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Publikationen 2019

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Abstract

Purpose: This case series illustrates a simplified soft tissue management, namely, the subperiosteal peri-implant augmented layer (SPAL), to increase hard and soft tissue dimensions at the most coronal portion of an implant. Materials and Methods: Twenty-seven implants in 16 patients presenting either a buccal bone dehiscence or a thin (< 1 mm) buccal cortical bone plate (BCBP) were consecutively treated. Briefly, a split-thickness flap (namely, the mucosal layer) was raised on the buccal aspect. Then, the periosteal layer was elevated from the bone crest. A full-thickness flap was elevated on the oral aspect. After implant site preparation, a xenograft was used to fill the space between the periosteal layer and the BCBP and/or exposed implant surface and, if present, to completely correct the bone dehiscence. The periosteal layer was sutured to the oral flap. The mucosal layer was coronally advanced and sutured to submerge both the graft and the implants. At 3 to 6 months, a re-entry procedure for implant exposure was performed. Results: Healing was uneventful, with no signs of infection in all cases. A wound dehiscence was observed in three implants in two patients at 2 weeks postsurgery. Out of 15 implants showing an initial bone dehiscence, 12 implants (80%) showed a complete resolution, with a subperiosteal tissue thickness (SPTT) at the time of re-entry of 3.1 ± 1.0 mm. Three implants presented a residual dehiscence of 1 mm (two implants) or 2 mm (one implant), with a SPTT of at least 2 mm. Out of 12 implants showing a thin BCBP at implant placement, 10 implants (90%) revealed a SPTT ≥ 2 at the time of re-entry. Two implants revealed a SPTT of 1 mm. Conclusion: The SPAL technique represents a valuable simplified surgical approach associated with a low rate of complications in the treatment of peri-implant bone dehiscence and in the horizontal augmentation of peri-implant tissue thickness.

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Osseointegration of dental implants can be promoted by implant-surface modifications using bisphosphonate coatings. In addition, it is of clinical interest to promote peri-implant bone formation and to restore bony structure in low bone-mass patients. The present study evaluated a combination of an anti-resorptive zoledronic acid (ZOL) implant-coating and a systemically applied sclerostin antibody, a known bone anabolic treatment principle, versus sole sclerostin antibody treatment or ZOL implant-coating in a rat osteoporosis model. 

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Abstract Background: Computer-assisted implant planning has become an important diagnostic and therapeutic tool in modern dentistry. This case report emphasizes the possibilities in modern implantology combining virtual implant planning, guided surgery with tooth and implant supported templates, immediate implant placement and loading. Case presentation: A straight forward approach was followed for the mandible presenting with hopeless lower incisors. Diagnosis, decision making and treatment approach were based on clinical findings and detailed virtual threedimensional implant planning. Extractions of the hopeless mandibular incisors, immediate and guided implant placement of six standard implants, and immediate loading with a provisional fixed dental prosthesis (FDP) were performed fulfilling patient’s functional and esthetic demands. The final computer assisted design / computer assisted manufacturing (CAD/ CAM) FDP with a titanium framework and composite veneering was delivered after 6 months. At the 1-year recall the FDP was free of technical complications. Stable bony conditions and a healthy peri-implant mucosa could be observed. Conclusions: Computer assisted implantology including three-dimensional virtual implant planning, guided surgery, and CAD/CAM fabrication of provisional and final reconstructions allowed for a concise treatment workflow with predictable esthetic and functional outcomes in this mandibular full-arch case. The combination of immediate implant placement and immediate loading was considerably more complex and required a high level of organization between implantologist, technician and patient. After the usage of a first tooth-supported surgical template with subsequent extraction of the supporting teeth, a second surgical template stabilized on the previously inserted implants helped to transfer the planned implant position in the extraction sites with a guided approach.

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Background
The characteristics of a dental implant surface have a decisive influence on the process of osseointegration. According to the current state of knowledge, surface modification can not only affect the morphology of cells, and in this way have a positive impact on osseointegration.

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Publikationen 2018

Abstract 

The modification of the implant surface influences implant osseointegration. A physico-chemical means to modify implant surfaces is the creation of hydrophilic surfaces. The aim is an accelerated osseointegration for earlier implant loading and possibly the increase of bone quantity and quality. This review gives an update on the current scientific knowledge on hydrophilic implant surfaces. In vitro, hydrophilic titanium surfaces exhibit different positive effects on hard and soft tissues with significant differences to hydrophobic surfaces. Several cell types and the initial wound healing phase are positively affected. In vivo, an increased osseointegration is detected in the early phase of wound healing. In later stages these significant differences are rarely detectable. Based on clinical trials, early implant loading of hydrophilic surfaces is considered safe and predictable. There is only few data on hydrophilic surfaces in areas of reduced bone quality or quality.

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Abstract 

The modification of the implant surface influences implant osseointegration. A physico-chemical means to modify implant surfaces is the creation of hydrophilic surfaces. The aim is an accelerated osseointegration for earlier implant loading and possibly the increase of bone quantity and quality. This review gives an update on the current scientific knowledge on hydrophilic implant surfaces. In vitro, hydrophilic titanium surfaces exhibit different positive effects on hard and soft tissues with significant differences to hydrophobic surfaces. Several cell types and the initial wound healing phase are positively affected. In vivo, an increased osseointegration is detected in the early phase of wound healing. In later stages these significant differences are rarely detectable. Based on clinical trials, early implant loading of hydrophilic surfaces is considered safe and predictable. There is only few data on hydrophilic surfaces in areas of reduced bone quality or quality.

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Abstract 

Objective: To demonstrate in a prospective cohort study that immediate implantation and provisionalization in combination with the socket-shield technique will result in volume stability of the mucosa adherent to the inserted implant.
Material and methods: Patients with an indication for a single tooth implant underwent application of the socket-shield technique and immediate implantation of a provisional implant crown. A noninvasive volumetric measurement was performed according to the method described by Windisch et al (2007) at baseline and 12 weeks later. The influence of potential confounders was evaluated. Patients rated their satisfaction with the treatment, fitting accuracy of implant, intraoperative discomfort, postoperative pain, and ability to chew soft and hard foods using visual analog scales. 

