A Periodontal Expert

台灣牙周補綴醫學會 2010 春季學術活動

2010-02-13T02:43:00.001+08:00

台灣牙周補綴醫學會 2010 春季學術活動

Posted using ShareThis

A reflection from the Live surgey

2008-01-22T20:12:00.000+08:00

@ A combined dental implantation & ridge spitting + bone grafting from Srcaper (May23, 06') [Bone Scraping with Bone Collec]
* post suture (10 days after surgery) * 2nd surgery on 25,26 sites and additional bone grafting on 24 site(post-implantation 6 months):

@ Cortical bone collector in this case is reusable 50 times; after that, changes the blade to bone scraped. Some detail see another blog of mine: http://implantproducts.blogspot.com/2006/05/cortical-bone-collector.html

* Final restoration:(Jan17,2007)
** Post restoration 1 year:

** Taking a Certificate from Prof. Isaksson (big guy): I learded the specific ridge splitting and bone grafting from Halstam university program. This csae presentation is my deep-heart thanks to them and some kinds of refection after the course.

Subantral Membrane Elevation with Balloon technique

2007-01-16T12:00:00.000+08:00

Balloon Subantral Membrane Elevator ( SME )

The advantages of Subantral Membrane Elevator, or SME:

Decreases Surgical Time
Reduces Risk of Membrane Tears
Mini Balloon Inflates to 3.1mm (Micro Mini Inflates to 1.9mm)
Can be used in small osteotomies
Single Use, Supplied Sterile
Supplied with 5cc Luer Lok® Syringe

@ Clinical Appilcation for SME with balloon technique:(by Dr. Perio Apr06')

*** 7mm bone height under sinus membrane >> localized elvation to insert 4.8X12mm dental implant.

@Detail s lideshow description of Balloon Subantral Membrane Elevator

...PostSx 1 wk

** 2nd surgery and final restoration: See next blog!

Final restoration after the Balloon technique

2007-01-16T07:38:00.000+08:00

* 2nd Surgery and Final restoration (apical films)

Simplified Mini-Incision (SMI) at Dental implant Surgery

2006-10-12T15:39:00.000+08:00

Simplified Mini-incision for Dental Implant Surgery:(Designed by Dr. Perio)

Fit to Stage 1- and 2- surgery
Incision & Suture: a/Slight semilunar crest incision; b/two short vertical incisions (stoped at mucoginigival junction); c/Mini- middle releaving incision; d/apically positioned flap; e/one sling suture to fix flap; f/two fixing simple loop sutures.
Advantages for this thechnique: a/Simple procedure; b/faster tissue healing and c/ post-surgery more comfortable.

A case using SMI technique: (postSx 1wk)

@ Final healing:

Blog capacity is full ---Move to second part

2006-06-30T10:19:00.000+08:00

** Notice !!!
Home move to Demtal Implant Professional !

See You .....

Localized Management of Sinus Floor (LMSF)

2006-06-01T09:21:00.000+08:00

Localized management of sinus floor (LMSF) achieves implant placement and sinus lifting simultaneously. LMSF is a further application of the principles of the edentulous ridge expansion (ERE) technique. It comprises the dissection of a partial-thickness flap, the buccal expansion of the residual alveolar bone, and the fracture and elevation of the sinus floor with simultaneous implant placement. The selected patients, who showed no signs of sinus pathology, exhibited insufficient vertical alveolar bone dimensions for the placement of dental implants with the traditional technique. The minimal residual alveolar bone height was between 5 and 7 mm. Based on the criteria established by Albrektsson and his coworkers in 1986, the success rate of the 499 implants placed with the LMSF was 97.5%.(Code by Dr.Buschi et al;1998.Three hundred three patients were treated with 499 implants placed using the LMSF between April 1988 and December 1993)
#Clinical Report by Dr. Perio:

@LMSF with Wide Implant + Bone Grafting: (Dec10,05)

PostSx 1wk>>><<PostSx 4 months---

@Final restoration (May30,06')-post implantation 6 months later

#15GBR + #16LMSF (Dec05')

