A methodological approach to assessing alveolar ridge preservation procedures in humans: soft tissue profile.

in Clinical Oral Implants Research (2013)

Introduction: The aesthetic results of implant restoration in the anterior maxilla are particularly related to the soft tissue profile. Although socket preservation techniques appear to reduce bone ... [more ▼]

Introduction: The aesthetic results of implant restoration in the anterior maxilla are particularly related to the soft tissue profile. Although socket preservation techniques appear to reduce bone remodelling after tooth extraction, there is still few investigations assessing the external soft tissue profile after such procedures. The goal of the present study was to describe an accurate technique to evaluate soft tissue contour changes after performing socket preservation procedures. The secondary objective was to apply the newly develop measuring method to a specific socket preservation using a “saddled” connective tissue graft combined with the insertion of slowly resorbable biomaterials into the socket. Materials and Methods: A total of 14 patients needing tooth replacement in the aesthetic region were included to receive a socket preservation procedure using a connective tissue graft. Impressions were taken before the tooth extraction (baseline) and at 2, 4, and 12 weeks after the procedure. The corresponding plaster casts were scanned, and the evolution of the soft tissue profile in relation to the baseline situation was assessed using imaging software. Results: The measuring technique allowed assessing the soft tissue profiles accurately at different level of the alveolar process. The insertion of a saddled connective tissue appeared to compensate significantly for the horizontal and vertical bone remodelling after a socket preservation procedure in most regions of the alveolar crest. After 12 weeks, the only significant change was located in the more cervical and central region of the alveolar process and reached a mean of 0.76 mm. Conclusion: Within the limitations of this study, we found that a saddled connective tissue graft combined with a socket preservation procedure could almost completely counteract the bone remodelling in terms of the external soft tissue profile. The minor changes found in the cervical region might disappear with the emergence profile of the prosthodontic components. The described technique might therefore enhance the aesthetic outcomes when a tooth has to be replaced in the aesthetic zone. The described protocol can be used to further compare the effectiveness of different extraction socket preservation protocols in randomised controlled trials. [less ▲]

A methodological approach to assessing alveolar ridge preservation procedures in humans: hard tissue profile.

in Journal of Clinical Periodontology (2012), 9

AIMS: Multiple surgical protocols using biomaterials have been proposed to limit the typical post-extraction bone resorption. However, because of the heterogeneity of the studies, particularly the ... [more ▼]

AIMS: Multiple surgical protocols using biomaterials have been proposed to limit the typical post-extraction bone resorption. However, because of the heterogeneity of the studies, particularly the differences in assessment methods, it is difficult to determine the superiority of one technique over another. The objective of this study was to describe a new radiographic method to draw a map of alveolar bone remodelling after alveolar ridge preservation procedures to compare different surgical techniques more accurately. The newly developed measuring method was applied to a case series describing a specific preservation technique. MATERIALS AND METHODS: Fourteen extraction sites (in 14 patients) located in the upper anterior maxilla were treated with bovine hydroxyapatite (0.25- to 1-mm particles) and a saddled connective tissue graft. A radiographic three-dimensional assessment of the hard tissues was performed at baseline and 3 months after the procedure. Standardized horizontal measurements were taken at three corono-apical levels (-2, -5 and -9 mm) and at three mesio-distal levels (mesial, centre and distal) in the buccal and palatal aspects. Vertical measurements were also recorded in nine regions superior to the alveolar crest. The measurements were performed by two independent observers and intra- and inter-observer effects were evaluated. RESULTS: No inter- and intra-observer effects were found when analysing the measurements from these two observers. The horizontal dimension of the crest decreased by 1.6 mm (20%) in the cervical regions (-2 mm level), decreased moderately, by 1 mm (12%), at the -5 mm level and decreased very little, 0.5 mm (6%), at the apical (-8 mm) level. The losses were always significantly higher in the buccal than in the palatal aspect. Buccally, the maximal bone remodelling at the cervical level remained below 1 mm. Vertical bone resorption was homogeneous and<1 mm in the nine measured regions. DISCUSSION: The radiographic measuring methodology proved to be reproducible. It can be applied in other clinical settings. It successfully assessed the alveolar ridge preservation technique (BHA+saddle connective tissue graft). [less ▲]

Description of a ‘soft tissue friendly’ protocol for immediate loading in the esthetic zone: 1 year result of 13 consecutive patients

Poster (2012, June)

Objectives: Repeted abutment connection and disconnections compromize the connective and epithelial sealing around implant components, leading to peri-implant bone remodeling (Abrahamsson, 1997). Placing ... [more ▼]