Results: Fifteen patients with a mean age of 49.2 ± 11.9 years were enrolled in the study. All implant sites showed uneventful healing and no socket-shield exposures were observed. The soft tissue volume change assessed with the mean distance change was < 0.5 mm in all cases (-0.07 ± 0.16; range -0.37 to +0.32). A slight but significant influence of the buccal bone plate width on the soft tissue volume change was observed (b = 0.25; P = 0.037). No influence was found for apical bone height, width of gingival tissue, buccal recession or probing depths. The patients were highly satisfied with their treatment as well as with the pain and functional outcomes.

Conclusions: Based on preliminary data, preservation of a buccal root segment in conjunction with immediate implant placement and provisionalization can minimize buccal contour changes after tooth extraction on a short-term basis.

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The digital transformation is becoming more and more important in our profession. For more than twenty years, our dental technicians have used CAD/CAM to make zirconia, cobalt chromium, titanium and lithium disilicate frameworks. Plaster cast impressions are scanned with a lab scanner, and the prosthesis is digitally designed and machined. In 2015, following consultation with our dental technicians, we decided to transition to intraoral optical impressions. Our goal was to replace physical analogue impressions with intraoral optical impressions [1–3]. The focus of our activities is mainly on periodontology and oral implantology, so we had to address some shortcomings of our implant system and certain pitfalls caused to the complexity of taking optical impression in implantology [4,5]. This article documents how the abutments and scanbodies of our implant system (Thommen Medical, Grenchen, Switzerland) evolved to adapt to the specific requirements of optical impressions. It demonstrates the benefits of a close cooperation between practitioners and engineers.

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Abstract

This study was undertaken to evaluate the relation between bone quality and alterations of implant stability quotient values measured during the initial phase of healing. Nineteen patients treated with 106 implants were included in the current study. The mean bone density of the implant recipient area was measured using Simplant 11 software incorporated in the computerized tomography (CT) machine. Mean bone density measurements were recorded in Hounsfield units. The implant recipient sites were subdivided into 5 groups according to bone quality. The numbers of the structures on the recipient site belonging to D1 and D5 types showed no statistical significance and were excluded. Standard 2-stage surgical technique was utilized to prepare the surgical sites. The implant stability quotient (ISQ) value at implant placement was recorded and did not influence the treatment procedure. The ISQ was measured by an Osstell instrument. The ISQ was further registered on the 21st and 60th days. SPSS statistical software was used for the statistical analysis. In comparison with the time of insertion, the mean values of the ISQ were decreasing for the first 21 days. However, on subsequent days, the ISQ values of all bone types have increased and on the 60th day reached the values recorded at the time of insertion. Analysis of the relation between changes in stability and bone type does not reveal statistical significance. With knowledge of the current clinical study, it can be concluded that bone quality in the recipient bone site does not effect changes in implant stability at the early stages of the osseointegration process.

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Abstract

Background
Maxillary sinus pathologies are a potential risk for failure of implant and bone augmentation. Management of lateral sinus floor elevation in the presence of a pseudocyst remains controversial, and reports on histological outcomes of endo‐sinus bone augmentation with maxillary cysts are scarce.

Purpose
To present a modified surgical technique for removal of maxillary pseudocyst with simultaneous sinus floor elevation, and to evaluate clinical and histological outcomes of the bone grafting.

Materials and Methods
Patients with a radiographic dome‐shaped opacity in the posterior maxillary sinus were included to receive lateral sinus floor elevation with simultaneous pseudocyst removal. Bone core specimens harvested from the lateral aspect of the augmentation sites were histomorphometrically analyzed. Data were recorded and evaluated in terms of survival rates and complications.

Results
A total of 15 patients were included who underwent 17 maxillary sinus augmentation surgeries. Implant survival rate was 97.0%. Bone biopsy specimens were obtained at 6 months after surgery. Histomorphometric analysis revealed that mean percentages of mineralized bone, bone substitute, and nonmineralized tissue were 24.9% ± 18.1%, 14.4% ± 12.5%, and 60.1% ± 12.44%, respectively. No recurrence of the pseudocyst was detected on radiographic examination.

Conclusions
The described technique could be successfully applied in clinical practice to perform sinus augmentation in the presence of pseudocysts.

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Abstract

In the present study, a novel surgical technique, namely the sub-periosteal peri-implant augmented layer (SPAL), to increase hard and soft tissue dimensions at the most coronal portion of an implant will be thoroughly described. The surgical buccal access at the time of implant placement first consisted of a split-thickness flap to raise the most superficial mucosal layer, followed by the elevation of the periosteal layer which was detached from the buccal cortical bone plate (BCBP). A full-thickness flap was elevated on the oral aspect. A xenograft was used to fill the space between the periosteal layer and the BCBP, and the periosteal layer was sutured to the oral flap. The mucosal layer was coronally advanced and sutured to submerge both the graft and the implants. At implant uncovering at 4 months, an increase in the thickness (>2 mm) of the buccal peri-implant tissues was observed. A free gingival graft was used to enhance the dimensions of buccal keratinized mucosa. The SPAL technique may represent a surgical option for the horizontal augmentation of periimplant tissue thickness.

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Publikationen 2017

Abstract
 

To ensure that similar primary implant stability measured by resonance frequency analysis (RFA) could be obtained in different jawbone densities by using a specific surgical drilling protocol and, to correlate those RFA measurements with actors related to the implant design, width and length, we are performed a one-year prospective clinical study was carried out using 27 subjects. A total of 67 hydrophilic titanium implants were placed using a standard two-stage implant placement protocol. The bone type at each implant site was determined by evaluation of a preoperative, highresolution cone beam computed tomography (CBCT) scan. A modified drilling protocol was used in softer bone (types 2, 3 and 4) that allowed for greater implant thread contact with the surrounding bone. The implant stability quotient (ISQ) was measured at four different times during the study: initially it was determined immediately after implant placement, then again at stage two uncovering surgery, then at six months' post-placement and, and finally at one-year post-placement. Data collected immediately after implant surgery demonstrated a high correlation (R2=0.99) between the ISQ and bone type classification. An overall trend towards a higher ISQ was found over the one-year study period for all types of bone. Implants remained clinically and radiographically stable during the one-year study period. Our data allow conclude that the primary stability of two-staged loaded implants placed in different bone types can be optimized by applying this surgical drilling protocol during the implant placement. The ISQ method was found to be a reliable predictor of implant stability.

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Abstract

PURPOSE: To evaluate the clinical outcome of four to five implants immediately restored with metal-resin screw-retained cross-arch fixed prostheses in edentulous jaws 1 year after loading.