@Post Sx 5 months (May06')

Dental Implant Fracture: a complication of treatment with dental implants

2006-05-30T23:48:00.000+08:00

Dental implants are a functional and esthetic solution to partial and total edentulism. The initial success rate of this treatment modality is 90-95%. But, that treatment modality is not free of complications. One of the rare complications yet, with severe clinical results is fracture of dental implants. The current literature review (Biomaterials. 2002 Jun;23(12):2459-65)presents the various causative factors that may lead to implant fracture. Implant failures may be sorted into groups by the timing of their appearance, or by the origin of failure. Fractures belong to the group of late complications, caused by a biomechanical overload. Overload may be caused by inappropriate seat of the superstructure, in-line arrangement of the implants, leverage, heavy occlusal forces (bruxing, clenching), location of the implant and the size of the implant or metal fatigue. Good clinical examinations and correct treatment plans may reduce the risk of implant fracture.
*A Case Report for Fractured Implant Removal: >>Trephine to remove the fractured implant

*New larger implant with bone graft into the old implant site>>

>>>one & 2.5 months later>>>

@Final Restoration:( after 6 months later from reimplantation!)

Periodontal Treatment Options for Receding Gumlines

2006-05-27T19:57:00.000+08:00

Erosion of the gums at the gumline is relatively common. It is seen as a result of chronic inflammation associated with chronic gum disease. I t is also fairly common in young adults with aggressive toothbrushing habits. Generally, teeth will develop gum recession when a root is prominent in the bone compared to other teeth. Patients who grind their teeth also stress the sockets in which the teeth reside. When this stress is delivered to sockets with thin bone, loss of bone and gum may occur. The resulting gum recession can lead to thermal sensitivity to the tooth and may be unsightly. Dentists are concerned about recession when the amount of gum tissue deteriorates. Research has shown that when the amount of attached gum tissue diminishes below one millimeter, these teeth are more vulnerable to developing further recession. When these teeth are treated with gum grafts, the recession will stabilize and help to prevent the further loss of tooth support.Soft Tissue Grafts are procedures that rebuild the protective gum tissue around the tooth or teeth.

The procedure usually follows the following protocol:
1) Local anesthetic is given.
2) The tissue below the receded gum is dissected away exposing underlying tissues.
3) Gum tissue is procured from the roof of the mouth. This is usually a 1-2mm paper-thin graft that can easily be positioned around the problem tooth. The roof of the mouth is essentially an eternal reservoir of gum tissue. The donor site will be slightly tender but usually heal quickly and return to normal after a few days.
4) The graft tissue is then sewed to place over the exposed underlying tissues. Sutures are enough to secure the graft and allow for proper healing. The graft will turn first white and then often red as the graft bonds to the surrounding tissue. Ultimately, grafts will range from normal colored to slightly.
New variations of grafting have emerged over the past several years. Tissue bank skin graft material is available for those patients who would prefer not to use the roof of the mouth as a donor site. These grafts tend to have more shrinkage but will provide more natural color matching to the surrounding gums. Root coverage is now a very predictable option for teeth with receding gum lines. Subepithelial Connective Tissue Grafts borrow internal tissue from the roof of the mouth. This tissue is positioned under a flap of gum in the area of recession. The combined nutrition from the gum under and over the graft keeps the graft alive over the previously exposed root surface. The result is both an increase in the amount of protective gum tissue as well as improved esthetics. These grafts also provide the best color match with the surrounding gums.

