Evaluation of Survival Rate of Zygomatic Implants Placed using Immediate Loading Protocol in Atrophic Maxillaa: A Clinical study

BACKGROUND: Zygoma implants are evidence –based surgical and prosthetic solution for rehabilitation of atrophic posterior maxilla with both classical two stage and immediate loading protocols. Zygoma implants avoid grafting and sinus lift procedures and therefore contribute to a shorter and more comfortable treatment. Zygoma bone is superior to that of the posterior maxilla in providing anchorage and success of zygomatic implant is due to Quad cortical stabilization, that he implant body engages four cortical bones: 1. Maxillary Lingual Plate, 2. Maxillary sinus floor, 3. Maxillary sinus roof, 4. Lateral cortex of the body of zygomatic bone. Immediate loading decreases the time of treatment and increases the acceptance of the treatment by the patient. AIMS AND OBJECTIVES: To evaluate the survival rate of immediately loaded zygomatic implant based on clinical criteria. MATERIALS AND METHODS: 5 patients with completely edentulous atrophic posterior maxilla fulfilling the criteria were selected. Nobel Biocare zygomatic implants were placed in the posterior region of completely edentulous maxilla and anterior conventional implants in selected subjects. The patients were assessed pre operatively and post operatively 1 week, 3 months 6, 9 and 12 months to assess clinical parameters like pain, infect ion, implant stability quotient, Lund – Mackay rhino sinusitis analysis, Ainamo and Bay gingival bleeding index and evaluation of position of apical third of zygomatic implant. The data collected was analyzed statistically. RESULTS: The zygomatic implants and the anterior conventional implants were immediately loaded and a survival rate of 100% was obtained in both zygoma and conventional implants in the current study. The mean ISQ achieved on the right side was 68.80 ± 4.14 and on the left side 65.6 intra operatively which was suggestive of good primary stability. Post operatively after a period of one year follow up the mean ISQ o the right and left side was 71 which indicate secondary stability. CONCLUS ION: Completely edentulous atrophic maxilla rehabilitated with immediate loaded zygomatic implants in combination with anterior conventional implants revealed a survival rate of 100% in one year follow up in current study. There were no potential complications encountered during the follow up period

Clinical and Radiological Evaluation of Basal Bi-Cortical Screw Implants in Freshly Extracted Tooth Socket

BACKGROUND: Basal implantology also known as bi cortical implantology or just cortical implantology is a modern implantology system which utilizes the basal cortical portion of the jaw bones for retention of the dental implants. The basal bone provides excellent quality cortical bone for retention of these unique and highly advanced implants. As basal implantology includes the application of the rules of orthopedic surgery, the basal implants are also called as “orthopedic implant”. The traditional implants use the alveolar bone, this type of bone is lost after teeth are removed and decreases throughout life as function reduces. The basal bone is always present throughout life, it is very strong and forms the stress bearing part of our skeleton. Basal implants can be loaded immediately after immediate placement of the implant in a freshly extracted tooth socket. Basal bi cortical screw implants are flapless implants and are inserted through the gums without giving a single cut, inserted like a conventional implant. AIMS AND OBJECTIVES: To evaluate the clinical and radiological parameters of basal bi-cortical screw implants placed in freshly extracted tooth socket based on the following criteria’s: 1. Primary stability of the implant at the time of implant placement. 2. Evaluation of pain during implant placement using VAS. 3. Evaluation of bone width and bone height using cone beam computed tomography. 4. Evaluation of bone loss in mesial and distal aspect of the implant using cone beam computed tomography. MATERIALS AND METHODS: The study populations are selected from the outpatient section of the Department of Oral and Maxillofacial surgery, Tamil nadu Govt. Dental College and hospital, Chennai. Study design is clinical trial and sampling method is simple random sampling and sample size is 10 implants. Average age of the patient selected 35 years [range 25- 55 years] followed 6, 9 and 12 months. Clinically healthy patient without any systemic disease which could contraindicate a surgical procedure & alter bone healing are selected. Pre-surgically evaluated patients with OPG, CBCT, IOPA. RESULTS: The study has been conducted in 4 patients with a mean age of 44.5±6.15 and male: female ratio of 70:30 with a total of 10 basal bi-cortical screw implants. The patients were followed for a period of six months and the clinical and radiological parameters were recorded. All the ten basal bi-cortical screw implants were placed in the freshly extracted tooth socket and no evidence of early failures or complications. The post-operative healing of implant surgery was uneventful. The patients showed good compliance and satisfaction as the extracted teeth were replaced at the same day of the surgery with a temporary crown and permanent crown within 72 hours of the surgery. All 10 implants had good primary stability with mean value of 55Ncm. All 10 implants had minimal marginal bone loss and minimal loss in bone width. The post-operative pain was minimal and all 4 patients were comfortable with the procedure. CONCLUSION: In our present study of 10 BCS implants placed in 4 patients immediately into freshly extracted tooth sockets and loaded immediately within 72 hours had good primary stability with a mean value of 55Ncm and minimal marginal bone loss and less pain perception. This indicates good success rate of the BCS implants placed in the above patients. Basal bi-cortical screw implants had good success rate in patients with immediate extraction and immediate placement of implants with immediate loading of prosthesis. BCS implants can be placed in severely atrophied jaws without need of bone grafts with good stability where conventional implants could not be placed. Though we had a good success rates of BCS implants in our present study, the sample size was small and the follow up period was short. Therefore, we require large randomized clinical trials to further evaluate the successful outcome of basal bi-cortical screw implants placed in freshly extracted tooth sockets

