Vertical ridge augmentation using guided bone regeneration (GBR) in three clinical scenarios prior to implant placement: a retrospective study of 35 patients 12 to 72 months after loading.
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The aims of the current study were to: (1) evaluate the results of vertical guided bone regeneration (GBR) with particulate autogenous bone grafts, (2) determine clinically and radiographically the success and survival rates of 82 implants placed in such surgical sites after prosthetic loading for 12 to 72 months, and (3) compare defects that were treated simultaneously with sinus augmentation and vertical GBR to other areas of the jaw treated with vertical GBR only.Eighty-two implants were inserted in 35 patients with 36 three-dimensional vertical bone defects. The patients were divided into three groups: single missing teeth (group A), multiple missing teeth (group B), and vertical defects in the posterior maxilla only (group C). All group C subjects were treated simultaneously with sinus and vertical augmentations. All patients were treated with vertical ridge augmentation utilizing titanium-reinforced polytetrafluoroethylene (e-PTFE) membranes and particulated autografts. After removal of the e-PTFE membrane, all sites received a collagen membrane.At membrane removal, mean vertical augmentation was 5.5 mm (+/-2.29 mm). Mean combined crestal remodeling was 1.01 mm (+/-0.57 mm) at 12 months, which remained stable through the 6-year follow-up period. There were no statistically significant differences between the three groups in mean marginal bone remodeling. One defect had a bone graft complication (2.78%, 95% CI: 0.00%, 8.15%). The overall implant survival rate was 100% with a cumulative success rate of 94.7%.(1) Vertical augmentation with e-PTFE membranes and particulated autografts is a safe and predictable treatment; (2) success and survival rates of implants placed in vertically augmented bone with the GBR technique appear similar to implants placed in native bone under loading conditions; (3) success and failure rates of implants placed into bone regenerated simultaneously with sinus and vertical augmentation techniques compare favorably to those requiring only vertical augmentation.Keywords:
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Pneumatized sinuses in the posterior maxilla often make implant placement difficult or impossible. A sinus lifting procedure can reliably augment the bone height, with the highest success rates reported when two-stage implants are placed 6 to 9 months later. The aim of this study was to evaluate the clinical reliability of a shortened approach in which nonsubmerged implants were placed at the time of sinus augmentation.All patients treated with sinus floor elevation and simultaneous implant placement at the authors' institution from 1999 to 2004 were retrospectively selected for a long-term follow-up study. Sinus elevation was considered when the remaining subantral bone height did not reach 6 mm in one or more implant sites. The lateral window technique was performed using bovine hydroxyapatite as a filler, and nonsubmerged implants were placed immediately. Implant and prosthodontic survival rates, as well as biologic and prosthodontic complications, were evaluated 2 to 6 years after loading.In a sample of 40 patients, 50 subantral bone augmentations were performed and 102 implants were placed using the one-stage approach. One implant remained submerged because of a lack of primary stability. No sinusitis was noted. Only two implants were lost before loading. No implants failed after the definitive restorations were placed, leading to a 98% implant survival rate and 100% prosthodontic survival rate after 2 to 6 years.Subantral bone regeneration with bovine hydroxyapatite as a space filler is an effective and safe procedure allowing high survival rates of implants placed in the posterior maxilla. If the remaining bone is sufficient to ensure primary stability, implant placement can be performed simultaneously with sinus lifting, and even in a nonsubmerged fashion.
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Lateral sinus augmentation is necessary when the residual bone height is insufficient in the posterior maxilla. Immediate implant placement following tooth extraction with lateral sinus augmentation will shorten the number of operations and treatment time.To evaluate radiologic and clinical results for at least 1 year after loading in patients who underwent tooth extraction, implant placement, and lateral sinus augmentation at the same time.We retrospectively evaluated 35 implants placed in 25 patients. Preoperative and postoperative CBCT were compared and analyzed for residual bone height (RBH) and increased bone height (IBH), the initial torque value (ITV), and the implant stability quotient (ISQ). A comparative evaluation was performed between a 1-stage (non-submerged) group and a 2-stage (submerged) group. After loading for at least 1 year, clinical and radiological evaluations were performed to evaluate the survival rate.One of the 35 implants failed in osseointegration, and the remaining 34 showed successful results. The failure-free survival rate at 1 year was 97.06% (95% CI, 91.38-100.0%). The RBH ranged from 3.1 to 9.6 mm (mean, 5.62 ± 1.68 mm), and the IBH ranged from 3 to 15.3 mm (mean, 8.87 ± 2.74 mm). Among the RBH, ITV, ISQ, treatment period, final bone height, and failure evaluation by stage of implant placement, only ISQ showed statistical significance between the groups (p < .001). A comparison of RBH, ITV, and ISQ, regardless of group, showed that each value tended to increase, but there were no statistically significant differences.Immediate implant placement following tooth extraction with simultaneous lateral sinus augmentation is considered reliable even though the procedures had been performed at the same time.
