Implant treatment in the esthetic area requires stable osseointegration and successful esthetic outcomes. Achieving this goal requires careful consideration of accurate implant axis and ideal three-dimensional position. Owing to the high esthetics and the special anatomical structure of the maxillary, a successful implant means a synthesized deli-beration of the residual bone dimensions, soft-tissue thickness, and the relationship of the residual alveolar ridge with the planned restoration. This article offers an in-depth analysis of the clinical decisions and key factors affecting the implant direction in the esthetic area.
Dental Implantation, Endosseous/methods* ; Dental Implants ; Esthetics, Dental ; Alveolar Ridge Augmentation/methods* ; Osseointegration ; Maxilla/surgery* ; Dental Implants, Single-Tooth

Adult ; Aged ; Alveolar Ridge Augmentation ; methods ; Dental Implantation ; methods ; Female ; Humans ; Male ; Maxillary Sinus ; surgery ; Middle Aged

Alveolar Bone Loss ; surgery ; Alveolar Ridge Augmentation ; Dental Implantation, Endosseous ; methods ; Guided Tissue Regeneration ; methods ; Humans ; Membranes, Artificial ; Polytetrafluoroethylene ; therapeutic use ; Reconstructive Surgical Procedures ; methods ; Tooth Loss ; surgery

AIMTo evaluate the effects of maxillary sinus floor elevation by a tissue-engineered bone complex of beta-tricalcium phosphate (beta-TCP) and autologous osteoblasts in dogs.

METHODOLOGYAutologous osteoblasts from adult Beagle dogs were cultured in vitro. They were further combined with beta-TCP to construct the tissue-engineered bone complex. 12 cases of maxillary sinus floor elevation surgery were made bilaterally in 6 animals and randomly repaired with the following 3 groups of materials: Group A (osteoblasts/beta-TCP); Group B (beta-TCP); Group C (autogenous bone) (n=4 per group). A polychrome sequential fluorescent labeling was performed post-operatively and the animals were sacrificed 24 weeks after operation for histological observation.

RESULTSOur results showed that autologous osteoblasts were successfully expanded and the osteoblastic phenol-types were confirmed by ALP and Alizarin red staining. The cells could attach and proliferate well on the surface of the beta-TCP scaffold. The fluorescent and histological observation showed that the tissue-engineered bone complex had an earlier mineralization and more bone formation inside the scaffold than beta-TCP along or even autologous bone. It had also maximally maintained the elevated sinus height than both control groups.

CONCLUSIONPorous beta-TCP has served as a good scaffold for autologous osteoblasts seeding. The tissue-engineered bone complex with beta-TCP and autologous osteoblasts might be a better alternative to autologous bone for the clinical edentulous maxillary sinus augmentation.

Alkaline Phosphatase ; analysis ; Alveolar Ridge Augmentation ; methods ; Animals ; Anthraquinones ; Biocompatible Materials ; therapeutic use ; Biomarkers ; analysis ; Bone Substitutes ; therapeutic use ; Bone Transplantation ; pathology ; Calcification, Physiologic ; physiology ; Calcium Phosphates ; therapeutic use ; Cell Adhesion ; physiology ; Cell Proliferation ; Dogs ; Fluorescent Dyes ; Guided Tissue Regeneration, Periodontal ; methods ; Maxilla ; surgery ; Maxillary Sinus ; surgery ; Models, Animal ; Osteoblasts ; transplantation ; Osteogenesis ; physiology ; Random Allocation ; Tissue Engineering ; methods ; Tissue Scaffolds ; Transplantation, Autologous

To investigate the biomechanical influences on two different cleft maxillary 3D finite element models pre- and post-alveolar bone graft, we developed a cleft palate bony model from a 17 year cleft palate male CT scan data and built an alveolar bone-grafted cleft maxillary 3D finite element model through gluing the graft model. Apply vector lip force on the anterior face of the models. Study the press (including S3 principal, S1 principal, von Mises and shear) distribution properties and localized area. The results suggested that the press principal spreads along the alveolar ridge and formed several focused areas. After bone grafted, the shear stress tends to be evenly. The grafted alveolar could resist the medially deformation of alveolar crest and the shear stress to the nasal base bony structure. The conclusions from results demonstrated that the deformation of alveolar ridge is possibly due to the lip pressure after the lip repair. The shear stress along the alveolar ridge could cause the severity of the dentition. The grafted bony structure could even the shear stress distribution evenly other than the distribution properties.
Adolescent ; Alveolar Process ; surgery ; Alveolar Ridge Augmentation ; methods ; Biomechanical Phenomena ; Bone Transplantation ; Cleft Palate ; diagnostic imaging ; physiopathology ; surgery ; Finite Element Analysis ; Humans ; Imaging, Three-Dimensional ; Male ; Maxilla ; diagnostic imaging ; physiopathology ; surgery ; Models, Biological ; Tomography, Spiral Computed

OBJECTIVETo evaluate the quality of the alveolar ridge augmented by Ti-Ni shape memory alloy (Ti-Ni SMA) distractor.

