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Poster Presentation Abstracts P1 Effects of Platelet-rich Plasma and Platelet-rich Fibrin on Bone RegenerationintheTreatmentofBoneDefectsaroundImplants:An

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Poster Presentation Abstracts - osseo.org

Poster Presentation Abstracts P1 Effects of Platelet-rich Plasma and Platelet-rich Fibrin on Bone RegenerationintheTreatmentofBoneDefectsaroundImplants:An

Poster Presentation Abstracts

P1 P3

Effects of Platelet-rich Plasma and Platelet-rich Fibrin on Bone A Histological and Histomorphometrical Report of 4 Cases of Human
Regeneration in the Treatment of Bone Defects around Implants: An Dental Implants Retrieved after a 3 to 10 Years Loading Period.
Experimental Study in Dogs.
A. Piattelli*, G. Iezzi, M. Degidi, J. Shibli, G. Vantaggiato, V. Perrotti Chieti,
S. Kim*, K. Jeong GwangJu City, Republic of Korea. Italy.

The purpose of this study was to evaluate the effect of tooth ash and platelet Introduction: Only the biopsy of human retrieved implants allows a precise
rich fibrin (PRF) or platelet rich plasma (PRP) graft into bone defect around evaluation of the events occurring at the interface. Histological evidence of
implants in bone formation. Six adult dogs with the weight of 10-15 kg were osseointegrated implants is rare in the literature, especially after a period of
experimental subjects. Graft materials were made into particulate type. 48 functional loading of more than one year. Aim of this study was, then, a
tapered type implants with the diameter of 3.7 mm and the length of 10 mm histologic and histomorphometric analysis of the peri-implant tissues reactions
and the surface treated with hydroxyapatite (HA) coating were used as implant and of the bone-titanium interface in loaded ANKYLOS® implants (DENTSPLY-
fixtures and they were divided into two groups, a 4 weeks and a 8 weeks group. Friadent, Mannheim, Germany) retrieved from man after loading periods longer
Using trephine bur, four bone defects with the diameter of 8 mm and the depth than one year. Methods: The archives of the Implant Retrieval Center of the
of 5 mm were formed and implants were placed in the femur of adult dogs. Dental School of the University of Chieti-Pescara, Italy were searched for human
In the control group, bone graft was not performed. In the experimental group ANKYLOS® implants, retrieved after a loading period of more than one year. A
1, tooth ash was grafted. In the experimental group 2, mixture of tooth ash and total of four implants were found: one of these had been retrieved after three
PRP with the ratio of 1:1 by volume was grafted. In the experimental group 3, years (FRIADENT® plus surface), two after 3.5 years (FRIADENT® plus surface),
mixture of tooth ash and PRF with the ratio of 1:1 was grafted in defect area. and one after ten years (Deep Profile Surface - DPS®). All implants had been
After 4 and 8 weeks each, the dogs were sacrificed. Using Osstell™ mentor on loaded; two of them had been immediately loaded. In three cases, the implants
the time of placement and after the sacrifice, the implant stability was evaluated had supported a partial fixed bridge, while, in one case had supported an
and using histopathological examination, the amount and rate of new bone overdenture. Two of the implants had been retrieved for a fracture of the
formation was evaluated. In all groups, implant stability was increased superstructure, and the other two for peri-implantitis reason. Results: All these
significantly at the time after the sacrifice compared to the that at the time of implants were stable before retrieval. Compact, mature, lamellar bone, with few
placement. And implant stability was increased in experimental group 1 than and small marrow spaces, was present around the three implants retrieved
control group, experimental group 3 than group 1 and control group. But there respectively after three and 3.5 years. Many remodeling areas were present.
were no significant difference between experimental group 1 and 2, 2 and 3. Trabecular bone was present around the implant retrieved after ten years. The
As the result of histomorphometric examination, the new bone formation rate bone-implant contact (BIC) of the three best threads was 35% for the implant
in the experimental group 3 of the 4 weeks group was significantly higher than retrieved after ten years, 99% for the implant retrieved after three years, and
that in the control group. Also, in the 8 weeks group, the significant increase it was 100% for the other two implants. No untoward effects were present at
of new bone formation was confirmed in the experimental group 3. The new the interface and a very high BIC was present around the implants with the
bone formation between control group and experimental group 2 and 3 didn’t microstructured surface. Conclusions: The present data showed that these
show statistically significant difference. In this study, bone graft method using implants had the potential to maintain osseointegration under long term
the mixture of tooth ash and PRF was confirmed to increase new bone function, with continuous and ongoing bone remodeling.
formation compared to the method using PRP. In addition, it was confirmed
that this effect was more prominent in the initial stage of bone graft.

P2

Evaluation of Pain and Anxiety Levels Intraosseous Anesthesia using a
Computer Controlled System (Quicksleeper).

M. Yaltirik*, S. Ozer, I. Kirli, I. Yargic Istanbul, Turkey.

Intraosseous anesthesia becomes a popular anesthetic technique because
it allows a quick and painless anesthesia while soft tissue numbness does not
take very long. In contemporary dental practice, pain control is a term which
should apply to dental practice in its entirety and the first step toward this
aim is to achieve local anesthesia. The aim of this study is to evaluate anxiety
level, pain caused during Quicksleeper intraosseous injection (DHT, Cholet,
France) system which delivers computer controlled intraosseous anesthesia
in impacted mandibular third molars. 40 subjects with impacted mandibular
third molars randomly received intraosseous injection. Intraosseous injection
has many advantages such as enabling painless anesthesia, less soft tissue
numbness, quick onset of anesthesia and lingual and palatal anesthesia with
single needle penetration. Although it is a useful technique employed in
dentistry for many treatments and despite its many advantages, the duration
of injection takes longer than conventional techniques; there is a possibility
of obstruction at the needle tip in patients with higher bone density, and the
duration of the anesthetic effect is inadequate for lengthier surgical procedures.

64

Poster Presentation Abstracts

P4 P5

Matrix Metalloproteinases (MMP) -2, -3, -8, -9 and -13 in the Peri-Implant Simplified Fabrication Technique for Implant-supported Screw-retained
Soft Tissues around Titanium and Zirconium Oxide Healing Caps. All-Ceramic Crowns.

D. Bacchiocchi*, M. Degidi, L. Artese, N. Franceschini, S. Sulpizio, A. Piattelli, G. Schmidtler*, M. Karl Erlangen, Germany.
M. Piccirilli, V. Perrotti, G. Iezzi Castelfidardo (An), Italy.
Introduction: The advent of cost-effective copy milling systems for zirconia
Introduction: Aim of this human study was a comparative ceramic and the development of more translucent zirconia ceramic materials
immunohistochemical evaluation of Matrix Metalloproteinases (MMP) -2, -3, - allow for the fabrication of full contour restorations without using veneering
8, -9, -13 in the peri-implant soft tissues of titanium and zirconium oxide healing porcelain. Based on a patient situation with a single implant in the region of
caps. Methods: Five patients, three men and two women (age 30 to 66 years, the lower right first molar, this poster step by step describes the manufacturing
mean 49) participated in this study. All patients received 3.8 mm in diameter process of an implant-supported screw-retained all-ceramic crown by means
and 11 mm in length dental implants (DENTSPLY-Friadent, Mannheim, of copy-milling. Methods: Following osseointegration of the implant, an alginate
Germany). All implants were left to heal in a non-submerged (single-stage) impression is made with the healing cap in place. On the resulting cast, a
mode. Healing caps (3.8 mm in diameter and 3.0 mm in height) (DENTSPLY- denture tooth is positioned and a matrix is vacuum formed which can
Friadent, Mannheim, Germany) were inserted in all implants. Half of the implants subsequently be used for temporization. Following removal of the healing cap,
were supplied with standard, prefabricated caps of c.p. titanium, while the other a prefabricated screw-retained cylinder for provisional crowns is seated on
half were provided with test zirconium oxide caps. After a six-month healing the implant shoulder and the screw access channel is shortened accordingly.
period, a gingival biopsy was performed with a circular scalpel (5.5 mm in A provisional crown is fabricated intraorally using the vacuum formed matrix
diameter) around the healing caps of both groups, without unscrewing or and composite resin. The temporary crown is then removed from the provisional
removing the healing caps. Results: Statistically significant differences were cylinder and serves as master for copy milling of a full contour crown from
found in the values of MMP -8 in the cells of the inflammatory infiltrate, with presintered zirconia ceramic. Following staining and sintering of the zirconia
higher values for the titanium samples (p< 0.0291). Statistically significant higher ceramic, the crown and the provisional cylinder are joined with adhesive resin
values were found, also in the titanium samples, for the MMP-9 in the cement. The crown is seated applying the insertion torque recommended by
endothelial cells of the blood vessels (p< 0.0291). No statistically significant the implant manufacturer and the screw access hole is restored with composite
differences were found between all the other values. Conclusions: The present resin. Results: Functional rehabilitation of the patient could be achieved using
results showed that the soft tissues around the titanium healing caps underwent the procedure described. Compared to traditional fabrication techniques, only
a higher rate of restorative processes, most probably correlated to the higher one prefabricated implant component (provisional cylinder) is needed resulting
inflammation processes observed in these tissues, due to the higher amount in significantly reduced treatment costs for the patient. Conclusion: Although
of bacteria present around the titanium samples. it is possible to fabricate full contour crowns by using copy milling systems
for zirconia ceramic, the restorations have an opaque appearance what may be
seen as a limitation of the technique described. From a materials perspective,
following aspects have to be considered when using zirconia ceramic without
adding veneering porcelain: low temperature degradation of zirconia ceramic,
induction of predamage during adjustment of the prosthesis and decreased
flexural strength of zirconia ceramic resulting from staining.

P6

Histological Evaluation of Straumann® Bone-Ceramic Used in Maxillary
Sinus Lift.

R.R. Garcia*, L.G. Paiva, A.C. Batista, R.F. Rejane, L.C. Carvalho Goiania, Brazil.

Sinus lift to permit insertion of implants when alveolar residual bone height
is insufficient may be considered a safe and effective procedure. The original
protocol uses autogenous bone from intraoral or extraoral sources and is still
considered as the gold stantard. However, there are several disadvantages,
for example donor site morbidity the unpredictable resorption rate and the
limited amounts of intraoral bone available. For these reasons, new bone
substitutes have been sought and investigated as the alloplasts grafts. This
investigation was designed to evaluate and compare the behavior of a fully
synthetic biphasic calcium phosphate (BCP) consisting of a mixture of 60%
hydroxyapatite and 40% of b-tricalcium phosphate (Straumann® Bone-Ceramic)
to the autogenous bone graft (ABG) in maxillary sinus floor elevation procedure
prior to installation dental implants. Ten healthy patients who were partially
edentulous in the posterior maxilla and required implant placement for dental
rehabilitation were included in this study after informed consent and approval
of the Ethic Committe in Human Researchs. They were submitted to a unilateral
maxillary sinus floor elevation procedure, with grafting using either ABG (control
group; 5 patients) or BCP (test group; 5 patients). After 6 months of healing
implant sites were created and biopsies taken for histological analyses. A
primary stability was achieved with all dental implants after the biopsies.
Histological investigation showed a viable new bone tissue formed in 4 of 5
BCP specimens. Also, showed close contact between new bone and BCP
particles, in 4 of 5 specimens. In 1 of 5 BCP specimens no viable bone tissue
was found. Both ABG and BCP produced similar amounts of newly formed bone,
with similar histologic appearance, indicating that BCP is a suitable material for
sinus augmentation for the placement of dental implants. Also, the close contact
between new bone and BCP particles appeared to indicate the osteoconductive
properties of this synthetic graft material

MMP-13 Zirconium. High expression of the positivity, mostly at the level of the spinous
layer of the superficial epithelium. ABC 20 X

65

Poster Presentation Abstracts

P7 Figure 1: Panoramic radiograph of mandibular fixed dental prosthesis 28 years after
implant placement.
28-year Follow-up of a Screw-retained Fixed Dental Prosthesis Supported
by Six Branemark Implants: A Clinical Report. P8

I. Turkyilmaz* San Antonio, TX. An Experimental Study: Influences of Immediate Dynamic and Static
Loading to the Titanium Implants in Rats.
Purpose: The aim of this report is to present the clinical outcomes of
machined-surface implants supporting a screw-retained fixed dental prosthesis A. Yagihara*, R. Kawasaki, Y. Kawahara, A. Mita, K. Takakuda Koga, Japan.
(FDP) 28 years after the implant placement. A 62-year-old woman with a
maxillary complete denture and a mandibular implant-supported screw- Introduction: The aim of this study is to investigate influences of immediate
retained FDP presented to our clinic. The patient’s chief complaint was “I can dynamic and static loading around the titanium implants in rats. Materials
not bite well anymore and the denture teeth are stained”. She stated that she and Methods: 2 pure titanium implants were placed into every 18 male SD
wanted the denture teeth replaced. The patient indicated her teeth were (12 weeks old) rats’ left tibias. Distance between each implant was defined 5mm.
removed in her twenties due to caries and periodontal disease and that she Implant surface was cylindrical shape and diameter was 1.5mm. All implant
wore dentures prior to implant therapy. The patient indicated that she was access halls were drilled 1.6mm diameter. These rats were divided into 3 groups:
terribly unhappy with complete dentures due to the instability of the dentures, dynamic loading group (DL), static loading group (SL) and unloaded control
difficulty chewing, and pain particularly in the premolar area. In 1983, 6 dental group (UL). We used super-elastic springs which stimulate 3.92N total
implants were placed in the anterior mandible, and she received a screw- continuous load to SL group for 4 weeks. DL group was stimulated at 3.92 N
retained FDP. Follow-up: We reviewed her chart and noticed that, over the 28 with a frequency of 3 Hz for 1800 cycles, for 4 weeks. UL group stimulated no
years of service, she has had the following dental treatments: a new maxillary affect the rest period of 4 weeks after surgery. After the experiment, they were
complete denture in 1997; a denture tooth (maxillary right lateral) fractured sacrificed and tibial specimens were isolated with remained implants. We tried
and replaced in 2003; a denture tooth (mandibular right central) fractured pulling examination and evaluated X-ray, histological and histomorphological
and replaced in 2005; and a denture tooth (maxillary left central) fractured and measurements. Results: Pulling examination: SL strength was significantly
replaced in 2009.The oral examination revealed that the dental implants were increased compared to the others. Pull-out strength of the DL and UL were
stable and the peri-implant soft tissues were healthy. The denture teeth of both similar. X-ray evaluation: We observed bone resorption around UL and DL
the maxillary complete denture and the mandibular fixed restoration were worn implants. SL wasn’t observed. Histological results: DL and UL were observed
resulting in decreased chewing efficiency. The radiographic examination some bone formation and soft tissue intervention between implants. But SL
revealed an atrophic mandible, but minimal marginal bone loss after 28 years showed no intervention of soft tissue. Firmly bone formation was detected in
(Figure 1). The mandibular prosthesis was removed for the second time in 28 SL group. Moreover, bone formation around SL implants was observed on both
years, showing healthy gingival tissue underneath. The new denture teeth were sides of the loaded and unloaded side. Histomorphological measurements: We
arranged; then processed, finished, and polished. The mandibular screw- compared all groups about the rate of bone to implant contact. UL and DL were
retained FPD with new teeth and the maxillary complete denture with new inferior to SL. Conclusion: Within the limitation of this study, our results indicate
teeth were inserted. Conclusion: This clinical report shows that the dental that appropriate immediate static loading contributes to implant
implants can successfully support a screw-retained fixed dental prosthesis over osseointegration. However, it was found that immediate dynamic loading to
28 years, and implant-supported restorations can be the treatment of choice implant which has poor initial fixation adversely affects osseointegration.
in order to eliminate clinical problems of traditional removable dentures.
Acknowledgement: This study has been supported by Nobel Biocare Services P9
AG. Study code: 2011-1021
Different Designs of Maxillary Implant-supported Bar Overdenture
(Clinical Cases).

F. Alqahtani* Rahway, NJ.

Implant-supported bar overdenture are appropriate treatment choices for
patients with inadequate bone volume in the posterior maxilla to placed more
implant for fixed type of restoration. Computer-aided design/computer-aided
manufacturing (CAD/CAM) technology has broadened the scope and
application of those treatment options, allowing for ideal substructure design
for optimal esthetics and biomechanics. Fabrication of a maxillary implant-
supported milled titanium bar with attachments and an overdenture will be
described.

66

Poster Presentation Abstracts

P10 P11

Postoperative Perforation of the Schneiderian Membrane in Maxillary Effect of Implant Surface Properties on Peri-implant Bone Healing: A
Sinus Augmentation: A Case Report. Histological and Histomorphometric Study in Dogs.

J. Cheong*, K. Yoon, K. Park, J. Bae, K. Jo, J. Shin, J. Baik Seoul, Republic of K.S. AlHamdan*, S.H. Al-Moaber, R. Junker, J.A. Jansen Riyadh, Saudi Arabia.
Korea.
Aim: The present study aimed to evaluate and compare two types of
Maxillary sinus floor elevation with graft materials has been performed implants, i.e. grit-blasted and acidetched implants (SLActives) with nano-meter-
successfully over the past 3 decades. It is considered a safe treatment modality, scale hydroxyapatite surface-modified implants (NanoTitet). Material and
with few complications. Perforation of the Schneiderian membrane constitutes methods: For histological and histomorphometrical evaluation, 22 SLActives
a major intraoperative complication, but postoperative perforation of the sinus and 22 Nanotitet implants were inserted in eleven Beagle dogs. The animals
membrane is very rare. Management of postoperative perforation of the sinus were divided into three groups of healing (A: 2 weeks; B: 4 weeks and C: 8
membrane is more complex than that of perforation that occurs during sinus weeks). Two, 4 and 8 weeks after implantation, the animals were sacrificed
surgery, because the membrane cannot be repaired by direct vision after and bone-to-implant contact (BIC %), first implant–bone contact (1st BIC) as
surgery, and the bone graft material may be displaced into the sinus, causing well as amount of bone (BV) were assessed. Results: For SLActives and Nanotitet
sinusitis. This report describes the case of a patient who experienced implants, BIC% increased significantly over time. No statistically significant
postoperative perforation of the sinus membrane with infection of the graft differences in BIC% were found between SLActives and Nanotitet at all the
material. Once perforation was confirmed by radiography, drainage was respective implantation times.Moreover, for the different healing periods, no
performed and systemic antibiotics were administered. After the acute significant differences for BV between SLActives and Nanotitet implants were
inflammation had subsided, removal of the bone grafts and implant placement found. Conclusions: The present study showed that SLActives and NanoTitet
with the Caldwell-Luc operation was planned, but the perforated membrane implants induce a similar bone response after implantation for 2, 4 and 8 weeks
and bone graft appeared to return to the original position after 2 weeks without in a non-submerged position in the mandible of dogs.
apparent bone scattering into the sinus. The patient was therefore referred to
the otolaryngologist for sinus evaluation. Although the infection recurred once, P12
treatment was completed with hydrogen peroxide and saline irrigation and
removal of the drain. No further complications were observed, and the implants Success Rates of Implants Placed using a Staged Osteotome Technique
were exposed and restored as planned after 6 months. Computed tomography for Site Development in Sites with Less than 3 mm of Native Bone – 5
(CT) scanning was performed 1 year postoperatively and showed that the sinus Year Result.
mucosa was healed well, covering the graft material entirely. Thus, conservative
treatment may be considered one modality of treatment for postoperative M. Adami*, T. Kang, M. Fien, R. Korn Davie, FL.
perforation of the sinus membrane.
Introduction: The osteotome technique can be used during simultaneous
implant placement or to develop a site for future implant placement depending
on the residual bone height beneath the sinus. The purpose of the present
article is to evaluate the success rate of implants placed in the latter situation
after 5 years of function. Methods: 12 patients with 18 posterior maxillary
implant sites were treated with a staged approach. The mean preoperative
distance from sinus floor to alveolar crest was 2.1mm (range: 0 - 3.0mm). Site
development was completed using the osteotome technique and implants
were placed 4-6 months later. The technique was described by Kang (2008).
To briefly describe, an osteotomy was initiated with a 3 mm round bur and
the drilling ceased approximately 1mm short of the sinus floor or until the
shadow of Schneiderian membrane was visible. A 2.8mm-diameter osteotome
was used, under gentle malleting forces, to gently fracture the sinus floor.
Anorganic bovine bone mineral was placed into the osteotomy hole, and the
osteotomy was subsequently widened with 3.5mm-diameter and 4.2mm-
diameter osteotomes. For continuous and broad lifting of the sinus membrane,
the tip of 3.5mm-diameter osteotome was revolved/stirred in the sinus cavity
at the end. Existence of the membrane perforation was evaluated using 1)
Valsalva maneuver 2) presence of dome-shape radiopacity on the radiograph.
The observation period ranged from 24 months up to 60 months. The success
criteria proposed by Buser (1990) was used. Results: Postsurgical complications
such as headache, nasal bleeding or sinus infection were not reported in this
study. There were two possible perforation sites (11.1%) during the site
development. Consistent sinus elevation of more than 5mm (average: 7.5mm)
was achieved radiographically at the time of implant placement despite possible
shrinkage and remodeling during the healing period (4-6 months). All of the
implants placed achieved a good stability. All of the implants were functioning
and the success rate was 100% despite possible perforations. Conclusion: In
sinuses with minimal bone height (< 3 mm), the osteotome technique is a more
conservative and highly predictable approach to lifting the sinus floor for future
implant placement.

67

Poster Presentation Abstracts

P13 P14

Observation of Interproximal Papilla following the Application of the Immediate Dental Implant Restoration of Maxilla using “All-On-4”
Modified Roll Technique in the Anterior Maxilla. technique.

S. Sani*, J. Jung, M. Adami Davie, FL. J. Christman*, S. Malik, S. Kukunooru Davie, FL.

Introduction: The modified roll builds upon Abrams roll technique in that Introduction: The “All-on-4” dental implant procedure uses four implants,
it involves reflecting and preserving the epithelium that overlies the connective with the posterior implants angulated to take maximum advantage of existing
tissue pedicle and then uses the epithelial pedicle to cover the donor site. bone and reduce the need for grafting procedures. With only four implants,
This method maximizes the volume of CT rolled to the buccal aspect leaving patients can receive an immediate load provisional the same day of extractions.
the palatal bone covered. A drawback of this approach is that the buccal soft This results in an overall reduction in costs and treatment time. Materials and
tissue proximal to the mesial and distal sides of the augmented area tends to Methods: A 48 year old female presents with hopeless maxillary dentition.
flatten rapidly leading to compromised gingival esthetics. The purpose of this The patient reported a chief concern of not wanting to “wear anything
article is to discuss the changes of the interproximal papilla height over time removable.” CBCT scan revealed pneumatized maxillary ridges bilaterally that
as a result of including interproximal tissue into the incision design. Methods: would require lateral window sinus if implants were going to be placed in the
Patient presents a fixed acrylic provisional prosthesis with a buccolingual first molar sites. This particular patient was treatment planned for “All-on-four”
alveolar ridge defect of 5mm. Tooth to be replaced with an implant but because restoration of the maxilla. Two 4 x 15 mm implants were placed angulated
of inadequate buccolingual width in the alveolar ridge, soft tissue augmentation following the anterior border of the maxillary sinuses. They were inserted at an
was required to fill the defect and provide an esthetic outcome. The modified angulation of about 30–45 degrees relative to the occlusal plane. Two 4 x 13
roll technique was used but with the inclusion of the adjacent interproximal mm implants were placed in anterior region between the canine-lateral
tissues in an attempt to widen augmented area. Four months after implant positions. Angled abutments were placed on each implant to fit restorative
placement, connective tissue augmented from the palate was rolled over needs. A previously fabricated screw retained acrylic prosthesis was delivered
towards the buccal aspect and sutured laterally to stabilize the tissue. Patient’s the same day as surgery. Results/Discussion: The patient in this study was very
interproximal prepared margins on adjacent teeth will be used as a reference satisfied as she was able to have a fixed prosthesis the same day her teeth were
points to measure interproximal soft tissue height change (tissue height from extracted. All four implants have healed uneventfully and are well integrated.
prepared margin to an apical position). Results: Post-operatively the Patient has since received her final hybrid prosthesis. “All on four” can be
interproximal tissue was at the contact point giving a measurement of 0mm. considered a good option for those patients like the one presented in this case.
Patient presented one month post-operatively with some signs of edema and The number of implants was reduced from the classical formula of six to four.
no signs of lost papilla height. At 3 months post operative the tissue has fully Any type of sinus grafting was avoided. The tilted posterior implants improve
healed with no signs edema. Measurement from the contact point to apical the anterior-posterior spread of the final prosthesis. This will aid in reducing
extent of tissue shows 1 mm increase compared with the pre-operative unwanted distal cantilevers and improving load distribution. Conclusions: The
measurement. This shows a loss of 1mm interproximal soft tissue height. present technique can be suitable for patients who do not want the extended
Conclusions: In esthetically demanding cases where horizontal alveolar defects treatment time and cost associated with grafting procedures and additional
are present, the incisions for the modified roll technique should not include implants, but do want an immediate fixed solution.
the interproximal tissue of adjacent teeth and should be kept 1-2mm away to
avoid disrupting the blood supply to the osseous structure.