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Purpose: The aim of this multicenter retrospective clinical study was to evaluate the survival rate of implants placed in the posterior maxilla with a residual bone height of <5 mm. Materials and Methods: One hundred seventeen patients, recruited from 6 different centers, had 134 implants placed below the maxillary sinus. The patient population consisted of 52 men and 65 women ranging in age from 39 to 78 years (mean age, 53.2 years). Sinus lift procedures were performed following a crestal approach using a specific sequence of drills (Cosci's technique). All implants were submerged. Periapical radiographs were obtained with a paralleling technique and were digitized. The pattern of bone remodeling was subsequently evaluated. Results: The average (±SD) follow-up time was 48.2 months (±29.30 months; range, 24 to 120 months). Of the original 134 implants placed, 5 implants (3.7%) failed. The implant survival rate was 96.3%. The average residual bone height was 3.46 mm (±0.91 mm) at baseline. The average height of the alveolar crest in the treated implant sites was 9.94 ± 2.29 mm. The radiographic bone gain was 6.48 ± 2.38 mm. Conclusion: The investigation suggests that this crestal drill approach can be a successful sinus lifting procedure in a severe atrophic maxilla with <5 mm of crestal bone height.
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Abstract: Sinus augmentation is a commonly used procedure in implant dentistry. However, a general consensus on implant survival after this procedure is still lacking. The objective of this study was to systematically review implant survival following sinus augmentation procedures compared with conventional implant placement in the posterior maxilla. Following the production of a detailed protocol, screening and quality assessments of clinical trials were conducted in duplicate and independently. The search yielded 579 abstracts and 93 were selected for full‐text screening. Six publications (five studies) fulfilled all the inclusion criteria and were relevant to the study. Heterogeneity of the selected papers prevented meta‐analysis. Implant survival ranged from 73% to 100% for non‐augmented sinuses and from 36% to 100% for augmented sinuses in patient‐based data. From implant‐based data, survival varied between 75% and 100% for both non‐augmented and augmented areas. Implant survival appears to show greater variability in grafted sinuses than in the posterior maxilla. However, prospective studies with larger patient numbers and control of confounding factors are urgently needed to provide definitive data on this important procedure.
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The aim of this study was to retrospectively evaluate the success and survival rate of implants with different types of prosthetic connections inserted in the posterior maxilla in native bone or in sinuses previously grafted with different biomaterials.A total of 310 implants inserted in 113 patients were evaluated, 87 of which were inserted in association with grafted maxillary sinuses (56 morse taper (MT) implants and 31 external hexagon (EH) implants) in 37 patients, and 223 implants were inserted in native bone areas (112 MT and 111 EH implants) in 76 patients. Peri-implant clinical analyses were performed (bleeding on probing, probing depth, clinical insertion level, peri-implant marginal level, and the presence of mobility or suppuration), and the radiographic bone level was evaluated.Two implants were lost, yielding a survival rate of 99.35%. The MT implants had lower probing depths and peri-implant bone levels than the EH implants in both grafted areas and native bone areas (P<0.05). No statistically significant differences in any parameter evaluated were found between implants inserted in native bone and those inserted in grafting areas. EH implants inserted in native bone areas showed higher peri-implantitis rates.It can be concluded that the MT implants connection reduce peri-implant bone loss, but implants inserted in maxillary sinuses previously grafted with osteoconductive biomaterials do not predispose patients to peri-implant bone loss.