Objectives: Repeted abutment connection and disconnections compromize the connective and epithelial sealing around implant components, leading to peri-implant bone remodeling (Abrahamsson, 1997). Placing the definitive abutment at the time of implant placement might be a treatment option to minimize this biological rupture. The aim of this study was to evaluate the effectiveness of pre-shaped zirconium abutments for immediate implant loading in the anterior maxilla. Materials and methods: A total of 13 patients needing the placement of one or several implant in the esthetic zone were treated with Regular Crossfit Bone Level (Straumann) implants. Implants were placed and immediately restored with a pre-shaped zirconium abutments and provisional resin crowns if the primary stability reached at least 20 N/cm2. Implant survival rate, biological and prosthodontic complications as well as peri-implant tissue status (papilla index) were recorded during a follow-up period of 1 year. Results: A total of 14 implants (8 incisors, 1 canines, 5 premolars) placed in 11 patients (4 men / 7 women) aged from 22 to 60 years old (48,5 +/- 11,5) could be assessed for the entire follow-up period. 2 patients dropped out. All implants reached an adequate primary stability (> 20N/cm2) to perform an immediate implant restoration. Straight pre-shaped Zirconium abutment was used in each case. Six implants were placed in socket preservation sites and five implants were placed simultaneously with a GBR. After a follow-up period of 1 year, all implants fulfilled survival criteria for dental implants with regard to osteointegration, including the absence of peri-implant radiolucency, implant mobility, suppuration, and pain. One abutment screw loosening was observed during the provisional period and no abutment fracture occurred. Definitive full ceramic-cemented restorations were successfully performed on each implant after a mean period of 6 months and no further complications occurred. In 11 out of 14 implants, an improvement of the papilla index was observed from baseline to 1 year follow-up whereas 3 implants showed a decrease of this index. Conclusion: The results from this prospective case series suggest that immediately restored implants using a final pre-shaped zirconium abutment in esthetic zone display favorable implant and prosthodontic outcomes and seems to allow an adequate papilla index improvement in most of the cases. [less ▲]

Dental extractions in patients treated with intravenous bisphosphonates and risk of osteonecrosis of jaws.

Poster (2012, June)

Aim : Dental extraction remains contra-indicated in patients treated with intravenous (IV) bisphosphonates for oncology reasons because of the high risk of bisphosphonate-related osteonecrosis of the jaw ... [more ▼]

Aim : Dental extraction remains contra-indicated in patients treated with intravenous (IV) bisphosphonates for oncology reasons because of the high risk of bisphosphonate-related osteonecrosis of the jaw (BRONJ). The objective of the present abstract was to present a preventive tooth extraction protocol in patients treated with IV bisphosphonates based on the surgical removal of the alveolar process. The second objective was to identify potential risk factors to develop BRONJ. Material and Methods : 17 patients treated with IV bisphosphonate and needing at least a tooth extraction, were included. A standardized extraction protocol was followed, including alveolectomy of at least 50% of the alveolar process, pre and post-operative antibiotherapy was administrated. The patients were followed for a mean period of 29 months (min:3 -max:62). Results : In all, 17 patients and 22 extraction sites mandible (15), maxilla (7) were involved in the study. No signs of inflamed tissue or necrotic exposed bone in any patient were observed during the follow-up period and the level of comfort for the patient was improved in all cases. Nevertheless, when a careful screening of the healing area was made using a probe, in 4 out of 22 (18,2%) sites, a remaining bone contact was found and appeared to be related location (mandible), duration of biphosphonate treatment and to concomitant. Conclusion : The present cases series suggests that the described extraction protocol in IV biphosphonate patients allowed 100% bone healing and complete soft tissues healing in 81.8% of the extraction sites.The sites that have not fully recovered seemed to be related to different factors. [less ▲]

The effect of collagenated space filling materials in sinus bone augmentation: a study in rabbits

in Clinical Oral Implants Research (2012)

Aim: The inclusion of biomaterial particles used for alveolar bone regeneration in a carrier or in binding agents such as collagen gel or fibers is of interest as a means to help with surgical handling ... [more ▼]