P15

Treating Peri-implantitis using a Combined Regenerative/Resective
Procedure.

A. Broderick*, B. Lorenz, W.B. Parker, C. Hsu, T. Kang Davie, FL.

Introduction: Peri-implantitis occurs due to various causative agents,
including unretrieved excess cement after restoring implants. Currently utilized
treatment modalities range from alterations to microflora within osseous defects
to surgically correcting the defects themselves. This case presentation
demonstrates the use of guided bone regeneration in combination with
selective resection to repair an osseous defect resulting from peri-implantitis.
Methods: The patient presented for implant placement and subsequent cement-
retained single crown restoration at the #4 position. At the 18-month post-op
visit, radiographs revealed bone loss in a pattern suggesting peri-implantitis.
Probing depths ranged from 8-10mm with moderate bleeding on probing and
suppuration of pus. Surgically exposing the coronal portion of the implant
revealed a circumferential osseous defect and buccal dehiscence surrounding
a piece of excess cement attached to the implant-crown interface. Mechanical
removal of the cement, GBR using FDBA and a Bio-Gide membrane, and minimal

68

Poster Presentation Abstracts

resection of interproximal bone peaks adjacent to the implant were performed.
Post-op prescriptions included chlorhexidine .12% rinse for two weeks and
amoxicillin 500mg tid for 10 days. Results: Three months after the corrective
surgery, a clinical examination was performed and radiographs were obtained.
Examination of the area revealed 1-2mm recession along the buccal surface
of the implant and adjacent crowns. Probing depths ranged 2-3mm at the
implant site and adjacent teeth with minimal bleeding on probing and no
suppuration. Radiographs obtained suggest bone fill of the circumferential
osseous defect. The combination approach of using both regenerative and
resective measures seems to have caused a resolution of peri-implantitis.
Conclusion: The results from this study suggest that peri-implantitis as a result
of excess restorative cement can be resolved by a combination of regenerative
(GBR using FDBA and resorbable Bio-Gide membrane) and resective (removing
osseous peaks from adjacent teeth) procedures. Although our results appear
to have achieved a state of health clinically, 1-2mm of recession was experienced
that was esthetically acceptable to the patient.

P16 P17

Different Methods for Increasing Keratinized Tissue around Implants in Comparison of Two Different GBR Approaches for Augmentation of the
the Maxilla and Mandible. Deficient Posterior Mandible.

A. Broderick*, D. Gober, W.B. Parker, S. Sani, T. Kang Davie, FL. A. Izarra*, M. Hernandez Davie, FL.

Introduction: Studies indicate that the presence of an adequate zone of Introduction: Guided bone regeneration is a well-established surgical
keratinized tissue is considered to be an important factor in the maintenance technique used for the augmentation of deficient alveolar ridges in areas where
of tissue health around implants. Bouri (2008) and Schrott (2009) suggested future implant placement is intended. Several approaches have been proposed
that implants with less than 2 mm of keratinized tissue were more likely to have in the literature and the purpose of this article is to compare two GBR
bleeding on probing and recession, despite good oral hygiene. The following techniques using different materials and performing different size cortical
two cases present different methods of increasing the zone of keratinized tissue perforations for increased blood supply. The approaches will be compared on
around implants using gingival grafts. Methods: Case 1: A 63 year old male the basis of their complications during the healing phase, amount of bone
(Patient A) presented for uncovery of 5 implants for a maxillary bar-retained volume regenerated through CBCT measurements, quality of bone at the time
overdenture. There was a lack of keratinized tissue on the facial aspect of these of implant placement, and short term implant success. Methods: A 60 year
implants. Because of the abundance of keratinized tissue on the palatal aspect old female presented with a Kennedy Class I partial edentulous mandibular
of the implants, a buccally displaced flap was designed and allowed to heal for arch and deficient volume of bone distal to the canines. Initial CBCT and bilateral
3 months. Case 2: A 72 year old male (Patient B) presented for uncovery of 3 GBRs were performed prior to implant placement. The right side received small
implants for a mandibular overdenture. The soft tissue around the implants was diameter decortications with Regenaform, BioGide, and tenting screws while
mobile and lacking in keratinized tissue with an inadequate vestibular depth. the left side GBR consisted of larger diameter decortications with FDBA,
A free gingival graft was placed on the buccal of the implants in conjunction Titanium mesh covered with BioGide, and fixation screws. Patient was followed
with the placement of healing abutments and allowed to heal for 3 months. through the healing period for complications and photo documentation. After
Results: Both patients were seen at 1 week, 2 weeks, 4 weeks and 3 months 4 months of healing, a post-op CBCT was taken to compare quantity of bone
post-operatively with no signs of delayed healing or infection. For patient A, before and after procedure and subsequently the sites were re-entered for
after 3 months of healing, an increased zone of keratinized tissue facial to the evaluation of bone quality and implant placement. Results: The patient
implants measuring 4 mm was evident. For patient B, the healing sequence presented at 1 week, 3 weeks, 6 weeks, and 16 weeks post op following both
followed that expected for a free gingival graft as described by Oliver et al treatments. Mild facial swelling was evident at 1 week post op with both
(1969). This included: surface epithelial degeneration, revascularization, techniques. There were no significant complications including signs of pain,
fibroblast proliferation, and re-epithelization of the graft. After 3 months of membrane exposure, or infection following both treatments. Clinical photos
healing, Patient A presented with a zone of immobile, keratinized tissue facial documented the healing sequence at these time intervals. Both sites were
to the implants measuring 3 mm and an increase in vestibular depth. amenable to implant after unevenful healing. Conclusion: Both GBR approaches
Conclusion: The importance of the zone of keratinized tissue and techniques are successful at achieving increased bone volume in deficient mandibles in
to increase this zone of tissue has been described. In the maxilla, where preparation for implant placement with minimal complications. As long as
keratinized tissue is available, a buccally positioned flap can be performed. In the biological principles of GBR are met bone augmentation may be possible
the mandible, where keratinized tissue is unavailable, a free gingival graft can regardless of approach utilized.
be performed. These procedures can predictably achieve a zone of peri-implant
tissue that is optimal for long-term health and maintenance.

69

Poster Presentation Abstracts

P18 was placed into the defect and covered with a nonresorbable membrane.
Primary closure was achieved. Augmented sites were allowed to heal for 6
Soft Tissue Augmentation with Palatal Pedicle Graft for Correcting months. Results: The patient presented for follow up visits at 1 week, 3 weeks,
Volume Deficiency at Maxillary Esthetic Region. 1 month, 3 months, and 6 months. The tissue appeared to heal unevenfully.
Gingival tissue looked pink and healthy during surgical removal of the
C. Park*, W. Seong, J. Delica, T. Kang Minneapolis, MN. membrane. Tissue thickness varied throughout in the grafted site, buccal and
lingual surfaces appeared thicker in comparison to crestal gingiva. Thin crestal
Introduction: Sufficient soft and hard tissue volume is prerequisite when gingival was probably affected since two pieces of membrane were used
restoring anterior esthetic region with dental implants. In case of insufficient compromising blood supply to this area. The augmented ridge maintained its
volume, it is challenging for clinicians to decide how and when to place implants width buccolingually throughout the study. Upon membrane removal,
for optimal result. The purpose of this case presentation is to illustrate how to regeneration of hard tissue (consistent with bone) was present and outer surface
augment tissue volume on anterior maxilla before placing implants. We focus covered with a fibrous connective tissue that measured ≤ 1mm. The defect
on staged corrective surgical procedures associated with managing insufficient induced by the tripodial implant had filled completely with a denser mass of
height and width for dental implant in an esthetic area. Methods: 32 year old hard tissue. It appeared that a hard material suggestive of bone had occurred
male, presented with an esthetic complaint regarding his maxillary incisors. up to the peaks of bone located on adjacent teeth. Using bovine bone mineral
Clinical and radiographic examination revealed inadequate gingival width and and growth factor with a nonresorbable membrane provided sufficient volume
height for an optimal esthetic result. The teeth in question showed mobility, of bone which will allow implant placement in an area without dehiscences
extrusion, prior root canal treatments, and severe root resorption. All three or fenestrations. Conclusion: Modification of the standard GBR procedure by
incisors were extracted with simultaneous soft and hard tissue augmentation. the addition of rhPDGF can provide clinicians with an additional approach to
Pedicle grafts spanning both sides of the palate were in the defect. Following augment alveolar bone defects for future implant placement.
extraction of teeth #8, 9, and 10, deproteinized bovine bone matrix was applied
to the defect and covered with the pedicle grafts. Six weeks later, tooth #7
was extracted and the patient received two implants at sites #7 and #10 for a
fixed restoration. Results: The patient presented postoperatively at 1, 2, 4, and
6 week without adverse post-operative sequale such as post-operative bleeding,
signs of infection, and pain. Significant gain in tissue volume was achieved in
the apico-coronal and bucco-lingual directions relative to pre-operative
measurements. The palatal pedicle flap blended perfectly with the surrounding
tissues. At 6 weeks after implant placement, soft tissue surgery was performed
to increase the depth of the vestibule and to move the mucogingival junction
apically. A partial thickness flap was sutured apically and the denuded site was
covered with an extracellular matrix membrane. Conclusion: Ridge deformities
due to tooth loss or trauma can significantly compromise esthetic results. The
pedicle graft is more advantageous than other soft tissue grafting methods
since it maintains vascularity. When there is a large defect on esthetic area,
the palatal pedicle graft can be in conjunction with implants to restore the
architecture and to get optimal esthetic results.

P19 P20

Bone Regeneration with rhPDGF in a Severe Defect Created by Tripodial Treatment of an Implant Apical Radiolucency: A Case Report.
Implants.
F. Rodriquez*, D. Alvarez-Rodriguez, M. Hernandez Davie, FL.
J. Lubin*, E. Kim, T. Kang Davie, FL.
Introduction: Periapical radiolucencies from preexisting infections and
Introduction: Scialom in 1970 advocated the use of multiple pins as necrosis of osteotomy site due to improper drilling technique can lead to apical
endossesous implants. This makes them impossible to keep clean and the result peri-implantitis. In this poster presentation, a case report for treatment of an
is plaque accumulation and periodontal breakdown. The purpose of this study osseointegrated implant with apical peri-implantitis will be described. Materials
is to describe several modifications to the standard guided bone regeneration and Methods: A 49-year-old female with nonrestorable, previously
(GBR) technique in achieving bone regeneration of a severe defect created by endodontically treated tooth #12. The tooth was extracted and grafted with
a tripodial implant. Methods: A 45 year old Hispanic male presented with a mix of bone bone mineral and freeze dried bone allograft (50%/50%). The
failing tripodial implant with an extensive defect on site #9. Probings ranged patient returned to have implant placed in site #12. She presented with an
from 10-12mm with bleeding on probing and suppuration. Vertical releasing apical periimplantitis after 4 months of healing. She presented with swelling
incisions were made on the distal line angles of tooth #7 -#10 followed by and a fistula on the buccal mucosa. Implant presented with normal probing
sulcular incisions. Buccal and palatal flaps were reflected and tripodial implant depths and no mobility. Patient was treated with “implant apicoectomy”
was removed. The defect was located on the buccal and palatal alveolar procedure. Briefly vertical incisions were made mesially and distally into
surfaces. A mixture of Bio-Oss collagen and TCP hydrated in rhPDGF (Gem-21S) vestibule. Full-thickness flaps were reflected and revealed a spherical area of
granulation tissue, approximately 7 mm in diameter, encircling apex of implant.
Granulation tissue along with 3 mm of the apical portion of the implant was
removed with a diamond bur and high speed handpiece with copious irrigation.
Bovine bone mineral was hydrated in sterile saline and mixed with 250 mg of
tetracycline and used to graft area. A Bio-gide membrane was trimmed and
placed over the grafted area. Primary closure was achieved with 4-0 vycril
interrupted and continuous sutures. Results: Area healed uneventfully with
no signs of inflammation or purulent exudates upon palpation. Gingiva appear
firm and healthy with no bleeding upon probing. No implant mobility was

70

Poster Presentation Abstracts

present. Radiographically, the grafted area appear more radioopaque with good
bone to implant contact extending around the apical region. The implant was
restored 6 months post-surgery .This conservative approach has been effective
and has maintained the implant in function one year after treatment Conclusion:
This case showed it was possible to treat apical peri-implantitis and salvage the
implant due to the fact that the implant was osseointegrated and the infection
remained apically compartmentalized. Also the implant was of a sufficient
length to allow for removal of its apical portion without jeopardizing stability.
This case report illustrates an effective procedure for treatment of an implant
with apical peri-implantitis based on these criteria.

Introduction about SLD Technique.

P21 P22

A Radiographic Study on the Changes in Height and Density of Grafting Prosthetic Solutions for Implant Cases with Complications - Case Series
Materials after Water-Lift System using SLD (Sinus Lift Drill) Kit.
F. Bouzanis*, A. Pedrol, J. Beley, T. Suzuki, I. Chikunov, T. Giugliano, S. Cho,
S. Han*, S. Yim, S. Yim, C. Chung, K. Hong, Y. Kim, H. Shin Cheon-an, Republic S. Froum, M. Bloom New York, NY.
of Korea.
Today, various hard and soft tissue augmentation techniques are available
Recently, maxillary sinus elevation using hydraulic pressure (crestal to allow the placement of implants even in the most challenging sites and help
approach) was developed to minimize the perforation of schneiderian the clinician in achieving an ideal implant placement. The prosthetic restoration
membrane and postoperative discomfort of patients. The aims of this study is of implants is often compromised, delayed or modified from the initial
to evaluate the difference of success rate in gender and implant design of treatment plan due to a number of problems that may be encountered. These
implantation, changes in bone density over time and radiographic changes complications can be surgical or restorative in nature, and may appear prior to,
in bone graft height in SLD Tech.: a kind of maxillary sinus elevation Tech. using or following loading of the restoration. The purpose of this retrospective study
hydraulic pressure. Materials and Methods. The subjects of this study were 97 is to present the surgical and prosthetic treatment of a series of complex implant
implants of 30 patients who were treated with maxillary sinus elevation using cases and discuss how the complications affected the overall treatment
SLD Tech. simultaneous implant placement. Following results were obtained sequence. The data and cases in this retrospective study will be obtained from
over time for 2 years after implantation. Results 1. The success rate of Implant the records of patients who underwent surgical and restorative implant
procedure with SLD Tech. showed 96.90% (94/3) between 13~24 month treatment at the New York University College of Dentistry Department of
(number of survival implants/ number of failed implants). 2. In success rate, Periodontology and Implant Dentistry and were entered in the Implant
men showed 95.31% (61/3), women showed 100% (33/-) of the cases and Dentistry Database which was approved by the NYUCD Office of Quality
straight form implant showed 96.42% (81/3), root form implant showed 100% Assurance. Twenty implant patients that required extensive surgical and
(13/-) of the cases. 3. BL/IL ratio decreased over time from 1.12 at implantation restorative treatment were included in this study. The parameters that were
to 1.09 at 2 years after implantation, but these changes were not statistically studied included the implant type, number and location, the surgical protocol
significant (BL: Bone length, distance from implant platform to base of Max. that was utilized and the restorative procedures and the complications that
sinus elevated by graft materials, IL: Implant length, distance from implant required treatment. The Results and Conclusions of this study will be reported
platform to apex). 4. The density of grafting materials over time showed following New York University Institutional Board of Research Associates
statistically significant increase from 126.33 at implantation to 157.88 at 2 years approval.
after implantation (p<0.05). From the result of above, in the case of maxillary
sinus elevation using SLD Tech. simultaneous implant placement, bone graft P23
was well maintained around the implant during study period and 96.90% of
implant success rate was shown between baseline and 13~24 month. Also, Various Surgical Techniques to Reduce Excessive Soft Tissue after Stage
Results from 13~24 months follow-up showed low resorption rate of grafting 2 Surgery Prior to Final Restoration.
materials and increase in bone density. Conclusions In this study, maxillary sinus
elevation using hydraulic pressure simultaneous implant placement seemed to O. Filippa*, C. Naoumis, F. Tayebaty, M. Yacker, S. Cho, S. Froum, M. Bloom
be stable clinically and radiographically. Therefore, it is judged to be useful New York, NY.
for implantation in max. edentulous regions.
Long term success of dental implants is indicated by bone as well as soft
tissue integration. Severely resorbed ridges often present thick and movable
mucosa. The presence of a loose mucosa adjacent to dental implants oftentimes
favors the ingress of bacteria and increase susceptibility to inflammation. In
addition, when this type of mucosa is associated with other factors such as a
shallow vestibule, hygiene procedures may become more difficult with
subsequent increase in plaque accumulation. Therefore it is of critical
importance to reduce excessive soft tissue while establishing an adequate
vestibule and a dimensionally stable band of keratinized tissue. The purpose
of this case series is to present and discuss different techniques in order to
create more attached mucosa while reducing pocket depths. The goal of these
procedures is to create an epithelial seal around the dental implant that is
less prone to infectious diseases like perimucositis and periimplantitis. The data
and cases of this retrospective study will be obtained from the records of

71

Poster Presentation Abstracts

patients who underwent maxillary and mandibular soft tissue reduction preserving buccal bone plate are crucial for the success of these cases. In fact,
procedures after stage 2 (abutment insertion) surgery prior to final restoration several authors have high-lightened the importance of the integrity of these
at the New York University College of Dentistry Department of Periodontology factors, discouraging the use of IIPIP when the facial soft tissue or the buccal
and Implant Dentistry and were entered in the Implant Dentistry Database bone were not ideal. However, some sockets meeting the previous inclusion
which was approved by the NYUCD Office of Quality Assurance. Three criteria can represent considerable difficulties during the placement of the
consecutive cases from the data base of NYU Implant department treated for implant including: slippage of the drill, angulation problems, achievement of
excessive mucosa following stage 2 surgery will be included in this case series. primary stability. Therefore precise surgical and restorative techniques are
The Results and Conclusions of this case series will be reported following New necessary for the success of IIPIP. The purpose of this case series is to discuss
York University Institutional Board of research Associates approval critical factors as well as case selection and present a surgical technique using
a new guiding device for predictable IIPIP. The data and cases in this case series
P24 were obtained from the records of patients who underwent IIPIP and were
entered into the Department of Periodontology and Implantology in the NYUCD
Applications and Fabrication of Chair-side Provisional Restorations Office of Quality Assurance approved Implant Dentistry Database. Ten patients
Utilizing Acrylic Shell with Alginate Impression. were included in this case series. They were clinically and radiographically
examined at the end of the surgical procedure to assess the primary stability
T. Suzuki*, M. Suzuki, Y. Yu, R. Trushkowsky, D. Galasso, S. Cho, S. Froum, of the implant and the possibility of immediate provisionalization. All ten
M. Bloom New York, NY. implants received a provisional restoration at the time of implant placement.
Survival rate, success rate and possible complications will be discussed. The
The provisional restoration is a critical part of successful implant treatment. Results and Conclusions of this study will be reported following New York
It allows restoration of the integrity of the dental arch, occlusal stability for University Institutional Board of Research Associates approval.
the opposing arch, restoration of masticatory function, proper speech and
esthetic substitution of the missing dentition. The purpose of this case series P27
is to describe the step by step procedure using a shell technique to fabricate
chair-side provisonals and to discuss the indications, contraindications, The Use of CT-scans to Guide Implant Placement Lateral to the Inferior
advantages and limitations of this technique. The data and cases from this case Alveolar Canal.
series will be obtained from the records of patients who underwent fabrication
of chair-side provisional restorations utilizing acrylic shells with alginate H. Kang*, D. Zangrandi, W. Hong, Y. Yoon, W. Kye, S. Cho, S. Froum, M. Bloom
impressions from the Department of Periodontology and Implantology in the New York, NY.
NYUCD Office of Quality Assurance approved Implant Dentistry Database. The
Results and Conclusions of this study will be reported following New York Implant placement is challenging in the severely atrophic posterior
University Institutional Board of Research Associate approval. mandible due to the proximity of mandibular canal. Several procedures have
been reported to overcome this anatomical limitation. These include guided
P25 bone regeneration, block grafting, distraction osteogenesis, use of short
implants, lateralization of mandibular nerve and placing implant lateral to
Histomorphometric Evaluation of the Healing Response Following Intra- mandibular canal. The latter has been used sparingly due to possible damage
oral Autogenous Block Grafts - Case Series. to inferior alveolar nerve. The purpose of the present study is to evaluate CT-
scan images to determine the amount of bone available for implant placement
L. Pariente*, J. Nehleber, J. Amzalag, J. Jimenes, O. Termechi, S. Cho, S. Froum, lateral to the inferior alveolar canal relative to the location of the mandibular
M. Bloom New York, NY. canal. The data and cases in this study will be obtained from the records of
patients who underwent implant placement in the posterior mandible area on
Dental implant restorations have been documented to have a high degree the Department of Periodontology and Implantology in the NYUCD office of
of success for completely and partially edentulous patients. However, horizontal Quality Assurance approved Implant Dentistry Database. The Results and
and/or vertical alveolar bone loss in fully and partially edentulous patients Conclusions of this study will be reported following New York University
constitutes a major challenge for implant placement. Many techniques are Institutional Board of Research Associates approval.
available today for the surgeon to rebuild lost bone: these include use of guided
bone regeneration, an allograft block, distraction osteogenesis and autogenous P28
onlay grafting. The latter is one of the most well-documented procedure for
regenerating bone in both horizontal and vertical dimension, thus allowing Comparison of Various Socket Preservation Techniques – A Literature
successful implant placement. The purpose of this report is to present the Review.
histomorphometric evaluation of the healing response following autogenous
block graft, analysis of the implant survival rate and potential complications for A. Hochstein*, A. Pérez, J. Wang, G. Kim, S. Froum, S. Cho, S. Froum,
this procedure. The data and cases for this case series were obtained from the M. Bloom, R. Schoor New York, NY.
records of patients who underwent autogenous block grafting procedures and
were entered into the Department of Periodontology and Implantology NYUCD It is well documented that the alveolar ridge undergoes resorptive changes
Office of Quality Assurance approved Implant Dentistry Database. Ten block following tooth extraction. Numerous techniques have been proposed to arrest
grafts harvested from the mandibular ramus and symphysis were used to or minimize these alveolar changes after tooth extraction in order to provide
augment partially atrophied ridges. Five maxillary defects and five mandibular an adequate volume of bone for implant placement. The purpose of the present
defects were treated in 8 patients. After 3.5 to 11 months of healing 22 implants literature review is to compare the efficacy of various post-extraction socket
were placed in grafted sites. At the time of implant placement a bone core was grafting techniques in humans. A MEDLINE/PubMed search will be conducted
taken and sent for histomorphometric evaluation. The Results and Conclusions of articles from peer review journals published from 1999 to August 2011 which
of this study will be reported following New York University Institutional Board will be assessed to complete this study. Additional data and cases in this
of Research Associates approval. literature review will be obtained from the records of the Department of
Periodontology and Implantology from the NYUCD Office of Quality Assurance
P26 approved Implant Dentistry Database. The Results and Conclusions of this study
will be reported following New York University Institutional Board of Research
Use of a New Guide for Predictable Immediate Implant Placement and Associates approval.
Provisionalization.