MATERIALS AND METHODS: In total, 104 consecutive patients received four 11 × 4.5 mm implants with a torque superior to 35 Ncm. If one implant did not reach a torque superior to 35 Ncm a fifth implant was added. If two implants did not reach a torque superior to 35 Ncm, loading was postponed after 3 months. A total of 127 metal-resin screw-retained fixed prostheses (59 mandibular and 68 maxillary) were to be delivered within 3 days. Outcome measures, evaluated by the treating clinician, were: prosthesis and implant failures, as well as complications.

RESULTS: In total, 549 implants were placed (195 immediate post-extractive implants). Twelve maxillary prostheses were delayed loaded, whereas all others were loaded immediately. One year after loading, six patients dropped out, 12 implants failed in eight patients (two patients lost three implants each), and 87 prostheses were remade in 68 patients, one because of three implant failures and then again in the recall programme (replaced twice), one because of tree implant failures and five prosthesis fractures, 10 because of prostheses fractures and 74 in a recall programme for prosthesis replacement. All patients were wearing the planned fixed prostheses at the end of the first year in function. Ninety-eight complications occurred in 66 patients, but all were successfully solved.

CONCLUSIONS: Immediately loaded cross-arch prostheses supported by four to five implants are a viable therapeutic option, if prostheses are made with resistant frameworks. Conflict of interest statement: This study was partially supported by Thommen Medical (Grenchen, Switzerland), the manufacturer of the implants evaluated in this investigation, however data belonged to the authors and by no means did the manufacturer interfere with the conduct of the trial or the publication of the results.

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Abstract 
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION:

Immediate versus delayed implant placement after anterior single tooth extraction: the timing randomized controlled clinical trial. Tonetti MS, Cortellini P, Graziani F, Cairo F, Lang NP, Abundo R, Conforti GP, Marquardt S, Rasperini G, Silvestri M, Wallkamm B, Wetzel A. Journal of Clinical Periodontology 2017;44(2):215-24.

SOURCE OF FUNDING:

Nonprofit, Foundations: European Research Group on Periodontology, Genova, Italy Industry: Thommen Medical AG, Switzerland and Geistlich AG, Switzerland (biomaterials).

TYPE OF STUDY/DESIGN:

Randomized controlled trial.

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Abstract 
OBJECTIVES:

Implant placement immediately after tooth extraction is often accompanied by resorption of surrounding tissues. A clinical technique was developed where the buccal portion of the root is retained to preserve the periodontal ligament and bundle bone. This technique is based on animal studies showing the potential to preserve the facial tissues utilizing this approach. The purpose of this study was to gain more insight regarding the safety of the technique with regard to biological and implant-related long-term complications and to observe the clinical appearance of the peri-implant tissues. Another objective was to evaluate volumetric changes of the affected facial contours in long-term and the esthetic outcomes.

MATERIAL AND METHODS:

This study is a retrospective case series of 10 consecutive patients with implant replacement between the maxillary first premolars. Impressions were made prior to extraction (t1) and 5 years post-implant placement (t2). 3D-surface scans of the casts were digitally superimposed for quantitative evaluation of alterations of the facial peri-implant tissue contours and soft tissue recessions. Additionally, clinical data were collected (PPD, BOP, peri-apical radiographs and photographs).

RESULTS:

All implants healed without adverse events. Peri-implant probing revealed healthy conditions. The comparison of radiographic images showed physiologic bone remodeling at the implant shoulders. Mean tissue loss on the facial side in oro-facial direction was -0.21 ± 0.18 mm. Average recession at implants was -0.33 ± 0.23 mm and at neighboring teeth -0.38 ± 0.27 mm. Mean loss of the marginal bone level at the implant shoulder amounted to 0.33 ± 0.43 mm at the mesial and 0.17 ± 0.36 mm at the distal aspect of the implants. A mean pink esthetic score of 12 was recorded.

CONCLUSION:

Volumetric analysis showed a low degree of contour changes from extraction and implant placement to the follow-ups. Mucosal recession at the implant restoration was comparable to that of the neighboring teeth. Within the limitations of this descriptive study, the socket shield technique offers reduced invasiveness at the time of surgery and high esthetic outcomes with effective preservation of facial tissue contours. This technique should not be used in routine clinical practice until a higher level evidence in the form of prospective clinical trials is available.

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Abstract 
OBJECTIVE:

Extraction-socket resorption is considered a major problem that can limit implantological rehabilitation options and compromise the esthetic outcome. Surgical techniques to reduce remodeling are of restricted predictability and commonly require several surgical interventions and grafting. This increases the treatment cost and places a physical and psychological strain on the patient. This clinical case report presents a replacement of an upper canine using the socket-shield technique (SST) with a CAD/CAM surgical guide, resulting in a predictable, high esthetic, and functional result.

CLINICAL CONSIDERATIONS:

The SST is an alternative approach to curbing remodeling and resorption by retaining the facial part of the root during tooth extraction. An immediately placed implant supports the facial root fragment, preventing the collapse of the buccal wall. The SST with digital precision planning in combination with a CAD/CAM surgical guide benefits patients by preserving their tissue architecture and causing only insignificant trauma. Furthermore, the SST reduces the number of surgical and prosthetic interventions required to one each for pre-operative planning, surgical procedures, and prosthetic rehabilitation.

CONCLUSIONS:

The socket shield technique is a minimally invasive implantological approach offers patients and clinicians multiple benefits.

CLINICAL SIGNIFICANCE:

The socket-shield technique (SST) represents an alternative approach to intervene remodeling and resorption processes by the maintenance of the facial part of the root during tooth extraction. The immediate placement of an implant supports the facial root fragment and thereby prevents a collapse of the buccal wall. The SST associated with a CAD/CAM fabricated surgical guide, can reduce the amount of appointments, due to the immediate fabrication of the definitive restoration with the existing model. Therefore, no further necessary appointments are required apart from first pre-operative planning, second for surgical treatment, and third for prosthetic rehabilitation.