Aim: The inclusion of biomaterial particles used for alveolar bone regeneration in a carrier or in binding agents such as collagen gel or fibers is of interest as a means to help with surgical handling. However, the possible influence of collagen on bone tissue response to biomaterials is poorly studied. The objective of the present study was to investigate, in a sub-sinus bone augmentation model in rabbits, the effect of collagen at different stages of the osteogenesis process. Histologic, histomorphometric and volumetric analyses were performed. Materials and methods: Rabbits underwent a double sinus lift procedure using bovine hydroxyapatite (BHA), collagenated bovine hydroxyapatite (BHAColl), and prehydrated and collagenated porcine hydroxyapatite (PHAColl). Animals were sacrificed at 1 week, 5 weeks or 6 months. Samples were subjected to X-ray micro-tomography and histology. Qualitative analysis was performed on the non-decalcified sections and quantitative histomorphometric analyses were conducted using scanning electron microscopy (SEM). Volume variations of bone augmentations were calculated at different time points. Results: The three biomaterials allowed an optimal bone formation and were able to equally withstand sinusal reexpansion. A comparable percentage of new bone, as well as 3D volume stability, was found between the groups at each time point. However, the PHAColl resorption rate was significantly higher than the rates in other groups (P = 0.0003), with only 3.6% of the particles remaining at 6 months. At 1 week, both collagenated groups displayed the presence of inflammatory cells although BHA did not show any sign of inflammation. At 5 weeks and 6 months, the inflammatory process had disappeared completely in the BHAColl groups, whereas some inflammatory-like cells could still be observed around the remaining particles of PHAColl. Conclusions and clinical implications: Within the limitations of this study in rabbits, the findings showed the presence of inflammatory-like cells at the early stage of bone regeneration when collagenated xenogenic biomaterials were used compared to xenogenic granules alone. Nevertheless, similar bone formation occurred and comparable 3D volumes were found at 6 months in the different groups. [less ▲]

Physico-chemical and morphological properties of current particulated biomaterials used in alveolar bone augmentations: a review.

in Journal of Osteology and Biomaterials (2011), 2

The efficacy of grafting materials for alveolar bone regeneration procedures has been repeatedly corroborated by clinical and scientific evidence. Although an ever growing number of biomaterials are ... [more ▼]

The efficacy of grafting materials for alveolar bone regeneration procedures has been repeatedly corroborated by clinical and scientific evidence. Although an ever growing number of biomaterials are available on the market, the origins, material characteristics, bioactivity and osteoconductive properties of these products are not always known by clinicians, hence often hampering an adequate product selection. The purpose of this contribution was to provide an overview of five different types of osteoconductive grafting materials frequently used in dentistry (Bio-Oss®, Cerasorb M™, Bone Ceramic®, Natix®, Genos®) and to summarize their physico-chemical and morphological characteristics at the macro- and micro-scale. Furthermore, the influence of these properties on the in vivo behaviour of these biomaterials is discussed. The results of this study are presented as data sheets, which may prove helpful for clinicians in the design of their treatment strategies. [less ▲]

Biofilms bactériens et médecine dentaire

in Revue Médicale de Liège (2010), 65 (10)

L'ostéonécrose maxillaire associée aux traitements aux bisphosphonates dans le traitement de l'ostéoporose. Consensus interdisciplinaire

in Louvain Medical (2010), 129(8), 305-309

One-piece zirconia implants : 18 months clinical outcomes.

Conference (2009, December)

Purpose : The aim of the present study was to evaluate prospectively the clinical outcomes of a prototype one-piece zirconia implants after a -18 month follow-up. Material and methods : 20 prototype one ... [more ▼]

Purpose : The aim of the present study was to evaluate prospectively the clinical outcomes of a prototype one-piece zirconia implants after a -18 month follow-up. Material and methods : 20 prototype one-piece zirconia implants were placed and immediately restored with provisional protheses. A flapless or a minimally invasive approach was used for every implant placement. Bone levels were recorded at baseline and -1 year. Surgical, biological and prosthetic complications were also assessed. Results : The study included 15 patients. Most of the implants (90%) were placed at the anterior maxilla. Six of the implant sites were previously augmented with autogenous bone block grafts, 8 were managed with socket preservation techniques, 3 implants were immediatly placed after extraction and one implant was placed simultanously with a guided bone regeneration. Insertion torque (> 30N/cm2) was reached for all implants. The implant survival and success rates reached respectively 100% and 95%. One implant abutment fractured at placement because of an excessive insertion torque (> 50 N/cm2). No further complication occurred. Conclusion : From the preliminary results of this prospective clinical study, one-piece zirconia implants seem to success after 1 year despite they were often placed in critical clinical situtations (bone augmentations) and immediately restored. Further follow-up is needed to evaluate the long-term outcomes. [less ▲]

Comparison of microleakage of photo-cured composites using three different light sources: halogen lamp, LED and argon laser: an in vitro study

in Lasers in Medical Science (2009), 24(1), 1-5