Early Osteotomy With Delayed Implant Placement: A Step Further for Immediate Loading.

Implant Dentistry. 15(1):18-23, 2006.
El Attar, M S. BD, MS, MD, PhD *; Mourad, Hazem H. BD +; Mahmoud, Aly BD, MS, PhD ++; Abdallah, Mohamed BD +; Garana, Hussien BD, MS, MD, PhD ++; Mansour, Khaled MS, PhD +; Fata, Mohamed MD, DDS, PhD [S]

The commonly used implantation technique involves a 2-stage surgical protocol for load-free and submerged healing to ensure predictable osseointegration. This article presents a new approach that benefits from previous bone and soft tissue protocols. It combines new surgical and insertion techniques to perform immediate loading with delayed implant placement, avoiding the problems of discomfort, inconvenience, and anxiety associated with healing periods. It maintains a similar success rate to the present common technique. After osteotomy, bone healing passes through 3 stages (i.e., inflammation, fibrous tissue, and maturation). In the new approach, implant insertion is performed 2 weeksafter drilling (i.e., during the fibrous phase). The insertion timing is so selected because collagen formation and revascularization represent an acceptable implant bed configuration. Flap surgery offers the optimal osteotomy approach, but esthetic outcomes are definitely compromised. Accordingly, adopting the punch technique alleviates several postoperative problems, such as pain, tenderness, and swelling. Moreover, the punch technique avoids the sutures needed to adjust the gingiva around the abutment. It provides both cosmetic and functional properties.

Absorbable versus nonabsorbable membranes

Absorbable versus nonabsorbable membranes and bone grafts in the treatment of ligature-induced peri-implantitis defects in dogs. Part I. A clinical investigation.

Clin Oral Implants Res. 2001 Apr;12(2):115-20.

Nociti FH Jr, Machado MA, Stefani CM, Sallum EA, Sallum AW.Dental School of Piracicaba, University of Campinas, Department of Periodontics-Piracicaba, Sao Paulo, Brazil.

The purpose of this study was to clinically evaluate an absorbable collagen membrane (Bio-Gide) and a nonabsorbable polytetrafluoroethylene membrane (PTFE), associated or not with bone grafts, for the treatment of ligature-induced peri-implantitis defects in dogs. The bilateral mandibular premolars were removed from 5 2-year-old mongrel dogs. After 3 months of healing, 3 titanium implants were placed on each side of the mandible. Experimental peri-implantitis was induced after abutment connection. Ligatures and abutments were removed after 1 month and the bone defects were randomly assigned to one of the following treatments: DB: debridement alone; GBR+BG-I: debridement plus PTFE membrane associated with mineralized bone graft (Bio-Oss); GBR+BG-II: debridement plus collagen membrane (Bio-Gide) associated with mineralized bone graft; GBR-I: debridement plus PTFE membrane; GBR-II: debridement plus collagen membrane; BG: debridement plus mineralized bone graft. The peri-implant bone defects were measured before and 5 months after treatment. Results showed the greatest percentage of vertical bone fill for GBR+BG-II (27.77+/-14.07) followed by GBR-II (21.78+/-16.19), BG (21.26+/-6.87), GBR+BG-I (19.57+/-13.36), GBR-I (18.86+/-10.63) and DB (14.03+/-5.6). However, the values were not statistically significant (ANOVA, contrast F test, P=0.612). Within the limits of the present investigation, it can be concluded that no difference was detected among treatments.

Alveolar distraction osteogenesis vs. vertical guided bone regeneration

Alveolar distraction osteogenesis vs. vertical guided bone regeneration for the correction of vertically deficient edentulous ridges: a 1-3-year prospective study on humans.

Clin Oral Implants Res. 2004 Feb;15(1):82-95.

Chiapasco M, Romeo E, Casentini P, Rimondini L.Unit of Oral Surgery, Department of Medicine, Surgery, and Dentistry, San Paolo Hospital, University of Milan, Italy.

The purpose of this prospective study was to compare vertical guided bone regeneration (GBR) and vertical distraction osteogenesis (DO) for their ability in correcting vertically deficient alveolar ridges and their ability in maintaining over time the vertical bone gain obtained before and after implant placement. Eleven patients (group 1) were treated by means of vertical GBR with autogenous bone and e-PTFE membranes, while 10 patients (group 2) were treated by means of DO. In group 1, six patients received implants at the time of GBR (subgroup 1A), while five patients had implants placed at the time of membrane removal (subgroup 1B). In group 2, implants were placed at the time of distraction device removal. A total of 25 implants were placed in group 1 and 34 implants were placed in group 2 patients. Three to 5 months after implant placement, patients were rehabilitated with implant-borne dental prostheses. The following parameters were evaluated: (a) bone resorption of the regenerated ridges before and after implant placement; (b) peri-implant clinical parameters 1, 2, and 3 years after prosthetic loading of implants; (c) survival and success rates of implants. Bone resorption values before and after implant placement were significantly higher in group 1. The results suggested that both techniques may improve the deficit of vertically resorbed edentulous ridges, although distraction osteogenesis seems to be more predictable as far as the long-term prognosis of vertical bone gain is concerned. Implant survival rates as well as peri-implant clinical parameters do not differ significantly between the two groups, whereas the success rate of implants placed in group 2 patients was higher than that obtained in group 1 patients.