골유도 재생술과 임프란트 식립을 이용한 상악 전치부의 수복

Successful implants should fulfill both functional and esthetic needs of patients. Especially on maxillary anterior region, many surgeons undergo difficult procedures because of improper quantity and quality of soft and hard tissue. To overcome these problems, regenerative procedures such as guided bone regeneration(GBR) and ridge spreading are often used. In this study, 2 implants were installed on maxillary anterior region using ridge spreading and GBR procedure. Before implantation, osteotomes were used to spread and compact alveolar bone. After insertion of implants, allograft and alloplast were grafted on buccal concavity, and surgical site were closed using non-resorbable membrane. There were no complications during surgery and the result was satisfyingope

심한 골흡수가 진행된 상악에서의 상악동 거상술을 동반한 임프란트 동시 식립

The sinus floor elevation procedure has been used to be one of the predictable treatments for rehabilitation of atrophic and pneumatized edentulous posterior maxilla. Sinus elevation with simultaneous implant placement could be an optimal procedure due to reduction in surgical procedures and to patient’s convenience. This study reports the successful results of sinus elevation with the sand blasted, large grit, acid-etched (SLA) surfaced implant(ITI dental imiplant system, StraumannⓇ, Basel, Switzerland) placement simultaneously. In the first case, the height of residual ridge was 2~4mm. Autogeneous bone from ramus and alloplast(Macroporous biphasic calcium phosphate-MBCP, BiomatlanteⓇ Sarl, Nantes, France) were applied after sinus elevation through lateral window approach. SLA surfaced implants(ITI) were installed simultaneously. Result after 17 months was showed successfully. In the second case, the height of residual ridge was 3~5mm. Allograft(Freeze dried bone allograft-FDBA, Oragraft, Lifenet health, Virginia Beach, VA, USA) and alloplast(MBCP) were used for sinus graft. All procedures were followed as in the first case. Result after 9 months was showed successfully. In conclusion, this study presented successful results, when sinus elevation through window approach with mixed graft material was performed with simultaneous SLA surfaced implant placement on severe atrophied maxillary alveolar ridge, minimizing patient discomfort.ope

Implant-related complications and Treatment of the ailing implants

Despite the long-term predictability of endosseous dental implants, some complications do occur including surgical, biologic, mechanical(or technical) and esthetic aspects. To deal with these problems, assessments in clinical states as well as radiographic findings are important. These case reports are to show the complications occurred in the followup period of functionally loaded implants and to find out the treatments of the ailing implants. Both of the case reports showed mechanical(or technical) complications like screw loosening with peri-implant crestal bone loss and some aspects of peri-implantitis which is one of the biologic complications. Mechanical complication, the most common aspect, is known to be largely related to the stress factor. Occlusal overload might cause mechanical problems such as screw loosening, fractures of the screw, fixture body or the prosthetic components. In addition, strain and the bending moment concentrated mainly at the crestal area might cause the initial crestal bone resorption(saucerization) and the late stage bone loss together with peri-implantitis. Treatments of the complications include minimizing occlusal overload, using systemic antibacterial therapy or the chlorhexidin, and the surgical access when the implants are thought to be amendable. Minimizing occlusal overload and distributing the stress can be accomplished by increasing the number, length and the diameter of the implant, tripod positioning of the implants, selecting the implant design which maximizes the surface area and analyzing the occlusion of the patient. In the case reports, many factors were seemed to be related to the complications of the functionally loaded implants. To treat and furthermore, to prevent the complications, treatment plans should be made under the considerations of these factors.ope

하악관 신경손상 방지를 위한 Cone beam CT 및 3차원 영상의 활용

For preoperative treatment planning before placement of dental implants, a radiographic examination is needed to obtain accurate information on bone dimensions. Especially, to avoid nerve injury during surgery in the foraminal area, guidelines were developed based on the literature with respect to verifying the position of the mental foramen. These guidelines included leaving a 2mm zone of safety between an implant and the coronal aspect of the nerve through observation of the inferior alveolar nerve and mental foramen on panoramic and periapical radiographs prior to implant placement. However, use of CT scans are becoming more widespread because panoramic and periapical radiographic views do not provide clarity with respect to the position of the nerve in many cases. Problems associated with conventional apparatus include high cost, bulk, and x-ray exposure. Recent advancements in Cone beam CT have made it possible to rapidly obtain higher resolution images using less bulky machines and lower radiation exposure. Moreover currently available software programs in combination with CBCT data allow 3-dimensional treatment planning in demanding clinical situations prior to implant placement.ope

좁은 직경 임플란트에 관한 장기간의 후향적 연구 결과

Purpose: The aim of this study was to retrospectively investigate (investigate retrospectively may be better) the survival rate and the influencing factors of narrow implants less than 3.5 mm in diameter. Materials and Methods: Included this study were the patients who received the implantation from January 1995 to December 2011 and visited the Department of Periodontology, Dental Hospital of Yonsei University after over 12 months from the time of their implantation. The cumulative survival rate was calculated and various factors affecting the rate were investigated according to the implant system, gender, age, implant position, length, and splinting. The causes of failed implants were also analyzed. Results: The overall survival rate was 98.6% and 11 implants were removed. There was no statistically significant differences among the survival rate according to the implant system, gender, position, length and the existence of splinting. The most frequent/common reason for failure was infection, which was responsible for 8 out of 11 failed implants. Conclusion: In conclusion, the present study suggests that the use of narrow diameter implants can be a predictable treatment option.ope

rhBMP-2 using biphasic calcium phosphate block as a carrier induces new bone formation in a rat subcutaneous tissue

