Dental Tribune U.S.Edition No.2, 2017

IMPLANT TRIBUNE The World’s Dental Implant Newspaper · U.S. Edition FEBRUARY 2017 — Vol. 12, No. 2 www.dental-tribune.com AO Orlando preview: The sinus floor bone graft Research shows how smoking affects healing after dental implant treatment. Photo/Provided by freeimages.com Research: Implant treatment plan should be adapted for smokers By Dental Tribune International A Chinese study comparing implant stability and peri- implant tissue response in heavy smokers and non- smokers has found that smoking did not affect the overall success of im- plant surgery, as all implants achieved osseointegration without compli- cations at least by the end of the 12th week after placement. However, smoking did cause the bone around the implants to heal more slowly; thus, implants began to osseointe- grate considerably later than in the non-smoking group. Research has demonstrated that smoking can negatively affect im- plant and bone integration. In order to improve treatment outcomes and avoid implant failure, surgeons need to have a precise understanding of how the habit will affect the healing process. In the current study, 45 ITI (Strau- mann) implants were placed in the partially edentulous posterior man- dibles of 32 male patients, including 16 who were heavy smokers and 16 who did not smoke at all. Implant stability and peri-implant tissue response were assessed at three, four, six, eight and 12 ” See RESEARCH, page B2 Photo/Provided by the Academy of Osseointegration: Getty Image, Kondor83 Dr. Jensen on ‘understanding when, how and if’ By Ole Jensen, DDS, MS Twenty years after the watershed Sinus Consensus Conference of 1996, co-chaired by Leonard Shulman, Michael Block, Vin- cent Lacono and myself, we editorialized in “The International Journal of Oral & Maxillofacial Implants,” highlighting five areas of significant change that have occurred since that time. These five ar- eas will be the topic of a session, titled “Sinus Consensus Update Session,” that I will moderate on March 17 as part of the Academy of Osseointegration 2017 An- nual Meeting. The state of the science of the sinus floor bone graft is not settled. There re- mains significant controversy, and there- fore ongoing innovation, as it relates to augmentation procedures to enhance osseointegration. The goal of this course will be to present key topics that have improved our understanding of when and how and if to do the sinus floor pro- cedure. One could say that the profession does not yet know what to do about aeration of the posterior maxilla with regard to tooth replacement, which is why every specialty must contribute to making treatment planning a success. Here are five key developments that have informed our thinking: • Graft material: At the time of the consensus conference in 1996, the use of autogenous bone, including mandibular, iliac, tibial and cranial graft, was cham- pioned, while alloplast and allografts were thought to be inferior (though the consensus conference found otherwise). Since that time, the use of xenogeneic bone has been found to be highly effec- tive, if not the most effective, for sinus floor augmentation — a mostly space- maintenance process with new bone for- mation migrating from the sinus floor. In fact, space maintenance without any graft material at all forms bone. Though the use of biomimetics are effective in the sinus floor and are an excellent tissue engineering advance, the use of growth factors and BMPs are generally reserved for more challenging cases. • Increased reports of combined al- veolar and sinus-floor grafting suggest that orthoalveolar form, that is, the for- mation of ideal shape and size of the al- veolus for emergence profile restoration is favored by clinicians even in the back of the mouth. Combined alveolar pro- cedures done in conjunction with the addition of bone to the sinus floor gains bone mass for osseointegration as well as helping to establish long term gingivo- alveolar health. • Technical advances since 1996 in per- forming the sinus graft now involve us- ing an alveolar approach instead of a lat- eral approach. Transcrestal osteotomes are used vertically to intrude the sinus floor, sometimes simultaneously alveo- lar splitting to gain alveolar width. • For the fully edentulous setting, with the advent of the “all-on-4” method, sinus grafting is generally avoided even in the severely deficient patient. Implant angu- lation circumvents the sinus by gaining apical anchorage into pyriform, nasal crest, pterygoid or malar bone structure, thus avoiding the need for sinus floor bone augmentation, a significant change in treatment prerogative since 1996. • Almost iconoclastic is the resur- gence of the use of short implants, even ultra-short implants that avoid sinus penetration or are only minimally invasive, having been shown in three- year studies to be just as effective as si- nus grafted implant sites using longer implants. The overarching theme of the sympo- sium is that ongoing clinical and basic science developments continue to strike a balance between biological efficacy and simplicity of treatment. To view the full program guide and register to attend, visit http://meetings. osseo.org.

Dental Tribune U.S.Edition No.2, 2017

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