Case report: A lower anterior area generalized gingival recessions/fenestration with roots exposure during orthodontic treatment__The Subepithelial connective tissue graft to improve the thickness of overlying gingival tissue and roots coverage __Referred from other general practitioner for some malpractice during the orthodontic therapy

Live surgery Case 3~5

2006-05-19T17:26:00.000+08:00

Live surgery case3:
Very narrow ridge over right mandibular -
Open type Ti mesh + Autogenous bone graft (Harvesting from Safe scaper)

@Live surgery case4: Lt' Maxillary sinus lift + Intra-antral bone grafting + Dental implantation

@Live surgery case5: Failing implant removal + Ridge augmentation / Sinus augmentation under Ti mesh

*** The Use of Ramus Grafts for Ridge Augmentation- Clinical Article-(Dental Implantology Update: June 1998)
@ Photo with professor Isaksson and Dr. Becktor

@ Ramus onlay graft harvesting procedures: Video (Please don't publish in public): http://www.youtube.com/watch?v=Xk8rstO-tME

A wonderful course in a lovly city

2006-05-18T17:30:00.000+08:00

Clinical Training Course -
Advanced implant Surgery with Forcus on Minor Bone Grafting Procedures

May 18-19, 2006
Maxillofacial Unit, Halmstad Hospital, Halmstad, Sweden

Astra Tech AB

Participants:
Dr. Ramon Gomez Meda (Spain)
Dr. Alberto Trigas Damian (Spain)
Dr. Lennart Mollersten (Sweden)
Dr. Sven-Ake Nilsson (Sweden)
Dr. Stefan Ohlsson (Sweden)
Dr. Chi-Chou Huang (Taiwan)
Dr. Yin-Pin Wang (Taiwan)

Faculty:
Sten Isaksson DDS MD PhD (Head of the maxillofacial Unit Oral & Maxillofacial Surgeon)
Jonas Becktor DDS

Two Live Surgery on First Day
#case 1
#case 2

Out town 1 week to attend advanced implant surgery course in Sweden

2006-05-15T17:12:00.000+08:00

Advanced Implant Surgery with Focus on Minor Bone Grafting Procedures

On two different occasions: May 18–19 and September 14–15, 2006 Maxillofacial Unit, Halmstad Hospital, Halmstad, Sweden. For the clinician with experience in conventional implant surgery and an interest in advanced surgical techniques.Various pre-implant surgical techniques suitable for general dentistry will be discussed and performed. The course includes local bone grafting such as sinus lifting and onlay grafting as well as distraction osteogenesis and fixture installation in grafted bone. Lectures, patient demonstrations and live surgery with opportunities for the participants to assist will illustrate the different procedures.

Lecturers:Sten Isaksson, DDS, MD, PhD, Clinical Director,Maxillofacial Unit, Halmstad Hospital, Halmstad, Sweden

Jonas Becktor, DDS, Consultant, Maxillofacial Unit, Halmstad Hospital, Halmstad, Sweden

Course ContentLectures
• Indications and limitations for local bone graftingtechniques suitable for general dentistry
• Distraction Osteogenesis (DOG)
• Treatment planning and discussions of participants’ own cases
• Postoperative treatment– Follow-up– Complications
• Various bone grafting techniques suitablefor local and general anesthetics
• Research and studies on implants and bone graftLive Surgery*
• Titanium mesh and bone graft• Bilateral sinus inlay bone graft
• Onlay bone graft for single tooth implant• Implant surgery in grafted bone

Duration: 2 days
Participants: Min 7, max 8
Course fee: SEK 11,300 ex. VAT.
Included in the fee: Course material, diploma, coffee,lunches and one dinner.
Language: English

@Welcome to my Astra nordic tour Blog: http://astratour.blogspot.com/
@ Join a special group for Astra dental implant:
http://health.groups.yahoo.com/group/astraimplant/join

Click to join astraimplant

How to predict the percentage of root coverage ?

2006-05-13T15:20:00.000+08:00

@ A case (#43) of severe gum recession and root exposure after orthodontic treatment:

Severe root prominence
Root outer the alveolar house
Miller's classification : Class III
Root exposure with wide and deep type

For severe gum recession + loss of some interproximal bone + wide and deep root exposure>>> 100% root coverage is not possible!

....70~80 % root coverage will be predictale goal.

....Cervical operative restoration may be needed to cover exposed root surface.

