The use of cone beam computed tomography in the management of displaced roots into the maxillary antrum

Posted on: November 9th, 2011 by 6th Avenue Periodontics No Comments

Displacement of roots into the maxillary antrum is an intraoperative complication during extraction of upper molar teeth. A combination of panoramic, intraoral and occipitomental radiography is normally considered the imaging method of choice in assessing the position of the displaced roots. We describe the use of cone beam computed tomography (CBCT) in the management of displaced roots in the antrum. CBCT aids in localising displaced roots and informs surgical access.

Oral Surgery

  1. R.Z. Haidar1,
  2. V. Sivarajasingam2,
  3. N.A. Drage3,*

Article first published online: 4 NOV 2011

DOI: 10.1111/j.1752-248X.2011.01137.x

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Two cases of bare bone graft with dental implant for mandibular defect

Posted on: November 9th, 2011 by 6th Avenue Periodontics No Comments

Bare bone graft is a method of mandibular reconstruction involving vascularised iliac bone graft without a skin flap, and secondary epithelialisation of the exposed iliac bone surface in the oral cavity. We herein report two cases of bare bone graft with dental implant for mandibular defect after tumour resection. Case 1: A 36-year-old woman with odontogenic myxoma of the left mandible underwent reconstruction with a free vascularised iliac flap after segmental resection of the mandible. The exposed iliac bone surface in the oral cavity required about 2 months for epithelialisation. Two implants were placed into the reconstructed mandible 12 months after initial surgery, and prosthetic rehabilitation was performed successfully after 6 months of osseointegration period. Case 2: A 32-year-old woman with desmoplastic ameloblastoma of the right mandible underwent reconstruction using free iliac bone after segmental resection of the mandible. As the reconstructed bone failed after surgery, the left mandible was reconstructed using a free vascularised iliac flap. The exposed iliac bone surface in the oral cavity required about 2 months for epithelialisation. Four implants were placed into the reconstructed mandible 17 months after surgery, and prosthetic rehabilitation was performed successfully after 6 months of osseointegration period. In both cases, the mandibular contour and occlusal function were satisfactory.

Oral Surgery

  1. T. Noguchi1,*,
  2. Y. Tsuchiya1,
  3. H. Itoh1,
  4. Y. Jinbu1,
  5. K. Tsukinoki2,
  6. S. Sarukawa3,
  7. Y. Sugawara3,
  8. I. Ohiwa4,
  9. M. Kusama1

Article first published online: 3 NOV 2011

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Influence of implant/abutment joint designs on abutment screw loosening in a dental implant system

Posted on: October 22nd, 2011 by 6th Avenue Periodontics No Comments

The objective of this study was to investigate the influence of implant/abutment joint designs on abutment screw loosening in a dental implant system, using nonlinear dynamic analysis of the finite element method (FEM). This finite element simulation study used two dental implant systems: the Ankylos implant system (Degusa Dental, Hanau, German) with a taper joint (taper joint-type model), and the Bränemark implant system (Nobel Biocare, Gothenburg, Sweden) with an external hex joint (external hex joint-type model). The nonlinear dynamic analysis was performed using three-dimensional finite element analysis. In comparing the movement of the taper type-joint model and external hex type-joint model, it was found that the external hex type-joint model had greater movement than the taper type-joint model. The external hex joint-type model showed rotation movement, whereas the movement of the taper joint-type model showed no rotation. It was concluded that the nonlinear dynamic analysis used in this study clearly demonstrated the differences in rotation of components in dental implant systems with taper or external hex joints. © 2005 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2005

  • Tsuyoshi Kitagawa1, Yasuhiro Tanimoto2,*, Misako Odaki1, Kimiya , Masahiro Aida1
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    Interventions for replacing missing teeth: dental implants in fresh extraction sockets (immediate, immediate-delayed and delayed implants)

    Posted on: October 14th, 2011 by 6th Avenue Periodontics No Comments

    Dental implants can be placed in sockets just after tooth extraction (immediate implants) or after a couple of weeks up to a couple of months (immediate-delayed implants) or thereafter (delayed implants). This review looked at which was the best time to place dental implants and whether it would be advantageous to augment sites with gaps present at implant placement. It also tried to determine the most effective bone augmentation procedure.

