Introduction: The current discussion about the use of short implants to avoid bone-augmentation (“sinus lift”) in the lateral maxilla remains a controversial topic and is increasingly at odds with the reality of evo...Introduction: The current discussion about the use of short implants to avoid bone-augmentation (“sinus lift”) in the lateral maxilla remains a controversial topic and is increasingly at odds with the reality of evolutionary biology. Aim of the study was to determine the percentage of cases from a large routine patient-sample in which short implants might be suitable to avoid sinus lift procedures. Materials and Methods: From January 2012 to June 2015, all patients in three general dental practices in Austria with at least one subantral edentulous area were subjected to routine panoramic X-ray screening. The subantral alveolar ridge heights and the mesial extension of the maxillary sinus towards the canine fossa were measured. Statistics were performed by Excel data analysis (mean value, standard deviation). Results: 2837 patients were screened with 2837 panoramic radiographs presenting 3528 edentulous subantral regions and the subantral bone heights of 5674 maxillary sinuses were surveyed. 57.43% revealed subantral alveolar ridge heights of 4 mm or less;24.43% of all measure-points indicated a maximum alveolar ridge height of 6 mm. In 39.32% of cases, the pneumatisation of the maxillary sinuses with a subantral residual ridge height of 6 mm or less extended as far as the anatomical position of the second premolars, in 20.51% as far as the position of the first premolar and in 10.84% as far as the canine fossa. Discussion: The sinus lift procedure will continue to be one of the basic standard surgical procedures carried out by practice-based dental surgeons who perform implant surgery since in at least two thirds of the cases short implants with lengths of less than 6 mm cannot be applied. Preference should be given to sinus lift-procedures, which can be learned safely with a minimum of time-effort, least risk of failure and lowest possible level of patient morbidity. Transcrestal hydrodynamic ultrasonic sinus lift-procedures with piezotomes seem to fulfill these basic demands.展开更多
Alveolar crest-splitting and horizontal distraction is an established surgical technique to enable implant insertion into the narrow, lateral atrophic alveolar crest. This surgical technique is challenging for the ora...Alveolar crest-splitting and horizontal distraction is an established surgical technique to enable implant insertion into the narrow, lateral atrophic alveolar crest. This surgical technique is challenging for the oral surgeon and restricted to crest-widths of 3 - 5 mm: significant procedural bone loss at osteotomy, the need to prepare a full thickness mucoperiostal flap and milling a baseline-osteotomy to weaken the bone for distraction inhere significant risks of accidental fractures. Aim of the study was to investigate if the recently developed novel Flapless Piezotome enhanced Crest-Splitting and Widening Technique (FPeCSWT) could safely narrow down the indication for this procedure to narrow alveolar crests of widths of even less than 2 mm in a three-year survey-period. 239 patients underwent 261 FPeCSWT-surgeries and 488 implants were inserted simultaneously in the upper and the lower jaw and clinical parameters such as intrasurgical complications, patient morbidity, implant loss and vertical bone loss (VBL) in the first three years after surgeries were recorded comparing sites with less than 2 mm width with sites of more than 2 mm. After three years a significant difference (p = 0.24) of VBL could be observed between the group with less than 2 mm crest-width (mean: 0.97 mm, max: 2.0 mm/min: 0.0 mm;SD: 0.41) compared with the group with more than 2 mm crest-width (mean: 0.69 mm, max: 1.5 mm/min: 0.0 mm;SD: 0.36) but was still significant lower when compared with the results of similar studies published with a mucoperiostal-flap approach and baseline bone-cut. The cumulative 3-year-implant-survival-rate was 98.8%, no accidental fracture of the distracted buccal bone-plate occurred. The re-sults of the study suggest that the FPeCSWT narrows safely down the indication for crest-splitting to also crest-widths of only 1 mm. The procedure is highly predictable and significantly reduces the challenge of surgical skills and leads to negligible patient-morbidity. The higher VBL in crest-widths of less than 2 mm can 展开更多
Aim of the study was to evaluate if there is a constant and significant reduction in traumaticity when mas- sively traumatic oral surgical procedures such as the removal of third molars are conducted with only ul- tra...Aim of the study was to evaluate if there is a constant and significant reduction in traumaticity when mas- sively traumatic oral surgical procedures such as the removal of third molars are conducted with only ul- trasonic surgical devices (Piezotomes) expressed in a reduction of postsurgical pain and swelling on the patient’s side since such clinical experiences by the authors suggested this. Since oral surgeons criticize a higher time consumption for surgeries with Piezoto- mes also the objective time consumption was evalu- ated and compared to the traditional methods. Mate- rial and Methods: 56 female and male patients were selected that already underwent a removal of an im- pacted third mandibular molar on one side with rota- ry instruments by bone destructive burring with a still persisting comparable third mandibular molar on the contralateral side complaining about recur- rent pain episodes and were already documented for pain and swelling before. The ultrasonic surgical re- moval with the Piezotome was conducted with a buc- cal osteotomy of the compacta lateral to the impacted third molar, preservation of the resected compacta in saline solution, removal of the third molar by single or multiple dentotomy and full anatomical restitution of the surgical site with the preserved buccal com- pacta. The swelling was documented by kephalome- try 24/48/72 hours and 1 week post surgery, the pain index by the total consumption of ibuprofen-400 mg—tablets. Lesions of the mandible nerve were documented. Netto surgery time was taken from the first incision to the last suture of the procedure. Re-sults: 6 patients had to be excluded from evaluation due to incomplete post surgical follow up. A signify-cant (***, p > 0.999) decrease in pain and swelling of 50% was detected both for the parameters swelling and pain with Piezotome-surgery. No lesions of the mandible nerve were detected with Piezotome sur- gery whereas surgery with rotary instruments re- sulted in 16% hypesthesia at least up to one week. Although netto 展开更多