A Dentist taking the implant surgery and restoration

2006-05-12T10:24:00.000+08:00

A handsome dentist (famous at his hometown) suffering an anterial tooth missing and flipper discomfort!
He decided to have a fixed restoration after dental impant and bone augmentation.
For his thin and bone concavity over the implant site, the bone augmentation and dental implantation should be together.
When a healing abutment into the implant at 2nd surgery, the implant position was far palatally. Lab technician (顏氏技工所) helped him to correct implant position by custom made angle abutment from bone crestal level.
Final result is OK. and he restores his shining smile again !

@Detail procedures see the following pictures:

Maxillary Sinus Septa

2006-05-08T21:09:00.000+08:00

Journal of Periodontology
2006, Vol. 77, No. 5, Pages 903-908
(doi:10.1902/jop.2006.050247)

Maxillary Sinus Septa: Prevalence, Height, Location, and Morphology. A Reformatted Computed Tomography Scan Analysis

Min-Jung Kim

Background: The sinus lift technique may be difficult to perform if an aberrant sinus anatomy is encountered during surgical exposure, such as when a septum is present on the sinus floor. The objective of this study was to determine the prevalence, size, location, and morphology of maxillary sinus septa in the atrophic/edentulous and non-atrophic/dentate maxillary segments.
Methods: The sample population consisted of 100 patients (41 women and 59 men, with a mean age of 50 years, ranging between 19 and 87 years) for whom treatment was being planned for implant-supported restorations. Reformatted computerized tomograms (CT) from 200 sinuses were analyzed using imaging software.
Results: The prevalence of one or more septa per sinus was found to be 26.5% (53/200), 31.76% (27/85), and 22.61% (26/115) in the overall study population and the atrophic/edentulous and the non-atrophic/dentate maxillary segments, respectively. In the analysis of the anatomic location of the septa within the sinus, it was revealed that 15 (25.4%) were located in the anterior region, 30 (50.8%) in the middle region, and 14 (23.7%) in the posterior region. The measured heights of the septa varied among the different areas. The mean heights of the septa were 1.63 ± 2.44, 3.55 ± 2.58, and 5.46 ± 3.09 mm in the lateral, middle, and medial areas, respectively.
Conclusions: It can be inferred that there is a wide anatomical variation in the prevalence, size, location, and morphology of maxillary sinus septa, irrespective of the degree of atrophy. Therefore, to prevent the likelihood of complications arising during sinus augmentation procedures, a thorough and extensive understanding of the anatomic structures inherent to the maxillary sinus is indispensable.

First Laser Gum Disease Procedure to gain FDA Clearance

2006-05-03T20:19:00.000+08:00

First Laser Gum Disease Procedure to gain FDA Clearance - “Laser Assisted New Attachment Procedure or Laser-ANAP®”

The US Food and Drug Administration cleared Laser-ANAP? ("Laser Assisted New Attachment Procedure") with a unique and specific claim for, "cementum-mediated new periodontal ligament attachment to the root surface in the absence of long junctional epithelium."
FDA clearance for Laser-ANAP?using the PerioLase?MVP-7?variable pulsed Nd:YAG dental laser follows three years of research at Louisiana State University, School of Dentistry, New Orleans, by principal investigator, Professor Raymond A. Yukna, DMD, MS, and coordinator of post-graduate periodontics at LSU. Professor Yukna led a controlled, blinded, clinical and human histology study that evidenced new root surface coating (cementum) and new connective tissue (periodontal ligament) formation (collagen) on on tooth roots by stimulating existing stem cells to grow following the use of the PerioLase?MVP-7?& Laser-ANAP?protocol.
"These results are very positive, very consistent, and very encouraging related to the treatment of deep gum pockets," said Yukna. "Dentists have been looking for ways to regenerate some of the tissues lost to gum infections and Laser-ANAP?is an exciting and revolutionary treatment protocol showing microscopically that we can form a new root coating (cementum) and new connective tissue attachment (collagen). Our consistent results (all LANAP treated teeth showed a positive result) suggest that the best possible type of healing can be obtained using the specific Laser-ANAP?protocol. This presents a wonderful alternative to traditional surgery."

