Purpose. Bone atrophy after tooth loss may leave insufficient bone for implant placement. We compared volumetric changes after autogenous ramus block bone grafting (RBG) or guided bone regeneration (GBR) in horizontally deficient maxilla before implant placement. Materials and Methods. In this retrospective study, volumetric changes at RBG or GBR graft sites were evaluated using cone-beam computed tomography. The primary outcome variable was the volumetric resorption rate. Secondary outcomes were bone gain, graft success, and implant insertion torque. Results. Twenty-four patients (28 grafted sites) were included (GBR, 15; RBG, 13). One patient (RBG) suffered mucosal dehiscence at the recipient site 6 weeks after surgery, which healed spontaneously. Mean volume reduction in the GBR and RBG groups was 12.48 ± 2.67% and 7.20 ± 1.40%, respectively. GBR resulted in significantly more bone resorption than RBG (P < 0.001). Mean horizontal bone gain and width after healing were significantly greater in the GBR than in the RBG group (P = 0.002 and 0.005, resp.). Implant torque was similar between groups (P > 0.05). Conclusions. Both RBG and GBR hard-tissue augmentation techniques provide adequate bone graft volume and stability for implant insertion. However, GBR causes greater resorption at maxillary augmented sites than RBG, which clinicians should consider during treatment planning.
BackgroundThe absence of sufficient bone volume is the most relevant problem in implant dentistry. Grafting from exogenous sources may provide a limited gain but exhibits poor performance in large bone defects. Autogenous bone block transfer (ABBT) from the mandibular symphysis and ramus has been used with varying rates of success. The aim of this study was to compare the efficacy of symphysal and ramus ABBT for the restoration of lost horizontal alveolar bone volume in the anterior maxilla. Implants placed in the augmented areas were also evaluated.MethodsThe maxillary alveolar bone deficits of 32 patients were treated by similar-sized autogenous bone blocks (7 × 7 × 4 mm) harvested from the symphysis or ramus area. After 4 to 5 months of healing, implants were inserted. At the end of the osseointegration period, the implants were restored by fixed prostheses. Baseline bone thickness was determined by Cone beam computed tomography and was compared to post-op and one-year post-loading bone thickness values where the implants were inserted. Any complications or consequences were noted. The success and survival of the 45 implants were evaluated. The results were analyzed using the Student t-test and Fisher’s exact test (p < 0.05).ResultsPost-op complications were frequent in both groups. Baseline bone thickness values were similar at the beginning of the study (p = 0.71) and exhibited a significant increase after the ABBT surgery (6.29 (SD 0.86) and 6.01 (SD 0.92) mm in the symphysis and ramus groups, respectively). The amount of bone thickness gain was 4.34 mm (SD: 0.92) and 4.36 mm (SD: 1.01) in the symphysis and ramus groups, respectively. After one year, the mean surface resorption was 0.6 mm (SD: 0.78) and 0.80 mm (SD: 0.56) for the symphysis and ramus groups, respectively (p = 0.089). The success and survival rates of the implants were 94.11 and 96.42 %, respectively. No graft failures were observed.ConclusionsBoth symphysal and ramus ABBT procedures were successful for the restoration of a horizontal bone defect in the anterior maxilla. Ramus harvesting may be advisable due to fewer complications. Implants placed in the grafted regions exhibited a high success and survival rate within the one-year follow-up period.