M. Tran*, H. Wu, M. Mitsias, C. Stappert, S. Cho, S. Froum, M. Bloom New
York, NY.

Immediate post-extraction implant placement has gained great acceptance
due to the advantages that it provides. These includes similar predictability
as delayed implant placement in healed sites, preservation on the peri implant
soft and hard tissue, a decreased time saved in surgical procedures and patient
satisfaction. One of the most critical considerations for immediate implant
placement and immediate provisionalization (IIPIP) to be successful is case
selection. It has been reported that factors including facial soft tissue and

72

Poster Presentation Abstracts

P29 maxilla from the Department of Periodontology and Implant Dentistry in the
NYUCD Office of Quality Assurance approved Implant Dentistry Database. Ten
Pre-extraction CT-scan Evaluation of the Maxillary Anterior Teeth to posterior partially edentulous cases from the database with posterior maxillary
Determine the Applicability of Immediate Implant Placement. atrophy were included in this study for single implant placement. The
population consisted of 4 male and 6 female patients with a mean age of 52
A. Perez-Asenjo*, A. Elkhaweldi, A. Kamer, S. Cho, S. Froum, M. Bloom New years (range 44 to 62). All 10 implants placed survived for a period of up to 9
York, NY. months following loading. The mean bone height gain was 6.92mm (range
4.67-8.61mm). The crestal bone loss around the implants from time of
Immediate implant placement with immediate provisionalization (IIPIP) has placement to the final follow-up was averaged 0.8mm (range of 0.31-1.47 mm).
been documented to be a successful procedure. Several extraction socket Simultaneous implant placement with sinus augmentation with the new
criteria have been identified in the literature as favorable for this technique. technique described in this report resulted in clinically successful outcomes
Most of these studies have focused on the labial soft tissue anatomy and the and suggests that this technique is a safe and predictable treatment modality
crestal buccal bone condition. However, another critical factor for successful in selected cases with posterior atrophic maxilla.
IIPIP is achieving adequate primary stability. This initial stability is obtained
through the palatal socket wall. Therefore it is important to consider the P32
preexisting condition of the bone present in the palatal area, as well as the
buccal bone and soft tissue present prior to tooth extraction. The objective of Selection Criteria for Techniques to Remove Hopeless Integrated
the present report is to propose a new categorization of extraction sockets Implants: Case Series.
for immediate implants which will include the condition of the palatal bone.
The classification is based on an ideal implant position as determined through K. Kim*, N. Aronna, R. Kelly, T. Yamanaka, J. Navarro, R. Eskow, S. Cho,
implant simulation, utilizing computer tomography (CT) scan images. The data S. Froum, M. Bloom New York, NY.
and cases in this retrospective study will be obtained from the records of the
Department of Periodontology and Implantology from the NYUCD Office of Due to implant failures, including malpositioning, fracture and advanced
Quality Assurance approved Implant Dentistry Database. One hundred CT-scans peri-implantitis, integrated implants oftentimes require removal. The purpose
will be randomly selected of patients that did not receive orthodontic or of this study is to evaluate the various surgical options to remove failed but
periodontal treatment. The six upper anterior alveoli (from canine to canine) immobile implants and to discuss the limitations and complications that may
will be evaluated. Measurements will be performed using Simplant software in arise with these removal methods. The data and cases in this retrospective study
a cross-sectional view and by virtual placement of a parallel-sided implant with will be obtained from the records of patients who underwent removal of
a 3.25mm diameter and a minimal length of 10mm, that include at least 3-4mm hopeless integrated implants on the Department of Periodontology and
of bone-to-implant contact bucally and 1mm palatally. The Results and Implantology in the NYUCD office of Quality Assurance approved Implant
Conclusions of this study will be reported following New York University Dentistry Database. The Results and Conclusions of this study will be reported
Institutional Board of Research Associates approval. following New York University Institutional Board of Research Associates
approval.
P30
P33
Accuracy and Limitation of Computer Guided Surgery - A Literature
Review. Utilizing Narrow Diameter Implant as Tent Pole for Vertical Ridge
Augmentation – Case Series.
J. Tomas Bueno*, N. Panday, E. El Chaar, P. Mascarenhas, S. Cho, S. Froum,
M. Bloom New York, NY. M. Oleaga*, A. Elzer, D. Gallego Rivero, C. Yu, J. Yip, S. Cho, S. Froum, M.
Bloom New York, NY.
The criteria for successful implant therapy include osseointegration as well
as optimal implant positioning for the fabrication of an esthetic and functional Implant placement requires an adequate amount of bone volume, in height
restoration. Improving the accuracy of dental implant placement thereby and width. Alveolar ridge augmentation using particulate bone grafts to
increases the opportunity for prosthetic success, this has led to the increased augment alveolar ridge defects prior to implant placement is a predictable
application of computer aided implant surgery (CAIS) in the field of implant method. However, large vertical and severely atrophic edentulous segments
dentistry. These modalities use computer software to develop programs which may require space maintainers preserving the volume gained preventing the
aim to assist the placement of implants in the desired position. It has been collapse of the bone graft and tissues. The purpose of this study is to evaluate
shown that CAIS increases the accuracy of implant placement. These guided the effectiveness of using narrow diameter implants in combination with
techniques require a computer generated surgical template and navigation- particulate mineralized allograft, in a “tenting” fashion, to augment large vertical
based protocol. The purpose of this literature review will be to 1) evaluate the alveolar ridge defects for implant placement. The data and cases in this study
accuracy of CAIS and 2) evaluate the uses of CAIS as diagnostic and treatment will be obtained from the records of patients who underwent ridge
aids 3) discuss the advantages, disadvantages, indications, contraindications augmentation using the “tent pole” technique and were entered into on the
and possible complications of CAIS. A MEDLINE/ PubMed search will be Department of Periodontology and Implantology in the NYUCD Office of Quality
conducted and the literature from September 1986 to September 2011 Assurance approved Implant Dentistry Database. The Results and Conclusions
reviewed and assessed for appropriate studies. Additional data and cases in of this study will be reported following New York University Institutional Board
this literature review will be obtained from the records of patients who of Research Associates approval.
underwent implant placement procedure on the Department of Periodontology
and Implantology in the NYUCD Office of Quality Assurance approved Implant P34
Dentistry Database. The Results and Conclusions of this study will be reported
following New York University Institutional Board of Research Associates Use of Implant Supported Orthodontic Movement to Enhance Soft
approval. Tissue Aesthetics.

P31 S. Ghamid*, G. Fishchgrung, K. Lin, D. Hasso, E. Rosenberg, S. Cho, S. Froum,
M. Bloom New York, NY.
A New Osteotome Technique in Atrophic Posterior Maxilla – A Case
Series. The purpose of this paper is to present a literature review comparing the
different types of orthodontic tooth movement technique, and to understand
R. Cayarga*, I. Khouly, A. Einhorn, M. Shabeesh, G. Bianco, V. Tang, S. Cho, their role in implant dentistry. Additionally, a new approach to reestablish a
S. Froum, M. Bloom New York, NY. missing papilla between a tooth and implant will be described, utilizing an
implant as the anchorage device for the orthodontic movement of an adjacent
The purpose of this case series is to evaluate the clinical success of placing natural tooth. Articles from peer reviewed journals published in English from
implants in the atrophic maxilla using an innovative surgical approach. Implant January 1970 to Aug 2011 were collected from a search performed using
survival, morbidity and complications were evaluated. Case selection criteria PubMed at the Waldman Library at the NYUCD Kriser Dental Center. The key
will be discussed as well as the advantages and disadvantages of this technique. words utilized will be “forced eruption” (593), “orthodontic extrusion”(511),
All cases in this series were obtained from the records of patients who “orthodontic intrusion” (386), “tooth site development” (417). Thirty articles from
underwent sinus augmentation and implant placement on an atrophic posterior the literature search that satisfied the inclusion criteria were selected. Based on

73

Poster Presentation Abstracts

the available literature, orthodontic extrusion of non restorable teeth prior to P38
implant placement appears to be a viable alternative to conventional surgical
bone augmentation for implant site development since there is less damage WITHDRAWN
to the tissue. In addition, when used as described, extrusion can effectively
move the papillae coronally to allow improved aesthetic restoration of implants P39
placed in extruded tooth position. A combination of extrusion and intrusive
movements on a tooth adjacent to an osseointegrated implant is presented Effect of a Modified Stepped Osteotomy on the Primary Stability of
as a viable solution in order to enhance missing interdental tissue. Dental Implants in Class D4 Bone: A Cadaver Study.

P35 C.M. Boustany*, H. Reed, M. Richards, G. Cunningham Englewood, WV.

A Surgical Guide to Place Implant in Proper Inter-implant Distance and Objectives: The aim of this study was to examine the effect of an alternative
Angulation. surgical technique on endosseous dental implant stability parameters in Class
D4 Bone. Materials and Methods: CT scans were taken on sixteen cadaver heads
Y. Fukuoka*, T. Tsutsui, S. Cho New York, NY. to determine implant sites and Hounsfield units (HU). A total of 22 implants
were placed in maxillary bone sites with Misch Class D4 bone. The control group
The immediate loading protocol involves both surgical and restorative received 11 conventional osteotomies and the test group 11 modified stepped
phases. This is a complex procedure requiring implant provisionalization on the osteotomies. The maximum insertion torques (IT) were recorded with the
day of the surgery. Therefore various techniques have been introduced to make Zimmer™ implant motor and confirmed with the Thommen™ torque driver. The
this procedure less technique sensitive, less time consuming, more accurate implant stability quotients (ISQ) were measured with the Osstell Mentor™.
and more predictable. The purpose of this case series is to demonstrate an Significant differences were analyzed with a Wilcoxon Signed Rank Test and
innovative paralleling device and a step by step surgical and prosthetic correlations were analyzed with the Pearson Correlation Test. Results: Maxillary
approach for achieving buccolingual and mesiodistal parallelism of immediately cadaver bone utilized in this study ranged from 173.4 – 312.1 HU. The mean
loaded implants. insertion torque in the conventional osteotomy group was 15.91 Ncm and in
the modified stepped osteotomy group 26.82 Ncm. A Wilcoxon Signed Rank
P36 test demonstrated that the modified stepped osteotomy had a significantly
greater mean insertion torque than the conventional osteotomy (S = 33.00 p
Long-term Evaluation of Success of Narrow Diameter Implants in Esthetic = 0.0010). A Wilcoxon Signed Rank test showed no significant difference
Areas - Case Series. between ISQ in the control and test group (S = 17.00, p = 0.01475). Pearson
correlations showed a significant positive correlation between the insertion
F. Fisselier*, M. Roge, C. Munoz Torrijos, M. Natour, S. Cho, S. Froum, torques in the control group and test group (r = 0.817, p = 0.0021). Significant
M. Bloom New York, NY. correlation between the ISQ in the test group and HU were found (r = 0.7099,
p = 0.0144). No other significant correlations between HU, IT and ISQ were
Narrow diameter implants (NDIs) were originally introduced as transitional found. Conclusion: Within the limits of the study, the following conclusion can
implants that were used in patients undergoing implant therapy to avoid be drawn: The modified stepped osteotomy resulted in significantly greater
removable provisional dentures. These enabled the patient to wear a fixed implant stability in terms of insertion torque (IT) than the conventional
appliance while reducing the risk to bone grafts by avoiding transmucosal osteotomy in Misch Class D4 bone. Significant correlations were found between
loading during the healing period. The transitional NDIs were ultimately the insertion torque (IT) produced in the modified stepped osteotomy and
intended to be removed. However, these implants became osseointegrated and bone density (HU). No significant correlations were found between insertion
showed a bone to implant contact similar to that of implants with conventional torque (IT) and implant stability quotient (ISQ).
diameters. This leads to clinical indications for permanent use of NDIs. In fact,
the success rate of NDIs as permanent implants has reported to be high. The P40
purpose of this report is to discuss the long-term success, indications and
esthetic results of NDIs. The data and cases in this retrospective study will be Radiographic Evaluation of Bone Behavior in Relation to the Depth of
obtained from the records of the Department of Periodontology and the Line of Marginal Cementation of Prostheses on Cone Morse Implants:
Implantology from the NYUCD Office of Quality Assurance approved Implant Experimental Study in Dogs.
Dentistry Database. The Results and Conclusions of this study will be reported
following New York University Institutional Board of Research Associates F.H. Stancari*, M.R. Araujo, A.R. Souza, R.F. Silva, R.M. Oliveira, D.M. Castro,
approval. C.M. Benfatti, A.B. Miranda, M.A. Laurent, C.P. Araujo Bauru, Brazil.

P37 Little is known about the behavior of the peri-implant bone tissue after
cementation of prosthetic implant. The aim of this study was to evaluate,
Simple and Predictable Immediate Loading - Case Series. through radiographic analysis, the effect of the depth of the crown cementation
line position on the bone response around Cone Morse implants. Five dogs
A. Bandar*, K. Konstantinidis, D. Suto, S. Kim, S. Cho, S. Froum, M. Bloom were used and had all their lower premolars extracted in the first stage surgery.
New York, NY. After three months, a second surgical procedure was performed in which was
used the technique of immediate loading, installing together implants and
The purpose of this case series is to demonstrate an innovative paralleling abutments. Thirty implants were installed at a depth of 3 mm below the bone
device and a step by step surgical and prosthetic approach for achieving level and they were equally divided between the Control and Experimental
buccolingual and mesiodistal parallelism of immediately loaded implants. group. The abutments had different transmucosal dimensions of 1.5, 3.5, and
Clinical outcomes including success rates, indications, advantages, 5.5mm. This meant that the depth of cementation line was positioned
complications, and limitations of this technique in cases using an immediate respectively to 1.5mm below the bone level, 0.5 above the bone level and
loading (IL) protocol will be discussed. The data and cases in this retrospective 2.5mm above the bone level. In the Control group, only the installation of
study was obtained from the records of patients who underwent immediate implants and abutments was performed. In the Experimental group, the
loading procedures at the New York University College of Dentistry Department installation of implants and abutments were performed and, over these, were
of Periodontology and Implant Dentistry and were entered in the Implant cemented cylinders of alumina. Periapical radiographs were taken, using the
Dentistry Database which was approved by the NYUCD Office of Quality paralleling technique, in all phases of the experiment. The radiographs were
Assurance. Thirteen consecutive cases from the database that were treated with scanned and analyzed with the AutoCAD software. The differences between
an IL protocol utilizing a paralleling device were included in this study. The the depths of cementation line position were evaluated through Student “t”
treatment sites included the interforamina area in 8 totally edentulous and 5 test of independent samples with the level of significance of p<0.05. The results
partially edentulous mandibles. In this case series the average survival rate was showed no statistically significant differences between the Control and
98.4% with a loading period of 6-28 months. There was one implant failure, one Experimental group at different depths in relation to bone tissue, both at the
provisional restoration fractured and two cases with cement wash out during mesial (P=0.18; Mean=-0.19; SD=0.14) and the distal faces (P=0.50; Mean=-0.09;
the follow-up period. Results of this case series demonstrated that implant SD=0.13) of the implantes. Within the limits of this study it can be concluded
placement in optimal position and angulation using the suggested IL protocol that, in dog mandibles, different depths of cementation line position were
and paralleling device produces predictable results. It is also simpler, faster and not able to influence the behavior of marginal bone around Cone Morse
more cost effective than the screw-retained protocol. implants.

74

Poster Presentation Abstracts

Experimental and Control Groups

P41 P42

Achieving Optimal Aesthetics for Implant-supported Restorations via CAD/CAM Zirconia Implant Fixed Complete Prostheses: Clinical
Surgical and Prosthetic Modalities. Outcomes and Complications after Mean Observation of 3 Years.

M. Nguyen*, A. Ntounis, P. Vassilopoulos Birmingham, AL. P. Papaspyridakos*, K. Lal New York, NY.

INTRODUCTION: A successful implant restoration in the esthetic zone is a Purpose: To report on the clinical outcomes and technical complications
challenging procedure. Proper emergence profile of an implant -supported with computer-assisted design/computer-assisted manufacturing (CAD/CAM)
restoration is important for hygiene and aesthetics. Several techniques have zirconia, implant fixed complete prostheses (IFCPs) after 2- to 4 years in function.
been described for creating a favorable emergence profile around implant Materials and Methods: Fourteen consecutive edentulous patients (16
restorations. This report aims to describe a combination of plastic surgical edentulous arches) were included in this study. Ten of the patients were female
techniques and prosthetic modalities to achieve optimal aesthetics for implant and 4 were male, with an average age of 58 (range 35-71). Ten mandibular
supported restorations. METHODS: Optimal soft tissue architecture around and 6 maxillary arches were restored with porcelain fused to zirconia (PFZ) IFCPs.
implant prostheses is accomplished by the use of peri-implant plastic surgery Out of the 16 arches, 14 received one-piece and 2 received segmented two-
techniques and periodically adjusted screw -retained provisional restorations. piece IFCPs, respectively. The mean clinical follow-up period was 3 years (range
Peri-implant plastic surgery incorporates techniques like the palatal roll to 24 to 48). After 2 to 4 years in clinical function, biological and technical
improve the volume and architecture of peri-implant soft tissues. Screw-retained parameters of dental implant treatment were evaluated. Results: The implant
provisional restorations allow for periodic retrieval and modification of the and prosthesis survival rate following prosthesis insertion was 100% up to 4-
contour of the peri-implant sulcus until a satisfactory emergence profile is year follow-up. Mean crestal bone loss was 0.1mm. The prostheses in 11 out
reached. DATA: A demonstration of a multidisciplinary perio-prosthetic of the 16 restored arches were structurally sound, exhibited favorable soft tissue
approach for enhancing peri-implant soft tissue architecture, is provided response, esthetics, and great patient satisfaction. Five IFCPs (31.25%) in 4
through a case-series. CONCLUSION: Replacing missing teeth in the anterior patients exhibited porcelain veneer chipping. Chipping was minor in 3
maxilla is a technically sensitive procedure. Common challenges include hard prostheses (3 patients) and was addressed intraorally with polishing (1
and soft tissue defects, thin soft tissue biotype and provisionalization. After prosthesis) or composite resin (2 prostheses). One patient with maxillary and
prosthetically-driven site preparation and implant placement, periodontal mandibular zirconia IFCP exhibited major porcelain chipping fractures which
plastic surgery techniques allow for biotype modification by increasing the had to be repaired in the laboratory. Function, esthetics and patient satisfaction
volume and the amount of keratinized tissue. The palatal roll technique can were not affected in 3 out of the 4 fracture incidents. The type of opposing
enhance the aesthetics of implant supported restorations by improving soft dentition, parafunctional activity and absence of occlusal nightguard were
tissue contours through which the restorations emerge. This procedure has the identified as primary risk factors for ceramic chipping (P<0.05). Conclusion:
advantage of a single surgical site and a pedicle blood supply. The utilization CAD/CAM zirconia IFCPs are viable prosthetic treatment after 2-4 years in
of screw-retained provisionals allow for refinement of the emergence profile function with increased patient satisfaction and favorable soft tissue response,
via periodic reshaping and provide the option of transferring the acquired but not without complications. The porcelain chipping/fracture was the most
emergence profile to the final restoration through the use of customized frequent technical complication, with a 31.25% chipping rate at the prosthesis
impression copings, that accurately capture the shape of the peri-implant sulcus. level.
This case series demonstrates soft tissue enhancement via prosthetic and
periodontal plastic surgery modalities, in order to achieve superior aesthetics
for implant supported restorations in the anterior maxilla.

75

Poster Presentation Abstracts

increase in the osseointegration of titanium implant can be achieved by surface
modification. Mg is considered to be a promising biodegradable metal that has
significant potential advantages as an implant material. In this study,
magnesium (Mg) and magnesium-hydroxyapatite (Mg-HA) coatings on titanium
substrates were prepared by RF magnetron sputtering. The samples were
divided into non-coated smooth Ti (Ti-S group), Mg coating group (Ti-Mg
group), and Mg-HA coating group (Ti-MgHA group). XRD, SEM, and EDX showed
that Mg and Mg-HA depositions on titanium substrates were performed
successfully. Ti-MgHA and Ti-Mg group had better cellular responses with regard
to the proliferation, ALP activity, and bone-associated markers, such as bone
sialoprotein and osteocalcin mRNA than Ti-S.In this study, the cells on Ti-Mg
and TiMgHA showed 50-60% higher ALP levels than those on Ti-S.The cells
on Ti-Mg and Ti-MgHA increased mRNA expressions more than the cells on
Ti-S. BSP mRNA expression on Ti-Mg and Ti-MgHA increased approximately 1.8-
fold and 2.1-fold respectively. OCN mRNA expression on Ti-Mg and Ti-MgHA
increased approximately 1.5-fold and 1.4-fold, respectively. The results
demonstrated that magnesium and magnesium-hydroxyapaptite coatings
could stimulate the differentiation into the osteoblasts of MC3T3-E1 cells,
potentially contributing to rapid osseointegration.

P43 P45

Sinus Lift Using Demineralized Bone and Cancellous Chips. Clinical Application of Implant Supported Removable Partial Dentures
(ISRPDs).
L.M. Lima* Imperatriz, Brazil.
K. Park* Gwangju, Republic of Korea.
The dental loss in the upper posterior generates problem to gnatus system,
and one of these is the alveolar dental loss, caused by sinus pneumatization, The clinical efficiency of implant is now beyond controversy. Diverse new
or by bone resorption. Since this problem when we think in dental rehabilitation procedures of implant placement have been developed even for completely
using dental implants, we need to rebuild the loss stuctures and sometimes edentulous patients in recent years. Fully bone anchored fixed bridge is ideal
through guided bone regeneration. In this bucal region the literature says to lift for total edentulous dention. However, in case that there is a personal financial
up the sinus mucous, to fill the concavity and to close the surgical sinus entrance. problem or anatomical limitation for alveolar bone resorption, implant retained
The great topic is: What kind of material do we use ? The necessity of using and tissue supported denture is in general use for restoration not only for total
second surgical wound, and sometimes the lack quantitity of autogenous bone anodontia but also partial edentulous dention by using a few implants. The
to fill the whole concavity have driven the science to search efficients substitutes. long period prognosis of implant supported removable partial dentures (ISRPDs)
Thus after some years of research many authors could comprove the biomaterials still generates a lot of controversy, but the clinical studies of it done by Dr.
and inductor efficacy for sinus elevation, and some authors considering better McAndrew R. shows high satisfaction of the patients. Partial edentulous dention,
than autogenous graft. However the majority traditional biomaterials have some with a few remaining healthy teeth, is frequently found. Extracting the
dificulties in handling and in the maintenance in the disered position, besides remaining teeth for implant supported overdenture could be a reckless
the high costs of the inductors. Hence have opened some space in this market treatment at this time. In this case, preserving the remaining teeth, placing
for some new products. In this work was used a demineralized bone and implants strategically only at the necessary spots of the missing teeth, and
cancellous chips which provide a natural structural scaffold to encourage the making removable partial denture supported by the implants could be one
attachment of osteogenic precursor cells. This allograft has a good cost and option. As far as I am concerned, preserving the remaining teeth, placing
the main feature is the easiness to put and to maintain in the desired position. implants only at the necessary spots, and using them as a support for partial
denture is a suitable and useful dental procedure for those who have difficulty
in financial conditions or implant placement for alveolar bone resorption if there
remain several healthy teeth. Therefore, I used 1) Overdenture combined RPD
and 2) Implant supported RPD combined According lip support for the patients
who still had a few remaining healthy teeth from 2003 to 2011. According to
my observation of 74 patients for 6.2 years on average, there have seen a crack
in partial dentures in part and slack in a clip, but the clinical usefulness was not
a problem with no complications, such as paresthesia and synostosis failure,
which made all patients satisfied with their prosthesis. Based on the cases,
implant supported removable partial denture could serve as favorable clinical
application.

