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Recognition of malignancy and dysplasia in the dental implant patient.

The purpose of this paper is to report what appears to be an unusually high number of head and neck malignancies in a limited group of patients where primary referral was to undergo implant procedures. While the tumors were probably coincidental, the occurrences point out the importance of careful oral examinations, particularly in this age group.

Adult↗

Fabrication of a dual-purpose surgical template for correct labiopalatal positioning of dental implants.

An implant-supported prosthesis can potentially provide a functional and esthetic reconstruction, provided that the implants are precisely placed in the predetermined location and angulation. Since the accurate placement of osseointegrated implants in the anterior maxilla with questionable bone support is often a clinical challenge, the use of computed tomography and surgical guides is crucial. This article describes a technique to fabricate a template that served as a guide for radiographic evaluation and was then modified for use in the surgical phase of the treatment.

Bone Resorption↗

Clinical outcome of dental implants placed in fibula-free flaps used for the reconstruction of maxillo-mandibular defects following ablation for tumors or osteoradionecrosis.

OBJECTIVES: (a) To evaluate the clinical outcome of fibula revascularized flaps used for the reconstruction of maxillary and mandibular defects due to resection for tumors or osteoradionecrosis and (b) to evaluate the survival and success rates of implants placed in the reconstructed areas. MATERIAL AND METHODS: In a 8-year period (1995-2002), 59 patients, 38 males and 21 females, aged from 13 years to 69 years (mean age: 48.7 years), presenting with maxillary and mandibular defects due to resection for tumors or osteoradionecrosis, were reconstructed with fibula-free flaps. Of the 59 patients, 16 received 71 implants for the prosthetic rehabilitation of the reconstructed edentulous areas. RESULTS: Out of 59 fibula-free flaps, three failed and had to be removed, nine underwent partial necrosis involving the bone segment and/or the skin paddle but survived, while the remaining 47 healed uneventfully. The mean follow-up of patients after the reconstruction was 55 months (range: 24-120 months). The cumulative survival rate of fibula-free flaps was 94.9%. The mean follow-up of the 16 patients treated with dental implants and implant-supported prostheses was 50.2 months (range: 24-96 months). The cumulative implant success and survival rates of implants were 98.6% and 93.1% respectively. CONCLUSION: The reconstruction of maxillo-mandibular defects following ablation for tumors or osteoradionecrosis with fibula-free flaps has been demonstrated to be a reliable technique with good long-term results. Implants placed in the reconstructed areas were demonstrated to integrate normally, with success and survival rates comparable to those obtained in case of implants placed in native bone.

Adolescent↗

Sinus augmentation for dental implants: the use of alloplastic materials.

The ability to augment the sinus floor has dramatically expanded the scope of implant dentistry. Clinical and scientific studies abound as to the efficacy of this procedure. The debate still ensues as to the best material to use for this augmentation, with autogenous bone, freeze-dried bone, xenografts, and alloplasts all being advocated. This article will substantiate through scientific and clinical studies, how the use of allplastic materials in sinus augmentation techniques can greatly reduce the morbidity and the expense of the procedure while predictably producing bone that has been shown to support dental implants in function for extended periods of time.

Alveolar Ridge Augmentation↗

Replacement therapy and the immediate post-extraction dental implant.

Immediate postextraction implant placement often deals with two major problems: maintaining the initial stability of the implant(s) and preventing soft tissue ingrowth during the healing period. Both problems may lead to the loss of the implant(s). The objective of this clinical study was to evaluate the effectiveness, reliability, and placement of single-stage implants in extraction sockets in combination with a synthetic bone substitute. Hopeless teeth were extracted and one-stage cylindrical screw implants, hollow and solid, were inserted together with a composite polymer without using a membrane. Rehabilitation was performed three to six months postoperatively by placement of different types of prostheses. Excellent initial results were confirmed by the follow-up of 7 to 10 years. The hollow screw-type showed a higher failure rate when compared with the solid screw-type. One-stage implant osseointegration in extraction sockets is enhanced if used with this synthetic graft material, and the simplicity of the method does not jeopardize outcome and predictability. It provides the patient with the benefits of implant-supported restorations in a simple, quick, cost-effective, and secure manner.

Adult↗

The use of lipiodol in spiral tomography for dental implant imaging.

Preoperative radiographic assessment is mandatory for the meticulous treatment planning and successful placement of implants. The precise topographical evaluation of selected implant sites, apart from the most straightforward cases, requires tomographic examination with the use of diagnostic radiographic templates. The incorporation of various radiopaque materials such as barium sulphate and lead foil as radiographic markers had not been entirely satisfactory. A new contrast medium, Lipiodol ethiodized oil (Laboratoire Guerbet, Paris, France), can easily be mixed with the monomer of autopolymerizing acrylic resin. The resultant acrylic template has several advantages. The tomographic images (Scanora; Soredex Orion Corporation, Helsinki, Finland) are radiographically homogenous and show the contour of the future prosthesis, the angulation of the planned implant, and the thickness of the soft tissue. In addition, the radiopaque template is optically transparent (with a slight yellow tint), which facilitates good visibility of surgical sites when the template is modified to become the surgical guide for implant placement. This transparent template can be further modified for implant position registration at the time of surgery. Because this multipurpose template is simple to construct and inexpensive, it can be recommended for routine use in implant dentistry.

Acrylic Resins↗

A comparison of hydroxyapatite (HA) -coated threaded, HA-coated cylindric, and titanium threaded endosseous dental implants.

PURPOSE: The purpose of this study was to compare the success of hydroxyapatite (HA) -coated and machined titanium (Ti) implants in a 5-year randomized, controlled clinical trial conducted at 2 centers. MATERIALS AND METHODS: Each of 120 edentulous patients received HA-coated threaded, HA-coated cylindric, and machined Ti threaded implants in a randomized design using 5 or 6 implants. Digital radiographs allowed for yearly measurements of bone loss. Calibrated clinicians also measured mobility, Gingival Index, Plaque Index, probing depth, and recession. A Kaplan-Meier analysis was used to compare the proportion of ailing implants (defined as less than 2 mm of alveolar bone loss over 5 years) for each type of implant design. The criteria employed to assess implant outcome included the need for successful implants to lose less than 2 mm of bone support over the 5 years following placement of the prosthesis. RESULTS: This analysis revealed that 95.2% of machined Ti threaded implants and 97.92% of HA-coated threaded implants were successful, while 99.0% of HA-coated cylindric implants experienced less than 2 mm of bone loss (P < .06). DISCUSSION: All types of implants placed in this study had success rates above 95%. CONCLUSION: Over 5 years, the success rate tended to favor HA-coated implants.

Adolescent↗

Complete dentures fixed on dental implants: chewing patterns and implant stress.

Electrognathographic measurements on 18 patients with implant-attached mandibular complete dentures showed larger and more stable chewing patterns compared to their former dentures without implants. Strain gauge measurements revealed mechanical stress acting on the implants even during the fixation of the bar. In addition to simulating the periodontal ligament, the intramobile element (IME) of the IMZ system compensated minor, clinically undetectable mismatches inherent with technical procedures (casting, soldering). Although the implants are loaded with tensile and compressive stress, tensile stress dominated during the chewing process. The implants were also loaded during swallowing. This load reached half of the value of the chewing loads.

Dental Implantation, Endosseous↗