Purpose: The carrier for the delivery of bone morphogenetic proteins(BMPs) should also serve as a scaffold for new bone growth. In addition, predictable bone formation in terms of the volume and shape should be guaranteed. This study evaluated the ectopic bone formation of recombinant human BMP-2(rhBMP-2) using a micro macroporous biphasic calcium phosphate (MBCP: mixture of βTCP$ and HA) block as a carrier in a rat subcutaneous assay model. Materials and Methods: Subcutaneous pockets were created on the back of 40 male Sprague-Dawley rats. In the pockets, rhBMP-2/MBCP and MBCP alone were implanted. The blocks were evaluated by histological and histometric parameters after a healing interval of 2 weeks (each 10 rats; MBCP and rhBMP-2/MBCP) or 8 weeks (each 10 rats; MBCP and rhBMP-2/MBCP). Results: The shape and volume of the block was maintained stable over the healing period. No histological bone forming activity was observed in the MBCP alone sites after 2 weeks and there was minimal new bone formation at 8 weeks. In the rhBMP-2/MBCP sites, new bone formation was evident in the macropores of the block. The new bone area at 8 weeks was greater than at 2 weeks. There was a further increase in the quantity of new bone with the more advanced stage of remodeling. Conclusions: A MBCP block could serve as a carrier system for predictable bone tissue engineering using rhBMPsope

재생 술식을 동반한 발치 후 즉시 임프란트 식립술

The placement of implants into fresh extraction socket provides many advantages to conventional delayed implant placement. It reduces total treatment time and surgical procedures with placement of the implant in an ideal position. However, it also has disadvantages such as creating a gap defect between the implant and alveolar bone and difficulty in primary closure of the surgical site. Therefore, need of a regenerative procedure is crucial in immediately placed sites for successful functional and esthetical outcomes. The current case report presents two cases with immediately placed implants performed in anterior and posterior region. A careful tooth extraction was performed to avoid any surgical trauma in the alveolar bone, and implants were successfully installed in both cases. Regenerative procedures such as guided bone regeneration and bone graft were performed in conjunction to fill the gap defect and compensate future ridge alterations. Both cases showed clinically successful results with functionally and esthetically high patient satisfaction. Immediate implant placement in conjunction with an appropriate regenerative procedure could provide successful outcome.ope

골이식을 동반한 구치부 임프란트의 식립 : 증례보고

ope

Simultaneous placement of an interpositional free gingival graft with nonsubmerged implant placement

PURPOSE: Various surgical techniques target achieving adequate keratinized tissue around dental implants; however, these techniques are usually performed before implant placement or upon the exposure of submerged implants. The aim of this case report is to describe a simultaneous placement of an interpositional free gingival graft (iFGG) with that of nonsubmerged implants in a patient lacking keratinized tissue and to assess the long-term outcome of this grafted gingiva. METHODS: A wedge-shaped free gingnival graft (FGG), including an epithelium-connective tissue (E-C) portion and a connective-tissue-only (CT) portion, was harvested from the palate. The CT portion was inserted under the buccal flap, and the E-C portion was secured tightly around the implants and to the lingual flap. RESULTS: At the 8-year follow-up, the gingival graft remained firmly attached and was well maintained, with no conspicuous shrinkage or reported discomfort during oral hygiene procedures. The use of an iFGG at a nonsubmerged implant placement minimizes the required number of surgical steps and patient discomfort while providing adequate buccal keratinized tissue. CONCLUSIONS: Therefore, the technique could be considered an alternative method in increasing the keratinized tissue for cases that have a minimal amount of keratinized tissue.ope

Randomized clinical trial on the efficacy of Escherichia coli- derived rhBMP-2 with β-TCP/HA in extraction socket

PURPOSE : This randomized clinical trial was conducted to assess the safety and effectiveness of the ErhBMP-2 in alveolar bone regeneration as well as preservation of the β-TCP bone graft material that contains ErhBMP-2. MATERIALS AND METHODS : This study involved 72 patients at the 3 study centers. The patients, who were divided into 2 groups: the experiment group who had ErhBMP-2 coated TCP/HA and the control group who had TCP/HA graft material alone transplanted immediately after tooth extraction. CT was taken before and 3 months after the transplantation and healing status was compared between the two groups. The efficacy endpoints that were used to measure the degree of bone induction included alveolar bone height and 3 measurements of bone width. The paired t test was used to determine the significance of the changes (P<.05). RESULTS : Changes in alveolar bone height were -1.087 ± 1.413 mm in the control group and -.059 ± 0.960 mm in the experimental group (P<.01). At 25% extraction socket length [ESL], the changes were 0.006 ± 1.149 mm in the control group and 1.279 ± 1.387 mm in the experimental group. At 50% ESL, the changes were 0.542 ± 1.157 mm and 1.239 ± 1.249 mm, respectively (P<.01 for 25% ESL, and P<.05 for 50% ESL). During the experiment, no adverse reactions to the graft material were observed. CONCLUSION : ErhBMP-2 coated β-TCP/HA were found to be more effective in preserving alveolar bone than conventional β-TCP/HA alloplastic bone graft materials.ope