A Retrospective Analysis of Dental Implants Replacing Failed Implants in Grafted Maxillary Sinus: A Case Series
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Abstract:
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.Keywords:
Sinus (botany)
OBJECTIVES:
Published information regarding the use of rat jawbones for dental implant osseointegration research is limited and often inconsistent. This study assessed the suitability and feasibility of placing dental implants into the rat maxilla and to establish parameters to be used for dental implant research using this model.
MATERIALS AND METHODS:
Forty-two customized titanium implants (2 × 3 mm) were placed bilaterally in the maxillary first molar area of 21 Sprague-Dawley rats. Every animal received two implants. The animals were subsequently sacrificed at days 3, 7, 14, 28 and 56 post-surgery. Resin-embedded sections of the implant and surrounding maxilla were prepared for histological and histomorphometric analyses.
RESULTS:
The mesial root of the first molar in the rat maxilla was the optimal site to place the implant. Although the most apical 2-3 threads of the implant penetrated into the sinus cavity, 2 mm of the remaining implant was embedded in the bone. New bone formation at day 7 around the implant increased further at day 14, as measured by the percentage of bone-to-implant contact (%BIC) and new bone area (%BA) in the implant thread chambers (55.1 ± 8.9% and 63.7 ± 7.7%, respectively). There was a further significant increase between day 14 and 28 (P < 0.05), however, no significant differences were found between day 28 and 56 in either %BIC or %BA.
CONCLUSIONS:
The mesial root socket of the first molar in the rat maxilla is a useful model for dental implant research. Osseointegration following implant placement as measured by BIC plateaued after 28 days. The recommended implant dimensions are 1.5 mm in diameter and 2 mm in length.
Maxillary molar
Maxillary first molar
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One common complication with dental implants placed in the atrophic posterior maxilla, especially with simultaneous transcrestal sinus augmentation, is the implant protruding into the sinus without apical bone support. Frequently, apically exposed implants contribute to various sinus pathologies that may lead to implant failure. Treatment options include (1) managing asymptomatic sinus pathology; (2) regrafting the apically exposed portion of the implant(s); and (3) removing the implant and placing a new implant with simultaneous grafting. The purpose of this case report is to present 4 clinical cases of apically exposed implants in the maxillary sinus. The report will cover: (1) exposed implants with asymptomatic sinus pathologies and (2) show successful management of protruding implants and pathologies using maxillary sinus floor augmentation. Various methods of implant surface detoxification, mechanical and chemical, are described for predictable bone remodeling around existing implants as well as newly installed implants. After 6 months of healing, osseointegration was well achieved for all implants and sinonasal complications were not observed. Clinical photographs and 3-dimensional imaging of surgical sites were used to validate clinical assessments.
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Background/Aim: Dental implant stabilities are essential to prevent implant loss. The purpose of the study is to appraise the physical properties, bone density, and bone thickness of dental implants and the effects of the implant locations on stability. Materials and Methods: Thirty-six patients participated in the study at the Harran University Periodontology Department (between 2019 and 2020). Of these patients, 19 patients were female, 17 patients were male, and the average age of patients was 48.21 years. Patients who underwent dental implant surgery were contained in the study. A total of 127 dental implants were placed using standard surgical protocols. The specific transducer compatible with implant system was fixed to the implant body by means of an abutment using a screw. The implant stability quotient (ISQ, Osstell™) values were determined for each implant 4, 8, and 12 weeks after surgery. Results: As a result of the statistical analysis, the values of the ISQ taken in the mandible region were higher in the 4, 8, and 12 weeks compared to the values of the ISQ values obtained from the maxilla region. Statistically significant differences were also found between these values (P < 0.05). Conclusion: We found that implants with a long and wide width represented higher ISQ values and stability compared to shorter and narrower implants. Higher values were found in the mesiodistal direction compared to the buccolingual and buccopalatal directions, and in the mandible compared to the maxilla. This situation increases the stability in places where bone density and bone thickness are higher.