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Background: Implant protrusion into the nasal and maxillary sinuses presents a challenge in cases of severely resorbed maxillae. Aim: The aim of this study was to evaluate the clinical and radiographic effects of BECES® implant penetration depth into the nasal and maxillary sinuses. Setting and Design: This was an observational study conducted in a tertiary institution. Materials and Methods: Forty-nine BECES® implants were inserted into the maxilla of patients who presented with severely resorbed ridges but no history of sinusitis. Forty-five implants protruded into the sinus cavities. Patients were examined clinically and radiographically at 1 week and 3, 6, 12, and 18 months after insertion. Maxillary sinus health, survival and success rates, and peri-implant health were assessed using the plaque index (PI), calculus index, modified gingival index (MGI), and probing pocket depth (PPD). Statistical Analysis: Wilcoxon signed-rank test and Mann–Whitney test were used in this study. Results: Four (8.16%) of the 45 implants that penetrated the cavities reached the sinus floor without disrupting the membrane; the penetration depth was ≥4 mm in 20 implants (44.44%) and <4 mm in 25 (55.56%). No patient showed clinical or radiographic signs of sinusitis during the observation period. There were significant differences in the PI, MGI, and PPD values between baseline and the 18-month follow-up with no association with the penetration depth. All implants showed radiographically direct bone-to-implant contact. Where the implant tip barely reached the sinus floor, the membrane healed uneventfully while when deeply penetrating the sinus, the membrane healed around the implant but did not cover the tip. All prostheses and implants survived during the observation period. Conclusion: Penetration depth of polished implants with cortical engagement into the maxillary sinus or the floor of the nose does not negatively affect implant survival, the success rate of the treatment, nor peri-implant soft-tissue health. It also does not provoke the development of sinusitis.
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The objective of this study was to determine the predictability of endosseous implants placed in a maxillary sinus grafted with a mixture of bovine porous bone mineral and demineralized freeze-dried bone. Sixty implants were placed in 20 patients representing 28 sinuses using either a one- or two-stage technique. After an implant loading period of more than 2 years, the survival rate (eg, a clinically functioning implant without signs of mobility or infection) varied from 90% to 96%. No infections or other complications were encountered. The data suggest that this treatment regimen can result in a high rate of survival.
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One of the goals of the sinus elevation procedure is the creation of vital bone to effect the osseointegration of dental implants placed in the posterior maxilla. With this goal in mind, in 1993 the Department of Implant Dentistry at New York University College of Dentistry began a long-term clinical, histologic, histomorphometric, and radiographic study of the sinus elevation procedure. The primary parameters included the effects of graft material selection, time allowed for graft maturation, and the effect of barrier membrane placement on the creation of vital bone in the sinus cavity. The effects of these and other parameters on implant survival rates were also to be evaluated. This paper reports the data collected on a subgroup of 113 sinus elevations that used anorganic bovine bone matrix (OsteoGraf/N) alone or in combination with autogenous bone and/or demineralized freeze-dried bone as a graft material. This is the second in a proposed series of papers that will result from this ongoing research project. The results of this study indicate that: OsteoGraf/N appears to be an effective graft material with a 98.2% implant survival rate to date: vital bone formation increased with time; vital bone formation increased moderately when demineralized freeze-dried bone allograft was added, and increased substantially when intraoral autogenous bone was added or when an expanded polytetrafluoroethylene membrane was used; and the increased height achieved by the procedure was stable over a 3-year period. Because of the high overall implant survival rate, it was not possible to determine the relationship between vital bone formation or membrane usage and implant survival.
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To evaluate the survival rate of dental implants replacing failed implants in grafted maxillary sinuses using the lateral approach vs nongrafted posterior maxillae.A retrospective analysis was conducted to study the survival of secondary dental implants inserted in the posterior maxilla in previously failed implant sites between the years 2000 and 2010. The study group consisted of patients who had also undergone maxillary sinus augmentation, and the control group consisted of patients in whom implants in the posterior maxilla had failed. Clinical and demographic data were analyzed using a structured form.Seventy-five patients with a total of 75 replaced implants were included in the study. The study group comprised 40 patients and the control group, 35 patients. None of the replaced implants in the study group failed, resulting in an overall survival of 100%; three replaced implants in the control group failed (92% survival). The main reason for the primary implant removal was lack of osseointegration (35 [87.5%] of 40 study group implants and 23 [65.7%] of 35 control group implants [P = .027]). The difference between the groups with regard to the timing of primary implant failure was statistically significant. The study group had more early failures of the primary implant than did the control group (77% vs 62%; P = .038).Dental implants replaced in the posterior maxilla had a high survival rate. A higher rate of survival was found in augmented maxillary sinus sites. Within the limits of the present study, it can be concluded that previous implant failures in the grafted maxillary sinus should not discourage practitioners from a second attempt.
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