Monday, March 21, 2011

Interpositional osteotomies for the atrophic posterior mandible - A Concept whose time has come?

The atrophic posterior mandible has been a challenge to restore with implants. A variety of approaches have been suggested ranging from short implants, distally angled implants (All-on-4), onlay grafts, nerve transposition and distraction osteogenesis. However interpositional grafts seem to offer a more predictable and complication free technique for augmenting the posterior mandible where there is atleast 4 to 6 mm of remaining bone above the IAN.
This paper in addition to being an excellent addition to the growing literature on this technique offers a more than adequate review of the relevant literature.

The International Journal of Oral & Maxillofacial Implants
January/February 2011
Volume 26 , Issue 1

Implant Rehabilitation of the Edentulous Posterior Atrophic Mandible: The Sandwich Osteotomy Revisited

Jose Luis López-Cedrún, MD, DDS, PhD

Purpose: Treatment of the posterior atrophic mandible has long been a challenge in implant dentistry and maxillofacial surgery. The objective of this study was to reevaluate the safety and efficacy of the sandwich osteotomy and bone grafting in patients with moderate to severe posterior mandibular atrophy. Materials and Methods: This retrospective study included patients with an edentulous posterior mandible in which there was not enough bone above the dental nerve to insert implants at least 10 mm in length; patients with adequate bone volume but with an excessive interocclusal distance at the posterior occlusal region were also included. Twenty-three patients with 30 sites of moderate to severe posterior atrophy were treated using a sandwich osteotomy above the mental nerve and an interpositioned block of autologous or allogeneic bone. Success criteria were based on the possibility of implant insertion after bone grafting. Results: The average gain in height was 5.3 mm (range, 2 to 10 mm). Partial loss of alveolar height was observed in only one patient from the allogeneic graft group. Patients were followed for 12 to 93 months after bone grafting. No signs of infection were observed. Minor dehiscence of the surgical wound occurred in four segments, but healing ultimately occurred in every patient. Sixty-five implants were placed, and none were lost during follow-up. Insertion of implants of 10 mm or more in length was successfully achieved in 90.8% of the sites, and partial success (ie, bone segments suitable for insertion of shorter implants) was seen in the remaining sites. Conclusions: Moderate to severe posterior mandibular atrophy can be successfully treated by interpositional sandwich osteotomy and bone grafting, allowing for the subsequent placement of implants and fixed prostheses in all segments. Int J Oral Maxillofac Implants 2011;26:195–202

Key words: atrophic mandible, dental implants, inlay bone grafting, sandwich osteotomy

Sunday, March 20, 2011

Does Elevating The Sinus Membrane Without Bone Grafting Really Work?

There have been a number of scholarly articles that have explored this question. There have been a number of animal studies and a few human studies - some based on the analysis of post operative radiographs and others on histology. The paper whose abstract is reproduced below questions the claims that bone can be reliably regenerated below an elevated sinus membrane without the use of a graft material. The authors observe that they observed no significant new bone formation . Until we have further clarifying research on the topic it may be wiser to stick to the conventional technique !

The International Journal of Oral & Maxillofacial Implants
January/February 2011
Volume 26 , Issue 1

New Bone Formation Following Sinus Membrane Elevation Without Bone Grafting: Histologic Findings in Humans

Jae-Jin Ahn, DDS, MS, PhD/Sung-Am Cho, DDS, MS, PhD/Gerard Byrne, DDS/Jae-Hyun Kim, DDS, MS/Hong-In Shin, DDS, PhD