In this case was done right and left sinus lift and used demineralized bone and P46
cancellous chips. After 8 months was placed 8 Biomet 3i implants for immediate loading.
A Novel Method for Achieving Enhanced Bone Graft - Implant Interface
P44 for Increased Primary Implant Stability using Calcium Phosphosilicate
Putty.
Effect of Magnesium and Calcium Phosphate Coatings on Osteoblastic
Cell Responses. S. Katta*, G. Kotsakis Athens, Greece.
K. Park*, Y. Kim, K. Lee, K. Sohn Suncheon, Republic of Korea.
Background: Alloplastic bone graft materials have recently evolved to enrich
The surface characteristics of titanium and its alloy are important factors the clinicians armamentarium with putty consistency bone substitutes. This
for the modulation of bone apposition at the bone-implant interface. An case report presents a unique method for placement of calcium phosphosilicate
putty bone substitute (CPS Putty) (NovaBone Dental Putty, NovaBone Products,
76 Alachua, FL, USA) in a fresh extraction socket prior to implant placement. This
method ensures increased primary implant stability and enhanced implant-
bone graft interface both of which are prime factors for successful
osseointegration. Methods: A modification of the “spontaneous in situ gingival
augmentation” technique advocated by Langer was performed prior to the
scheduled extraction of the tooth. The crown was dissected and the remaining
root was trimmed to 2mm below the gingival margin. The surgical step was
repeated again after two weeks. Four weeks after the initial surgery, the soft
tissue was adequate and the tooth was extracted as atraumatically as possible.

Poster Presentation Abstracts

Surgical drills were used to prepare the socket for the placement of a tapered
implant. With the final drill still in place the space around the drill bur and the
socket wall was filled with CPS Putty. After the graft was compacted, the final
drill was removed from the socket and the implant placed in its position. The
consistency of CPS Putty and its viscosity prevented collapse of the graft into
the prepared area after the removal of the final drill bur. The condensation of
the putty graft as the implant is placed increases the implant insertion torque
by transferring the spongeous bone’s resistance through the putty graft to
the implant. In this case it helped achieve an initial stability of 45N/cm2. Results:
Clinically the implant was stable and had no signs of mobility; radiographically
the trabecular pattern in the grafted area was indistinguishable to the adjacent
native bone. This was measured by calculating a difference in radio density
measurements on both the pre-op and the post-op radiographs. Conclusion:
This procedure helps to enhance the bone graft – implant interface essential
for achieving osseointegration at the same time increasing the initial implant
stability which could potentially allow for immediate loading.

P47 P48

Histological and Histomorphometrical Evaluation of a Human Dental A Light and Scanning Electron Microscopy (SEM) Evaluation of 2 Human
Implant Retrieved 8 Years after Insertion in a Sinus Augmented with Dental Implants Retrieved after 5 and 10 Years.
Anorganic Bovine Bone and Anorganic Bovine Matrix Associated with
a Cell-binding Peptide: A Case Report. G. Paggi* Novara, Italy.

G. Zoia* Ghemme, Italy. Evaluation of retrieved human dental implants is extremely useful and
important to improve our knowledge about the osseointegration process.
Only few histological and histomorphometrical reports are present in the Usually, the retrieved implants are removed for failure, and in these cases there
literature about the peri-implant bone response around implants inserted in is often little information about the bone interface. More rarely, removed
sinuses grafted with different biomaterials. Anorganic bovine bone (ABB) and implants present an intact bone-implant interface. Modifications of surface
anorganic bovine matrix additioned with an active cell-binding peptide (PepGen microarchitecture, such as sandblasting and acid-etching, may play a significant
P-15) are xenogenic materials which have been reported to present role in the bone response. The aim of this study was a light and Scanning
biocompatibility and osteoconductivity. A monolateral sinus augmentation Electron Microscopy (SEM) evaluation of the peri-implant tissues around
procedure with ABB (50%) and PepGen P-15 (50%) was performed in a 54-year- sandblasted, acid etched implants, retrieved from man, respectively after a
old male patient. Two titanium dental implants with a sandblasted and acid- loading period of 5 and 10 years. Two implants, with a sandblasted, acid-etched
etched surface were inserted after 6 months. After an additional 6 months, a surface (Leone Implant SystemR, Florence, Italy), had been retrieved for a
fixed prosthetic restoration was made. One of these implants, after an 8 years fracture of the prosthetic superstructure respectively after 5 and 10 years of
loading period, fractured in the coronal portion and was removed with a 5 mm loading. Both implants were stable before retrieval, and both implants had been
trephine bur. Few particles of both grafting materials were present in the peri- retrieved with a 5 mm trephine bur. One implant was treated to obtain thin
implant bone. Both graft materials particles were never found in contact with ground sections, while the other underwent evaluation under Scanning Electron
the implant surface, and bone was always interposed between the grafted Microscopy (SEM). Compact, mature, lamellar bone, was present over most of
materials and the surface. No inflammatory cell infiltrate, multinucleated giant the implant perimeter, in close contact with the implant surface, and with
cells or foreign body reaction cells were found. The tissues around the implant osteons and many remodeling areas. The newly formed bone appeared to be
were composed by 51.4 ± 4.8 % of bone, by 6.2 ± 0.7 % of ABB particles and strongly stained, and was easily differentiated from the older bone. Small
by 2.4 ± 0.5% of PepGen P15, and by 40 ± 7.1 % of marrow spaces. The bone marrow spaces were present. Many osteocytes were present close to the implant
implant contact percentage was 78.4 ± 4.1%. In conclusion, the present results surface. No epithelial proliferation, bacteria or calculus were present. No
show that ABB and PepGen P-15 are highly biocompatible materials, conducive inflammatory or multinucleated giant cells were present at the interface or in
to bone regeneration, with no adverse effects like acute or chronic inflammatory the marrow spaces. At higher magnification, no gaps or fibrous, connective
cell infiltrate or foreign body response. ABB and PepGen P-15 used as graft tissues were present at the interface. The BIC was 47.2%. Under Scanning
materials in sinus augmentation procedures have the potential to achieve and Electron Microscopy (SEM), small concavities, completely filled by mineralized
maintain osseointegration of dental implants in grafted sinuses over an 8 years bone, were present on the implant surface. The present histological results
period, with no untoward effects at the bone-metal interface, and with stable showed that these implants were well integrated over the long term, and the
contours and vital newly formed bone at the interface with the implant. peri-implant bone was undergoing a continuous remodeling at the interface.

P49

How Much Keratinized Gingiva Do We Need Around Dental Implants?
Review of the Literature.

K. Wallin*, P. Famili Pittsburgh, PA.

There has long been controversy in academic dentistry regarding strategies
how gingival health can best be preserved and maintained, and how much
keratinized tissue patients really need to preserve to keep a tooth healthy.
Harald Löe (1972) showed definitively that 2mm keratinized gingiva around a
natural tooth is required to maintain gingival health and that less can cause
persistent, damaging inflammation. In 1982, Dorfmann et al. posited the
opposing argument, demonstrating that in the presence of consistent good
oral hygiene there is no need for keratinized gingiva. But the controversy
persisted in the research and the literature. As implants increasingly become
the modern dentistry standard of care and implant attachment is different from
natural teeth, the question remains to be resolved. Materials and Methods. To

77

Poster Presentation Abstracts

present a comprehensive review of the current literature. PubMed [U.S. National Astellas Pharma US, Deerfield IL), macrolide immunosuppressant produced
Library of Medicine] and OvidMedline™[OvidSP Wolters Kluwer Health] from by streptomyces tsukubaensis, suppressing T-lymphocyte activation. While
1948 to August 16, 2011 were accessed, searching keywords ‘keratinized gingiva’ immunosuppressants have made transplant medicine successful, the most
(192 citations); ‘dental implants’ (13,761) and combined, resulting in 24 articles common post-transplant complication remains infection, occurring in 59
in English, one review in German. Results. Ten single/multiple-subject case percent of patients, cytomegalovirus comprising 90 percent. Managing post-
reports describe either surgical technique related to augmenting the keratinized transplant bacteremia is always a concern when treating transplant patients
gingiva or TGF-β/VEGF composition of failing versus healthy keratinized gingiva. who seek dental treatment including implants to replace missing teeth. Case
Six reviews of the subject and existing research and literature, eight articles Report: Fifty-year-old male Caucasian with primary sclerosing cholangitis 1996,
describing independent results of prospective research. Most investigators developing liver cirrhosis 2002, liver transplantation 2004, currently prescribed
agreed on the need for an adequate margin of keratinized gingiva to maintain immunosuppressive tacrolimus FK506. Patient was missing #9, which he wanted
the health of dental implants. In general the literature agreed with the restored with an implant 2009. Thorough periodontal examination showed 2-
conclusion that an adequate margin of keratinized gingiva and hygienic 3mm probing at adjacent teeth. Day of surgery: patient was premedicated with
restoration are essential for implant health and success. Only one early-years 2g amoxicillin prior to procedure, a full-thickness flap was raised, one Nobel
citation (1990) concludes no need of keratinized gingiva to maintain implant Biocare™ 4.3x13 Tapered Groovy™ endosteal implant was placed, post operative
health. Conclusions: From this review of the current literature regarding the radiograph taken. After healing six months, the implant was restored. Follow-
subject, we can conclude that the width of the margin of keratinized gingiva up with recall continues every six months. All procedures uneventful with no
around the healing dental implant remains an important indicator of ultimate complications. Results: After 30 months, implant remains stable in oral bone,
implant survival and success. But the question how much keratinized gingiva restoration intact. No signs of inflammation or further soft tissue recession,
is definitive for long-term maintenance and esthetics around healing dental bone loss around the implant at acceptable level. Conclusion: This case report
implants still remains to be answered. shows a successful rehabilitation using dental implants in a liver transplant
patient undergoing immunosuppressive therapy.
P50
P52
Osseointegration with Zirconium Dioxide Ceramics: Case Report.
Peri-implant Bone Tissues around Retrieved Human Implants after Time
E. Al-Khalifa*, P. Famili Pittsburgh, PA. Periods Longer than 5 Years: A Retrospective Histologic and
Histomorphometric Evaluation of 8 Cases.
Introduction. Modifications to dental implants meeting esthetic, functional
satisfaction are in high demand. Zirconia products (zirconium dioxide ZrO2) L. Ravera*, G. Iezzi, A. Piattelli, C. Mangano, J. Shibli, G. Vantaggiato,
show excellent resistance to corrosion and wear, good biocompatibility, high M. Frosecchi, C. Di Chiara, V. Perrotti Chieri, Italy.
bending strength (>1000MPa), fracture toughness. Stabilized by yttrium oxide,
bending strength boosted by aluminum oxide, zirconia (German chemist M.H. Only more rarely, implants can be retrieved after having become clinically
Klaproth 1789) is used in medicine (prostheses) and dental medicine as Y-TZP osseointegrated. In almost all of these cases the retrieved implants have an
(yttria-stabilized tetragonal zirconia polycrystals). Additional sintering, Hot excellent bone anchorage. These implants can help us to understand the
Isostatic Postcompaction (HIP) [>1500C°:>1800-bar pressure] creates high-tech reactions of peri-implant bone. Only rarely it is possible to find in the literature
ceramic used in dental implants. Tooth-colored, metal-free, tolerated well by histological reports of human retrieved implants, especially after several years
the gingiva and popular in Europe from 2004, Swiss manufacturer Z-Systems of functional loading. Aim of this study was a histologic and histomorphometric
(Oensingen Switzerland) was first to bring an FDA-proven zirconia system to analysis of the peri-implant tissues reactions and of the bone-titanium interface
U.S. market. Z-Look3/Z-Look3 EVO (conical abutment) are specialized zirconia in titanium dental implants retrieved from man after time periods longer than
ZrO2-TZP-A-Bio HIP. Case report. Caucasian female (49) (smoker quit 24 mos.) 5 years. The archives of the Implant Retrieval Center of the Dental School of the
good health seeking favorable, visually-pleasing implant outcome in esthetic University of Chieti-Pescara were searched for human dental implants, retrieved
zone. Right maxillary center incisor absent, extracted one year following root after a loading period of more than 5 years. A total of 8 implants were found:
canal failure. Complete perio therapy concluded May 2011, maintenance recall. three of these had been retrieved after 5 years, 1 after 6 years, one after 10
Surgery June 10, this operator. Operative report. General medical, oral health years, 1 after 14 years, 1 after 18 years, 1 after 22 years. Only the bone to implant
history unremarkable. Periapical. Alginate impressions, both arches. Diagnostic contact in the 3 best threads was evaluated. Compact, mature, lamellar bone,
wax-up, school lab. Essex tray. Full-thickness flap, intra-sulcular then two vertical with few and small marrow spaces, was present around the implants. Osteons
release incisions. Surgical site prepped, accessed per Z-Systems protocol. ATZ- with Haversian canals were present inside some threads, in close proximity to
Zirconia round drill, next ATZ-Zirconia 2.3mm pilot drill into jawbone 13mm, the interface, at both cortical and trabecular regions. Other osteons had a
then 3.25 mm twist drill for final osteotomy. Implant bed prepared 4.0mm wide, direction perpendicular to the direction of the long axis of the implants.
finished at shoulder via ATZ-Zirconia 4.0mm countersink drill. One Z-Look3 EVO Numerous reversal lines were present. At higher magnification, no gaps or
implant 4.0x13mm with laser modified surface treatment surgically placed in fibrous, connective tissues were present at the interface. The BIC of the 3 best
prepared bed. Torque to 45 N-cm, primary stability. One digital periapical, per threads for all implants varied from 94% to 100%. In conclusion, the present
University of Pittsburgh routine. Essex appliances placed. Results. Initial healing: histological results confirmed that these different implants with different
No surgical complications. No noticeable bone resorption, no soft-tissue surfaces presented all the potential to maintain osseointegration over a long
recession. No adverse events or unanticipated problems. Implant stable, fixed period, with a continuous remodeling at the interface.
in oral bone. Patient satisfied with aesthetic, functional results. Conclusions.
Zirconia dental implants provide valuable esthetic alternative to titanium
products. Further research evaluating long-term survival, success, is appropriate.

P51

Dental Implant Placement in a Liver Transplant Patient: Case Report.

O. Akmal*, P. Famili Pittsburgh, PA.

Introduction: As medicine rapidly advances in science, technology and
technique, patients whom 10 years ago would have had a poor prognosis now
live long, fulfilling lives. In a world of transplant medicine, with longer patient
survival and more returning to normal health, individuals living with healthy
transplanted organs will seek dental implants. Approximately 5000 liver
transplants took place in the U.S. in 2000, and about 6000 more are performed
annually, with 75 percent survival at five years, although in some transplanted
livers the original disease may recur, requiring a second transplant (American
Liver Foundation). Development of the anti-rejection drug cyclosporine
increased one-year survival from 25 to 60-80 percent. This case report presents
a patient taking the newer immunosuppressive drug tacrolimus FK506 (Prograf,

78

Poster Presentation Abstracts

P53 P55

An In Vitro Study of Bacterial Leakage in Implants with Different Implant- Dental Implant Success, Dental School Implant Center Setting.
Abutment Connections.
R. Goyal*, P. Famili, F. Begum Pittsburgh, PA.
M. Blazic* Loano, Italy.
Implant dentistry is a successful way to replace missing teeth. In academia,
Two-piece implants present gaps and cavities between the implant and the dental residents in advanced general dentistry, periodontics, oral and
abutment, and these hollow spaces can act as a trap for bacteria. Aim of the maxillofacial surgery, and implant dentistry are directly involved in placement
present in vitro study was an evaluation of the migration of two different of implants. Several factors influence survival of dental implants: patient medical
microbial species from the inside to the outside of the implant-abutment condition, smoking behavior, lack of implant follow-up care, early occlusal
assembly in three different types of connection. A total of 30 implants (10 overload, and skill of the surgical operator. Objective: Retrospectively assess
implants per group) were used. The implants presented a screwed trilobed rate of survival among implants in patients of the Multidisciplinary Implant
connection (Group 1, Replace Select, NobelBiocare, Gothenburg, Sweden), a Center at the University of Pittsburgh. Secondary: Correlate effect of smoking,
cemented implant-abutment connection (Group 2, BoneSystem, Milan, Italy), gender on implant survival. Material and methods Retrospective review of
and an internal implant-abutment conical connection (Group 3, ANKYLOS plus, electronic medical records (EHR) August 2008 to June 2011. All implants placed
DENTSPLY-Friadent, Mannheim, Germany). The inner parts of five implants, per by graduate dentists. Medical history, age, sex, smoking, loading, and arch
group, were inoculated with P. aeruginosa suspension and the remaining five position recorded. Criteria for implant failure: lack of primary stability at
implants, per group, with A. actinomycetemcomitans. The penetration of uncovery, radiographic bone loss, removal of the implant. Analysis of maximum
bacteria into the surrounding solution was determined by the observation of likelihood estimates, logistic regression performed. Results Males 410 (47%);
turbidity of the broth. Results: In Group 1, bacterial contamination was found 464 (53%) female patients 20-89 years old (mean: 58 years). Ages categorized:
in six out of ten implants. In Group 2, no contaminated samples were found. 50 (6%) <29 years old; 138 (16%) were 30-49 years; 235 (27%) were 50-59 years;
In Group 3, bacterial contamination was found in one implant out of ten. 298 (34%) were 60-69 years; and 153 (17%) were >70 years. Gender was
Statistically significant differences were detected between Group 1 vs Group significant predictor. For males, estimated odds of implant failure is 5.19
3 (p < 0.05), and between Group 1 vs Group 2 (p < 0.01), while no significant times>females, statistically significant (p=.036) at 0.05 percent. Reported 570
differences were found when comparing Group 2 vs Group 3 (p > 0.05). non-smokers (65%), 184 current smokers (21%), 120 former smokers (14%).
Conclusion: The present study confirmed the previous results about the Odds ratio of implant failing among smokers was 2.726, not statistically
hermeticity of the cement-retained implant-abutment assembly, the very low significant (p=0.22). Among total implants, 426 (49%) maxilla:448 (51%)
permeability to bacteria of the conical implant-abutment connection, and the mandible. Neither arch position significant for failure (p=0.47). Total 268 (31%)
high prevalence of bacterial penetration of screw-retained implant-abutment cases not loaded; 2 (0.2%) cases still in temporary crowns; 532 (61%) cases
assemblies. had been loaded, and 72 (8%) were loaded outside the dental school. Overall
863/874 total implants placed survived (98.7%). Conclusions Rate of implant
P54 failure when placed by dental residents was close to nationwide rates,
comparing similarly to general implant dentistry success. Smoking could be
Free Gingival Graft as a Technique to Reduce Clinical Signs of factor affecting dental implant survival and success, but the difference smoking
Inflammation and to Improve Patient Comfort around Dental Implants vs. not smoking was not statistically significant (p=0.22). Failing implants were
by Increasing the Width of Keratinized Tissue. fewer in females than males p=0.0209, possibly due to better homecare habits
among women. This inference requires further study.
M. Doeste*, D. Gober, A. Rohrer, J. Jaeyong Hollywood, FL.
P56
Introduction: The amount of keratinized mucosa around implants has been
documented to have an impact on the incidence of peri-implant disease. Chung Compliance with Dental Implant Maintenance at the University of
(2006) indicated that the lack of keratinized tissue around implants was Pittsburgh.
associated with higher plaque accumulation and gingival inflammation. Schrott
(2009) concluded that the presence of at least 2mm of keratinized mucosa R. Yousefi*, P. Famili, E. Sampene Pittsburgh, PA.
around implants reduced bacterial plaque accumulation, bleeding and recession
around implants. This case shows the use of a free gingival graft to increase the Treatment with dental implants is the currently accepted standard of care
zone of keratinized mucosa around dental implants to improve peri-implant in dental medicine. Although implant failure rates are low (implant success
tissue health. Materials and methods: 61 y.o female patient presented with exceeds 96%), since bacteria around dental implants are the same as those
provisional crowns on implants #29, 30. She complained about sensitivity to found around natural teeth, there is always the risk of peri-implantitis and
touch by the soft tissue in this area. The marginal tissue by the buccal of #29 loss of the dental implant. This makes compliance with the dental implant
exhibited erythema and edema. The tissue was mobile with a vestibular pull. maintenance appointment schedule as important as the periodontal recall.
A metal hue was evident around the cervical area, as well as an absence of Wilson (1984) has showed that compliance with periodontal maintenance and
keratinized tissue. The area was treated using a free gingival graft harvested
from the palate. Results: Post-operative evaluation 1 week after the procedure
indicated that the graft tissue was undergoing the normal healing process as
described in the literature. There was a white film on the surface of the graft
indicating epithelial degeneration and there was evidence of red color
underneath the surface indicating revascularization. The new vestibular margin
was still intact, without coronal migration. There were no signs of infection and
the patient reported no complaints. The graft is expected to continue healing
within normal limits and result in an increased band of keratinized tissue which
is immobile, and increase in vestibular depth which will be conducive to long
term patient comfort and maintenance. Conclusion: Surgically reconstructing
keratinized tissue at the time of implant placement minimizes treatment time
and improves treatment results. In cases when the implant is already in place,
the use of free gingival graft is a successful way to increase the area of
keratinized tissue, which can lead to better soft tissue health with reduced
inflammation and sensitivity, better esthetics and easier maintenance of the
implant and the peri-implant soft tissues.