@ Laser-assisted new attachment procedure inprivate practice by David M. Harris, PhD
-Article in PDF

***AAP-Commissioned ReviewLasers in Periodontics: A Review of the Literature Charles M. Cobb*
Conclusions: Based on this review of the literature, there is a great need to develop an evidence-based approach to the use of lasers forthe treatment of chronic periodontitis. Simply put, there is insufficient evidence to suggest that any specific wavelength of laser is superior to the traditional modalities of therapy. Current evidence does suggest that use of the Nd:YAGor Er:YAG wavelengths for treatment of chronic periodont it is may be equivalent to scaling and root planing (SRP) withrespect to reduction in probing depth and subgingival bacterial populations.However, if gain in clinical attachment level is considered the gold standard for non-surgical periodontal therapy, then the evidence supporting laser-mediated periodontal treatment over traditional therapy is minimal at best. Lastly, there is limited evidence suggesting that lasers used in an adjunctive capacity to SRP may provide some additional benefit. J Periodontol 2006;77:545-564.

Dental Implant Overload

2006-04-29T09:36:00.000+08:00

Dental Implant Overload
@information from the atlantadentalimplants.com
Nobody likes to be overworked. Dental implant dentists say that a dental implant is overloaded when the dental implant has too much work to do. It is always best to have one dental implant replace one missing tooth. However, dental implant patients do not always want to pay for the best treatment available and dental implant dentists try hard to please their patients. Yes, a dental implant patient can get by with less than one dental implant per missing tooth, but this is not ideal and leads to overworking the dental implants harder than the original natural teeth! In the long run, the money saved may not be worth it. In matters of health, it is always best to choose the best road, not the cheapest.
Dental implants can also be overloaded by poorly designing the dental work on top of the dental implants or by poorly placing the dental implants. Both of these problems can often be avoided with excellent dental implant treatment planning before the dental implants are ever placed. Dental implants should ideally be placed so that a dental implant patient's biting forces are directed straight downward onto the dental implant. This can not always be achieved especially when a dental implant patient has lost a great deal of bone.

@Evaluation of load transfer characteristics of five different implants in compactbone at different load levels by finite element analysis. (PDF!)

@ A case with another implant rescure and bone augmentatrion after dental implant overloading. (Surgery by Dr. Perio)

Paroxysmal positional vertigo as a complication of osteotome sinus floor elevation

2006-04-28T11:35:00.000+08:00

Eur Arch Otorhinolaryngol. 2005 Aug;262(8):631-3. Epub 2005 Feb 27.

Paroxysmal positional vertigo as a complication of osteotome sinus floor elevation.
Di Girolamo M, Napolitano B, Arullani CA, Bruno E, Di Girolamo S.
School of Dentistry, University of Rome Tor Vergata, Rome, Italy.

Paroxysmal positional vertigo (PPV) is a high prevalence, vestibular end organ disorder due to the detachment of the utricular otoconia floating in the posterior or lateral semicircular canal. Even though in the majority of cases the etiology of PPV is unknown, it may follow viral infection, vascular disorders and head trauma after different surgical procedures. The aim of this study was to investigate the correlation between PPV and the surgical trauma induced by the vibratory and percussive forces on the upper maxilla during the osteotome sinus floor elevation procedure. We performed a complete otoneurological examination on 146 patients affected by atrophic ridges before and after upper maxilla surgery. Four patients showed a PPV of the posterior semicircular canal controlateral to the implanted side 1 or 2 days after the surgical procedure, which promptly was solved with the Epley re-positioning maneuver. We hypothesize that the surgical trauma, and specifically the pressure exerted by the osteotomes, determines the detachment of the otoliths from the utricular macula while the patient head position, hyper-extended and tilted opposite to the side where the surgeon is working, favors the entry of these free-floating particles in the posterior semicircular canal of the implanted side. Although this disease is rather frequent in the normal population and it is a benign, self-limiting peripheral disorder, it should be considered by the oral surgeon as a possible complication of pre-prosthetic upper maxilla surgery, and the patient should be informed before undergoing surgery.