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Abstract

Blood clots stop bleeding and provide cell-instructive microenvironments. Still, in vitro models used to study implant performance typically neglect any possible interactions of recruited cells with surface-adhering blood clots. Here we study the interaction and synergies of bone marrow derived human mesenchymal stem cells (hMSCs) with surface-induced blood clots in an in vitro model by fluorescence microscopy, scanning and correlative light and electron microscopy, ELISA assays and zymography. The clinically used alkali-treated rough titanium (Ti) surfaces investigated here are known to enhance blood clotting compared to native Ti and to improve the healing response, but the underlying mechanisms remain elusive. Here we show that the presence of blood clots synergistically increased hMSC proliferation, extracellular matrix (ECM) remodelling and the release of matrix fragments and angiogenic VEGF, but did not increase the osteogenic differentiation of hMSCs. While many biomaterials are nowadays engineered to release pro-angiogenic factors, we show here that clot-entrapped blood cells on conventional materials in synergy with hMSCs are potent producers of pro-angiogenic factors. Our data might thus not only explain why alkali-treatment is beneficial for Ti implant integration, but they suggest that the physiological importance of blood clots to create pro-angiogenic environments on implants has been greatly underestimated. The importance of blood clots might have been missed because the pro-angiogenic functions get activated only upon stimulation by synergistic interactions with the invading cells.

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Abstract
Aim: To compare need for bone augmentation, surgical complications, periodontal,
radiographic, aesthetic and patient reported outcomes in subjects receiving implant
placement at the time of extraction (Immediate Implant) or 12 weeks thereafter.

Methods: Subjects requiring single tooth extraction in the anterior and premolar
areas were recruited in seven private practices. Implant position and choice of
platform were restoratively driven. Measurements were performed by calibrated
and masked examiners.

Results: IMI was unfeasible in 7.5% of cases. One hundred and 24 subjects were
randomized. One implant was lost in the IMI group. IMI required bone augmentation
in 72% of cases compared with 43.9% for delayed (p = 0.01), while wound
failure occurred in 26.1% and 5.3% of cases, respectively (p = 0.02). At 1 year,
IMI had deeper probing depths (4.1  1.2 mm versus 3.3  1.1 mm, p < 0.01). A
trend for greater radiographic bone loss was observed at IMI over the initial 3-
year period (p-trend < 0.01). Inadequate pink aesthetic scores were obtained in
19% of delayed and in 42% of IMI implant cases (p = 0.03). No differences in
patient reported outcomes were observed.

Conclusions: Immediate implant placement should not be recommended when
aesthetics are important, IMI should be limited to selected cases. Longer followup
is needed to assess differences in complication rates.

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Publikationen 2016

Abstract 
The present study aimed to evaluate primary stability (PS) and osseointegration of dental implants in polylactide [70/30 poly(L-lactide-co-D, L-lactide); (PLDLA)] modified bone in 30 Goettingen minipigs. Each animal received three implants per jaw quadrant. In a split-mouth design, one side of the maxilla and mandible was randomly allocated to the experimental treatment (PLDLA applied into the drill hole before implantation), while the contralateral sides served as intraindividual controls (no PLDLA applied). The required insertion torque and the implant stability quotient (ISQ) were measured during implantation. ISQ, volume density (VD) of new bone formation (NBF), and the bone-implant contact (BIC) were evaluated at the end of the observation period (1, 3, 6, 12, and 24 months, respectively) in six animals each. Across all study groups, the PLDLA treatment resulted in a) a comparable insertion torque, b) an equivalent ISQ, c) a reduced BIC, and d) a reduced VD of NBF, as opposed to the untreated controls. In conclusion, the PLDLA treatment did not affect the PS, but rather led to an impaired osseointegration, which was particularly strong in the compact mandibular bone, and decreased in the spongious maxillary bone. PLDLA induced anchoring in spongious bone should be evaluated in further investigations.

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Conclusion

This case illustrates an experimental technique for preserving a buccal root segment in conjunction with immediate implant placement and provisionalisation. The socket shield technique may be a valuable technique to minimise buccal contour changes after tooth extraction, leading to increased volume stability of the mucosa adjacent to the inserted implant. However, it is important to note that this technique should not be used in daily practice until long-term multicentre studies are available.

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Introduction: Despite recent advancements in ridge preservation techniques, complete tissue regeneration remains difficult to achieve when managing multiple tooth loss in the esthetic zone. Guided bone regeneration has been shown to be effective in creating sufficient bone support, but post-surgical complications including soft tissue deficiencies have been reported. Obtaining “natural” esthetic results has proven challenging, especially when restoring adjacent implants in patients with a high smile line. The addition of extrusion and palatal positioning of the implant facilitates
ridge preservation surgery as well as the esthetic outcome, but requires an additional treatment phase devoted to orthodontics.
Case Presentation: A healthy 43-year-old female with a longstanding history of smoking presented with terminal periodontal disease on teeth #7 and #8 together with a wide diastema between teeth #8 and #9. Comprehensive dental treatment
included smoking cessation, oral hygiene instruction, full-mouth scaling and root planing, orthodontic realignment, and implant placement to manage those teeth with a hopeless prognosis. Orthodontic therapy included forced eruption of teeth #7 and #8 to create optimum implant receptor sites. One year after prosthetic restoration, interproximal papillae height proved stable and similar to the contralateral side.
Conclusion: A multidisciplinary approach proved beneficial in achieving an improved esthetic outcome in a challenging situation in implant therapy. Clin Adv Periodontics 2016;6:146-152.
Key Words: Bone regeneration; esthetics, dental; heterografts; humans; orthodontic extrusion; tissue transplantation.

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ABSTRACT
Aim: The ligature-induced defect model still remains the model of first choice to
experimentally investigate the cause, effect and treatment approaches of periimplantitis. It was the aim of the present in-vivo trail to revisit the ligature-induced
peri-implantitis minipig model regarding its current scientific value and ethical
justification in implant research.
Materials and methods: Six minipigs were used for the analysis of peri-implant hard
and soft tissue structures. Animals were randomly allocated to an experimental
silk ligature-induced peri-implantitis group (n=4 animals) and a reference healthy
group (n=2 animals). After six weeks mean pocket depths (PD) and bleeding on
probing (BOP) measurements were performed just before animals were sacrificed.
Results: Overall, ligature-induced peri-implantitis provoked a local inflammation
around the experimental implants. Additionally, a loss of crestal bone surrounding
the implants could be detected. Mean pocket depths (PD) were 2.2 ± 1.1 mm for
healthy animals and 5.4 ± 1.9 mm for peri-implantitis sites. Healthy sites showed
a BOP of 60%, whereas peri-implantitis sites disclosed a BOP of 90% within 10 s
after probing.
Conclusion: Clinical, radiological and histological findings of the present animal
experiment supported the overall applicability of the ligature-induced periimplantitis
minipig model. A rapid breakdown of peri-implant hard tissues could
be detected mainly on the buccal side.
Keywords: Mucositis; Bone loss; Inflammation; Dental implant; Animal model