METHODSAll of the mandibular premolars and the first molars were extracted from 12 adult mongrel canines. One month later, box-shaped osteotomy was carried out in the left mandibles and Ti-Ni SMA distractors were imbedded. The right sides served as blank control. The canines were killed 3 or 6 months later and specimens were taken from corresponding area of the experiment sides and the control. Bone mineral density and biomechanical function were measured.

RESULTSBone mineral density, ultimate compressive strength and Young's Modules of the augmented ridge were lower than the blank control three months after distraction. But the indexes increased and showed no significant difference with the control six months after distraction.

CONCLUSIONSThe canines mandibular posterior alveolar ridge could be augmented by distraction osteogenesis using Ti-Ni SMA distractor, and the new bone is strong enough for implant placement.

Alveolar Ridge Augmentation ; methods ; Animals ; Bone Density ; Bone Regeneration ; physiology ; Compressive Strength ; Dogs ; Male ; Mandible ; physiology ; Nickel ; Osteogenesis, Distraction ; Titanium

OBJECTIVETo evaluate the use of acellular dermal matrix (ADM) to improve esthetic effects of alveolar ridge in dental implantology.

METHODSFifty patients with similar single missing tooth in the anterior maxilla were randomly divided into two groups: the ADM group was treated with dental implant therapy plus ADM transplantation; the control group was treated with dental implant therapy alone. The periodontal parameters and the changes of horizontal width of alveolar crest at implant zones were evaluated before surgery and 12 weeks after surgery.

RESULTSAll operated sites healed uneventfully. Mean horizontal width of alveolar crest in ADM group increased by (3.10 +/- 0.64) mm at 12 weeks and the control group increased by (0.30 +/- 0.50) mm, The volume increase showed a significant difference groups (P < 0.05). Mean horizontal width of alveolar crest in ADM group was (11.50 +/- 1.48) mm and the contralateral alveolar crest was (11.60 +/- 1.60) mm (P > 0.05).

CONCLUSIONSADM is a suitable material for the treatment of soft tissue deformities due to its biocompatibility and horizontal gain of soft tissue.

Adult ; Alveolar Bone Loss ; surgery ; Alveolar Ridge Augmentation ; methods ; Dental Implants, Single-Tooth ; Dermis ; cytology ; transplantation ; Extracellular Matrix ; transplantation ; Female ; Humans ; Male ; Skin, Artificial

Alveolar Ridge Augmentation ; methods ; Humans ; Osteogenesis, Distraction

OBJECTIVETo evaluate the result of bone regeneration due to using PRP in combination with beta-TCP in bone defect adjacent to oral implantation.

METHODSTen patients (6 males, 4 females, with an average age of 49.6 years) participated in this study. Seven of them underwent maxillary sinus augmentations, and 3 underwent GBR for peri-implant bone defects. PRP + beta-TCP was used in 4 cases and beta-TCP in other 6 as control. X-ray examinations were carried out prior to operation and in 1 week, at 3 months, 6 months after operation. After 4 - 6 months, 3 biopsy specimens were obtained at the time of the second stage operation in each group.

RESULTSBone grafts healed well without any infection in all cases. Radiographs showed that bone grafts integrated together with the bone. The histological result showed that new bone was formed among particles of beta-TCP in both groups, but in PRP + beta-TCP group denser and better arranged woven bone was observed, and more new bone was formed into the micropores of the particles.

CONCLUSIONSThe result in this study implied that PRP in combination with beta-TCP can improve bone regeneration in bone defect adjacent to oral implantation.

Adolescent ; Adult ; Aged ; Alveolar Ridge Augmentation ; methods ; Bone Regeneration ; Bone Substitutes ; therapeutic use ; Bone Transplantation ; methods ; Female ; Guided Tissue Regeneration, Periodontal ; methods ; Humans ; Male ; Maxillary Sinus ; surgery ; Middle Aged ; Oral Surgical Procedures, Preprosthetic ; methods ; Platelet Transfusion ; methods ; Treatment Outcome

OBJECTIVETo introduce and evaluate the procedure and the effect of localized management of sinus floor (LMSF), bone graft and simultaneous implant placement with trephine bur in maxillary posterior region.

METHODS24 patients without enough alveolar bone height received LMSF, bone grafting and implants placement were carried out simultaneously.The autogenous bone were harvested by trephine bur in situ. Patients were followed up after 1 week, 1, 3 and 6 month.

RESULTSThere was no implant loose or lost and maxillary antritis. 6 months postoperatively, bone graft reformed to new bone seen in X-ray films, sinus floors were augmented and reached the requirements of dental implants. The implant osseointegrated tightly with new bone which was satisfactory to second-step prosthesis after implant placement of 6 months later.

CONCLUSIONSThe method enlarges the indication of dental implants and avoids operation of harvesting autogenous bone in other site. It is simple and valuable to clinical application.

Adult ; Alveolar Ridge Augmentation ; methods ; Bone Transplantation ; Dental Implantation, Endosseous ; methods ; Dental Implants ; Female ; Humans ; Male ; Maxillary Sinus ; surgery ; Middle Aged