Novel grafting materials for sinus floor elevation in the sheep model

Introduction: Sinus floor elevation (SFE) may be required for implant placement in the severely resorbed posterior maxilla. Although often successful, autologous bone grafting requires a donor site and may lose substantial volume while remodelling. Bone replacement grafting (BRG) materials were developed to overcome these limitations. This study investigated three novel grafting materials: 1) equine collagen cone (CN), 2) equine collagen cone filled with biphasic calcium phosphate particles (CO), 3) deproteinized bovine bone particles coated with polylactic acid and poly ε -caprolactone copolymer (SB). These were compared with the most commonly-used bovine bone BRG, Geistlich Bio-Oss® (BO). Methods: The extra-oral access sinus grafting model from Haas et al. (1998) was used in 11 cross-bred female sheep. Two experimental sites on each side of the animal were prepared. CN, CO, SB, BO were each placed through separate 10 mm access window in the antral wall, under the elevated Schneiderian membrane. BO sites were covered with a porcine collagen membrane (Geistlich Bio-Gide®), while for CO, SB, BO sites the equine collagen membrane (RESORBA PARASORB®) from the manufacturer of these experimental materials was used. The animals were euthanised after 16 weeks. New bone, residual graft particles and connective tissue areas were measured on un-demineralised resin-embedded sections. Results: One sheep did not survive the surgery. All sites in remaining ten sheep healed uneventfully. The CN and SB grafting materials resorbed completely and failed to form new bone. BO and CO particles were bridged by the new bone, the new bone fraction was 10% (±9%) for BO and 4% (±5%) for CO. The differences were not statistically significant. Conclusions: CN and SB cannot be recommended for sinus grafting, based on this model. BO and CO demonstrated comparable histologic and histomorphometric outcomes

A Textbook of Advanced Oral and Maxillofacial Surgery

The scope of OMF surgery has expanded; encompassing treatment of diseases, disorders, defects and injuries of the head, face, jaws and oral cavity. This internationally-recognized specialty is evolving with advancements in technology and instrumentation. Specialists of this discipline treat patients with impacted teeth, facial pain, misaligned jaws, facial trauma, oral cancer, cysts and tumors; they also perform facial cosmetic surgery and place dental implants. The contents of this volume essentially complements the volume 1; with chapters that cover both basic and advanced concepts on complex topics in oral and maxillofacial surgery