文摘Introduction: The current discussion about the use of short implants to avoid bone-augmentation (“sinus lift”) in the lateral maxilla remains a controversial topic and is increasingly at odds with the reality of evolutionary biology. Aim of the study was to determine the percentage of cases from a large routine patient-sample in which short implants might be suitable to avoid sinus lift procedures. Materials and Methods: From January 2012 to June 2015, all patients in three general dental practices in Austria with at least one subantral edentulous area were subjected to routine panoramic X-ray screening. The subantral alveolar ridge heights and the mesial extension of the maxillary sinus towards the canine fossa were measured. Statistics were performed by Excel data analysis (mean value, standard deviation). Results: 2837 patients were screened with 2837 panoramic radiographs presenting 3528 edentulous subantral regions and the subantral bone heights of 5674 maxillary sinuses were surveyed. 57.43% revealed subantral alveolar ridge heights of 4 mm or less;24.43% of all measure-points indicated a maximum alveolar ridge height of 6 mm. In 39.32% of cases, the pneumatisation of the maxillary sinuses with a subantral residual ridge height of 6 mm or less extended as far as the anatomical position of the second premolars, in 20.51% as far as the position of the first premolar and in 10.84% as far as the canine fossa. Discussion: The sinus lift procedure will continue to be one of the basic standard surgical procedures carried out by practice-based dental surgeons who perform implant surgery since in at least two thirds of the cases short implants with lengths of less than 6 mm cannot be applied. Preference should be given to sinus lift-procedures, which can be learned safely with a minimum of time-effort, least risk of failure and lowest possible level of patient morbidity. Transcrestal hydrodynamic ultrasonic sinus lift-procedures with piezotomes seem to fulfill these basic demands.
文摘Alveolar crest-splitting and horizontal distraction is an established surgical technique to enable implant insertion into the narrow, lateral atrophic alveolar crest. This surgical technique is challenging for the oral surgeon and restricted to crest-widths of 3 - 5 mm: significant procedural bone loss at osteotomy, the need to prepare a full thickness mucoperiostal flap and milling a baseline-osteotomy to weaken the bone for distraction inhere significant risks of accidental fractures. Aim of the study was to investigate if the recently developed novel Flapless Piezotome enhanced Crest-Splitting and Widening Technique (FPeCSWT) could safely narrow down the indication for this procedure to narrow alveolar crests of widths of even less than 2 mm in a three-year survey-period. 239 patients underwent 261 FPeCSWT-surgeries and 488 implants were inserted simultaneously in the upper and the lower jaw and clinical parameters such as intrasurgical complications, patient morbidity, implant loss and vertical bone loss (VBL) in the first three years after surgeries were recorded comparing sites with less than 2 mm width with sites of more than 2 mm. After three years a significant difference (p = 0.24) of VBL could be observed between the group with less than 2 mm crest-width (mean: 0.97 mm, max: 2.0 mm/min: 0.0 mm;SD: 0.41) compared with the group with more than 2 mm crest-width (mean: 0.69 mm, max: 1.5 mm/min: 0.0 mm;SD: 0.36) but was still significant lower when compared with the results of similar studies published with a mucoperiostal-flap approach and baseline bone-cut. The cumulative 3-year-implant-survival-rate was 98.8%, no accidental fracture of the distracted buccal bone-plate occurred. The re-sults of the study suggest that the FPeCSWT narrows safely down the indication for crest-splitting to also crest-widths of only 1 mm. The procedure is highly predictable and significantly reduces the challenge of surgical skills and leads to negligible patient-morbidity. The higher VBL in crest-widths of less than 2 mm can
文摘Aim of the study was to evaluate if there is a constant and significant reduction in traumaticity when mas- sively traumatic oral surgical procedures such as the removal of third molars are conducted with only ul- trasonic surgical devices (Piezotomes) expressed in a reduction of postsurgical pain and swelling on the patient’s side since such clinical experiences by the authors suggested this. Since oral surgeons criticize a higher time consumption for surgeries with Piezoto- mes also the objective time consumption was evalu- ated and compared to the traditional methods. Mate- rial and Methods: 56 female and male patients were selected that already underwent a removal of an im- pacted third mandibular molar on one side with rota- ry instruments by bone destructive burring with a still persisting comparable third mandibular molar on the contralateral side complaining about recur- rent pain episodes and were already documented for pain and swelling before. The ultrasonic surgical re- moval with the Piezotome was conducted with a buc- cal osteotomy of the compacta lateral to the impacted third molar, preservation of the resected compacta in saline solution, removal of the third molar by single or multiple dentotomy and full anatomical restitution of the surgical site with the preserved buccal com- pacta. The swelling was documented by kephalome- try 24/48/72 hours and 1 week post surgery, the pain index by the total consumption of ibuprofen-400 mg—tablets. Lesions of the mandible nerve were documented. Netto surgery time was taken from the first incision to the last suture of the procedure. Re-sults: 6 patients had to be excluded from evaluation due to incomplete post surgical follow up. A signify-cant (***, p > 0.999) decrease in pain and swelling of 50% was detected both for the parameters swelling and pain with Piezotome-surgery. No lesions of the mandible nerve were detected with Piezotome sur- gery whereas surgery with rotary instruments re- sulted in 16% hypesthesia at least up to one week. Although netto