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SUMMARY 
There is little evidence of the effect of implants restored with fixed partial dentures on oral health-related quality of life (OHRQoL) in partially edentulous Kennedy class II and III patients. The aim of this study was to determine the change in OHRQoL in Kennedy classification II and III patients treated with a two-implant-supported fixed dental prosthesis (FDP). Kennedy class II and III patients received dental implants and an FDP. Oral health-related quality of life was measured by administration of the Oral Health Impact Profile-14 (OHIP-14NL) questionnaire at intake (T1), 2 weeks after surgery (T2) and after 1 year of loading (T3). The mean OHIP score at T1 was 65  12, 24  10 at T2, and 09  03 at T3. There was a statistically significant difference between T1 and T2 (P = 0002) and T1 and T3 (P < 0001) but not between T2 and T3 (P = 0407). The OHIP score in Kennedy II patients decreased from 48  32 at T1 to 1 5  20 at T2 and 11  18 at T3, and that in Kennedy III patients decreased from 89  96 at T1 to 3 6  89 at T2 and 08  22 at T3. There were no statistically significant differences in the reductions in Kennedy II and III patients. Oral health-related quality of life changed positively in patients treated with implants and an FDP in both groups. There was no change in OHRQoL between the times of implant placement and FDP placement.

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Abstract

Objective: The objective of this study was to evaluate crestal bone changes around bone- and tissue-level implants related to initial mucosal thickness.
Materials and methods: Patients received at least 2 implants: one with the prosthetic abutment connection at the crestal bone level (MC) and one with the prosthetic abutment connection at 2.5 mm supra crestal (LC). Flap thickness measurements were taken using a periodontal probe after raising the buccal flap. Patients were divided into 2 groups according to the mucosal thickness— Group A (thickness, ≤2 mm) and Group B (thickness, >2 mm).
Results: Our study included 33 patients and 78 implants. Each patient received at least 1 implant of each type: Group A (MC), 17 implants, with a mean bone change of 0.6  0.5 mm; Group B (MC), 20 with a mean bone change of 0.2  0.4 mm; Group A (LC), 15 with a mean bone change of 0.1  0.5 mm; and Group B (LC), 22 with a mean bone change of 0.2  0.4 mm. A pairedsamples t-test for groups A (MC) and B (MC) yielded a statistically significant difference (P = 0.003); there was no statistically significant difference for groups A (LC) and B (LC) (P = 0.518).
Conclusion: If the initial mucosal thickness surrounding bone-level implants is more than 2 mm, there is significantly less crestal bone change compared with bone-level implants placed in initial mucosal thicknesses of 2 mm or less. This difference is not statistically significant when tissue-level implants are used and the implant–abutment connection is 2.5 mm above the crestal bone level.

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Abstract

Aim: Based on the hypothesis that maxillary sinus floor elevation with a transcrestal approach (tSFE) does not increase the morbidity of implant surgery, the study evaluated the patient-reported outcomes as well as the type and incidence of complications when implants are placed either concomitantly with tSFE (performed according to Trombelli et al. 2008, 2010a,b) or entirely in native bone.

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Abstract
This article describes a direct technique for communicating implant abutment and pontic intaglio surface forms with the dental laboratory. The technique uses a matrix and a screw-retained custom interim restoration. The matrix is used to transfer the interim restoration and periimplant tissue forms from the patient's mouth to an implant position-verified cast. After being connected to this cast, a silicone soft tissue replicating material is injected into the matrix. The result is a definitive cast with accurate implant position and soft tissue forms.

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xyz

Abstract

Objective: The objective of this study was to evaluate crestal bone changes around bone- and tissue-level implants related to initial mucosal thickness.
Materials and methods: Patients received at least 2 implants: one with the prosthetic abutment connection at the crestal bone level (MC) and one with the prosthetic abutment connection at 2.5 mm supra crestal (LC). Flap thickness measurements were taken using a periodontal probe after raising the buccal flap. Patients were divided into 2 groups according to the mucosal thickness— Group A (thickness, ≤2 mm) and Group B (thickness, >2 mm).
Results: Our study included 33 patients and 78 implants. Each patient received at least 1 implant of each type: Group A (MC), 17 implants, with a mean bone change of 0.6  0.5 mm; Group B (MC), 20 with a mean bone change of 0.2  0.4 mm; Group A (LC), 15 with a mean bone change of 0.1  0.5 mm; and Group B (LC), 22 with a mean bone change of 0.2  0.4 mm. A pairedsamples t-test for groups A (MC) and B (MC) yielded a statistically significant difference (P = 0.003); there was no statistically significant difference for groups A (LC) and B (LC) (P = 0.518).
Conclusion: If the initial mucosal thickness surrounding bone-level implants is more than 2 mm, there is significantly less crestal bone change compared with bone-level implants placed in initial mucosal thicknesses of 2 mm or less. This difference is not statistically significant when tissue-level implants are used and the implant–abutment connection is 2.5 mm above the crestal bone level.

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Publikationen 2015

Abstract STATEMENT OF PROBLEM:
Limited information is available regarding the accuracy of mechanical torque-limiting devices (MTLDs) after their clinical use. PURPOSE:
The purpose of this study was to determine the accuracy of 2 types of MTLDs (friction-style and spring-style) after clinical use. MATERIAL AND METHODS:
Twenty-seven MTLDs in clinical service at The Ohio State University College of Dentistry were collected. Thirteen were friction-style and 14 were spring-style. A total of 6 different dental implant companies were represented (Astra Tech, Zimmer Dental, Biomet 3i, Straumann, Nobel Biocare, and Thommen Medical). All MTLDs had been in use for at least 6 months without being recalibrated, and all were tested to determine their accuracy in delivering target torque values. Statistical analysis used nonparametric tests to determine the accuracy of the MTLDs in delivering target torque values, and Bonferroni post hoc tests were used to assess pairwise comparisons. RESULTS:
After clinical service, spring-style MTLDs were significantly more accurate than friction-style MTLDs (P<.05). CONCLUSIONS:
Within the limitations of this study, it was concluded that after clinical service, spring-style MTLDs were more accurate than friction-style MTLDs. All MTLDs delivered torque values within 10% of the target torque value.

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Abstract

Objectives:
The aim of the present observational medical device performance study was to test whether implants with an intra-operatively conditioned hydrophilic surface can be safely reconstructed when applying an early loading protocol after 21 days in partially edentulous posterior mandibles.