Implant stability quotient
Resonance frequency analysis
Mandible (arthropod mouthpart)
Abutment
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Abstract Objectives Published information regarding the use of rat jawbones for dental implant osseointegration research is limited and often inconsistent. This study assessed the suitability and feasibility of placing dental implants into the rat maxilla and to establish parameters to be used for dental implant research using this model. Materials and methods Forty‐two customized titanium implants (2 × 3 mm) were placed bilaterally in the maxillary first molar area of 21 Sprague–Dawley rats. Every animal received two implants. The animals were subsequently sacrificed at days 3, 7, 14, 28 and 56 post‐surgery. Resin‐embedded sections of the implant and surrounding maxilla were prepared for histological and histomorphometric analyses. Results The mesial root of the first molar in the rat maxilla was the optimal site to place the implant. Although the most apical 2–3 threads of the implant penetrated into the sinus cavity, 2 mm of the remaining implant was embedded in the bone. New bone formation at day 7 around the implant increased further at day 14, as measured by the percentage of bone‐to‐implant contact (% BIC ) and new bone area (% BA ) in the implant thread chambers (55.1 ± 8.9% and 63.7 ± 7.7%, respectively). There was a further significant increase between day 14 and 28 ( P < 0.05), however, no significant differences were found between day 28 and 56 in either % BIC or % BA . Conclusions The mesial root socket of the first molar in the rat maxilla is a useful model for dental implant research. Osseointegration following implant placement as measured by BIC plateaued after 28 days. The recommended implant dimensions are 1.5 mm in diameter and 2 mm in length.
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Maxillary first molar
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Abstract Background Implant stability is one of the key factors for a successful osseointegration. At present, several techniques are available to regenerate bone tissue, but it is not clear whether implants placed in grafted bone are as stable as implants in native bone over time. Purpose The aim of the present study was to compare, by means of resonance frequency analysis ( RFA ), the stability of implants placed in sinus‐grafted and ‐nongrafted sites during 12‐month follow‐up. Methods Twenty‐five patients received a total of 38 implants. Nineteen implants were placed in maxillary native bone (group A ) and 19 implants following maxillary sinus floor augmentation using anorganic bovine bone and autogenous bone (group B ) in a 50:50 ratio. Group B was divided into groups B1 and B2 depending on the timing of implant insertion, that is, B1 simultaneously and B2 6 months after sinus lift. The implants were inserted according to a two‐stage procedure. RFA values were collected at baseline, 6 and 12 months after implant placement. Results Between the tested groups, no statistically significant difference was found in RFA values of implants placed in sinus‐grafted and ‐nongrafted sites after the surgery as well as at 6 and 12 months, while a significant difference was recorded in group B1 ( p = .0297) when RFA values were compared over time. Conclusions The results of the present study suggest that regenerated bone can offer good stability for dental implants.
Resonance frequency analysis
Sinus lift
Sinus (botany)
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ABSTRACT Background: Recent clinical studies have described maxillary sinus floor augmentation by simply elevating the maxillary sinus membrane without the use of adjunctive grafting materials. Purpose: This experimental study aimed at comparing the histologic outcomes of sinus membrane elevation and simultaneous placement of implants with and without adjunctive autogenous bone grafts. The purpose was also to investigate the role played by the implant surface in osseointegration under such circumstances. Materials and Methods: Four tufted capuchin primates had all upper premolars and the first molar extracted bilaterally. Four months later, the animals underwent maxillary sinus membrane elevation surgery using a replaceable bone window technique. The schneiderian membrane was kept elevated by insertion of two implants (turned and oxidized, Brånemark System®, Nobel Biocare AB, Göteborg, Sweden) in both sinuses. The right sinus was left with no additional treatment, whereas the left sinus was filled with autogenous bone graft. Implant stability was assessed through resonance frequency analysis (Osstell TM , Integration Diagnostics AB, Göteborg, Sweden) at installation and at sacrifice. The pattern of bone formation in the experimental sites and related to the different implant surfaces was investigated using fluorochromes. The animals were sacrificed 6 months after the maxillary sinus floor augmentation procedure for histology and histomorphometry (bone‐implant contact, bone area in threads, and bone area in rectangle). Results: The results showed no differences between membrane‐elevated and grafted sites regarding implant stability, bone‐implant contacts, and bone area within and outside implant threads. The oxidized implants exhibited improved integration compared with turned ones as higher values of bone‐implant contact and bone area within threads were observed. Conclusions: The amount of augmented bone tissue in the maxillary sinus after sinus membrane elevation with or without adjunctive autogenous bone grafts does not differ after 6 months of healing. New bone is frequently deposited in contact with the schneiderian membrane in coagulum‐alone sites, indicating the osteoinductive potential of the membrane. Oxidized implants show a stronger bone tissue response than turned implants in sinus floor augmentation procedures.