    The seven identified studies included too few patients to answer the questions. Four studies evaluated which is the best time to place implants. One study evaluated whether bone grafting is advantageous at implant placement and two studies evaluated which are the best grafting techniques.

    There is currently too little evidence to draw any reliable conclusions, however, the aesthetic outcome could be slightly better when placing implants early after tooth extraction, though early placed implants might be at a higher risk of failure. There is not enough evidence supporting or refusing the need of bone augmentation when extracted teeth are immediately replaced with dental implants, nor it is known whether any augmentation procedure is better than the others. Bone substitutes (anorganic bovine bone) can be used instead of self generated (autogenous) bone graft.

    The Cochrane Oral Health Group’s Trials Register (to 2 June 2010), CENTRAL (The Cochrane Library 2010, Issue 2), MEDLINE via OVID (1950 – 2 June 2010) and EMBASE via OVID (1980 – 2 June 2010) were searched. Several dental journals were handsearched.

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    Bone Grafting Techniques For Maxillary Implants

    Posted on: October 5th, 2011 by 6th Avenue Periodontics No Comments

    Implant rehabilitation using titanium screw-shaped implants has been an extremely important innovation as reported in numerous publications over the years. In the beginning of the implant era, the anterior mandible was the primary implant site because it demonstrated remarkably good results in long-term follow-up studies (Adell 1981; Albrektsson 1997). Long-term results point to the impressive stability and safety of the procedure. Over time, the use of implants in other sites such as the maxilla and posterior mandible have shown almost the same predictability (Adell implants are continuously introduced into the market, often with little or no scientific documentation; however, the screw-shaped implant has the longest and most reliable documentation available today. The mandible demonstrates the highest predictability of results, especially in the frontal region between the mental foramina. It is possible to consider immediate loading of the implants due to the mandible’s initial stability compared to the maxilla, which in most cases is considerably more problematic in relation to bone quality and quantity. Patients with poorer bone quality and less quantity of bone have been excluded from implant treatment for a long time. However, the advent of bone reconstruction of deficient areas, both in the mandible and the maxilla, has improved the possibility of treatment for the bone deficient patient. Different bone grafting techniques have been developed and orthognathic surgical procedures adapted to the special demands of implant surgery have meant that most bone problems can now be solved. One-stage techniques employ grafting and implant surgery in the same operative procedure, whereas two-stage techniques employgrafting and reconstruction in one procedure and implant surgery in second phase. Depending on the amount of bone graft necessary, the source for the graft can been chosen from different parts of the body.If only small amounts of bone graft are necessary for the implant site, bone may be harvested from the mandible or maxilla, for example, from the mandibular symphysis region, mandibular angle and ramus, maxillary tuberosita or adjacent to the implant site. Using bone collectors, it is also possible to filter out bone powder during drilling of the implant site. Bone substitutes or demineralized bone in combination  with autogenous bone material have also been shown to function well in alveolar bone reconstruction (Henry Bone grafts have been used in oral and maxillofacial surgery for a long time in for the reconstruction of the jaw bones to rectify facial deformities, for pre-prosthetic reconstruction, and also for reconstruction after trauma and tumour damage. Where the bone graft has been used as a bridge over bony defects or filling out defects, the results have been good, but when used as an augmentation material for preprosthetic reconstruction, more progressive resorption of the graft has occurred. Onlay bone grafting in connection with implant surgery was the first method developed to overcome the bone deficient maxilla, however, the graft in an onlay position with or without a denture on top of it has not been a predictable procedure (Gordh 1998). The graft was most frequently taken from the iliac crest, initially as a horseshoeshaped graft in one or two pieces. The graft was modeled to fit the alveolar crest and stabilized with the implants into the residual bone.  Surgical techniques for the rehabilitation of severe bone deficiencies in the maxilla are described and detailed illustrations of patient cases are provided. et al. 1996; Pinholt et al. 1992).   