Material and Methods: 
Partially edentulous patients with missing teeth in the posterior mandible were recruited. Immediately after implant placement, the implant position was indexed using a pickup impression technique. ISQ values were measured after 21 days of healing. When ISQ values were ≥70, the implants were directly restored with provisional reconstructions in occlusal contact allowing an early loading protocol. ISQ values were repeated again at 1, 3, and 6 months postloading. Clinical parameters (mPLI, mSBI, PPD, DIM, and CAL) were assessed. Standardized periapical radiographs were obtained after surgery, at implant loading and 3 and 6 months later. Changes over time were analyzed for statistical significance using the nonparametric method by Brunner & Langer (SAS Proc Mixed).

Results: 
Fifteen partially edentulous patients with healed sites in the posterior mandible received 20 implants. All implants healed uneventfully. At 21 days, all implants achieved an ISQ value of ≥70 (mean of 3 measurements) and were reconstructed at this time point with provisionals. ISQ values showed a gradual increase from baseline to 3 and 6 months postloading. The assessment of clinical parameters revealed stable tissue integration. The evaluation of the radiographs showed that 3 and 6 months after loading the median mesial and distal marginal bone levels had stabilized at the border between the rough surface and the 1-mm machined implant collar.

Conclusion: 
Functional occlusal loading of implants with a hydrophilic, moderately rough endosseal surface 3 weeks after placement appears to be a safe and predictable treatment option in healed sites in the posterior mandible without need of bone augmentation procedures.

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ABSTRACT
Background:
Current strategies to reduce medical device-associated infections propose zirconia as a potential implant material which may limit bacterial adhesion. Because multinucleated giant cells (MNGCs) have been detected on these implant surfaces, concerns have been raised regarding tissue integration.

Purpose: 
The present study examined the presence of MNGCs and their subsequent effect upon tissue integration. Surface-modified implants made of yttria-stabilized (TZP) and alumina-toughened zirconia (ATZ) were compared with commercially pure titanium (Ti).

Materials and Methods: 
Seven miniature pigs received three implants on either side of the maxilla. After healing periods of 4 and 8 weeks, the tissue response at the implant surfaces was characterized according to three specific parameters: bone-to-implant contact (BIC), MNGC-to-implant contact (MIC), and the peri-implant bone density (BD).

Results: 
Despite being present on all tested implant surfaces, MNGCs were not associated with an inflammatory cell infiltrate or with fibrous encapsulation. MNGCs were less numerous on the Ti implants (range: 3.9–5.2%) compared with the ceramic implants (range: 17.6–30.3%, p < .0001). Even though the values of newly formed bone and pristine bone in direct contact with the implant surfaces were high at 4 weeks (tBIC: Ti = 82.3%, TZP = 64.3%, ATZ = 70%), a negative correlation was observed between the presence of MNGCs and newly formed  bone at the implant surface (p < .001). Interestingly, the newly formed peri-implant bone density, defined as the percentage of new bone area inside the screw threads (nBD), was not diminished by the presence of MNGCs.

Conclusions: 
Differences in the presence of MNGCs and the BIC parameters between Ti and the ceramic implants appear to be a local cellular phenomenon which is restricted to the implant-bone marrow interface and do not affect the peri-implant bone formation. Factors triggering MNGC differentiation and their persistence in response to biomaterial surface need to be investigated in future studies.

KEY WORDS: 
biomaterials, endosseous dental implantation, giant cells, macrophages, osteogenesis, surface chemistry,
titanium, zirconium oxide

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Abstract
Zunehmend stellen periimplantäre Entzündungsprozesse nach der prothetischen Versorgung für den Behandler besondere Herausforderungen dar. Doch einen Standard für die Therapie der periimplantären Mukositis oder Periimplantitis gibt es bis heute nicht.
Periimplantitis-Prävention beginnt daher schon mit der Planung der Versorgung und der Auswahl des Implantats.

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Abstract
Während die Anfänge der Implantologie durch das "chirurgisch orientierte" Implantieren geprägt waren, etablierte sich später der Begriff des "prosthetically driven implant placement". Dieser schaffte durch eine optimierte Implantatposition technische Vorteile sowie die bestmöglichen Voraussetzungen hinsichtlich biologischer Langzeitkomplikationen, die gerade hinsichtlich des Risikos periimplantärer Erkrankungen besondere Beachtung verdienen. Dadurch können Suprastrukturen derart gestaltet werden, dass sie die optimale Reinigungsmöglichkeit durch den Patienten und in der Erhaltungstherapie (Sondierbarkeit) erlauben. Neben dem positiven Effekt für die Reinigbarkeit der Suprastrukturen eröffnet sich auch die Möglichkeit zur Wahl der präferierten Befestigungsart. Im Falle verschraubter Suprastrukturen, die durch neuartige implantatprothetische Komponenten an Attraktivität gewinnen, können Zementreste mit ihren biologischen Risiken vermieden sowie Schwierigkeiten bei technischen Langzeitkomplikationen reduziert werden. Zudem kann eine Vereinfachung des klinischen Prozedere erreicht werden.

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Abstract
The aim of this study was to obtain a randomized, clinical and radiological comparison of implants with and without platform switching (PFS). The two compared titanium implant types differed only in the microgap position: test (PFS) or control (StE, no PFS). All implants were inserted in posterior regions and followed up for six months after abutment connection (AC). Twenty one patients with 21 PFS and 18 StE implants completed the six-month evaluation. No implant failed. One complication (exposed cap screw) was reported at AC. No statistically significant difference was observed between the marginal bone level of PFS and StE implants. Their bone level stabilized approximately 1 mm below the microgap. Based on the outcome of this short-term study with a limited number of patients, it seems unlikely that the optimal clinical and radiological outcome obtained with the tested standard implant (no PFS) can be improved by introducing an inward microgap shift (PFS).

