases. http://dx.doi.org/10.1016/j.ijom.2013.07.318 T17.OR019 Simultaneous implant placement with ridge augmentation using bone ring transplant M. Omara ∗ , N. Abdelwahed, M. Ahmed, A. Hendi Faculty of Oral and Dental Medicine, Egypt Background and objectives: Root-form endoosseous immediate implants are considered the best teeth replacement alternative as they preserve bone integrity. Sufficient bone at the desired implant location is important factor for implant placement. Defective sockets limit the quantity and quality of bone necessary for
1265
successful implant placement. A new technique was introduced in a case report by Stevens et al. (2010) to augment the defective socket three-dimensionally with autologous ‘bone rings’ and immediate implant placement in a one-stage procedure. This study aims to evaluate the Bone Ring transplant clinically and radiographically as a technique for augmentation of defective fresh extraction socket with immediate implant placement. Methods: Ten patients were selected with fresh extraction sockets. The extraction sockets were defective due to periodontal disease or traumatic extraction. Twelve defective sockets were prepared using a trephine bur. Bone rings were outlined by a larger trephine bur at the mandibular symphysial area and a central osteotomy for implant placement was done before their removal. The rings were then removed bicortically and then snugly fitted in the prepared defect. This was followed by screwing the implant through the ring and basal bone. Patients were radiographically examined pre- and postoperatively using cone beam computed tomography (CBCT). Crestal bone changes around the implants were measured and statistically evaluated. Results: Based on the clinical and radiographic findings, the twelve implants showed criteria of success including: no implant loss, absence of infection or graft dehiscence and alveolar bone healing with no significant amount of crestal bone loss. Conclusion: The examined technique for augmentation of localized alveolar bone defects proved to be reliable with high rate of success. Key words: ridge augmentation; bone ring; immediate implant. Disclosure: There is no any financial relationships between the authors and any manufacturer/supplier of any commercial products or services related to the work. http://dx.doi.org/10.1016/j.ijom.2013.07.319 T17.OR020 Effect of platelet-rich fibrin on osseointegration E. Öncü 1,∗ , E. Alaaddinoðlu 2 1
Konya Necmettin Erbakan University, Faculty of Dentistry, Department of Periodontology, Konya, Turkey 2 Baþkent University, Faculty of Dentistry, Department of Periodontology, Ankara, Turkey Background and objectives: Platelet-rich fibrin (PRF) is as autogenous source of growth factors that stimulates and accelerates bone formation and soft tissue regeneration. Activated platelets in PRF secrete growth factors resulting cellular proliferation, collagen synthesis and osteoid production. The use of PRF in bone regeneration, both around dental implants and in periodontal treatments, has become particularly appealing. The aim of this study was to compare the stability of dental implants inserted with one-stage surgical protocol with or without PRF application. Methods: 19 healthy patients with adequate alveolar bone, having at a minimum 2 adjacent missing teeth extracted at least 6 months ago were included in this study. After surgical preparation of implant sockets, preoperatively prepared PRF was placed randomly to one of the sockets (PRF+). Acellular plasma portion of PRF was used to wash the implant inserted into this socket while control implants (PRF−) were placed conventionally. Resonance frequency measurements were made by Osstell ISQ intraoperatively, on the post-operative first week, and the following first month. Statistical analysis of the data was performed.