Purpose: To determine whether sinus membrane elevation alone can lead to new bone formation on the maxillary sinus floor. Materials and Methods: Among patients who were to receive implant treatment, those who had 4 to 5 mm of bone height in the maxillary sinus floor (as measured radiographically) were selected as candidates for sinus membrane elevation. The lateral sinus wall was exposed through a buccal mucoperiosteal incision. The sinus membrane was elevated through a bone window, and the space underneath the membrane was filled with absorbable collagen sponge (Collaplug). In the presence of blood in the space, the collagen sponge was left to soak up the blood; in the deficiency of blood, the sponge was saturated with venous blood drawn from the brachial vein. The mucoperiosteal flap was repositioned and closed with interrupted silk sutures. The sinus was left to heal for 6 months. Core specimens of the maxillary sinus floor were obtained using a trephine bur at 6 months after sinus elevation in patients treated between January 2006 and June 2009. The trephined sites were used for implant placement. The biopsy specimens were analyzed histologically to identify the presence and amount of new bone tissue. Results: Thirteen specimens from eight patients were included in the study. Microscopically, 11 specimens exhibited no recognizable new bone tissue. Two specimens exhibited a small amount of woven bone on the surface of the sinus floor. Conclusion: Within the limits of this study of eight patients, little to no new bone formation was observed on the maxillary sinus floor at 6 months following sinus membrane elevation and support with blood-soaked collagen sponges. Int J Oral Maxillofac Implants 2011;26:83–90

Key words: bone formation, bone graft, lateral window, maxillary sinus, membrane elevation, sinus floor augmentation

Friday, March 18, 2011

Low Risk of Jaw Problems With Oral Osteoporosis Drugs

We are all beginning to see cases of ONJ that can be linked to Biphosphonates. The article below shows that we still don't understand the problem in depth and there is disagreement about its treatment.

Low Risk of Jaw Problems With Oral Osteoporosis Drugs

Wednesday, March 9, 2011

Fwd: This Month in Compendium of Continuing Education in Dentistry

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Compendium of Continuing Education in Dentistry
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MARCH 2011 | Vol. 32; No. 2 |
Continuing Education 1
Tissue Engineering with Recombinant Human Platelet-Derived Growth Factor BB for Implant Site Development
Marc L. Nevins, DMD, MMSc; and Mark A. Reynolds, DDS, PhD
Continuing Education 2
The CEJ: A Biofilm and Calculus Trap
Keerthana Satheesh, BDS, DDS, MS; Simon R. MacNeill, BDS, DDS; John W. Rapley, DDS, MS; and Charles M. Cobb, DDS, MS, PhD
Case Report 1
Piezocision-Assisted Invisalign® Treatment
Elif I. Keser, DDS, PhD; and Serge Dibart, DMD
Case Report 2
Using a Nanohybrid Composite and Diode Laser to Achieve Minimally Invasive Esthetic Anterior Restorations
Wilson J. Kwong, DMD
Full-Mouth Rehabilitation of a Patient with Crohn's Disease

David A. Cauble, DMD | READ MORE +


REVIEW—Periodontal Probing Systems: A Review of Available Equipment

Srinivas Sulugodu Ramachandra, MDS; Dhoom Singh Mehta, MDS; Nagarajappa Sandesh, MDS; Vidya Baliga, MDS; and Janardhan Amarnath, MDS | READ MORE +

RESEARCH—Cigarette Smoke Combined with Staining Beverages in Composite Resin Restorations

Paula Mathias, DDS, MS, PhD; Thais Aranha Rossi, DDS; Andrea Nóbrega Cavalcanti, DDS, MS, PhD; Max José Pimenta Lima, DDS, MS; Céres Mendonça Fontes, DDS, MS; and Getulio da Rocha Nogueira-Filho, DDS, MS, PhD | READ MORE +

SPECIAL REPORT—Adhesive Technologies: Innovative Science Becomes Essential Element

Michael R. Sesemann, DDS | READ MORE +


CASE REPORT—An Alternative Donor Site for an Epithelialized-Free Soft-Tissue Autograft

Jody S. Harrison, DDS, MS; Michael J. Conlan, DDS, MS; and David E. Deas, DMD | READ MORE +

REVIEW—Use of Antioxidants in Oral Healthcare

Symone M. San Miguel, DMD, PhD; Lynne A. Opperman, PhD; Edward P. Allen, DDS, PhD; and Kathy K.H. Svoboda, PhD | READ MORE +

RESEARCH—Alveolar Ridge Augmentation: Comparison of Two Socket Graft Materials in Implant Cases

Len Tolstunov, DDS; and Jibin Chi, MD, MBA, MBI | READ MORE +
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