@ Clinical suggestions for preventing BPPV: (Dr. Perio had the BPPV after ridge expansion with Osteotome technique twice!) @ Dignosis and Therapy for BPPV: Epley maneuver
***Supplemental material on the site CD: Animation of Epley Maneuver.
Note that this maneuver is done faster in the animation than in the clinic. Usually one allows 30 seconds between positions

Multiple dental fractures following tongue barbell placement

2006-04-26T16:20:00.000+08:00

** a picture download from frickr
Multiple dental fractures following tongue barbell placement: a case report

The number of adolescents and young adults undergoing intra-oral piercing, is increasing worldwide. There have been several case reports documenting oral and systemic complications of this practice. These include damage to the dentition, gingivae, infection, speech impediments and nerve damage. The case presented here draws attention to the possibility of multiple tooth fracture as a result of trauma incurred from a barbell inserted into the tongue.

## Worldwide warning for Tongue Piercing:
@A complication of tongue piercing. A case reportand review of the literature (PDF)
@Investigating tongue piercing (BDJ)
@Tongue piercing: Case report and review of currentp r a c t i c e (ADA in Australia)
@Tongue Piercing andAssociated ToothFracture (cda-adc.CA)
@Oral piercing and oral trauma in a New Zealand sample

Stimutainous dental implantation with other techniques

2006-04-25T10:01:00.000+08:00

Presurgery - Long-term apical lesion with persistant sinus teact

Atrumatic extraction and socket curettage

Immediate dental implantation

GBR for periimplant bony defect with BioOss bone graft + Ti mesh + Teruplug

Immediate provionalization

Post Sx 2 wks

台灣牙醫植體醫學會暨南台灣口腔植體醫學會２００６年年會

2006-04-23T23:25:00.000+08:00

台灣牙醫植體醫學會暨南台灣口腔植體醫學會２００６年年會

將於高雄金典酒店舉辦
時間：2006 4/22~23(六,日)，
地點：高雄金典酒店４１樓
主辦：台灣牙醫植體醫學會
承辦：南台灣口腔植體醫學會
協辦：中華民國口腔植體醫學會
　　　台北市牙科植體醫學會 @ Dr. Perio present a post at academy meeting (Apr22~23,06)

"Sandwich" bone augmentation technique

2006-04-21T23:47:00.000+08:00

Int J Periodontics Restorative Dent. 2004 Jun;24(3):232-45.

"Sandwich" bone augmentation technique: rationale and report of pilot cases.
Wang HL, Misch C, Neiva RF.

The aim of this article is to present a new technique for augmentation of deficient alveolar ridges and/or correction of osseous defects around dental implants. Current knowledge regarding bone augmentation for treatment of osseous defects prior to and in combination with dental implant placement is critically appraised. The "sandwich" bone augmentation technique is demonstrated step by step. Five pilot cases with implant dehiscence defects averaging 10.5 mm were treated with the technique. At 6 months, the sites were uncovered, and complete defect fill was noted in all cases. Results from this pilot case study indicated that the sandwich bone augmentation technique appears to enhance the outcomes of bone augmentation by using the positive properties of each applied material (autograft, DFDBA, hydroxyapatite, and collagen membrane). Future clinical trials for comparison of this approach with other bone augmentation techniques and histologic evaluation of the outcomes are needed to validate these findings.

Mucogingival pouch flap for sandwich bone augmentation: technique and rationale.

2006-04-21T15:58:00.000+08:00

Implant Dent. 2005 Dec;14(4):349-54
Park SH, Wang HL

This article introduces a novel flap design, mucogingival pouch flap (MPF), to enhance the clinical outcome of sandwich bone augmentation. MPF uses a pouch flap reflection via mucogingival junction extension incisions to provide an improved graft retention, minimized membrane exposure, preserved papilla dimension, and soft tissue camouflage for improved esthetics.There are 4 implant-associated buccal dehiscence defects in 3 patients treated with sandwich bone augmentation technique in conjunction with MPF. All cases yielded an adequate new bone thickness of 1.5-3.5 mm as well as a height of 84% to 100% at 6 months. Rationales, indications, contraindications, advantages, and disadvantages for MPF designs are further discussed.

