implants - international magazine of oral implantology

I research Editorialnote: Tobecontinuedwithresults, discussionandconclusion andanextensivephoto documentationin implants2/2013. Acompletelistofreferencesis availablefromthepublisher. Preliminarysubjectevaluation A preliminary clinical and radiographic evaluation (panoramictomogramandCTscan)wasperformed.The results,alongwiththedentalcasts,confirmedposterior mandibularatrophy.21 Studymaterials ANanoBoneblock(ArtossCo)wasusedforgroupA and an allograft bone block (Fisiograft, Ghimas) was used for group B. The tioLogic dental implant system (Dentaurum Implants) was used for both groups in a two-stageprocedure. Ridgeaugmentation Antibiotic prophylaxis (1 g Augmentin, orally) was administered to all patients two hours preoperatively. After preoperative medication, posterior mandibular ridgeaugmentationwascarriedoutunderlocalanaes- thetic combined with a sedative (5 mg midazolam, in- tramuscularly).21 Surgicalprocedures Kazanjian’svestibuloplastywasperformedaccord- ingtothemethoddescribedbyKhouryetal.22 Afterex- posure of the bone surface, bleeding points were cre- ated in the vestibular sulcus using a fine round bur.23 Theboneblockwasadaptedtotheridgeusingascalpel. Oncetheblockswereflushwiththeridge,itwasaffixed by a two-hole micro-plate and two micro-screws, re- sulting in rounded edges. A lingual pedicled flap was then reflected and sutured to the periosteum as far as possibleinthevestibuletopreventrelapseofthemus- cle attachment, representing a second-layer closure overthegraftedarea.22 A Systemic antibiotics (1 g Augmentin twice a day for ten days) and non-steroidal analgesic (400 mg Ibuprofen twice a day for three days) were adminis- teredtobothgroupspost-operatively.Theparticipants were advised to follow a soft-food diet for two weeks and an appropriate oral hygiene routine, including rinsing with 0.2% chlorhexidine digluconate twice a day. Sutures were removed seven to ten days after the surgicalprocedure.Theparticipantsattendedaclinical examination every week in the first month after sur- gery, and twice in the second and third months. They were not permitted to use removable dentures. Radi- ographic assessment (panoramic tomogram and CT scan)wascarriedoutaftersixmonths. Efficacyoftheridgeaugmentation Standardised measurements for each patient were recorded before and after ridge augmentation.24 An acrylic reference stent was fabricated for each patient to assist in standardisation of all measurements. The stentwasdesignedtocovertheocclusalsurfaceofthe teethadjacenttotheaugmentationsite.Eachstenthad predetermined measurement points to determine the alveolar height using a periodontal probe on the oc- clusalsideandtodeterminethealveolarwidthusinga calliperonthebuccalandlingualsides. AssessmentofalveolarridgedimensionsbyCT Bone induction was compared by CT scans before (baseline) and six months after ridge augmentation. The holes in the stent were filled with gutta-percha to provideradiopaquelandmarkstoindicatethelocations for comparative ridge measurements. The image with the clearest gutta-percha imprints was selected for measurement of the buccal and lingual aspects. The measurements were performed using a software measurement tool.24 Measurements were taken at baseline and six months after augmentation.25 The densityofthenewlyinducedbonewasassessedusing CTwiththeaidofastandarddensityblock.Thechange in bone gain or bone loss after treatment is the six- month measurement minus the baseline measure- ment. Alveolar ridge dimensions were assessed by measurements.26 Alveolarheightwasdeterminedwith a periodontal probe, measuring the distance from a fixed point on the occlusal surface of the stent to the crest of the alveolar ridge. Measurements were taken with the probe placed perpendicular to the ridge. The changeinboneheightaftertreatmentisthesix-month measurement minus the baseline measurement. Buc- colingual width measurements for each patient were recorded using a calliper device, which was sterilised properlyandusedforeachpatient.Thechangeinbone width after treatment is the six-month measurement minusthebaselinemeasurement. Histopathologicalexamination During the placement of the dental implant, full- thickness bone core biopsies were obtained by a trephine (Figs. 1a & b). The biopsies were immediately stored in 10% buffered formalin, decalcified in EDTA andprocessedforhaematoxylin-eosinstainandMas- son’strichrome.21 Eachspecimenwasevaluatedhisto- logically._ 22 I implants1_2013 Dr Omar Soliman PhD candidate Perioimplant dentistry Tel.:+20 1009634358, +20 1201005457 Omar.Soliman77@yahoo.com Prof.Dr Dr Mohamed Nassar Professor of Perioimplant dentistry Faculty of Dentistry,Tanta University,Egypt. Tel.:+20 1121522221 Prof_Nassar@yahoo.com _contact implants