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      Maxillary segmental osteoperiosteal flap with simultaneous placement of dental implants: case report of a novel technique

      case-report
      1 , 2 , 1 , 2 ,
      International Journal of Implant Dentistry
      Springer Berlin Heidelberg

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          Abstract

          Dental restorative space from the opposing dentition requires adequate distance for restorative material for an acceptable restoration. Typically, long-standing edentulous alveolar ridges will have vertical and or horizontal defects that require alveolar ridge augmentation for ideal dental implant restorations. Along with these defects, one will see the opposing dentition supra erupt which can obliterate the restorative space. Multiple surgical techniques have been described to address these dilemmas. The use of osteoperiosteal flaps has been described to address vertical height deficiencies. The purpose of this paper is to document and introduce a maxillary segmental osteoperiosteal flap intrusion to increase the restorative space with simultaneous dental implant placement. As with most dilemmas in treatment planning dental implants, multiple acceptable treatment options are available to the practitioner. This technique is another of many that can be added to the available options. When appropriately planned in select cases, this technique will result with ideal dental implant restorations without compromising the esthetic and functional harmony of the native dentition.

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          Bone augmentation procedures in implant dentistry.

          This review evaluated (1) the success of different surgical techniques for the reconstruction of edentulous deficient alveolar ridges and (2) the survival/success rates of implants placed in the augmented areas. Clinical investigations published in English involving more than 10 consecutively treated patients and mean follow-up of at least 12 months after commencement of prosthetic loading were included. The following procedures were considered: onlay bone grafts, sinus floor elevation via a lateral approach, Le Fort I osteotomy with interpositional grafts, split ridge/ridge expansion techniques, and alveolar distraction osteogenesis. Full-text articles were identified using computerized and hand searches by key words. Success and related morbidity of augmentation procedures and survival/success rates of implants placed in the augmented sites were analyzed. A wide range of surgical procedures were identified. However, it was difficult to demonstrate that one surgical procedure offered better outcomes than another. Moreover, it is not yet known if some surgical procedures, eg, reconstruction of atrophic edentulous mandibles with onlay autogenous bone grafts or maxillary sinus grafting procedures in case of limited/moderate sinus pneumatization, improve long-term implant survival. Every surgical procedure presents advantages and disadvantages. Priority should be given to those procedures which are simpler and less invasive, involve less risk of complications, and reach their goals within the shortest time frame. The main limit encountered in this literature review was the overall poor methodological quality of the published articles. Larger well-designed long-term trials are needed.
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            Sinus lift procedures: an overview of current techniques.

            For more than 30 years the maxillary sinus augmentation graft has been a mainstay of implant-directed maxillary reconstruction. The purpose of this article is to review the fundamentals of maxillary sinus reconstruction including anatomy and physiology of the sinus, indications for surgery, preoperative evaluation, surgical techniques, and management of complications. While there are some relative contraindications for the procedure, there are almost no absolute contraindications. With preparation, education, and experience, the maxillary sinus augmentation/elevation graft is a procedure that greatly benefits the patient, with a predictable outcome. Copyright © 2012 Elsevier Inc. All rights reserved.
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              Efficacy of injectable demineralized bone matrix as graft material during sinus elevation surgery with simultaneous implant placement in the posterior maxilla: clinical evaluation of 49 sinuses.

              The purpose of the present retrospective investigation was to evaluate the survivability and success of single implants placed simultaneously during direct sinus lifts with allograft forms of bone and to investigate the effect demineralized bone matrix paste has on time management and membrane integrity during these procedures. The charts of 49 consecutively treated nonsmoking patients who had met the inclusion criteria were examined. All the patients had undergone unilateral direct sinus augmentation using the lateral window technique, during which only 1 implant (minimum 10 mm in length) was placed in the premolar or molar maxillary region. All implants were submerged using a 2-stage technique and with at least 3 mm of residual sinus floor bone height. The control group of 27 patients had received particulate allograft bone as the graft material, and the 22 test patients had received allograft bone in a paste form (DynaBlast). No implants were loaded before a minimum of 6 months from the date of fixture placement. All implant-supported single crowns in the present study had been functioning for at least 12 months. All patients were seen immediately after placement of the final crown and were requested to return to the surgeon's practice for 1 annual radiographic follow-up examination. The range of follow-up for these patients was 12 to 24 months based entirely on patient compliance. This interval constituted the loading time. The patients were not seen by the specialist in between the "final crown" appointment (original radiograph) and the "annual" follow-up evaluation (final radiograph). No patients experienced complications that required surgical re-entry. The average loading time for the control group was 13.62 months and was 18.77 months for the test group. The survivability and success of the implants were studied, along with the operative time, between the 2 groups. Statistical analysis was performed for various comparisons in the present study. None of the fixtures placed in these patients failed. The success and survivability criteria as stated were met for all 49 implants, regardless of the allograft formulation used. The average operative time in the control group was 70.11 minutes and was 62.36 minutes in the test group. This difference was statistically significant (P < .05). Using an injectable formulation of allograft material during simultaneous direct sinus lift and implant placement seems to be an acceptable alternative to particulate forms of allograft bone. In addition, when using the injectable graft evaluated in our study, a statistically significant 11% decrease in the operative time resulted. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                Tibebu.M.Tsegga.mil@mail.mil
                Thomas.L.Wright2.mil@mail.mil
                Journal
                Int J Implant Dent
                Int J Implant Dent
                International Journal of Implant Dentistry
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                2198-4034
                19 January 2017
                19 January 2017
                December 2017
                : 3
                : 2
                Affiliations
                [1 ]Department of Oral & Maxillofacial Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Dr., Ft. Sam Houston, 78234 TX USA
                [2 ]ISNI 0000 0000 8665 0557, GRID grid.417097.c, Department of Oral & Maxilofacial Surgery, , Wilford Hall Ambulatory Surgical Center, ; 2200 Bergquist Dr, Suite 1, Lackland AFB, TX 78236 USA
                Author information
                http://orcid.org/0000-0003-4415-4821
                Article
                67
                10.1186/s40729-017-0067-5
                5247389
                28105589
                88d1b6e3-21ca-4d58-9e26-7c5546b461c2
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 6 December 2016
                : 13 January 2017
                Categories
                Case Report
                Custom metadata
                © The Author(s) 2017

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