79

Poster Presentation Abstracts

recall is not good (16%). An interval of three months between maintenance bonding (DFB) and interference fit (IFF). The interfacial strength achieved by
appointments for patients with a history of periodontal disease has been shown IFF between TM shell (70-80µm thick) and Ti components was evaluated using
to be effective. However maintenance appointments should be individualized 8 samples from each of 3 implant diameters (4.1mm, 4.7mm & 6.0mm) using
and based on treatment and needs. Hypothesis: Since patients spend fair a torque test and were compared to prototype implants (PI) designed to
amounts of money to replace teeth with dental implants and successful measure only the frictional force of TM shell. Fatigue characteristics of the
restorations, they are more compliant with the dental implant maintenance final implant design were evaluated in a test setup (ISO14801) using 8 samples
schedule than periodontal patients. Methods and Materials: One hundred of 4.1 & 4.7mm implant diameters. Results: Static compression testing to failure
patients with implants placed and restored at the Multidisiplinary Implant of CVD, DFB & IFF samples yielded mean values of 600.3, 572.6 & 589.3N for
Center University of Pittsburgh July 2008 to July 2009 were contacted and asked 3.7mm samples and 1267.1, 1433.2, 1329.8N for 4.7mm samples, respectively.
about their maintenance routine. Patients who reported not having regular Fatigue testing at 157N demonstrated that CVD & DFB samples failed well below
maintenance appointments were asked to schedule maintenance appointments 5 million cycles whereas IFF samples reached that cycle count. Metallography
at the Graduate Periodontics Department. Results: Among 100 patients who indicated that CVD & DFB samples were impacted by secondary processing
had implants placed and restored in one year: eleven lost-to-follow-up (11%); at high temperatures (~970°C). IFF was determined as the optimal configuration
12 patients (12%) under collection code alert (locked contact information); 24 for this implant. Torque values for the IFF samples were recorded as 34.6±3.6,
in treatment with a private dentist for routine maintenance (24%); 33 messages 75.3±8.0, 123.5±14.1Ncm for 4.1, 4.7 & 6.0mm implants, respectively and those
were left either on an answering system or with a family member; and 10 for the PI samples were recorded as 4.8±0.4, 29.7±2.8 & 43.4±2.3Ncm for the
patients (10%) were directly solicited to schedule an appointment for same diameters, respectively. Fatigue testing of the final implant design (Fig 1)
maintenance with grad perio. Out of the 33 messages: 5 patients called back yielded endurance limits for 4.1 & 4.7mm diameters for loads greater than
and scheduled maintenance appointments (15%). Of the 10 directly solicited, reported maximum single tooth bite force in the molar region, 350.22N.
five (50%) made maintenance appointments. Conclusion: We reject the initial Conclusion: The final design of the TM dental implant assembly, with
hypothesis. Although implant patients pay more money for their treatment, interference fit between the TM and Ti sections, has the mechanical strength
they are not more compliant than periodontal patients. to withstand physiological loads in the oral cavity.

P57 Final design of the TM dental implant

Platform Diameter Influencing Implant Survival: Review of the Literature. P59

S. Nigro*, P. Famili, A.M. Rodriguez Pittsburgh, PA. Resorption of Anorganic Bovine Bone and of Anorganic Bovine Matrix
Added to a Synthetic Peptide 8 Years after a Sinus Augmentation.
Introduction. Various implant diameters are available. Depending on clinical
situation, placement of a certain diameter implant may be more indicated than A. Henschen*, M. Degidi, V. Perrotti, A. Piattelli, G. Iezzi Pietra Ligure, Italy.
another. Narrow diameter implants (<3.75mm) may be of benefit if reduced
inter-radicular bone is present, if thin buccal-lingual dimension exists, or if teeth The long term fate of some biomaterials is still unknown and the reports
of small cervical diameter are being replaced. Hypothesis: Narrow-diameter present in the literature are not conclusive whether these biomaterials are
implants are as successful as wide-diameter platforms. Methods. Comprehensive resorbed over time or not. Different reports can be found about the resorption
review of current literature OvidMedline™[OvidSP Wolters Kluwer Health] 1948- behavior of anorganic bovine bone (ABB). The aim of the present study was a
August 16, 2011. Searching keyword ‘implant diameter’ yielded 142 citations, comparative histological and histomorphometrical evaluation, in the same
96 articles (English) specifically dental implants in humans. Entire set hand- patient, of two specimens, retrieved from a sinus augmented with ABB and with
searched for relevance, discarding ‘platform switching’ (3), ‘offset placement’ (1) anorganic bovine matrix added to a cell-binding peptide (PepGen P-15),
or those conclusions or focus other than implant diameter (16). Three articles respectively after a healing period of 6 months and after 8 years implant loading,
discussing orthodontic success with ‘mini’-(≤1.4 mm) implants excluded. Results. to evaluate the resorption of both biomaterials. A monolateral sinus
Total 73 articles: 5 case reports, 6 literature reviews, 15 retrospective data; 19 augmentation procedure with ABB (50%) and with PepGen P-15 (50%) was
prospective clinical, including the Dental Implant Clinical Research Group (1991), performed in a 54-year-old male patient. Two titanium dental implants with a
which did not distinguish value between implant diameter and length. sandblasted and acid-etched surface were inserted after 6 months. During this
Remainder (28) were finite element analyses. Most significant: retrospective procedure, two tissue cores were retrieved from the sinus with a trephine, before
research (Shin Bryant 2004) comparing wide (5mm) v. regular platform implant insertion. After an additional 6 months, a fixed prosthetic restoration
(>3.75mm) implants in posterior jaws. After five years, failure was greater for was made. One of these implants, after an 8 years loading period, fractured
wide diameter implants, possibly due to limited remaining bone after placing in the coronal portion and was removed. Both specimens, one retrieved after
wide diameter implants. Ivanoff (1999) likewise concluded greatest failure a 6 months healing period and the other after 8 years loading period, were
associates with wide platform (5mm) implants. In early research implant treated to obtain thin ground sections. In the 6 months specimen, the
diameter is given significance, later investigations demonstrate little relationship histomorphometry showed that the percentage of newly formed bone was
between implant survival and diameter. Implant diameter does allow better 27.2% ± 3.6%, marrow spaces 35.6% ± 2.3%, residual ABB particles 25.1% ±
stress distribution and less strain on the alveolar crest (Baggi 2008, Petrie 2005), 1.2%, residual PepGen P-15 particles 12.1% ± 2.2%. In the 8 years specimen, the
but even this important fact does not necessarily equate increased implant histomorphometry showed that the percentage of newly formed bone was
survival. According to Degidi and Piattelli (2008), narrow diameter implants 51.4% ± 4.8%, marrow spaces 40% ± 7.1%, residual ABB particles 6.2% ± 0.7%,
have high success rates similar to regular diameter. Conclusions. Implant survival residual PepGen P-15 particles 2.4% ± 0.5%. Both biomaterials underwent
tends to be more favorable in situations where a greater volume of bone significant resorption over the course of this study. Both biomaterials were
surrounds the implant. The anterior maxilla tends to possess a thin buccal plate; osteoconductive and their continued presence in the peri-implant bone didn’t
hence placing a narrow-diameter implant allows for a greater volume of produce any untoward effect. Both biomaterials appeared to be histologically
surrounding bone compared to use of regular- or wide-diameter implants.

P58

Mechanical and Interfacial Strength Evaluations of a Trabecular Metal
Dental Implant Assembly.

S. Battula*, S. Papanicolaou, M. Lomicka, H. Wen Carlsbad, CA.

Introduction: A dental implant assembly consisting of (a) a titanium (Ti)
cervical and internal core section covered by (b) a trabecular metal (TM) shell
and joined by (c) a Ti apical section has been designed to enhance fixation
via bone ingrowth and ongrowth (Fig 1). The objectives of this study were to
determine the (1) optimal design configuration of implant’s component parts,
(2) interfacial strength between the TM and Ti components and (3) fatigue
characteristics of the final implant design. Methods: Mechanical testing and
metallography were conducted to evaluate 3 different methods of assembling
a 3.7mm-diameter implant design: chemical vapor deposition (CVD), diffusion

80

Poster Presentation Abstracts

biocompatible in that no inflammatory cell reactions and no foreign body peri-implant tissues of a HA-coated implant retrieved, for peri-implantitis, after
reactions were observed. a 10 years loading period. The implant was retrieved with a trephine and treated
to obtain thin ground sections. The coronal portion of the implant and bone
was probably lost during the implant retrieval. At low-power magnification,
at the interface with the implant, mostly compact, mature bone, with small
marrow spaces, was present. The coating was always present in the areas where
bone was present at the interface with the implant. The bone was always in a
very close contact with the coating, and it was never possible to observe the
presence of a detachment between metal and coating, and between coating
and bone. Areas of bone remodeling were evidenced by the presence of many
secondary osteons, close to the implant surface, and of many reversal lines. The
bone-implant contact percentage was 36.3 ± 1.2 %. The percentage of the
implant surface covered by the HA coating without bone was 32.6 ± 2.8. In
conclusion, the present report concerns a well integrated HA-coated implant,
that, after many years of function continued to demonstrate more than
adequate BIC and the potential to maintain osseointegration under long-term
function. Fig

P60 P62

10 Years’ Evaluation of Crestal Bone Loss around Implant Immediately Clinical and Histological Evaluation in Man of Maxillary Sinus
Placed in TCP Grafted Extraction Sockets. Augmentation with Biphasic Calcium Phosphate Ceramics.

Z. Ormianer*, O. Moses, A. Palti Ramat Gan, Israel. A. Bussone*, C. Mangano, V. Perrotti, J. Shibli, F. Mangano, A. Piattelli,
G. Iezzi Orbassano, Italy.
Introduction: Immediate implant placement into extraction sockets is
performed to decrease healing time for the patients. The dilemma concerning This study evaluated both the clinical and histological aspects of bone
implant placement in such a case is the horizontal gap between the implant formation in maxillary sinus augmentation using MBCP (Macroporous Biphasic
surface and the labial or the lingual plate. It was postulated the connective Calcium Phosphate) composed by HA/TCP 60/40 as the bone-grafting material
tissue may grow between the implant and the bone when the gap is larger (Leone, Firenze, Italy). Ten patients were selected and MBCP was used as a bone
than 1.5 mm at the coronal aspect of the implant when augmentation substitute material in two-stage sinus augmentation. The protocol of the study
procedure is not performed in such cases. Various grafting material have been was approved by the Ethical Committee of the University of Guarulhos (UnG),
used to fill the gap in order to ensure the constitution of osseous interface with Sao Paulo, Brasil. After a healing period of 6 months, bone core biopsies were
the implant. TCP, a calcified alloplast have been evaluated in a limited number harvested during implant insertion. Thirty implants (Leone implant, Florence,
of studies where it was grafted successfully simultaneously with immediate Italy) were inserted. The implants had been placed exactly in the sites where
implantation into fresh extraction sockets. The aim of this 10 years retrospective biopsies were harvested, under the guide of CT template for guided bone
study was to evaluate the crestal bone loss around immediate implant placed surgery. These bone cores were evaluated under light microscopy. The
in TCP grafted extraction sockets. Materials & Methods: Data were collected histological examination of 10 biopsies showed the MBCP particles in close
from the files of 60 patients [26 females (43.4%), 34 males (56.6%), average age contact with new bone in all biopsies. Histomorphometrical evaluation
51.6 years ], undergoing, immediate implant placement into fresh extraction demonstrated that that newly formed bone constituted 28.3 +/- 2.7%, residual
socket with or without the use of TCP (Cerasorb®) grafting. After implant grafted material 27.3 +/- 1.2% and marrow spaces 45.9 +/-1.9%. The present
placement, horizontal gaps between the implant surface and the bony plate, histological results showed that the MBCP grafted particles were embedded
larger than 1.5 mm were grafted with TCP without the use of a membrane while and integrated in the newly formed bone; this bone was in close and tight
smaller gap was not grafted. 266 implants were inserted (126 without a graft, contact with the biomaterial particles. One year after implantation, all 30
140 with a graft). Bone loss recording ware performed using periapical x-ray implants are clinically in function; no surgical or prosthetic complications
radiography. Measurements were performed from the neck of the implant to occurred. No clinical signs of sinus pathology were observed, and none showed
level of the surrounding bone. Results: No implant was lost during the follow- any sign of maxillary sinusitis. Data from the present study demonstrated
up period in both groups. 90 (71.42%) implants in the non-grafted and 103 biocompatible and osteoconductive properties of MBCP (HA/TCP 60/40) and
(73.57%) in the grafted group did not lose bone radio-graphically. 1 mm loss this biomaterial can be used as a grafting material for sinus floor augmentation.
of bone was found around 19 (15%) in the non-grafted and 12 (8.5%) in the
grafted group. Conclusion: The use of TCP (Cerasorb®) as a grafting material
during immediate implant placement allowed no bone loss in 73.5 % of the
implants which was very similar to the non-grafted cases were implants were
placed in favorable conditions.

P61

Histologic Evaluation of a Human Hydroxyapatite (HA)-coated Implant
Retrieved after a 10 Year Loading Period.

C. Mazzanti* Oleggio, Italy.

Only a few studies of in situ implants in humans have been reported. Clinical
studies of hydroxyapatite (HA)-coated implants have shown a high, more than
90 %, success rate. However, a concern about degradation, dissolution,
resorption and cracking of the coating has been raised over the years: it has
been hypothesized that the resorption of the HA coating could produce
instability of the implant due to voids between implant and bone. Aim of the
present case report was a histologic and histomorphometric evaluation of the

81

Poster Presentation Abstracts

P63 P65

Immediate Loading of NobelActive Implants Placed in Anterior Maxillary Histologic and Histomorphometric Analysis of Recombinant Human
Postextraction Sites: Retrospective Analysis of the 1-year Clinical and BMP-2 and Heparin Mixture’s Osteoinductive Effect.
Radiological Outcome Dr. Enric Pintado Manresa - Spain.
Y. Kim*, W. Jang, S. YIm, C. Chung, K. Hong, H. Shin, S. Han, J. Yim Cheonan-
E. Pintado* Manresa (Barcelona), Spain. si, Republic of Korea.

INTRODUCTION The purpose of this study was to retroprospectively evaluate Introduction rhBMP-2 stimulated ectopic bone formation when it was
survival rate, marginal bone changes and soft tissue health when using implanted in rat muscles with insoluble bone matrix by differentiating muscle
immediately loaded NobelActive implants in extraction sites of the front upper cells into chondrocytes and osteoblasts.This aimed to evaluate the
jaw MATERIAL AND METHODS In routine practice 37 consecutive patients of osteoinductive potential of the mixture of rhBMP-2 and heparin at the critically
both sexes with a mean age of 52 years (range 27- 83) received 54 NobelActive sized rabbit calvarial defects and reveal that heparin also acts to enhance the
(Nobel Biocare, Gothenburg, Sweden) implants replacing single teeth in the activity of rhBMP-2. Material and Methods 12 rabbits (4-month-old; NewZealand
maxillary intercanine zone. All implants but one, where a simultaneous GBR White) were used in study.5 µg/ml of rhBMP-2 and 0, 0.25 or 25 µg/ml of heparin
was required, were immediately placed in post-extraction sites and immediately were mixed and blotted into anorganic bovine bone and filled cranial defects.A
loaded with a cemented provisional. In 10 sockets with gap > 3 mm a bone animals were sacrificed follwed by time schedule(1,3,6 weeks).Section were
substitute ( Bio-Oss, Geistlich Pharma, Switzerland) was used. Definitive measured about total area of internally formed bone in grafted particles and
prosthesis was delivered within 6 months of surgery. Implant cumulative total area of grafted particles by using IPTK 5.0 software (Reindeer company,
survival rate (CSR) was assessed. Evaluation of soft tissue health and marginal USA). Results 12 rabbits did not showed any infective sign during all
bone remodeling were also conducted. Marginal bone level was evaluated by experimental periods and recovered well after surgery. Internal bone formation
an independent radiologist from periapical radiographs taken at implant was not developed in the particles of graft materials in group 1 (5 ug/ml rhBMP-
insertion, 3, 6, and 12-month visits. RESULTS All patients have passed the 1-year 2, no heparin).In control group, osteoinduction did not appear significant.
clinical follow up. No implants have failed resulting in a 1-year implant CSR of However, in experimental groups, osteoinduction was significantly outstanding,
100%. During the follow up large majority of implants showed normal as the concentration of heparin mixed with rhBMP-2 increased, osteoinduction
periimplant mucosa, absence of recession and no visible plaque. The mean was increased.The amount of internal bone increased following time lapsed
bone level at implant insertion, 3, 6 and 12 months visits was reported as - in groups which were administered with heparin, but the significant value
1.00 mm (SD 1.68, n = 54), -2.01 mm (SD 2.42 n = 19), - 0.98 mm (SD 1.28, n = between group 1 at 1 week and group 1 at 6 weeks exhibited the only
35 ) and - 1.35 mm ( SD 2.54, n = 13) respectively. The mean change in bone significant relation (P<0.05).That is to say the amount of early formed internal
level from implant insertion to 3, 6 and 12 months was – 0.97 mm (SD 1.91, n bone increased as the concentration of heparin increased, but the amount of
= 18), - 0.14 mm (SD 1.20, n = 35) and – 0.63 mm (SD 3.00, n = 13). Notably, lately formed internal bone decreased as the concentration of heparin
compared versus baseline 5 out of 13 of the radiologically assessed implants increased.At 6 weeks, the amounts of internal bone were increased followed
showed marginal bone gain at 1 year follow up. Neither biologic nor mechanical by increasing of concentration of heparin, but all P-values among 0.25 and 25
complications occurred. CONCLUSIONS This retrospective 1-year follow up of µg/ml were not statistically significant. It means that the effect of heparin was
37 patients treated with NobelActive implants immediately placed in not proportional to the concentration of heparin. Conclusion Heparin enhanced
postextraction sockets of the front upper jaw and immediately loaded the osteoinductive effects of BMP-2 but this enhancing effect was not
demonstrated good treatment outcome with regard to implant success, soft proportional to the heparin concentration, and mode of action of heparin
tissue condition and marginal bone response. exhibited a short-acting pattern.

P64

Clinical and Histologic Evaluation of Two Pore Sizes of Titanium Mesh
Used for Ridge Augmentation in Humans.

D. Lee*, K. Kim, S. Kim, M. Yu, Y. Park Seoul, Republic of Korea.

Among a variety of materials, titanium mesh had been used for a
predictalble space maintenance and various products are commercially
available. The purpose of this preliminary study was to evaluate the effectiveness
of pore size of titanium meshs for bone augmentation on the area of localized
alveolar ridge defects to place implants. 13 patients with alveolar crest defect
or peri-implant dehiscences participated in this study. Bone grafts was
performed before or simultaneously with the placement of dental implants.
Before augmentation, all graft sites were evaluated by the periodontal probe
placed parallel and perpendicular, respectively, to the long axis of the implant
was used. Measurements were recorded to the nearest 1 mm marks. 6 patients
were covered the micro-porous titanium mesh(Cytoflex Mesh;Unicare
biomesucal, USA; Pore-size:0.25mm) and 7 patients were used the marco-porous
titanium mesh(Titanium mesh;Biogenesis, Korea; Pore-size:1.5mm) on the
grafted sites. All sites were filled with particulate allograft and xenograft
completely. After 5 to 6 months, the grafted sites were uncovered and the meshs
were removed and a small specimen of the underlying tissue retrieved with a
small trephine bur for histologic evlaution. Pre- and Postoperative defects were
evaluated at the bony levels. The postoperative healing was mostly uneventfully.
A total of 21 implants with a suitable size were placed into the grafted site in
this series of patiens. Up to now all implants have been or being restored. In
micro-porous group, the height gain ranged from 0 to 7 mm (mean 2.8mm)
and width gain ranged from 3 to 6mm (mean 4.2mm). In macro-porous group,
the height gain ranged from 1 to 6mm (mean 3.16mm) and width gain ranged
from 1 to 5mm (mean 4.16mm). We consider that there is no significant
difference in bone regeneration between micro- and macro-porous mesh, but
found that there were more amount of engagement of soft tissue with micro-
than macro-porous mesh. During the removal of mesh, a layer of connective
tissue was consistently observed underneath the mesh. Further research should
be directed toward identifying a optimal pore size that would prevent excessive
soft tissue ingrowth in ridge augmentation procedure.

82

Poster Presentation Abstracts

(3) to five (5) years following dental treatment with implant supported
restorations. This study included twenty individuals (10 diabetic and 10 healthy)
with a total of 88 implants were randomly selected from a group of 234 patients
for a study conducted during dental implant maintenance recall visits. The data
and measurements used in the analysis were bacterial plaque (BP), bleeding
on probing (BOP), bleeding in associated with bacterial plaque (BOP + BP),
absence of the manifestations (NBOP) probing depths (PD) and bone loss (BL).
The percentage of relative frequency of bacterial plaque (BP), bleeding on
probing (BOP), bleeding in associated with bacterial plaque (BOP + BP), and
absence of the manifestations (NBOP) between the groups of healthy and
diabetic patients (Graph). There was no significant statistical difference between
diabetics and healthy patients in all the parameters studied (p>0,05) The authors
concluded that diabetes Mellitus type II did not reveal as a predisposing factor
for bleeding on probing, probing depth and bone loss and; accordingly, does
not favor the development of peri-implant diseases.

A:1 week after graft materials with 5 µg/ml rhBMP-2 only.(H&E, X200)(bar=50 µm)
B:1 week after graft material with 5 µg/ml rhBMP-2 mixed with 0.25µg/ml heparin.(MT,
X200)
C:1 weeks after graft material with 5 µg/ml rhBMP-2 mixed with 25µg/ml heparin.(MT,
X50)Newly formed vivid bones(red arrow)
D:3 weeks after graft materials with 5 µg/ml rhBMP-2 only.(MT, X50)
E:3 weeks after the graft material with 5 µg/ml rhBMP-2 and 0.25µg/ml heparin.(MT,
X50)
F:3 weeks after the graft material with 5 µg/ml rhBMP-2 mixed with 25µg/ml
heparin.(MT, X50).Newly formed vivid bones(red arrow)
G:6 weeks after graft materials with 5 µg/ml rhBMP-2 only.(MT, X200)
H:6 weeks after graft material with 5 µg/ml rhBMP-2 and 0.25µg/ml heparin.(MT, X50)
I:6 weeks after graft material with 5 µg/ml rhBMP-2 mixed with 25µg/ml heparin.(MT,
X50)

P66 P68

Clinical Outcome of Two-Piece Zirconia Implants: Preliminary Data after Modified Oval Pontic in the Aesthetic Zone.
24 Months of Clinical Function.
I.A. Diaz*, E.M. Vicente, L.F. Grisolia Guatemala, Guatemala.
M. Payer*, R. Kirmeier, M. Koller, A. Heschl, G. Arnetzl, M. Lorenzoni, N. Jakse
Graz, Austria. A modified design for ovate pontic is a rounded end which is currently used
where aesthetics is important for fixed partial dentures. This design helps the
Background: Zirconia has been increasingly discussed and questioned as clinician to prepare the edentulous area. It is less convex than the ovate pontic.
implant material. So far no reliable clinical data are available on zirconia Changing the oval pontic buccolingual thickness does not take much to create
implants. Aim: Aim of this prospective controlled pilote study was to evaluate an emergence profile. There Are contraindications when the residual ridge
the clinical outcome of two-piece zirconia implants treated according to a height is insufficient, creating a relationship with the lip of the pontic
conventional standard protocol. Material and methods: 31 implants (16 inadequate. In these cases you can use different surgical methods to increase
zirconia/15 titanium) were inserted primary stable (>30 Ncm), in the maxilla (7) the alveolar ridge. They provide excellent aesthetics and produces a correct
and mandible (24) of 20 patients (13 male/ 7 female) requiring neither bone emergence profile, function, easy to clean, effective air-sealing.
nor soft tissue augmentation. Implants were restored adhesively with all-ceramic
crowns (4 months) after placement. Radiographic coronal bone levels, implant
survival and success were evaluated after a minimum of 12 months of clinical
function. Results: Measurements of mean marginal bone levels 12 months after
surgery showed a significant bone loss (p < 0.05) in both groups. One zirconia
implant was lost 5 months after restoration. No further complications were
recorded resulting in an overall survival and success rate after of 93.75% for
zirconia and 100 % for titanium implants after a period of 24 months in clinical
function. Conclusion: So far no final conclusions can be drawn from this pilot
trial. Larger long-term RCTs are needed to confirm predictability and evidence
of two-piece zirconia implants as an alternative to titanium implants.