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Abstract
BACKGROUND:
The “socket-shield technique” has shown its potential in preserving buccal tissues. However, front teeth often have to be extracted due to vertical fractures in buccolingual direction. It has not yet been investigated if the socket-shield technique can only be used with intact roots or also works with a modified shield design referring to vertical fracture lines.
PURPOSE:
The aim of this study was to assess histologically, clinically, and volumetrically the effect of separating the remaining buccal root segment in two pieces before immediate implant placement.
MATERIAL AND METHODS:
Three beagle dogs were selected in the study. The third and fourth premolars on both sides of the upper jaw were hemisected and the clinical crown of the distal root was removed. Then, the implant bed preparation was performed into the distal root so that a buccal segment of healthy tooth structure remained. This segment was then separated in a vertical direction into two pieces and implants placed lingual to it. After 4 months of healing, the specimens were processed for histological diagnosis. In a clinical case, the same technique was applied and impressions taken for volumetric evaluation by digital superimposition.
RESULTS:
The tooth segments showed healthy periodontal ligament on the buccal side. New bone was visible between implant surface and shield as well as inside the vertical drill line. No osteoclastic remodeling of the coronal part of the buccal plate was observed. The clinical volumetric analysis showed a mean loss of 0.88 mm in labial direction with a maximum of 1.67 mm and a minimum of 0.15 mm.
CONCLUSION:
The applied modification seems not to interfere with implant osseointegration and may still preserve the buccal plate. It may offer a feasible treatment option for vertically fractured teeth.

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Abstract
This study presents a novel bone reconstructive technique based on guided bone regeneration for localized three-dimensional hard tissue augmentation. This two-stage technique utilized a titanium osteosynthesis plate and a collagen membrane to form a physical barrier resembling a fence that contains bone graft biomaterial composed of a combination of deproteinized bovine bone matrix and autologous bone grafted from intraoral sites. Six patients were treated. At 6 months postsurgery, an increase in bone volume of 953 mm³ was shown. Mean maximum linear augmentation in the vertical direction was 6.75 mm. Histologic analysis of the regenerated area revealed the presence of compact newly formed bone with no sign of inflammation. A total of 13 implants were placed. Peri-implant marginal bone level was 0.94 mm at implant placement and 1.30 mm after 6 months. The patients were satisfied with the procedure and no complications were observed.

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Abstract
The aim of this chart review was to obtain an objective, quantitative assessment of the clinical performance of an implant line used in an implantological office setting. Implants with hydrophilic (INICELL) and hydrophobic (TST; both: Thommen Medical AG, Grenchen, Switzerland) enossal surfaces were compared and the cumulative implant survival rate was calculated. The data of 1063 patients that received 2918 implants (1337 INICELL, 1581 TST) was included. The average follow up time was 2.1 (1.1–5.4) years for INICELL and 4.5 (1.3–5.9) years for TST implants (Thommen Medical AG, Switzerland). In the reported period 7 implants with INICELL (0.5%) and 23 TST implants (1.5%) failed. This difference was statistically significant. The analysis of cases treated and followed up in a single implantological office for 6 years confirmed the very good clinical outcome that was achieved with both used implant lines. Within the limitations of this retrospective analysis, the overall early failure rate of the hydrophilic implants was significantly lower than that of hydrophobic implants. The use of hydrophilic implants allows the clinician to obtain less early failures, hence the interest of an up-to-date surface for the daily work of an implant practice.

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Publikationen 2014

Abstract
Objectives: To evaluate the association between smoking status and the outcomes of transcrestal sinus floor elevation (tSFE) performed with a minimally invasive technique (Smart Lift).

Methods: Forty-five implants were placed in 25 non-smoker (NS) and 20 smoker (S) patients in conjunction with the tSFE procedure. In all cases, an additional graft, chosen among different hydroxyapatite-based or ß-tricalcium phosphate-based biomaterials, was pushed into the sinus by gradual increments. Immediately after surgery, residual bone height, implant penetration into the sinus, extent of sinus lift (SL) and the height of the graft apical to the implant apex (aGH) were assessed on periapical radiographs. At 6 months after surgery, SL and aGH were reassessed.

Results: (i) The Smart Lift procedure resulted in substantial 6-month SL and aGH in both treatment groups; (ii) smoking status did not significantly affect the 6-month radiographic outcomes; (iii) a similarly low incidence of intra- and postoperative complications was observed in NS and S patients.

Conclusions: Smoking has a limited impact on the outcomes of tSFE performed with the Smart Lift technique.

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Publikationen 2013

Abstract

Aim: The loss of maxillary posterior teeth leads to a dimensional reduction of the bone crest, which is partly due to the pneumatization of the maxillary sinus. Transcrestal sinus floor elevation (tSFE) is a bone augmentation procedure based on the creation of an access through the edentulous bone crest. To date, several techniques for tSFE have been proposed and validated. Recently, we proposed a simplified, minimally invasive technique for tSFE (namely, the Smart Lift technique) which is based on the use of specifically designed drills and osteotomes. The present paper describes the postextraction dimensional alterations of the alveolar crest in the maxillary posterior sextants focusing on the contribution of sinus pneumatization,
illustrates the operative steps of the Smart Lift technique and presents available data on clinical and patient-centered outcomes of tSFE when performed with this specific technique.

Conclusion: The Smart Lift technique represents a simplified, user-friendly option, since it allows for a substantial extent of sinus lift at limited operation times along with limited morbidity.

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Publikationen 2012

Abstract


Objectives: The present study was performed to comparatively evaluate the effectiveness and post-operative morbidity of transcrestal sinus floor elevation (tSFE) performed with a minimally invasive procedure (Smart Lift technique) combined with the additional use of two graft biomaterials.

Methods: Thirty sites in 30 patients were randomly assigned to tSFE in association with either deproteinized bovine bone mineral (DBBM) (n = 15) or synthetic  hydroxyapatite in a collagen matrix (S-HA) (n = 15). In both groups, the extent of the sinus lift (SL) and the height of the graft apical to the implant apex (aGH) were assessed on periapical radiographs taken immediately after surgery and at 6 months following surgery. Surgical and post-surgical complications as well postsurgical
pain and discomfort were also assessed.

Results: The results of the study indicated that (i) immediately post-surgery, both DBBM and S-HA resulted in substantial SL and aGH, which were maintained at 6 months, (ii) greater aGH and SL were observed in S-HA group compared with DBBM group at 6 months post-surgery and (iii) limited surgical complications and post-operative pain/discomfort were associated with the use of both graft biomaterials.

Conclusions: The Smart Lift technique in conjunction with the additional use of either S-HA or DBBM may provide a predictable elevation of the maxillary sinus floor along with limited postsurgical complications and post-operative pain/discomfort. SL and aGH were significantly greater at 6 months for S-HA than DBBM.

