Short Dental Implants? Is the tide turning?

Short dental implants were looked upon unfavorably until very recently. But gradually with newer designs, surfaces and better evidence it seems that this is gradually changing. In fact when I first began in implant dentistry 10mm was considered a short implant. Today anything shorter than 7 is a short implant. That's a significant change ! Some systems offer implants as short as 5mm albeit in wide diameters only. Ante's law and rules about Crown to Implant ratio seem not to apply in the same way to implants as to teeth. Advertisements for companies such as Bicon and Endopore regularly feature pictures of implant restorations that seem to defy every rule of conventional prosthodontics and still seem to thrive if the votaries of the system are to be believed !

Finally it is the gradual accretion of studies such as the one below that will convince us of the effectiveness of 'short implants' as an accepted modality of treatment.

Short Dental Implants

A Systematic Review

1. S. Annibali1,*
2. M.P. Cristalli1
3. D. Dell’Aquila1
4. I. Bignozzi1
5. G. La Monaca1
6. A. Pilloni2

1. ¹Department of Odontostomatological and Maxillofacial Sciences, Oral Surgery Unit, “Sapienza” University of Rome, Via Caserta, 6, 00161-Rome, Italy
2. ²Department of Odontostomatological and Maxillofacial Sciences, Periodontology Unit, “Sapienza” University of Rome, Rome, Italy

1. ↵* susanna.annibali@uniroma1.it

Abstract

Growing evidence has suggested the utility of short dental implants for oral reconstructive procedures in clinical situations of limited vertical bone height. The aim of this review was to systematically evaluate clinical studies of implants < 10 mm in length, to determine short implant-supported prosthesis success in the atrophic jaw. Implant survival, incidence of biological and biomechanical complications, and radiographic peri-implant marginal bone loss were evaluated. Screening of eligible studies, quality assessment, and data extraction were conducted by two reviewers independently. Meta-analyses were performed by the pooling of survival data by implant surface, surgical technique, implant location, type of edentulism, and prosthetic restoration. Two randomized controlled trials and 14 observational studies were selected and analyzed for data extraction. In total, 6193 short-implants were investigated from 3848 participants. The observational period was 3.2 ± 1.7 yrs (mean ± SD). The cumulative survival rate (CSR) was 99.1% (95%CI: 98.8-99.4). The biological success rate was 98.8% (95%CI: 97.8-99.8), and the biomechanical success rate was 99.9% (95%CI: 99.4-100.0). A higher CSR was reported for rough-surfaced implants. The provision of short implant–supported prostheses in patients with atrophic alveolar ridges appears to be a successful treatment option in the short term; however, more scientific evidence is needed for the long term.

Small Mirrors ?

Most of us use No.4 or No.5 mouth mirrors. Most of the time these are exactly what we need. But working in the posterior of the mouth, in a patient with restricted mouth opening AND while using an microscope it might be mighty difficulty to use these large mirrors. A more useful size are size 2 or Size 3 front surface rhodium coated coated mirrors.
I've been trying to get these sizes locally for some time without success. Can anyone who is reading this help
?

Sinus floor elevation using osteotome technique without grafting materials: a 2-year retrospective study

Sinus floor elevation using osteotome technique without grafting materials: a 2-year retrospective study:

Abstract

Objective

The study aimed to assess the clinical results after osteotome technique to lift sinus floor, without graft materials in the residual bone height (RBH), below 8 mm.

Material and methods

Twenty-two patients aged from 19 to 70 years old in need of maxillary sinus floor augmentation were enrolled in this study. Preoperative and postoperative cone beam computerized tomography (CBCT) were taken to guide the surgery. Twenty-seven implants were inserted and followed clinically, another CBCT exam was taken at 6 months postoperatively. The diameter of the implants was 4.7 mm (SD 0.4 mm), the length was 10 mm (SD 1.0 mm). The average residual bone height was 6.7 mm (SD 1.2 mm).

Results

No implants were lost after the surgery and the 2 years follow-up. There was no obvious marginal bone loss during the 6 months follow-up verified by CBCT. The mean bone gain at the implant sites was 2.5 mm (SD 1.5 mm).

Conclusion

The study verified the good and stable clinical result of the OSFE technique without using bone grafting materials when the RBH was only 4.1–8 mm.

Implant Survival Rates after Osteotome-Mediated Maxillary Sinus Augmentation: A Systematic Review

Implant Survival Rates after Osteotome-Mediated Maxillary Sinus Augmentation: A Systematic Review:

ABSTRACT

Purpose: The aim of the present study was to systematically evaluate the implant survival rate after osteotome-mediated maxillary sinus augmentation with or without using grafting materials.

Materials and Methods: MEDLINE database was searched using a combination of specific search terms. Furthermore, a hand searching of the relevant journals and of the bibliographies of reviews was performed. Prospective and retrospective clinical studies with at least 20 patients treated by osteotome-mediated sinus floor elevation were included.