Immediate provisionalization after dental implantation

2006-04-20T21:09:00.000+08:00

@ Single tooth immediate provisional restoration of dental implants: technique and early results.
J Oral Maxillofac Surg. 2004 Sep;62(9):1131-8
Block M, Finger I, Castellon P, Lirettle D

PURPOSE: Patients desire efficient restoration of missing teeth. Immediate provisionalization of implants at the time of placement can provide the patient with a tooth-like restoration. Our hypothesis is that preoperative fabrication of the implant abutment and provisional restoration can provide successful immediate provisionalization of implants, if specific diagnostic criteria are used for patient selection.
PATIENTS AND METHODS: This hypothesis is evaluated by prospectively following 74 implants thus treated for 6 months to 2 years. A technique is presented to illustrate a simple and reliable method to provisionally restore a single tooth restoration. The method involves preoperative placement of an implant analog into a model, preparation of the abutment on the model, and fabrication of a provisional crown out of occlusion. At the time of surgery, the implant is placed according to the prescription of the restorative dentist, the surgeon places the abutment and provisional crown, and the final restoration is fabricated after the implant integrates.
RESULTS: Seventy of 74 (94.6%) restorations have been successful with up to 2-year follow-up, which is similar to single tooth implants treated using a 2-stage protocol.
CONCLUSIONS: Single tooth immediate provisionalization implants are effective techniques when specific diagnostic criteria are used.

@Single-tooth replacement in the aesthetic zone with immediate provisionalization: fourteen consecutive case reports.

Immediate dental implantation + Bio-Col socket augmentation

2006-04-19T19:32:00.000+08:00

Immediate Implantation in Fresh Extraction Sockets. A Controlled Clinical and Histological Study in Man

Dr. Michele Paolantonio et al.
Journal of Periodontology
2001, Vol. 72, No. 11, Pages 1560-1571

Background: Early implantation may preserve the alveolar anatomy, and the placement of a fixture in a fresh extraction socket helps to maintain the bony crest. Although a number of clinical studies exist, no histological reports show the outcome of implantation in fresh extraction sockets without the use of membranes in humans compared to implants placed in mature bone.

Methods: Forty-eight healthy patients, receiving at least 4 fixtures in each of 2 symmetrical quadrants, underwent placement of 1 experimental fixture placed in a fresh extraction socket (TI) and 1 contralateral fixture in mature bone (CI). TI were placed after atraumatical tooth extraction, with a surgical site at the apex of the socket and a tight contact between the fixture and the socket's walls, but without the use of filling materials or membranes. The flap was coronally repositioned to obtain primary wound closure. Immediately after surgical intervention, a standardized periapical radiograph was taken. Second-stage surgery was done after 6 months. Six months after the second surgery, a second standardized periapical radiograph was taken and clinical parameters (bleeding and plaque index) recorded. Marginal bone loss (MBL) from the time of implant placement to the time of fixture removal was calculated by comparing periapical radiographs. TI and CI were then removed by a hollow drill to obtain histological specimens. Non-demineralized sections were stained by acid fuchsin and toluidine blue, and by von Kossa to evaluate the degree of bone mineralization. The percentage of direct implant-bone contact (DBC) was calculated by a computerized microscopic digitizer.

Results: No significant differences in the clinical and radiographic parameters were observed between the 2 experimental categories. There was no statistically significant difference between TI and CI for DBC either in the maxilla or in the mandible. No connective or fibrous tissues were present around TI or CI. Bone resorption was not present in any of the histological sections.

Conclusions: The present study shows that when a screw-type dental implant is placed without the use of barrier membranes or other regenerative materials into a fresh extraction socket with a bone-to-implant gap of 2 mm or less, the clinical outcome and degree of osteointegration does not differ from implants placed in healed, mature bone. J Periodontol 2001;72:1560-1571

@ Clinical procedure for Immediate dental implantation after premolar tooth extraction + Socket augmentation with BioOss bone graft /Collage plug Bio-Col technique