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Bone grafting
Resonance frequency analysis
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Osseointegrated dental implants have now become an accepted form of treatment for patients with a fully or partially missing dentition. The purpose of this study was to evaluate the performance of 3i threaded and cylindrical implants. During a 5‐year period, a total of 1969 3i endosseous implants were placed at 6 centers in the United States and 2 elsewhere in the edentulous and partially edentulous jaws of 653 consecutive patients ranging in age from 18 to 82 years. Of the total number of implants placed, 1341 were commercially pure titanium threaded implants and 628 were titanium plasma‐sprayed implants with a cylindrical configuration. A total of 28 patients with 110 implants were lost to follow‐up. Implants in these patients were considered neither a success nor a failure. Success was predicated on the osseointegration of each and every implant followed in this analysis rather than the persistence of prosthetic function. Confirmed bone anchorage was considered essential for success. A total of 625 patients with 1871 implants remain in the study with a follow‐up period ranging from 6 to 60 months. A total of 93 implants (5.0% of the total implants followed) were considered as failures. A mean implant survival rate was 95.0% for both the threaded and the cylindrical implant was calculated. The success rate of threaded implants was 97.0% in the mandible and 93.8% in the maxilla. The success rate for the 3.3mm cylindrical implants was 96.0% in the mandible and 95.5% in the maxilla, and the success rate of 4.0mm diameter cylindrical implants was 95% in the mandible and 92.0% in the maxilla. Causes of failure consisted of loss of osseointegration 2.3%crestal bone loss requiring periodontal therapy after the first year of function 1.7% and mechanical problems associated with the prosthesis 0.9%. This retrospective analysis of the 3i endosseous implant system is comparable to previous reports on other implant systems in terms of implant survival and prosthesis stability. It is demonstrated that 3i implants are predictable and can provide lasting osseointegration leading to improvement of oral function if the recommended surgical and restorative protocol is followed.
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We describe the use of a rabbit maxillary sinus model, characterized by thin osseous tissue and low bone density, for the evaluation of surface-treated implants by histologically and histomorphometrically comparing the osseointegration patterns depending on the surface treatment methods. Twenty rabbits were randomly assigned to two groups of 10 animals, one receiving 5 × 3 mm customized implants (machined, MA or sandblasted and acid etched, SLA) placed in sinus and the other receiving implants placed in a tibia. Histological observation of the implant placed in sinus shows relatively more active new bone formation, characterized by trabecular bone pattern underneath the cortical bone in sinus as compared with that in tibia. Histomorphometric analysis in the rabbits receiving implants in a tibia, the NBIC (%) associated with the SLA surface implant was greater than that associated with the MA implant at 2 weeks (55.63 ± 8.65% vs. 47.87 ± 10.01%; P > 0.05) and at 4 weeks (61.76 ± 9.49% vs. 42.69 ± 10.97%; P < 0.05). Among rabbits receiving implants in a sinus, the NBIC (%) associated with the SLA surface implant was significantly greater than that associated with the MA surface implant both at 2 weeks (37.25 ± 7.27% vs. 20.98 ± 6.42%; P < 0.05) and at 4 weeks (48.82 ± 6.77% vs. 31.51 ± 9.14%; P < 0.05). As a result, we suggest that the maxillary sinus model is an appropriate animal model for assessing surface-treated implants and may be utilized for the evaluation of surface-treated implants in poor bone quality environment. Microsc. Res. Tech. 78:697-706, 2015.
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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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Demineralized bone matrix
Sinus lift
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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.
Sinus (botany)
Cite
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