Results: Nineteen studies were selected for data analysis. A total of 1,822 patients, accounting for 3,131 implants were considered. Mean weighted cumulative implant survival at 1, 2, 3, and 5 years was estimated as 98.12%, 97.40%, 96.75%, and 95.81%, respectively. No significant difference was found in relation to the use of grafting material nor in relation to implant length. Overall implant survival was 92.7% for 331 implants placed in <5 mm ridge height and 96.9% for 2,525 implants inserted in ≥5 mm ridge height. The difference was significant (p = .0003).

Conclusions: The transalveolar sinus augmentation technique could be a viable treatment in case of localized atrophy in the posterior maxilla even in case of minimal residual bone height. The prognosis can be more favorable when the residual ridge is at least 5 mm high.

InQu Bone Graft Extender/Substitute Receive CE Mark Approval

InQu Bone Graft Extender/Substitute Receive CE Mark Approval:

Bone grafting is one of the cornerstones of orthopaedic surgery. In cases like trauma, tumors, fusions and skeletal reconstruction there are often spaces and gaps that need to be filled in with bone. This is where bone grafting comes into play, and there are many options. The best bet is to use bone harvested from the patient, such as iliac crest bone graft from the pelvis. This is termed autograft and contains bone-producing stem-cells, growth factors and a structural scaffold to provide mechanical stability. In cases where a surgeon would like to avoid the pain and risk associated with harvesting bone, there are less invasive options. You can use bone obtained from organ donors, termed allograft (also less appropriately dubbed “croutons”). Allograft, however, carries the risk of infection and other transplant associated problems. Then there are bone graft substitutes/extenders, synthetic bioactive materials that provide a scaffold for healing bone to grow into. These usually are the least effective, however they can be combined with various modalities such as bone marrow aspirate to be a safe and effective (although more expensive) alternative to traditional bone grafting.

So in related news, ISTO just announced that their InQu Bone Graft extender/substitute material just received CE Mark approval (it received 510(k) clearance in the US in 2007). The product is somewhat unique, in that it combines polylactide-co-glycolide (PLGA) and unmodified hyaluronicacid (HyA), which are materials not commonly found in most commercially available bone graft substitutes. There is little research available regarding the effectiveness of this combination in skeletal surgery in the extremities, but it sounds promising. The PLGA is meant to provide an osteoconductive scaffold while the HyA improves handling, cell attachment and supports vascular ingrowth. It is designed for use in non-structural areas of bone, such as small voids from benign tumor excisions or hardware removals. The material is available as granules, a paste, putty and 3-dimensional structures.

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How To Do High-Quality 3D Bone Model Printing On The Cheap

Again form the MEDGadget blog.

Enjoy !

How To Do High-Quality 3D Bone Model Printing On The Cheap:

Orthopedic and maxillofacial surgeons sometimes prepare for surgery by creating physical models of 3D scans of bones that they need to work on. Such models are also useful in educating med school students, doctors, and patients. However, these models tend to be very expensive, usually seen only in well-funded research projects or used by expensive medical professionals. Oftentimes, because the cost of the model is so high, a compromise must be made, so the resulting models end up being truncated or less than actual size.

Shapeways, a company that prints custom-designed 3D models, published a blog post about how Max Frame, an orthopedic surgeon at the Royal Hospital for Sick Children in Glasgow, Scotland, managed to produce a full-size human pelvis for about $230, less than one-fifth the cost of a smaller, professionally made model.

He accomplished this by taking CT scans and importing them into two programs, one to fill in any gaps and eliminate any artifacts on the CT scan and the other to create a 3D surface render that Shapeways can read. After being sent to Shapeways, it took less than a week for Max to receive the models. According to Max, the models were verified and shown to be virtually identical to the bones in the CT scan. Moreover, the white plastic that composed the models proved to be a great bone analog in which to practice using regular orthopedic drills, screws, and saws.

Blog entry from Shapeways: 3D Printing Bone on a budget!

Medtronic launches Artisan System for Bone Graft Protection In Oral-Maxillofacial Surgery

From the MedGadget Blog !

I am not aware if this has been released in India but it seems awesome !

Medtronic launches Artisan System for Bone Graft Protection In Oral-Maxillofacial Surgery:

Bone grafting is the use of either native, cadaveric, or artifical bone pieces to fill a void where you would like new bone to grow. Often at first, bone grafts have poor structural qualities and need hardware to protect them, the bone around and to keep them in place. In Oral-Maxillofacial surgery bone loss is often caused by infection, trauma, tumors and other conditions.

Medtronic has announced the launch of its Artisan space maintenance system which is a set of a customizable titanium mesh, special screws for mesh fixation, as well as socket screws. The mesh is specifically designed for the protection of bone graft and has unique handling and structural properties for this purpose. The socket screws in particular are being marketed as ground breaking since the umbrella-shaped screw design allows for the protection of bone graft while eliminating the need to lift a second flap for the removal of the screw.

Press release: Medtronic Announces Launch of ARTISAN™ Space Maintenance System