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Publikationen 2011

Abstract

Questo articolo descrive la Smart Lift technique, ovvero una tecnica mini-invasiva per il rialzo del seno con accesso attraverso la cresta ossea residua. Tale procedura è basata sull’uso controllato di frese e osteotomi. Il suo razionale è ottenere un rialzo prevedibile del pavimento osseo del seno mascellare sfruttando come innesto dotato di capacità osteoinduttiva [N.d.T.: di indurre attivamente la rigenerazione ossea a partire da cellule progenitrici] l’osso residuo presente in situ e2 limitando l’incidenza statistica della perforazione accidentale della membrana sinusale e il tasso di morbilità postchirurgica. Gli step chirurgici di tale procedura sono qui illustrati nei dettagli facendo riferimento a un caso clinico esemplare. La tecnica Smart Lift si è dimostrata adatta a ottenere l’elevazione del seno mascellare e a fornire una stabilità intraorale degli impianti per un periodo di follow-up di un anno dalla chirurgia implantare. Non si sono presentate complicazioni né intraoperatorie né  postchirurgiche. Alle indagini radiografiche periapicali si osservava un’area radio-opaca al di sopra della porzione apicale dell’impianto e quindi corrispondente alla zona del pavimento osseo del seno mascellare andata incontro a aumento volumetrico.

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Publikationen 2010 und älter

Abstract

Background: Recently, we proposed a minimally invasive technique to limit the postoperative morbidity of transcrestal sinus floor elevation procedures. The technique is based on the use of specially designed drills and osteotomes. The purpose of the present study is to present data on the clinical outcomes and postoperative morbidity of sinus floor elevation procedures performed using the proposed technique.

Methods: Fourteen implants were placed in the posterior portions of the maxilla areas of 11 patients using the proposed technique. Postoperative pain and discomfort were assessed using a 100-mm visual analog scale (VAS). The incidences of intra- and postoperative complications were recorded. The position of the grafted sinus floor with respect to the implant apex was assessed on periapical radiographs 6 months post-surgery.

Results: The augmented sites had a presurgery residual bone height of 6.1 mm, whereas the mean length of the implants inserted in augmented sites was 10.3 – 0.9 mm. Immediately after surgery, VAS scores for pain and discomfort were 9.4 – 13.4 and 17.0 – 22.2, respectively. The 7-day VAS score for pain was 2.1 – 4.9. No complications were observed during or after the surgical procedure. Six months after
surgery, a newly formed mineralized tissue was found at or beyond the level of the implant apex in all cases.

Conclusion: The proposed technique represents a suitable option to elevate the sinus floor due to a predictable displacement of the sinus floor and a limited post-operative morbidity. J Periodontol 2010;81: 158-166.

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Abstract

Aim: Recently, we proposed a minimally-invasive technique (Smart Lift) to limit the post-operative morbidity of transcrestal sinus floor elevation procedures. The technique is based on the use of specially-designed drills and osteotomes. The aim of this work is to present data on the clinical outcomes and post-operative morbidity of sinus floor elevation procedures performed using the Smart Lift technique, in association with a hydroxypatite-collagen biomaterial.

Materials: 5 implants were placed in the posterior portions of the maxilla area of 4
patients using the Smart Lift technique in association with hydroxyapatite-collagen biomaterial. Post-operative pain and discomfort were assessed using a 100mm-VAS scale. The incidence of intra- and post-operative complications was recorded. The position of the grafted sinus floor with respect to the implant apex was assessed on periapical radiographs at 6 months post-surgery.

Results: The augmented sites had a pre-surgery residual bone height of 5.4 ± 1.1
mm, while the mean length of the implants inserted in augmented sites was 9.8 ± 0.7 mm. Immediately after surgery, VAS scores for pain and discomfort were 4.0 ± 5.2 and 13.0 ± 16.7, respectively. No complications were observed either during or after the surgical procedure. At 6 months after surgery, a newly formed mineralized tissue
entirely covered the portion of the implants exposed into the sinus cavity in all cases.

Conclusions: The Smart Lift technique associated with a hydroxyapatite-collagen
biomaterial represents a suitable option to elevate the sinus floor due to a predictable displacement of the sinus floor and a limited post-operative morbidity.

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Abstract

The present report describes a minimally invasive technique for transcrestal sinus floor elevation, namely the Smart Lift technique, which is based on the controlled use of drills and osteotomes. The rationale of this technique is to provide predictable vertical bone augmentation into the sinus cavity by (1) using the existing residual bone as a viable graft and (2) limiting the incidence of membrane perforation and postsurgery morbidity. Surgical steps of the procedure are thoroughly illustrated by means of a paradigmatic case. The Smart Lift procedure was compatible with sinus floor elevation and implant stability for up to 1 year following surgery. No complications occurred during or after surgery. On periapical radiographs, a radiopaque area corresponding to the augmented sinus floor was present above the apical portion of the implant.

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Abstract

Elevation of maxillary sinus floor with crestal approach
INTRODUCTION. The elevation of maxillary sinus floor with a crestal approach is a clinically consolidated surgical procedure. Implants positioned in augmented sinuses show a long-term success rate similar to implants positioned in native bone. CLINICAL ASPECTS. Unfortunately conventional surgical techniques are affected by important limitations, such as poor control of the working depth of surgical instruments and excessive trauma of residual osseous crest. These limitations could increase the risk of perforating the sinus membrane or increasing post-surgical adverse events affecting ear and vestibule. AIM OF WORK. The aim of this study is to describe a new method for sinus floor elevation with a crestal approach, developed in order to overcome the limitations of conventional techniques. CASE REPORT. The operative steps and a case report are illustrated in details.

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Abstract

L’elevazione del pavimento del seno mascellare eseguita utilizzando un accesso crestale è una procedura clinicamente consolidata. Diversi studi condotti su impianti posizionati in siti sottoposti ad elevazione del seno mascellare dimostrano una percentuale di successo a lungo termine sovrapponibile a quella degli impianti posizionati in osso nativo. Ad oggi, tuttavia, le tecniche chirurgiche disponibili presentano indubbi svantaggi (scarso controllo delle lunghezze di lavoro degli strumenti utilizzati, eccessivo traumatismo a livello dell’osso crestale residuo durante la preparazione del sito), che possono aumentare le probabilità di perforazione della membrana sinusale e/o aumentare l’incidenza postchirurgica di disturbi al sistema oto-vestibolare. Scopo del presente studio è quello di illustrare una metodica originale (Smart Lift) perottenere il rialzo del pavimento del seno mascellare per via crestale, elaborata nel tentativo di superare le limitazioni delle tecniche convenzionali. Verrà illustrata in dettaglio la sequenza operativa e descritto un caso chirurgico paradigmatico.

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