P67 Final result of using Ovate Pontic

Clinical and Radiographic Impact of Diabetes Mellitus Type II on Patients
with Implant-supported Prostheses.

C.F. Ferreira*, P.R. Andrade, J.O. Souza, D.K. Lopes, M.A. Bianchini,
A.C. Cardoso Memphis, TN.

The notable success of dental implants resulted in an increased use of this
treatment modality for replacing missing teeth and in addition for a need to
identify factors associated with its failures. Patients presenting diabetes Mellitus
are at risk for aggravation of peri-implant and periodontal disease. Analyze the
clinical and radiographic impact of diabetes Mellitus type II on patients three

83

Poster Presentation Abstracts

P69

Dental Implants for Maxillary Edentulous Patients Fixed Detachable
Prosthesis: Case Report.
D.J. Rosales*, L. Grisolia, E. Rodriguez, J. de Leon Guatemala, Guatemala.

A significant benefit of the maxillary implant overdenture over the
conventional full denture is our ability to expose a large portion of the palatal
vault. Patients can feel when the rugae of the palate the with he tongue, they
experience a taste and texture sensation renewed with foods that are denied
full conventional with the denture. The psychological effect on patients have
this positive attitude enhances the results of this type of prosthesis. The hybrid
prosthesis or fixed-detachable appliance represents an option somewhere
between those of fixed and removable restorations. Technically, the hybrid
prosthesis is dental prosthesis that is composed of different materials, types
of denture teeth, acrylic, differing metals or design. However, it is also
“removable” clinicians unscrew and remove prosthesis for maintenance or repair
it if necessary. Although applicable to restoration of both arches, it is more
commonly fabricated for the edentulous mandible. This type of prosthesis four
to six implants, or more, implants to support it. The fixed aspect of the hybrid
is attractive to some patients who do not like the thought of anything
removable.

P70 P71

Mandibular Fixed Detachable Prosthesis over 4 Implants. Strain Gauge Analysis of Occlusal Forces on Implant Prosthesis at Various
Occlusal Heights.
M.A. Castro*, L.F. Grisolia, E.J. Rodriguez, Y.M. Castillo Guatemala City,
Guatemala. Y. Cho*, E. Park, J. Park Seoul, Republic of Korea.

Screw retention of implant-supported prostheses was validated by studies Introduction: The purpose of this study is to evaluate and compare the strain
of many different authors. Screws are used to attach abutments to implants development at different occlusal heights of the implant prosthesis and
and prostheses to abutments. This type of prothesis are very useful for adjacent teeth using strain gauges.Materials and Methods: The test model was
edentulous patients. The clinical and laboratory procedures must be carefully constructed using polyurethane resin,anatomic resin teeth and an implant gold
observed. Clinical techniques to improve the passive fit of framewoks include crown. The resin block containing implant fixture (MK III, Nobel Biocare, Yorba
custom impression trays, adequate impression materials, radiographs, alternate Linda, CA, USA) and gold crown was sectioned and 2 expansion screws were
finger pressure, tactile sensation, one-screw test, etc. Because the fabrication attached. Groups were classified as follows; Group 1: occlusal height of implant
of the framework requires many steps, the distortion in implant frameworks prosthesis was 46µm lower than adjacent teeth. Group 2: occlusal height of
generally is multifactorial. The criteria for optimal fit of implant abutments to implant prosthesis was 23µm lower than adjacent teeth. Group 3:occlusal height
implant fixtures is 10 microns or less, which is difficult to achieve consistently of implant prosthesis was just the same as adjacent teeth. Group 4:occlusal
with fixed-detachable hybrid superstructures made with conventional methods height of implant prosthesis was 23µm higher than adjacent teeth. 3 strain
and materials. This type of screw retained prosthesis is an adequate and simple gauges were attached to #45, #46i, #47. Beef jerky, carrot and bread were used
procedure with a high esthetic outcome. as test foods. For statistical analysis, one-way and two-way ANOVA were
performed.Results: When biting beef jerky, the mean strain value for the implant
prosthesis of group 1 was 33.31N, group 2 was 34.97N, group 3 was 89.77N and
group 4 was 100.27N. When the occlusal height of the implant gold crown
increased, the occlusal force applied to the implant prosthesis increased.
However, when the occlusal height of the implant prosthesis decreased, occlusal
force was concentrated on the adjacent teeth. In the case of carrot, the mean
strain value for the implant prosthesis of group 1 was 119.96 N, group 2 was
126.87N, group 3 was 167.06N, and group 4 was 209.14N. The alteration of
occlusal height of the implant prosthesis had very little effect on the adjacent
teeth. For bread, the mean strain value for the implant prosthesis of group 1
was 3.76 N, group 2 was 3.84N, group 3 was 5.75N and group 4 was 8.50N.
When the occlusal height of the implant gold crown increased, the occlusal
force applied to the implant increased.Conclusion: In the case of carrot and
bread, decreasing the occlusal height had not significant effect on the adjacent
teeth. For beef jerky, decreased occlusal height of the implant prosthesis exerted
a harmful effect on the adjacent teeth.

84

Poster Presentation Abstracts

roughness of 100 µm, a second level of grooves in the dimensions of about 12-
75 µm, each of which embraced an arrangement of smaller round-shaped
groups with diameters of about 1-5 µm. Aim of the present retrospective
analysis was an evaluation of 14 human retrieved implants with this wettable,
highly hydrophilic, microstructured surface. The archives of the Implant Retrieval
Center of the Dental School, University of Chieti-Pescara, Italy were searched
for human retrieved implants with this surface. A total of 14 implants retrieved
after a loading period comprised between 4 and 8 weeks were found. This
studies has been approved by the Ethical Committee of the University of
Guarulhos (UnG), Sao Paulo, Brazil. All these implants were stable before
retrieval. The implants have been retrieved with a 5 mm trephine bur. Around
all implants, newly-formed bone was found in direct contact with the implant
surface, no connective fibrous tissue found at the interface. Around all implants,
newly-formed bone was found in direct contact with the implant surface, with
no connective fibrous tissue found at the interface. In all implants, no epithelial
downgrowth was present. Most of the interthread spaces were filled by newly-
formed bone. In all implants, no epithelial downgrowth was present. A very
high bone-to-implant contact percentage was found after a healing period of
only 4-8 weeks. The efficacy of dental implants is mostly related to biological
stability and to the integration between the bone and the implant.This
integration plays a key role in the fixation and anchoring of the implants.

P72 IL= Immediate Loading

Multifactorial Analysis of Implant Failure: A 19-Year Retrospective Study. P74

J.H. Kim*, S.T. Kim, H.J. Han, D.H. Han Seoul, Republic of Korea. Accuracy of Three Different Types of Stereolithographic Surgical Guides
in Implant Placement: An In Vitro Study.
Purpose: Despite the predictability of dental implants for replacement of
missing teeth, few patients continue to experience implant failure. The aim of S.K. Turbush*, I. Turkyilmaz San Antonio, TX.
this retrospective study was to reduce implant failure rate by analyzing
characteristics of failed implants and its failure causes. Materials and Methods: The aim of this study was to compare the accuracy of implants placed using
Objects of the study were those who experienced one or more implant failure, three different types of surgical guides: bone-supported, tooth-supported and
selected from 2796 implant cases from 879 patients treated at the Implant clinic mucosa-supported. The value of this investigation lies in the fact that there are
of Yonsei Dental College Hospital between February 1991 and May 2009. Results: very few studies comparing the accuracy of surgical guides with different types
Out of total 2796 implants from 879 patients, 150 implants from 91 patients of support. In addition, the overwhelming popularity of dental implants,
were failed. Early implant failures occurred in 86 implants (57.33%) and late specifically implants placed in the mandible to support overdentures, make this
implant failures in 64 implants (42.67%). Causes of early implant failure were a significant study that will benefit clinicians. Methods: Thirty acrylic resin
inflammation (40 implants, 47%), failure of osseointegration(23 implants, 27%), mandibles were fabricated with stereolithography based on data from an
premature loading(11 implants, 13%), host response(7 implants, 8%), edentulous patient’s CBCT scan. Ten of the mandibles were modified digitally
unknown(3 implants, 3%) and combined reasons(2 implants, 2%). Causes of with the addition of teeth and ten of the mandibles were modified with soft
late implant failure were overload (34 implants, 53%), fixture fracture acrylic resin to simulate mucosa. Each acrylic resin mandible had five implants
(11implants, 17%), peri-implantitis (8 implants, 13%), unknown reasons (6 virtually planned in 3-D on a pre-surgical CBCT scan. A total of 150 implants
implants, 9%), host response(4 implants, 6%) and inflammation(1 implants, 2%). were planned and placed by the researcher using SLA guides generated from
In cases of early implant failure, especially when its failure cause was SLA. Presurgical and postsurgical CBCT scans were overlapped to compare
inflammation, risk factors were as follows: maxillary incisor, poor primary the virtual implant placement with the actual implant placement. Results: The
stability, smooth implant surface, more than 15mm of implant length, mean angular deviation of the long axis between the planned and placed
reconstructive technique and two stage surgery. In cases of late implant failure, implants was 2.2°± 1.2°; the mean deviations in linear distance between the
especially when its failure cause was overload, risk factors were as follows: planned and placed implants were 1.18 ± .42 mm at the implant neck and 1.44
smooth implant surface, reconstructive technique, two stage surgery and ± .67 mm at the implant apex for all 150 implants. Following the overlapping
telescopic denture. When the failure cause was fixture fracture, risk factors were procedure, the angular deviation of the placed implants with the tooth-
male, smooth implant surface and two stage surgery. Conclusion: Within the supported, bone-supported and mucosa-supported SLA guides were 2.26° ±
limit of this study, in implant failure, there exist various causes which include 1.30°, 2.17° ± 1.02°, and 2.29° ± 1.28° respectively. The mean deviations in linear
inflammation, loss of osseointegration, premature loading, host response. The distance between the planned and placed implants at the neck and apex were
major causes of early and late implant failure were found to be different. Key 1.00 ± 0.33 mm and 1.15 ± 0.42 mm for the tooth-supported guides; 1.08 ± 0.33
words:implant failure causes, early implant failure, late implant failure, mm and 1.53 ± 0.90 mm for the bone-supported; and 1.47 ± 0.43 mm and 1.65
inflammation, overload ± 0.48 mm for the mucosa-supported SLA surgical guides. Conclusion: 1. There
was not a statistically significant difference between any of the guides when
P73 comparing angular deviation. 2. Mucosa-supported guides were less accurate
than both tooth-supported and bone-supported guides for linear deviation
A Histological and Histomorphometrical Evaluation of Retrieved Human at the implant neck and apex. 3. Overall, the accuracy of this system was good
Implants with a Wettable, Highly Hydrophilic, Hierarchically for all types of guides.
Microstructured Surface: A Retrospective Analysis of 14 Implants.
85
C. Lenzi*, G. Iezzi, M. Degidi, A. Piattelli, J.A. Shibli, M. Giuliani, A. Petrilli,
V. Perrotti Bologna, Italy.

Analysis of human retrieved implants provides a unique opportunity to
evaluate osseointegration processes. There is evidence that faster bone
apposition is present at textured surfaces, with a very high success percentage.
Clinical success rate alone is insufficient to prove the osseointegration.
FRIADENT® plus surface (DENTSPLY-Friadent, Mannheim, Germany) was
obtained with a novel grit blasting and acid etching technique, in time and
temperature controlled processes12, and showed a regular microroughness
with pores in the micrometer dimension overlaying a macroroughness structure
caused by the grit-blasing. The spatial architecture has shown a first level of

Poster Presentation Abstracts

Overlap of planned and placed implant locations. P76

P75 Final Abutment Driven Second Stage Surgery as a Means to Reduce Peri-
implant Tissue Changes: Introduction of a New Concept.
Diagnosis, Placement and Immediate Loading Based in CAD-CAM A. Ntounis*, S. Pelekanos Birmingham, AL, AL.
Technology.
R.I. Zamora Domínguez*, E. Medina García Distrito Federal, Mexico. Introduction:Preservation and management of hard and soft tissue around
implants in the anterior maxilla consists a challenge. Severe alterations are
The use of treatment systems with computer-guided implant is growing, taking place after extraction of teeth. From the time of extraction to the implant
is important to note that not all patients are candidates for guided surgery, installation and restoration, several techniques have been implemented to
primarily because of anatomical situations that require additional techniques reduce bone loss and preserve soft tissue architecture. Dis and reconnections
as guide tissue regeneration, however, the diagnosis of these conditions is of the abutment result in apical positioning of the connective tissue zone. Many
predictable through the use of CT scans, the patients evaluated positively for restorative dentists use the provisional restorations in order to reshape the peri-
use surgical guides computerized suffer less surgical trauma, shorter operating implant soft tissues, until an optimum emergence profile is achieved. This is
time, less bleeding, less pain, less recovery time, the treatment is less invasive, potentially deleterious to the stability of the soft tissues. Connection of the final
have less risk of postoperative infection, fewer complications, more accurate abutment once, immediately after implant exposure, may provide stability for
placement of implants than any other technic, this situation does not require the periimplant soft tissues. Methods: A favourable peri-implant soft tissue
specialized abutments to correct the path of insertion of the prosthesis or architecture is created indirectly in the lab and the final abutment guides the
require complex and less predictable techniques for long-term success of healing of the soft tissue to immitate this optimal architecture. Data: A
implant-supported restoration. Planning the location of the implants is done demonstration of the final abutment driven second stage surgery and the effect
by software that gets the best position of the implants based on the anatomy on the stability of periimplant soft tissues is demonstrated through a series
in 3-D, so you will have better distribution of occlusal forces and a prosthesis of cases. Conclusion: The ‘one abutment- one time’ concept entails the use of
may immediately loaded provisional until a definitive prosthesis immediately. the final abutment from the beginning. This approach has the advantage that
It has considered the use of three-dimensional images obtained by CT scan for the abutment does not have to be removed at any time until final crown is
the design of surgical guides and the possible immediate provisional restoration. delivered, thus promoting the development of a stable biologic width. An
The use of technology computer aided design and computer aided additional modality, involves the use of smaller diameter final abutment than
manufacturing significantly reduces the patient’s time in the dental office. The the implant platform. The ‘platform switching’ concept has been shown to
possibility to perform immediate loading in such protocols is predictable due preserve bone level around implants, inhibiting crestal bone loss. The use of
to CT scan that provides us with data to bone density in Hounsfield units we all- ceramic, and especially ZrO2 abutments in the esthetic zone provides
indicate whether the patient is a candidate or not. Another benefit of CT is that superior esthetics. Recent evidence from a human study, support that the low
image in 3D dont suffers geometric distortions. With the new CT systems surface energy of this material limits bacterial adhesion and colonization of
applied to the patient radiation is minimal compared to past systems. bacteria. Additionally, the dimensions of the mucosal barrier remain stable
Immediate loading of multiple splinted implants is a very good option to short around ZrO2 abutments. This case series demonstrate an innovative approach
and long term. The use of CAD-CAM technology has been used for decades that allows for an optimal development of the peri-implant tissues, utilizing the
in dentistry the main advantages in these systems are passive fit better than final abutment during uncovery surgery.
any other technic, design and manufacture individualized for each restoration
with great accuracy. Due to the many advantages offered by the CAD-CAM P77
systems in combination with CT for guided surgery over conventional
techniques, digital dentistry is constantly growing. In Vitro and In Vivo Combined Evaluation of a Novel HA/TCP Scaffold
for Maxillary Sinus Lift.
86 F. Mangano*, B. Barboni, D. Nardinocchi, P. Berardinelli, R. Peli, A. Muttini,
L. Valbonetti, S. Tetè, R. Bedini, C. Mangano, A. Piattelli, M. Mattioli
Gravedona, Italy.

Background: Synthetic calcium phosphate ceramics are well accepted as
bone substitutes. Aim: The aim of this study was to compare a novel
hydroxyapatite and tricalcium-phosphate (HA/TCP) ceramic with a natural coral-
derived HA. Materials and methods: Calcium phosphate scaffolds were
produced by the foam replica technique. The scaffold with a HA/TCP ratio 60/40
had a high (91-96 vol%) interconnected porosity with a bimodal pore size
distribution; smaller pores of 200-500 microns and larger pores of 750-975
microns diameter. In order to assess their osteoinductive properties, HA/TCP
and coral-derived HA underwent a preliminary in vitro investigation. Epithelial
and mesenchymal amniotic cells were cultured with the scaffolds. Cell adhesion,
proliferation, viability and differentiation were evaluated. The osteoinductive

Poster Presentation Abstracts

properties of the scaffolds were then confirmed in vivo, in bilateral sinus floor P79
augmentations performed in 4 adult sheep. In one side the sinus lift was
performed with HA/TCP, while the contralateral side received the coral-derived Complete Maxillary Rehabilitation with Hybrid Denture Over 8 Endo
HA. Animals were sacrificed after 45 and 90 days. Augmentation sites were Osseous Implants: Double Impression Technique, Transfer Impression
analyzed by x-ray high resolution micro-tomography and histology. Results: to Fabricate Soft Tissue Model and Durlay Bar Transfer to Fabricate Solid
Proliferation indexes and viable/dead cell ratios were significantly higher for Model.
the HA/TCP scaffold. HA/TCP supported a marked osteogenic differentiation,
in both epithelial and mesenchymal cells, after 10 days of culture. By contrast I. Navarro*, D. Carr, C. Brenes, J. Jimenez Curridabat, Costa Rica.
osteogenic differentiation became detectable only after 21 days of culture on
coral-derived scaffolds, and exclusively in epithelial amniotic cells. In vivo, Introduction The rehabilitation of an edentulous maxilla is always a
HA/TCP scaffolds exerted a marked bone tissue generation 45 days after surgery. challenge, especially if we want to offer the patient a fixed restoration with
Osteogenesis was particularly evident in the regions where the scaffold was endo osseous implants. Because of the pattern of resorption of the maxilla and
contacting host bone tissue. At 90 days extensive bone deposition had occurred, the poor quality of the bone available, the success rate of the overall treatment
diffused to the internal sections of the scaffolds. The new bone consisted of decreases. This is why we need to do a proper diagnosis and treatment plan
lamellae of living bone, containing osteocytes, in close contact with the scaffold taking in consideration all the limitations. When we restore an edentulous
that was undergoing a progressive resorption. Coral-derived scaffolds supported maxilla with dental implants we need to take into consideration the anatomy
a slower osteogenesis with signs of new bone formation detectable only 90 of residual bone, quantity and quality of bone, type of prosthesis, number of
days after surgery. Conclusions: This study shows that, following sinus lift implants, antagonist dentition, maxilla and mandible interrelation. Materials
augmentation in sheep, HA/TCP scaffold can support an accelerated new bone and methods Following the principles of oral implantology for maxillary
formation thus opening the possibility of an early placement of implants. rehabilitations and taking in consideration the protocol describe by Zarb et al
in 1987, we proceed to treat a 68 years old white male that was diagnose with
P78 generalize severe periodontitis and multiple carious lesions. The patient was
treatment plan for extractions of all the maxillary remaining dentition, and
Clinical Investigation on Axial versus Tilted Implants for Immediate Fixed fabrication of immediate complete denture, two months later, bilateral sinus
Rehabilitation of Edentoulous Arches. lift, six months later placement of eight endo osseous implants and six months
later a two stage protocol of maxillary hybrid prosthesis. Discussion The hybrid
A. Mastrorosa Agnini*, A. Agnini, L. Pariente, C. Stappert Modena, Italy. prosthesis offers multiple advantages when we compare it to other type of
restorations like porcelain-fused metal prosthesis to restore this type of cases.
Purpose: Clinical study to investigate the outcome of full-arch fixed dental Among the advantages we can mention the low cost, the good esthetics, easy
restorations supported by immediate loaded axial and tilted implants, using to clean, less maintenance, better proprioception and is more versatile because
the ‘one-model technique’. The survival rate of axial and tilted implants was is a removable fixed prosthesis and the clinician can remove it easily to fixed
compared. Materials and Methods: Thirty patients (20 females and 10 males) the acrylic or to fixed a broken tooth. Conclusion Oral implantology is a
were included in the study. Six patients received dental implants in the upper prosthodontic science with a surgical component, due to this fact we need to
and lower jaw at the same day. A total of 36 arches (20 maxillae and 16 plan ahead our case with study models so we can define our prosthetic plan
mandibles) were treated with implants. Each arch received a fixed dental before placing our dental implants and not backwards. Doing this we going
prosthesis screw-retained over axial or axial and tilted implants within 24 hours to be able to give our patients the best result taking in consideration the
from the surgery. A total of 202 implants (118 in the maxilla and 84 in the individual needs of each other.
mandible) were placed. Patients were scheduled for follow-up at 6, 12, 18, 24
months, and annually up to 7 years. Plaque level and bleeding scores were
assessed after 3 months and 1 year of loading; moreover, patient’s satisfaction
for function and aesthetics were evaluated by a questionnaire. Radiographic
evaluation for marginal bone level change was performed at 1 year. Results:
Patient follow up ranged from 15 to 67 months (mean 40 months). 43% of
the implants were evaluated at the 4-year recall. Four axial implants were lost
in three patients, leading to 98.02% implant (98.8% in the mandible and 97.46%
in the maxilla) and 100% prosthetic cumulative survival rate, respectively. Plaque
and bleeding indexes showed decrease over time, parallel to increase of
satisfaction for both function and aesthetics. No significant difference in
marginal bone loss was found between tilted and axial implants at 1-year
evaluation. Conclusions: Within the limitations of this study, the mid-term results
confirm that immediate loading of axial and tilted implants provide a viable
treatment modality for the rehabilitation of edentulous arches.

Pre Op Panoramic X ray, Final Panoramic X ray and Clinica Views of Maxillary Hybrid
Bridge

P80

Success Criteria in Implant Dentistry: A Systematic Review.
C. Chen*, P. Papaspyridakos, H. Weber, G. Gallucci Tainan, Taiwan.

PURPOSE: (a) To examine the most frequently used criteria to define
treatment success in implant dentistry and based on this observation (b) to
propose standardized parameters for assessing treatment success. MATERIALS
& METHODS: An electronic MEDLINE/PubMED search was conducted to identify
randomized controlled trials and prospective studies reporting on outcomes
of implant dentistry. Only studies conducted with roughened surface implants
and at least 5-year follow-up were included. Pooled data were analyzed for
success at implant level, peri-implant soft tissue, prosthetic and patient
satisfaction. RESULTS: Most frequently reported criteria for success at implant
level were mobility, pain, radiolucency and peri-implant bone loss (>1.5mm);

87

Poster Presentation Abstracts

and for peri-implant soft tissue level were suppuration and bleeding. The criteria bone formation at 4 months postoperatively. 3. Collagen PVP proved to be a
of success at the prosthetic level were the occurrence of technical drug that regulates the inflammatory process and accelerate scar
complications/prosthetic maintenance, adequate function and esthetics during
the 5-year period. The criteria at patient satisfaction level were discomfort and
paresthesia, satisfaction with appearance and ability to chew/taste.
CONCLUSION: The definition of success in implant dentistry should ideally be
redefined including implant/prosthetic parameters and patient-centered long-
term outcomes. Further clinical research should systematically include all four
parameters (implant, peri-implant soft tissue, prosthesis and patient satisfaction)
for the assessment of dental implants outcome.

grafth and collagen solution polyvinylpyrrolidone in colapse alveolar.

P81 P82

Effectiveness of Collagen in Solution Polyvinylpyrrolidone Combined Implant-Supported Obturator Overdenture for Edentulous
with Graft in Reconstruction Process in Alveolar Implant Therapy. Mandibulectomy Patient: A Case Report.