     

    Kahnberg, K.-E. (2008) Frontmatter, in Bone Grafting Techniques for Maxillary Implants, Blackwell Munksgaard, Oxford, UK. doi: 10.1002/9780470759578.fmatter

     

     
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    Comparison of soymilk, powdered milk, Hanks balanced salt solution and tap water on periodontal ligament cell survival

    Posted on: September 28th, 2011 by 6th Avenue Periodontics No Comments

    Moazami F et al. – Statistical analysis showed that Hank’s balanced salt solution (HBSS), powdered baby formula, and soymilk maintain cell viability equally well in different periods of times. Tap water cannot keep cells viable as well as other solutions. Soymilk and powdered baby formula can be recommended as suitable storage media for avulsed teeth for up to 8 h.

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    Unhealthy Gums Can End in Heart Attacks,Say Experts

    Posted on: September 22nd, 2011 by 6th Avenue Periodontics No Comments

    You better start taking your oral health seriously because the trouble in your mouth could be a subtle indicator of something as grave as diabetes or even heart attack.

    City doctors revealed many such facts on the occasion of World Oral Health Day on Monday. Other than diabetes and heart disorders, they said mouth-related diseases could also be symptoms of hypertension, breathing problems, weakening of bones and even hint at a probable miscarriage in pregnant women.

    “Several studies have been done in the west in this regard. Women with poor gum hygiene are more likely to have miscarriages,” said Dr Achuth Baliga, head of the department of dental sciences in Manipal Hospital.

    He said pregnant women with gum diseases are seven times more likely to have a baby that is born prematurely or underweight. He added that these women’s babies might be born with physical anomalies.

    “The circulating bacteria from the mouth can harm the foetus,” he explained.

    There is more that poor health of gums suggests. Dr CD Dwarakanath, director of postgraduate studies and head of the department of periodontics (a field of specialisation in dentistry) at Oxford Dental College and Hospital, said gum diseases might lead to heart attack.

    He said in people suffering from periodontitis (a gum disease), the bacteria might enter the bloodstream while chewing or brushing and the bacteria could contribute to formation of clots in the arteries, thereby causing heart attack.

    He said research had shown that people with gum diseases are almost twice as likely to suffer from coronary artery disease when compared with people with healthy gums.

    Unhealthy gums have more warning about an unhealthy heart.

    Dr Baliga said tooth decay and gum disease for a long time could lead to inflammation of the inner lining of the heart’s chambers and heart valves.

    He said it could start with fever, anaemia and lead to formation of a blood clot.

    Oral health has a connection with diabetes too. Dr Dwarakanath said gum disease is often considered the sixth complication of diabetes. Diabetics are prone to have periodontal disease if their condition is not under control, he added.

    Osteoporosis—characterised by weak bones, decrease in the bone density—is another complication that is reflected in poor oral health.

    Dr Dwarakanath said loose teeth, severe gum disease and even difficulty in eating and speaking could be a sign of decreasing bone density, an advanced stage of osteoporosis. Osteoporosis’s symptoms often go unnoticed until a major fracture occurs.

    However, your dentist may be able to detect the early signs of osteoporosis during a regular dental exam.

    Studies show that the top oral health complaints in India comprise tooth decay, gum problems and bad breath. The oral health experts say a lot of people suffer from such complaints without being aware of it, letting the complication affect their quality of life

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    Bone-Creating protein could improve the success of dental implant

    Posted on: July 25th, 2011 by 6th Avenue Periodontics

    Using a bone-creating protein to augment the maxillary sinus could improve dental implant success, according to Georgia Health Sciences University researchers.