ÖZET Amaç: Dişlerin kaybedilmesi sonrası alveolar kemikte rezorpsiyon meydana gelmektedir. Posterior maksillada yetersiz kemik yüksekliği durumunda, implant yerleştirilmesi için sinüs tabanı operasyonu uzun yıllardır başarılı bir şekilde uygulanmaktadır. Bu çalışmanın amacı posterior maksillada sinüs tabanı altında kemik yüksekliğinin implant yerleştirilmesi için yetersiz olduğu durumlarda, sinüs tabanı yükseltme operasyonu ile eşzamanlı yerleştirilen implantların başarısını değer-lendirmektir. Gereç ve Yöntem: Bu retrospektif planlanan çalışmaya sistemik olarak sağlıklı ve posterior maksillada dental implant ihtiyacı olan hastalar dahil edilmiştir. Hastalar dental volumetrik tomografi kullanılarak sinüs tabanı altında mevcut kemik yük-sekliği ölçülerek ≥5 mm (Kontrol grubu) ve < 5 mm (Test grubu) olmak üzere iki gruba ayrılmıştır. Yerleştirilen implantların takip süresince sağkalım oranları değerlendirilmiştir. Bulgular: Çalışmada toplam 31 hastaya yerleştirilen 62 implant (Kontrol: 35, Test: 27) değerlendirilmiştir. Çalışmaya dahil edilen her iki grup kıyaslandığında sağkalım oranları açısın-dan istatistiksel olarak anlamlı bir fark olmadığı gözlemlenmiş-tir. Sonuçlar: Çalışmada rezidüel kemik yüksekliğinin, sinüs tabanı yükseltme operasyonu ile aynı seansta yerleştirilen dental implantların sağkalımını etkilemediği sonucuna varılmıştır.Anahtar kelimeler: Dental implant, sağkalım oranı, tek aşama sinüs tabanı yükseltme SUMMARY Aim: Resorption occurs after teeth loss in alveolar ridge. In case of insufficient bone height in posterior maxilla, sinus floor operation for implant placement has been successfully applied for many years. The purpose of this study is to assess the success of implants placed simultaneously with sinus floor elevation operation, in cases where bone height under the sinus floor in the posterior maxilla is insufficient for implant placement. Materials and Methods:In this retrospective study design, patients who were systemically healthy and required dental implant in posterior maxilla were included. Patients were divided into two groups; ≥5 mm (control group) and <5 mm (test group) by measuring the bone height under sinus floor using dental volumetric tomography. Survival rates of implants were evaluated during follow-up. Results: In this study, 62 implants placed in 31 patients (Control: 35, Test: 27) were evaluated. When the two groups included in the study were compared, it was observed that there was no statistically significant difference in survival rates. Conclusions:The study concluded that the residual bone height did not affect the survival rate of dental implants placed simultaneously with the sinus floor elevation operation. Keywords: Dental implant, survival rate, one stage sinus floor elevation ÖZGÜN ARAŞTIRMA 62 7tepeklinik GİRİŞ Modern diş hekimliğinde diş eksikliğinin rehabilitasyonunda dental implantlar en çok kullanılan yöntemlerden biridir. Dental implantların yerleştirilebilmesi için yeterli hacimde kemik dokusuna ihtiyaç vardır. Konvansiyonel tedavi protokolünde denta...
Background/purpose The presence of adequate bone volume is a critical factor in rehabilitative dentistry. Despite the use of many promising alloplasts, success in stimulating bone formation has been limited, mostly due to poor local biological response. Growth factors have been introduced to stimulate angiogenesis and new bone formation. This histologic and histomorphometric study aimed to evaluate the effect of vascular endothelial growth factor (VEGF) and a biphasic alloplastic graft material (BA) on the healing of endosseous defects in rats. Materials and methods Twenty male Wistar rats were used. Two critical-sized bone defects were created in both the right and left femurs of each rat. Each defect was randomly assigned to be treated with VEGF, BA, or VEGF + BA, or to be left empty as a control. Half of the animals were sacrificed after 1 week, and the remaining half were sacrificed after 2 weeks. Inflammation, necrosis, and new bone areas were evaluated by means of histologic and histomorphometric analyses. Results Compared to the control group, defects treated with VEGF alone or in combination with BA showed higher rates of bone formation (33.10–46.60%) on Day 7. Additionally, VEGF significantly reduced inflammation and necrosis (P < 0.001). However, the differences were no longer discernable on Day 14. Conclusion VEGF makes a significant contribution to angiogenesis and osteogenesis in the early stages of bone defect healing, and its combination with an osteoconductive grafting material (BA) may further enhance new bone formation.
Simultaneous occurrence of multiple dental anomalies is relatively common and has been reported particularly in cases with systemic alterations or syndromes. However, in 1974, Ekman-Westborg and Julin described a unique case of multiple macrodontia and multituberculism of posterior teeth accompanied by multiple dental malformations without other systemic anomalies. Here we report the case of a 20-year-old female patient who presented with macrodontia affecting her maxillary lateral teeth, mandibular incisors, and impacted multituberculated wisdom teeth accompanied by other dental anomalies that manifested itself as a variant of the Ekman-Westborg–Julin trait.
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