J. Benitez*, F. Guerrero, H. Tellez, E. Tudon, J. Torres, R. Oliver Tampico, Mexico. S. Hye Won*, S. Yu Anynag, Republic of Korea.

Background: Periodontics and implantology has developed over the past It can be difficult for edentulous mandibulectomy patient to achieve proper
30 years and has developed and implemented effective new techniques to retention, support by conventional complete denture. In that case, the
make this practice more and more simple, efficient and obtain more predictable overdenture using implantation can improve the retention, stability. Defect
results. Dental implants have a high rate of success in edentulous patients, of alveolar ridge, the tissue remaining on the defect side, mandiular deviation,
but the increase in hard and soft tissues is frequently necessary conditions abnormal movement are adversely affected by radical mandibular surgery.
for aesthetic and functional restorations with implants. Graft materials such An understanding of postsurgical anatomy and physiology is an obvious
as allografts, xenoingerto, alloplastic and more recently have been used growth prerequisite to the development of new prosthetic procedures for
factors for this purpose. In the pre-and postprotesico increase the soft tissue mandibulectomy patients. The implant-retained overdenture can improve the
augmentation has also been used. Type I collagen derived from pigs and retention and rigidity of the denture by selecting the suitable attachment.
polyvinylpyrrolidone (PVP) is a biologic, a polymerized collagen injectable The Locator system need small vertical space and compensate implant
immunomodulating properties. electrophoretic physicochemical and parallelism.
pharmacological properties are unique because the covalent bonding between
them. Methods: The sample included 20 patients attending the Graduate P83
Periodontics diagnosed with moderate to advanced periodontal disease and
partially edentulous patients with alveolar collapse vertically and transverse of Histological and Histomorphometrical Evaluation of 3 Human Dental
said area corresponding to the loss of a tooth body, to accept regenerative Implants Retrieved after 5 Years Period.
therapy and implant and who meet the selection criteria. and they were divided
into 2 groups: a) Control (10 patients) using demineralized freeze-dried bone P. Di Domizio*, G. Iezzi, G. Vantaggiato, J. Shibli, E. Fiera, A. Falco, A. Piattelli,
+ resorbable collagen membrane. b) Experimental (10 patients) using V. Perrotti Chieti, Italy.
demineralized freeze-dried bone CPVP Solution + + resorbable collagen
membrane. Statistics were captured for patients. Statistical tests were performed Introduction Only rarely, it is possible to obtain implants, retrieved for
on the results in the control group as in the experimental group. Results: different causes, where the interface with mineralized bone is maintained.
Presenting clinically satisfactory healing of soft tissues in the preservation of Human retrieved implants with an intact bone-implant interface play a pivotal
the alveolar process collapsed in relation to height and anteroposterior role in validating data obtained from in vitro studies and animal experiments.
dimensions, without exposure of the biomaterial. Was verified histologically Aim of this study was a histologic and histomorphometric analysis of the peri-
mature new bone formation at 4 months after surgery for subsequent implant tissue reactions, and of the bone-titanium interface in 3 machined and
placement of dental implants. Conclusions: 1 .- Collagen PVP solution, used sandblasted titanium dental implants, with an intact bone-implant interface,
Returning the anatomic characteristics of the alveolar process collapsed in retrieved from man after a loading period of 5 years. Methods Three implants
combination with allograft. 2. Histologically confirmed the presence of new (Implacil, De Bortoli, Sao Paulo, Brasil), with an intact bone-implant interface,
and a loading history of 5 years, were found in the Archives of the Implant
88 Retrieval Center of the Dental School of the University of Chieti-Pescara, Italy.
The 3 implants had been retrieved from two different patients. All implants had
been used in a two-stage submerged procedure, and all implants had been
loaded and had been part of a small prosthetic restoration. One implant had
been retrieved for a fracture of the abutment, while the other two for problems
related to the prosthetic superstructure. One implant was located in the maxilla
(sandblasted surface), and two in the mandible (one with a machined and the
other with a sandblasted surface). All these implants were stable before retrieval
were retrieved with a 5 mm trephine bur. All implants had been treated to
obtain thin ground sections. Results All three implants presented mature,
compact, lamellar bone at the interface. Many remodeling areas were present
in the peri-implant bone, and especially inside the implant threads. The bone
was always in close contact with the implant surface. The bone-implant contact
percentage (BIC) of the machined implant was 92.7%, while the two sandblasted
implants showed a BIC of 85.9%, and 76.6%, respectively. Conclusions The

Poster Presentation Abstracts

present histological results confirmed that these implants with different surfaces points with patient and implant as statistical unit respectively. No statistically
maintained a very good level of osseointegration over a 5 year loading period, significant differences were found comparing peri-implant bone loss occurring
with a continuous remodeling at the interface, and showed a very high BIC. during the first 3 months and 12 months on patient (p > 0.05)and implant level
(p >0.05) for both groups. At any time point T-implants showed more peri-
implant bone loss compared to O-implants (p < 0.001). CONCLUSION TiOblastTM
and OsseospeedTM implants were highly successful with 100% survival, limited
bone loss and steady-state bone levels. Nevertheless, TiOblastTM implants show
more peri-implant bone loss at any time point. Whether this bone loss is
predicting future complications remains to be evaluated.

P84 Boxplot showing mean peri-implant bone loss for TiOblast and Osseospeed implants
after 3, 12 and 24 months on implant level.
Socket Preservation with Easy-graft CRYSTAL®: A Histomorphometric
Analysis of 5 Specimens. P86

M. Jurisic*, B. Brkovic, V. Kokovic, V. Danilovic, M. Manojlovic Beograd, Serbia. A Light Microscopy and Scanning Electron Microscopy Study of Peri-
implant Collagen Fibers around Human Direct Laser Metal Forming
Tooth loss and different pathosis may results in extensive jaw bone (DLMF) Dental Implants.
resorption.To correct insufficient bone volume, different materials and
augmentation technique were introduced. Now days, it is still uncertain which F. Luongo*, C. Mangano, A. Piattelli, A. Scarani, M. Raspanti, J.A. Shibli,
socket preservation material is the most predictable in gaining sufficient bone F. Mangano, V. Perrotti, G. Iezzi Chieti, Italy.
volume and quality . Biphasic beta-tricalcium phosphate (TCP)composed of
60%HA, 40% beta-TCP coated with polylactide (PLGA)(Easy-graft CRYSTAL®) The establishment of a firm functional soft tissue barrier is considered to
have good osteoconductive properties, micro porous surface which facilitates be important to protect the implant interface from invasion of bacteria from
the anchorage of proteins and cells to the surface of the graft. This the oral cavity. The presence of a direct fiber attachment to dental implants has
Histomorphometric analysis of 5 specimens was performed in order to calculate been debated in a controversial and critical way in the literature. A
the percentages of mineralized bone, residual graft materials, and connective perpendicular orientation to the implant surface may result in a better
tissue and/or bone marrow. The biopsies/specimens, 5 µm thick, were stained anchorage to the metal. The attachment of functionally oriented CT would
by Goldner’s trichrome method. All stereological analyses were carried out using impede the apical migration of the JE and preserve the crestal bone level.
a workstation comprised of a microscope (Olympus, BX-51) equipped with a Changes in the surface microscopic texture can be used to change the response
microcator (Heidenhain MT1201). Results of histological analysis have shown of the peri-implant bone and soft tissue. Direct laser metal forming (DLMF) is
bone tissue formation at the most apical part of the defect, while grafted a metal forming procedure in which an high power laser beam is directed on
material particles were present in more coronal parts of the defects. a metal powder bed and programmed to fuse particles according to a CAD file,
Histomorphometry showed that newly formed bone represented 30,5±6,5%, thus generating a thin metal layer. With DLMF, it is now possible to fabricate
residual grafted material 29,8±8,8%, while connective tissue 39,7±12,2. dental implants with a superficial porous surface (TixOs Nano OvdR, Leader-
Novaxa, Milan, Italy). Aim of the present light and Scanning Electron Microscopy
P85 (SEM) study was an evaluation of the peri-implant soft tissues around human
retrieved DLMF dental implants. Collagen fibers, in form of bundles, were
The Effect of Surface Modifications on Implant Survival and Peri-implant oriented perpendicularly, until to a distance of 100 µm from the surface, where
Bone Loss of Immediately Loaded Implants in the Mandible: A 2-year they became parallel, running in several directions. In some portions, it was
Comparison. possible to observe that collagen fiber bundles appeared to be oriented
perpendicularly or obliquely to the plane of the section. Collagen fibers
S. Vervaeke*, B. Collaert, H. De Bruyn Ghent, Belgium. appeared to form a 3-D network around the implants. Under SEM, an intimate
contact of the fibrous matrix with the implant surface was evident, and some
INTRODUCTION Implant surfaces have undergone modifications to enhance collagen bundles could be seen to bind directly to the metal surface. In
osseointegration. The OsseospeedTM (Astra Tech Dental, Mölndahl, Sweden) conclusion, in this study it was possible to confirm previous data that changing
surface is grit-blasted and additionally treated with fluoride-acid resulting in the surface microtexture it was possible to change the response of the peri-
a faster and stronger bone-to-implant contact during the first weeks of healing. implant soft tissues.
The aim of this study was to compare the outcome of TiOblastTM vs
OsseospeedTM implants in the mandible in terms of survival and bone loss under 89
immediate loading. MATERIALS & METHODS 125 OsseospeedTM implants (O)
were installed in 25 patients. Implants were functionally loaded the day after
surgery (baseline). Bone loss was measured on peri-apical radiographs after
3, 12 and 24 months. The results were compared with the outcome of 25
previously described patients with 125 TiOblastTM implants (T) using the same
protocol. RESULTS 250 implants were installed in 50 patients. After 24 months
3/25 patients in the T-group and 1/25 in the O-group were lost to follow-up.
No implants failed resulting in a survival rate of 100%. After 3, 12 and 24 months
the mean bone loss for the T-group was 0.60mm (SD 0.68, range -0.12–2.14),
0.81mm (SD 0.84, range -0.30–2.34), 0.84mm (SD 0.92, range -0.21–2.57) and
0.60mm (SD 0.82, range -0.6–3.95), 0.80mm (SD 1.02, range -0.9–3.85),
0.86mm(SD 1.14, range -0.9–4.65) with patient and implant as statistical unit
respectively. For the O-group a mean bone loss of 0.14mm (SD 0.18, range -
0.11–0.57), 0.11mm (SD 0.12, range -0.11–0.30), 0.11mm (SD 0.12, range -0.11–
0.43) and 0.14mm (SD 0.32, range -0.55–1.75), 0.11mm (SD 0.22, range -0.55-
1.05), 0.11mm (SD 0.21, range -0.55–1.00) was observed at the different time

Poster Presentation Abstracts

P87 and 12:29 m/s for digital impressions (P <0.001). Mean preparation time was of
4:42 m/s for conventional and 3:35 m/s for digital impressions (P = 0.001). Mean
Comparison of Gold UCLA Abutment and Cobalt-Chromium-Molybdeum working time and retakes demanded 20:00 m/s for conventional vs. 8:54 m/s
Abutment. for digital impression (P <0.001). On a 0 to 100 VAS scale, participants scored
a mean difficulty level of 43.12 (± 18.46) for conventional and 30.63 (± 17.57)
Y. Cho*, Y. Park, K. Lee Jinju, Republic of Korea. for digital impression technique (P= 0.003). Sixty percent of the participants
preferred the digital impression, 7% the conventional impression technique
Due to the highly rising price of noble metals, the alternative base metal and 33% preferred either technique. Conclusions The digital impression was
alloys have become more attractive in implant dentistry. Recently, CCM (Cobalt- more efficient than the conventional impression based not only on amount
Chromium-Molybdenum) alloy abutment has been introduced. CCM alloy has of time consumed but also on participants’ perception. Digital impressions
long been used in medical fields for its biocompatibility and corrosion allows for additional re-scans without the need of repeating entirely the
resistance. Once premachined CCM abutment is casted to build up the upper impression technique. Conventional impression would require more experience
part of the abutment with base metal alloys, it is necessary to remove oxide to achieve the same level of proficiency than digital impressions. This study
layer. However, there is no report on the effects of oxide layer removal and wear yielded initial evidence that the digital impression can be successfully applied
and galvanic corrosion between titanium implant and CCM abutment after to the impression for implant restoration based on efficiency and participants’
functional cyclic loading. The purpose of this study was to compare gold UCLA perception. The assessment of implant impressions’ accuracy in producing a
abutment with CCM abutment for (1) the surface characteristics after casting working model, clinical comparison of efficiency and accuracy of both
procedure and (2) the wear pattern of connection part of implant and abutment impression techniques are under current investigation.
after functional cycling loading and (3) the reverse torque value after chewing
simulation. A total of 16 identical crowns were fabricated. Eight of them were
made with Gold UCLA abutment and noble metal alloy (Control); other 8 were
made with CCM abutment and base metal alloy (Test). CCM abutment and
crowns were blasted with 50µm beads at 0.3 - 0.5 MPa to remove the oxide
layer. Surfaces of both control and test groups before and after casting were
examined using scanning electron microscope (SEM) and that of test group
after blasting were observed too. All crowns were tightened at 30Ncm into the
fixture. Loadings were performed vertically at 2mm away from the center of
crown at 2Hz, 400,000 times in distilled water. Reverse torque values (RVT) of
each specimen were recorded and the surfaces of connection parts between
fixture and abutment were examined. In control group, there were no surface
difference before and after casting, however in test group, the oxide layer
formed after casting procedure and micro surface irregularities were detected
after the blasting procedure. The wear was detected in the noble metal alloy
abutment, while in test group the wear was detected in the fixture. Mean RVT
of control group was 10.3Ncm and test group was 10.4Ncm. There is no
significant difference between control and test groups. In conclusion, even
though mean RVTs of both groups are not statistically different, further studies
may be needed because wear spots detected in the fixture of the test group
may cause the failure of implant in the long term periods.

Conventional and digital impression techniques for single implant restoration

P88 P89

Digital vs. Conventional Implant Impression: Efficiency Outcomes. Three Year Outcomes of Early Loaded Implants in Posterior Maxilla.

S.J. Lee*, G.O. Gallucci Boston, MA. C. Stanford*, J. Mellonig, W. Wagner, D. Dawson Iowa City, IA.

Introduction The advent of digital impressions comes to complete the work Objective: purpose of this study was to investigate effects of early loading
flow of Digital Dental Technology (DDT) by integrating an intraoral scanning of dental implants in posterior maxilla. Methods: 47 patients with edentulous
with the well-established CAD/CAM systems currently used in implant dentistry. posterior maxilla at three centers were treated with a total of 131 implants. Two
Objectives This study was to evaluate the efficiency, difficulty and operator’s to three, self-tapping implants were placed with a one-stage approach.
preference of a digital impression compared to a conventional impression for Resonance Frequency Analysis (RFA) and radiological assessment were made.
single implant restorations. Materials & Methods Thirty HSDM 2nd year dental After 6 weeks of healing, provisional restorations were fabricated. Results: 80
students performed conventional and digital implant impressions on a implants in 32 subjects were loaded within 56 days of placement (Early Load
customized model with a single implant. The outcome of the impressions was Group), 43 implants in 14 subjects had conventional healing periods due to
evaluated under acceptance criteria and need for retake/rescan was decided. lack of implant stability at 6 weeks. In the early load group, 41% were male and
The efficiency of both impression techniques was evaluated by measuring 59% female. 62 % were non-smokers and 38 % ex-smokers. In the early load
the preparation, working, and retake/scan time (m/s) and the number of group, 56% were placed with Osteotome technique and 98% had primary
retakes/rescans. Participants’ perception on difficulty, preference, effectiveness fixation at placement with 85% placed in type 3 and 4 bone. Initial RFA
and proficiency was accessed by a visual analogue scale (VAS) and multiple measurements had median values of 66 ± 7 ISQ at placement in the early load
questionnaires. Results Mean treatment time was of 24:42 m/s for conventional group and a final median of 70 ± 7 ISQ at 60 weeks. There was no significant
change in ISQ value over the repeated seven ISQ measurements over the first
60 weeks ( p<0.05). Mean marginal bone loss in the early load group over three
years from implant placement was 0.37 mm +/- 0.74 (range -2.70 loss to 1.55
mm gain). Cumulative Implant Survival Rate (CISR) for all implants at risk were
92% (n=10 losses of a 131 at risk), 96% for the early load group (3 of 80 at
risk) and 98% (1 of 43 at risk) for the delayed loading group. Conclusions: Three
year results in posterior edentulous maxillas indicate satisfactory results with
early loading of implants when implants have initial primary stability. Supported
by Astra Tech AB & NIH NCRR CTSA UL1RR024979.

90

Poster Presentation Abstracts

P90 a definitive prosthesis was fabricated using Zirconia. Discussion: The results
indicate that calcium phosphosilicate putty is an ideal choice for restoring
16 year-Cumulative Survival Rate of the Implants Placed in the Maxillary fenestration defects. The ability to contour the graft to the desired helps achieve
Sinus Combined with Sinus Floor Augmentation. an esthetically pleasing result. Large scale controlled clinical studies are
recommended.
S. Kim*, M. Kim, J. Park Seoul, Republic of Korea.

Objectives: The aim of this study is to evaluate the long-term cumulative
survival rate and the risk factors associated with implants placed with maxillary
sinus augmentation. Subjects & Methods: The authors reviewed the records
of 174 patients undergoing implant surgery between November 1993 and May
2010. Data of 579 implants placed in the maxillary sinus combined with sinus
floor augmentation by lateral approach were collected from the Department
of Oral and Maxillofacial Surgey, Ewha-Womans University Mokdong hospital.
Survival analysis by use of Kaplan-Meier method and Cox proportional hazards
regression model was carried out on host and related factors. The characteristics
of failed implants was analyzed by Chi-square test. Results and Conclusions 1.
A 16-year Cumulative Survival Rate of the dental implants placed in posterior
maxilla combined with sinus graft was 88.44% by Kaplan-Meier analysis. 2.
Kaplan-Meier analysis of overall cumulative survival rate of the implants
according to the period resulted in 81.10% for 1993-2000 and 93.02% for 2001-
2010. 3. Gender, diameter of implant fixture, donor site, and timing of
implantation were the four main prognostic factors determined by Multivariate
analysis using Cox proportional hazards model. 4. 46.8% of 47 failed implants
were found within one year after implantation, and the failure was correlated
significantly with the kinds of implant system significantly. Key words: sinus
floor augmentation, lateral approach, implant failure, cumulative survival rate

Figure 1. Overall cumulative survival rates of the implants after installation. P92

P91 Local Effects of Human Growth Hormone associated with Autogenous
Bone Graft in Rabbits: Histomorphometric Analysis.
Restoration of a Fenestration Defect with a Novel Calcium
Phosphosilicate Putty: A Case Report. H. Simoes*, R. Limberte, M.V. Goulart, S.L. Miranda, W.R. Sendyk Guaruja,
Brazil.
U. Kher*, L. Mahesh, S. Katta Athens, Greece.
Since the efficiency of autogenous bone grafts for the subsequent
Background: A 24 year old healthy, non-smoker, female patient reported installation of oral implants is generally known, the aim is to speed up
with a badly infected tooth #9. Radiographic examination revealed a moderate treatment, shortening the time of bone mineralization in order to rehabilitate
sized periapical lesion with external resorption of the root. The best prognosis the individuals faster. The purpose of this study was to evaluate the effect of
involved tooth extraction with implant placement. Methods: Tooth #9 was local use of a single dose of human growth hormone (rhGH) in the bone
extracted atraumatically. The infected tissue was thoroughly cleaned using bone incorporation of the autogenous graft because the growth hormone is one of
currettes. Bone sounding was done with an explorer and a labial fenestration the most important substances that regulate the growth and bone remodeling.
was detected. The marginal bone was found to be intact and undisplaced. A We have worked with 24 adult rabbits, separated in test group (T2, T6 e T8) and
3.8mm x 15mm implant (internal tapered with Laser Loc, Biohorizons inc., control group(C2, C6 e C8). Surgeries have been performed in the autogenous
Birmingham, AL) was placed using a flapless approach. Ossteotomy was bone graft which was removed from the Iliac side face and fixed with a titanium
performed on the intact palatal wall of the socket. Primary stability was screw in the side face of the mandibles. In the test group, the bone graft as well
achieved. An Ochsenbein Leubke incision was made on the attached gingival as the receptive area were soaked in 0,85 mg of rhGH and in the control group
making sure it rests on sound bone. A fully synthetic Calcium Phosphosilicate was used a sterile saline solution. Four animals were sacrificed in each group
Putty (NovaBone Dental Putty, NovaBone Products, Alachua, FL) was injected at 2, 6 and 8 weeks after surgery. The histological results for all the evaluation
into the fenestration defect and the gap between the implant and labial cortical periods of the experimental group show that rhGH had an important function
plate (jumping distance). A collagen membrane and silk sutures were used to in the integration of the graft, favoring greater trabecular and medullar
achieve mucosal closure over the grafted area. A fiber reinforced provisional neoformation. The results evaluated in the period of two weeks showed a well
prosthesis was made and the implant was left submerged for 6 months. cellularized osteogenic tissue, rich in osteogenic cells and osteoblasts.
Results:A radiograph after 6 months revealed excellent bone fill. Clinical pictures Neoformed trabeculae in greater quantities in the test group were distributed
reveal good soft tissue contour over the fenestration area indicating a complete throughout the region and integrated with the mature bone trabeculae present
bone fill. The area was dense on palpation. A final impression was made and in the bone graft treated with human growth hormone. In assessing the period
of six weeks, the region of the interface was replaced by mature and immature

91

Poster Presentation Abstracts

trabecular bone and bone marrow. There was the incorporation of the fragment Wolhusen, Switzerland) and Bio-Gide® (Geistlich, Wolhusen, Switzerland). Second
of bone graft with the bone tissue receptor resulting in bone graft, which was surgery was done in 6 months after implant placemen and provisionalization
lower compared to the previous period. At eight weeks, we noticed the was done during 3 months. Definite abutment was made of porcelain,gold and
formation of jaw new cortical bone fully mature, thickening greater when zirconia, and was attached after provisionalization. Two-dimensional slices were
compared with the cortical bone adjacent to the receptor. We conclude that created to produce sagittal, coronal, axial and 3D by using OnDemand3D
the local use of rhGH single dose may accelerate the process of integration of (Cybermed, Seoul, Korea). RESULTS. 1. Seventeen implants showed the existence
the autogenous graft bone in the mandibles of adult rabbits. of labial bonein top third of implant. Existence of labial bone in top third scored
about 65%. 2. The mean value of bone resorption(distance from top of implant
to labial bone) was 1.32±0.86mm and the mean thickness of labial bone was
1.91±0.45mm in CBCT. CONCLUSION. Conclusively, it is suggested that the
thickness more than 1.91mm could reduce the amount and incidence of
resorption of labial bone in maxillary anterior implant. Key Word : implant, labial
bone, bone resoroption, cone beam computed tomography

P93 P95

Surface Changes between Implant and Zirconia Abutment after Loading. Use of Cortical Lamina for Reconstruction of Alveolar Bony Defects: Case
Report.
H.J. Kim*, D.I. Lee, M.S. Kim, C.H. Chung, S.W. Park, K.D. Yun, J.G. Lee Gwang-
Ju, Republic of Korea. A. Ismail* Cairo, Egypt.