    Dental implants, screws that anchor permanent prosthetic teeth, won’t work if the bone in which they are anchored is too thin. Bone-thinning is a common cause and consequence following tooth loss. The current favored solution is to supplement the area with bone grafts to stabilize the implant base. But that technique is problematic “primarily because it involves additional surgeries to harvest the bone,” said Dr. Ulf M.E. Wikesjö, Interim Associate Dean for Research and Enterprise in the GHSU College of Dental Medicine.

    In animal studies, he and his team at the GHSU Laboratory for Applied Periodontal & Craniofacial Regeneration found that implanting bone morphogenetic protein in the sinus more new bone will form within four weeks than using conventional bone grafting at the same site.

    “We found that BMP induced superior bone quality over that following bone grafts, which improves the chances for successful implants,” Wikesjö said. “BMP is phenomenal, because it’s a true, off-the-shelf product with ease of use that can produce real results, and it could be the new gold standard for this procedure.”

    According to the American Association of Oral and Maxillofacial Surgeons, 69 percent of adults ages 35-44 have lost at least one tooth due to decay, disease or trauma, and 26 percent of adults have lost all permanent teeth by age 74. Before dental implants were available, the only options for replacing these missing teeth were dentures and dental bridges, both of which could lead to further bone loss. Implants provide patients with numerous benefits, including improved oral health, appearance, speech, convenience, durability and ability to eat.

    Source : Georgia Health Sciences University

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    Oral Cancer: The Scary Truth

    Posted on: July 11th, 2011 by 6th Avenue Periodontics No Comments

    Please watch Dr. Oz Explaining about the importance of Oral Cancer screening on at least yearly bases.

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    Uses For Dentures And Bridges

    Posted on: June 21st, 2011 by 6th Avenue Periodontics 9 Comments

    We’ve all seen the commercials where the dentures get dropped into the water with the fizzy cleaning material that takes all the bacteria, food particles and other debris off the dentures to leave a shinning, white set of teeth. The other one I like is the one where the lady is out on a date and is having trouble keeping her dentures to stay put and in her mouth. It’s all quite funny until you are faced with making a decision about what to do when you are missing a tooth or teeth.

    Most people these days, if they take good care of their teeth and see their dentist regularly as recommended, will keep most of their teeth during their lifetime. However, there are circumstances that include certain mouth and tongue cancers as well as accidents you never see coming that cause people to loose one or two teeth up to all of them. It’s during those times they have to make some pretty big decisions between the different types of bridges and dentures that are available today.

    Dentures replace the entire set of teeth and can consist of the upper teeth, the lower teeth or both. It’s extremely important to have dentures fitted well for comfort and so you can secure them without embarrassment. The main issue over time is that when your teeth are gone the gums area tends to shrink. When that happens, you may have to get the dentures refitted or made over altogether.

    They are not as easy to take care of either as you might be led to believe. You don’t want to leave them in water or chemicals because they can absorb the moisture and become soft. This means you have to take them out and clean them everyday to remove the food and debris. You also need to continue to brush your gums so they stay healthy as well. The healthier your gums the less they tend to shrink.

    Bridges are normally used when there is a tooth on either side of missing teeth. You can have one tooth missing or a few. Bridges are also sometimes permanent or “fixed” but can also be removable. It will be up to you, along with your dentist, to decide which one is right for your situation. Whatever you decide it is of the utmost importance that you continue to keep the bridge clean as well as the gum area around the bridge. People forget that even though you are missing teeth, you have to continue to clean both the appliance and the gums to avoid diseases that can affect it.

    Both dentures and bridges have a place as viable solutions to many dental issues. If you have to choose between having teeth and not having teeth, being able to get a set of dentures could not only add to the way you look but to your overall mental health and attitude. Being able to smile, eat and enjoy life with a mouth full of wonderful bright teeth cannot be replaced. So no matter how you have felt about those crazy commercials in the past, just know that there will always be a place for restorative bridges and dentures.

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