Purpose: The purpose of this study is to evaluate the surface changes Objective Alveolar bone defects represent a challenging problem for
between implant and zirconia abutment after loading through FESEM. Material reconstruction; as it needs cortical cover, good adaptability and easy fixing
and Method: In this study, titanium abutments and zirconia abutments were technique. Although the Autogenous bone is the golden standard for
connected to each implant in external type implants. After that they were augmentation. However, it lacks adaptability, donor side morbidity, difficulty
loaded 10000 times with 20Kg as occlusal force. The surface changes of external of fixation and stability. Contouring and reshaping of the ridge with cortical
hexgon part and platform were observed in FESEM image. Viker’s hardness of contoured bone is considered a real challenge because of absence of semi-
an implant, a titanium abutment and a zirconia abutment were measured flexible bone. Usage of Cortical Lamina can provide semi-flexible degrees
respectively. Results 1. Viker’s hardness of an implants, a titanium abutment customized to the exact defect shape. Methods 36 Y. male suffering from a large
and a zirconia abutment was 309.80±11.78 HV, 318.40±11.82 HV, and bony defect following history of surgical removal of upper central incisors
1495.30±16.21 HV respectively. There was no statistical significance between Clinical examination showed loss of contour of alveolar buccle bone with large
an implant and a titanium abutment (P>0.05, Anova). However, there was depression at the vestibular site with slight spearing fistula CBCT revealed
statistical significance between an implant and a zirconia abutment(P<0.05, loss of apical bone Defect analysis revealed buccle bone defect of 7mm width
Anova). 2. The wear was observed at the joint of implant and abutment in both X 12 mm length The flab was totally elevated; granulation tissue in the bed was
a titanium abutment group and a zirconia abutment group after loading 10,000 excised The fistula was curated to a healthy bone margin Lamina was dipped
times. The zirconia abutment showed more remarkable wear than the titanium in warm saline for 7 minutes, then a piece was cut fashioned to close the defect.
one. Conclusion: In conclusion, the wear of external hexagon and platform was The defect filled with collagenated corti-cancellous bone chips The Lamina was
much more notable in a zirconia abutment group than a titanium one. It was fixed in place using 3.0 vicryl sutures to surround periosteom Results Lamina
suggested that it could result from the difference of surface hardness between was tolerated to a convex shape restoring the contour according to the pre
titanium and zirconia. The wear of junction between an implant and a zirconia CBTC The flab was scored from its undersurface to allow stretch and complete
abutment becomes more severe, the connection of an implant and an coverage of Lamina No major complication developed post operative Minor
abutment is much more unfit. This is likely to cause loosening and fracture of complications like edema and lip swelling developed post operatively increased
the abutment screw. so it is considered that the possibility of implant supra- after 72 hours and then regress totally after 7 days Slight dehiscence appeared
structure failure can be increased. at crestal palatal interface which was treated with careful cleaning and irrigation
completely resorbed after 10 days CBCT after 6 months reveals closure of the
P94 defect and valuable bone formation Conclusion Versatility and adaptability of
the Cortical Lamina and easy way for fixation provide a good solution in such
Resorption of Labial Bone in Maxillary Anterior Implant. a case without secondary surgery for bone augmentation with high morbidity
of the donor side This case report demonstrates the possibility of using Cortical
C. Chung*, J. Kim, Y. Cho, H. Kim Gwngju, Republic of Korea. Lamina in small-medium sized alveolar bone defects

PURPOSE. The purpose of this study was to evaluate the change, the amount P96
of resorption and thickness of labial bone in anterior maxillary implant using
cone beam computed tomography with Hitachi CB Mercuray(Hitachi, Medico, Esthetic Reconstruction for a Previous Implant Restoration.
Tokyo, Japan). MATERIALS AND METHODS. Twenty-two patients with 26
impalnts were followed -up and checked with CBCT. 21 OSSEOTITE W.G. Moussa*, E.W. Moussa Alexandria, Egypt.
NT®(3i/implant Innovations, Florida, USA) and 5 OSSEOTITE® implants (3i/implant
Innovations, Florida, USA) were placed at anterior region and they were Introduction: Implant treatment has become a wide spread treatment
positioned vertically at the same level of bony scallop of adjacent teeth. modality in the last 25 years, especially in developing countries like Egypt. This
Whenever there is no lesion or labial bone was intact, immediate placement led to a lot of badly restored and misplaced implants. The case presented is a
was tried as possible as it could be. Generated bone regeneration was done malpositioned implant with an extremely non esthetic restoration for an elegant
in the patients with the deficiency of hard tissue using Bio-Oss® (Geistlich, looking women. In addition there was food accumulation and difficulty in oral
hygiene. The Patient requested improving her condition. Objectives: Improving
the esthetic look and hygiene for this patient, by removing the old implant and
reinserting another implant and restoration . Materials & methods: A screw type
implant was used with a Zirconium oxide crown restoration. Treatment plan: 1-
Removal of the current crown and implant 2- Grafting of previous implant
site in conjunction with insertion of a new implant. 3- Management of the
soft tissue defect. Treatment was done in a single visit due to patient
circumstances. Inserting the implant was via expander technique as the x-ray
indicated a very small bone width. Result & discussion: Removal of the crown
and implant indicated a close to horizontal position for the old implant, leaving
a labial soft tissue defect. The Bone was extremely thin so using an expander
was the correct technique of choice in inserting the new implant. The implant
was inserted with a reasonable angle which could be adjusted during the final
restoration. Final restoration with a zirconium crown was very pleasing for the

92

Poster Presentation Abstracts

patient. Regaining her smile made her very grateful and satisfied leaving our P98
center.
Dental Implants in the Oral Bisphosphonates Patients.

G.C. Leghissa*, F. Demarosi Milano, Italy.

A conclusive cause and effect relationship between bisphosphonates
therapy and osteonecrosis of the jaws has not been established. Unfortunately
there is limited data to aid in the identification of other risk factors for
development of the disease. The aim of this prospective study is to determine
the extent to which oral bisphosphonate-associated osteonecrosis occurs after
oral and dental implant surgery using a drug holiday protocol. We also wanted
to determine whether there was any indication that bisphosphonates affected
the overall success of the implants. Materials and Methods. We described
patients undergoing oral or implants surgery who had took oral
bisphosphonates. All patients received the follow protocol to prevent
osteonecrosis. - Professional oral hygiene performed at least two weeks before
the intervention. - Oral rinses with chlorhexidine mouthwashes for two weeks
before the intervention. - Antibiotic therapy with amoxicillin, one week before
the intervention. - The intervention has been done minimizing the soft tissues
and bone trauma. - Oral rinses with chlorhexidine mouthwashes for two weeks
after the intervention. - Antibiotic therapy with amoxicillin, at least for two
weeks after the intervention. Clinical monitoring was carried out one, three, six,
nine and twelve months after surgery and then annually. Panoramic radiographs
were obtained prior to, immediately after, and 6 months following the surgery.
Results. A total of 91 interventions (28 oral surgery, 7 sinus elevation, 21 implant
surgery, 35 post-extraction implant surgery) were performed in 61 patients who
reported having received oral bisphosphonates. All patients stopped oral
bisphosphonates therapy 3 to120 months before the intervention. The mean
duration of bisphosphonates therapy prior to the surgery was 62.5 months. No
infection was noted during the post-operative period and healing was
uneventful in all patients. There is no evidence of osteonecrosis in any of the
patients evaluated. Of the 111 implants placed, all but 5 integrated fully and
meet criteria for establishing implant success. Follow-up ranged from 6 to 58
months. Conclusion. In this study of 91 interventions, implant placement and
oral surgery appear to be safe and successful procedures in patients who have
took oral bisphosphonates. Considering the number of patients taking oral
bisphosphonates, further studies will be helpful in clarifying this issue.

before and after treatment P99

P97 Evaluation of NobelActive Implants in Anterior Extraction Sites:
A 6-month Analysis.
Bone Loss by the Gap Formation between Implant Body and Abutment.
J. Ganeles*, F.J. Norkin, S. Zfaz Boca Raton, FL.
R. Ikeya*, Y. Nameta, T. Noguchi, K. Hirota Tokyo, Japan.
INTRODUCTION The purpose of this study was to prospectively evaluate
There are several reasons for bone loss around a dental implant. The success rate, marginal bone remodeling and soft tissue health in anterior
understanding of bone loss is important to lead clinical success. The purpose maxillary extraction sites, using implants with an anodized surface. MATERIAL
of this study is to confirm that the gap formation between implant body and AND METHODS Fifteen patients received 15 NobelActive (Nobel Biocare,
abutment may cause the bone loss in animal study. The implant is applied to Gothenburg, Sweden) implants replacing single teeth in the maxillary esthetic
3 macaca fascicularis. Aadva implant manufactured by GC Corp was used as a zone. The implants were immediately provisionalized and the definitive
basic implant. This implant has moderate rough surface by sandblasting and prosthesis was delivered within 6 months of surgery. Marginal bone level was
acid etching. The basic connection part between implant body and abutment evaluated by an independent radiologist from standardized radiographs taken
is conical sealing type. The conical angle is 16 degree. 4 different types of model at implant insertion, 3 and 6-month visits and will be continued annually. Torque
were used, 1. basic connection, 2. no connection (one-piece implant), 3. less and RFA values were recorded. Soft tissue parameters utilizing the Silness and
plat form shifting 0.1mm (normally 0.225mm), and 4. gap, around 30µm. Astra & Löe plaque index, Mombelli modified sulcus bleeding index and Jemt papilla
implant (conical sealing type, Astra Tech) and Genesio implant (butt joint type, index were recorded. Cumulative survival rate (CSR) and success rate (van
GC Corp.) were also applied as controls. The mandibular occlusal teeth were Steenberghe criteria) were assessed. RESULTS Fifteen implants were placed in
extracted and the healing period was taken for approx. 6 month. 6 kinds of 15 patients. All implants were immediately placed in extraction sites (27% in
different implant were applied afterward, and 8 implant bodies with healing infected sites) with insertion torque values between 35 to 70 Ncm. All patients
abutment were placed to each macaca fasciculary. They were x-rayed to check completed the 6-month visit. 14 implants have been restored. In 1 patient the
for bone loss every two months. Also, the bone loss was looked into by dental final restoration was not delivered due to patient management problems. No
X-ray and CT X-ray microscope when they were sacrificed 14 months after the implant failures occurred during the first six months resulting in a success rate
implantation. The bone loss around gap implant started to be shown 6 months and CSR of 100%. The mean bone level at implant insertion, 3 and 6 months
later. Clear bone loss of all other specimens was not identified before that. All visits was reported as -2.34 mm (SD 1.98, n = 15), -0.74 mm (SD 1.05, n = 14),
gap type of implant body leads bone loss. The depth of bone loss with gap - 0.90 mm (SD -1.32, n = 15 respectively. The mean change in bone level from
implant was 1-2mm in 14 month. All other type shows less than 0.5mm bone implant insertion to 3 and 6 months was 1.73 mm (SD 2.16, n = 14) and 1.44
loss. Bacteria inhabited in gap grooves are supposed to cause the bone loss mm (SD 2.11, n = 15). No significant change was reported between RFA values
as widely understood. The further study is necessary to understand the more at the implant insertion and the 3-month visit (mean 69 and 67, n = 15). Papilla
precise mechanism. indices remained stable from baseline to the 6-month visit. No bleeding on
probing or plaque was observed in 73% of implants at the 6-month visit.
CONCLUSIONS Interim 6 month results show stable bone and soft tissue levels.
Marginal bone remodeling, with a mean bone gain of 1.44 mm representing
socket fill at the 6-month post extraction visit, was observed. These findings
indicate that NobelActive implants can be used predictably and effectively in

93

Poster Presentation Abstracts

extraction sites of the anterior maxilla. Nobel Biocare Services AG, Grant number results demonstrated that conical implants distributed the tension uniformly
2009-847, has supported this study around the entire model, while the cylindrical one concentrated tension at
the crestal and it dissipated to the middle third and apical. Conclusion: The
P100 conical implants support a distribution of the compaction forces in a bigger
and better defined area, which turns less destructive for the biological tissue,
Indication and Results for Grafting by Onlay Block Grafts or Ridge in that, at the cylindrical implants, the force concentration was fully localized
Splitting. in small areas around the implant. Besides that, the size of the crown and the
material type, affect the pattern and the tension type.
J. Neugebauer*, M. Scheer, F. Kistler, S. Kistler, D. Rothamel, G.A. Bayer, J.E.
Zöller Landsberg, Germany. P102

Due to the atrophy implant placement requires in many cases a grafting Simultaneous Implant Placement and GBR with Alloplast Putty Following
technique. Various techniques are available which state to improve the implant Extraction of Impacted Canine: A Case Report.
side. To evaluate the results of ridge splitting and retro-molar block grafts an M. Salama*, L. Mahesh, N. Venkataraman, S. Katta Athens, Greece.
analysis of the initial results after one year was performed. Out of 46 patients
10 (21.7%) received a ridge splitting and 36 (78,3%) a retro molar block graft. Background: A 26 yr old female patient presented with pain and mobility
31 implants were placed simultaneously to the ridge splitting (3,1 implants in associated with tooth #10. Clinical examination revealed grade II mobility and
average), while 68 implants were placed for the patients with block graft in a a missing canine. Radiographic examination revealed a horizontally impacted
staged approach after 9.8 weeks(1,8 implants in average). Two out of the 99 canine causing root resorption of the affected tooth. Extraction of involved
implants showed no osseointegration at second stage surgery (97.9% success). teeth (#10 & impacted canine), restoration of the area with bone graft substitute
All implants in the retromolar block graft were osseointegrated. Remaining pain and placement of an placement of implant was the treatment of choice.
level on a scale between 0 and 100 after 10 and 21 days were stated for the Methods: A semi-lunar incision was made in the mucosa to expose the bone
retromolar block in average 23/2 and for the ridge splitting 33/14 in average. above the impacted canine. The bone was removed using an ultra-sonic bone
The pain level was stated highest by patients receiving a rigde splitting surgical system (Resista, Italy). The impacted canine was luxated out of the area.
procedure in the mandible. At the time of prosthetic delivery the marginal bone The huge defect that resulted after extraction was filled with 2cc of synthetic
loss on the implants after retromolar block transplant was 0.4 mm and for ridge calcium phosphosilicate putty (NovaBone Dental Putty, NovaBone Products,
splitting 1.6 mm. With ridge-splitting a loss of 1.5 mm vertical dimension were Alachua, FL). Tooth #10 was extracted under local anesthesi and A 3.5mm
observed, while with the retromolar block transplant a vertical height gain of diameter 13mm long Narrow Platform impalnt (Nobel Biocare, Switzerland) was
2.5 mm was realized. Retromolar block grafts require two surgery to place the placed through the #10 socket. Additional 1 cc of the calcium phosphosilicate
implants, but less material like bone substitute material or membranes are putty was placed on the buccal defect over the implant and covered with a
necessary. The overall expenses show no difference for each technique. Ridge Biomend membrane (Zimmer Dental, Carlsbad, CA). After suturing, an
splitting is a favorable procedure in the anterior maxilla if the patient accepts immediate resin bonded prosthesis was given to protect the site. Results: The
an removable suprastructure or fixed restoration with pink porcelain to patient was recalled after 6 months the implant was exposed for the 2nd stage
compensate the loss of vertical dimension. Retromolar block grafts are surgery. A periotest value of -6.4 was recorded indicating excellent
supporting bone and soft tissue for anterior single teeth. Depending on the osseointegration. Radiographic examination revealed excellent bone fill in the
patient demands and the anatomical finding each procedure has its indication. restored site which was indistinguishable from the adjacent unrestored area.
A temporary crown was given to help prosthetically modify the soft tissues.
Four months following the second surgery, a final zirconia based restoration
was fabricated and the area restored.

A1 Implant insertion simultaneous with ridge splitting
A2 Support of ridge split by membrane and grafting material
B1 3D-reconstruction with vestibular incision and particulated block graft
B2 Delayed implant placement after 10 weeks in consolidated graft

P101

Distribution of Stress in Conical and Cylindrical Implants - A Laboratorial
Study with Photoelasticity.
N. De Bortoli Jr.*, S.A. Gehrke, E.C. Ferreira Santa Maria, Brazil.

Objective: Compare the transmission of forces after the action of loads on
conical and cylindrical implants using the methodology of experimental
photoelasticity. Material and methods: Were used internal hexagon implants
(Implacil, DeBortoli), positioned in two photo elastic models made with resin.
The implants were positioned on prosthetic abutment type wax-one, with a
metal-ceramic crown. In a polariscope set the metal-ceramic crown received
an axial load of 100N, allowing the visualization of the difference in the tensions
distribution in each type of implants at the photo elastic models. Results: The

94

Poster Presentation Abstracts

P103 P105

Evaluation of Implants for Sandblasting Microparticles of Titanium Oxide One Year Results following Immediate Implant Placement and Ridge
- Clinical and Laboratorial Studies. Preservation: A Report of Five Cases.

S.A. Gehrke*, B.A. Dedavid, M. Santos Santa Maria, Brazil. M. Tallarico*, A. Vaccarella, M. Papagno Rome, Italy.

Objective: The aim of this study was the observation in vitro and in vivo Aim: To evaluate hard and soft tissue alterations and radiological outcomes
implants sandblasted with particles of TiO. The in vitro observation was made of immediate single implants placed/loaded in esthetic area. Materials and
with imaging in SEM and evaluation of morphological characteristics. Material methods: Five consecutive patients requiring an immediate restoration of a
and Methods: For in vivo evaluations were used six New Zealand rabbits, adult fractured non-treatable upper premolar were recruited for atraumatic tooth
with average weight of 3.5 kg obtained from the Bioterio of the Federal extraction, immediate implant placement/loading according to an appropriate
University of Santa Maria. Were used 24 cylindrical implants with internal hex tridimensional bone-to-implant relationship and ridge preservation procedure
manufactured by the company Implacil Dental Material (Implants DeBortoli) with anorganic bovine bone mineral. Outcome measures were failures of
sandblasted to TiO. A marker of bone growth of fluorescence, calcein was implants/prosthesis, any complication, peri-implant bone crest resorption (BCR),
injected subcutaneously at two different time intervals to assess the calcium implant stability quotient (ISQ), bucco-palatal change (BPC) and pink esthetic
deposition in the bone in the period from second to fourth week, corresponding score (PES) at implant placement/loading and at 1-year follow-up. Results: No
to the experimental group 1 (exp1) with 3 animals, and from sixth to eighth implant failed (cumulative success rate at 1-year: 100%). The mean BCR was
week, corresponding to the experimental group 2 (exp2) with 3 animals. The 0.30±0.72mm (10.06%; P=.6346). A moderate initial ISQ value was found at
samples obtained were cut 3 slices of each implant using a histological implant placement, then it significantly increased after 6 months (73.10±3.21;
technique for each: light microscopy, fluorescence and scanning, which were 82.00±1.27; P=.0004). In 4 of 5 cases, the thickness of the ridge is slightly
analyzed and compared the contact areas between bone/implant times of 30 increased, thus mean BPC after 1-year was 0.08±0.55mm (0.71%; P=.9152).
days and 60 days. Results: The results demonstrate that the proposed surface The mean PES was 9,00±1.87 before tooth extraction and 11,00±1.73mm 1-year
bone stimulation promotes very effective in the times studied. Implants of bone after implant placement/loading with an average increase of 2.0 (18.18%; P=.12).
presented large areas corticalized and a feature of lamellar bone. Calcium Conclusion: The results of this case series suggest that these technique and
deposition occurs with more intensity after 30 days of implantation. materials could be considered a viable treatment option for the immediate
Conclusions: Thus we conclude that the implant surface by DeBortoli placement/loading of dental implants in esthetic area.
sandblasted with particles of TiO have good bone-conductive capacity,
promoting proper growth and bone corticalization.

P104 P106

Maintain Peri-implant Bone in the Aesthetic Area with Morse Taper Light Emitting Diode Irradiation Influences the Release of PDGF-BB from
Implant. Platelet-rich Fibrin.

M.S. De Bortoli*, S.A. Gehrke, P.C. Santos Santa Maria, Brazil. K. Yang*, K. Bang, S. Yoo, B. Kim Gwang-ju, Republic of Korea.

The success of dental implants is directly related to the integration between Phototherapy, such as lighting emitting diode (LED) and platelet-rich fibrin
the implant and surrounding tissue. Any change in these tissues can promote have recently been used as a means of enhancing wound healing and new
changes and even aesthetic compromise the longevity of implants. There are bone formation in regenerative therapy. The aim of this study was to evaluate
different hypotheses for the loss of bone crest, such as: absence of biological the release of three growth factors, platelet-derived growth factors-BB (PDGF-
space module and the crest of the implant, surgical trauma, occlusal overload, BB), vascular endothelial growth factor (VEGF), and insulin-like growth factor-
peri-implantitis, presence of the interface microgap abutment/implant. The aim 1 (IGF-1) from the PRF clot exudate serum irradiated with LED. Blood collection
of this study was to present, through a clinical case, the advantages of the was carried out on 20 healthy volunteers (non-smoker males from 22 to 27 years
implant system with morse-taper connection Implacil DeBortoli to avoid peri- of age). Blood of 20 ml was collected from each volunteer. Blood samples were
implant bone loss, trying to maintain the anatomy of the tissues of these areas. taken in 10 ml glass-coated plastic tubes (without anticoagulant) that were
Its influence can be demonstrated by the results obtained with the use of immediately centrifuged at 3,000 rpm (approximately 400g) for 10 minutes.
morse-taper implants and the making of the immediate provisional, because LED with 618 nm wavelength and 20 mW/cm2 output power irradiation was
the proximal areas are unchanged in the gingival papilla and buccal, which applied to the PRF membranes during 20-, 40- and 60-minutes, respectively.
directly influence the aesthetic treatment. Thus,the possibility of this system The values of PDGF-BB, IGF-1, and VEGF from these samples after stimulating
with respect to the use of prosthetic platform smaller in diameter than the
implant and morse-taper connection performed very positive and effective way
to obtain the results of the case.

95

Poster Presentation Abstracts

with LED was quantified by ELISA. All experiments were triplicated. The values P110
obtained were analysed statistically the difference of the each average. The
experimental results were tested by using paired t-test, with a 5% significance In Vitro Analysis with Human Bone Marrow Stem Cells on Titanium Disks
threshold. Within the limits of this study, the results showed that LED irradiation with Different Surface Topographies.
influences the release of PDGF-BB from PRF as time goes.
L. Manzon*, V. Perrotti, A. Palmieri, A. Pellati, M. Degidi, A. Piattelli, F. Carinci
P107 Chieti, Italy.

WITHDRAWN Introduction The aim of this study was to assess how surface topography
can induce osteoblast differentiation in mesenchymal stem cells by analyzing
P108 the expression levels of bone related genes and mesenchymal stem cells marker.
Methods Thirty disk-shaped, commercially pure Grade 2 titanium samples (10
A Human Comparative Histological Evaluation, After a 6 Months Healing x 2 mm) with 3 different surface topographies (DENTSPLY-Friadent GmbH,
Period, of Different Biomaterials Used in Sinus Lifting. Mannheim, Germany) were used in the present study: 10 Ti machined disks
(control), 10 Ti sandblasted and acid etched disks (DPS®) and 10 sandblasted
G. Fratto*, G. Iezzi, M. Degidi, A. Piattelli, C. Mangano, A. Scarano, J. Shibli, and acid etched disks at high temperature (Plus®). Samples were processed
V. Perrotti Chieti, Italy. for real time Reverse Transcription-Polymerase Chain Reaction (RT–PCR) analysis.
Results By comparing machined and Plus® disks quantitative real-time RT–
Introduction Various grafts or combination of graft materials have been PCR showed a significant reduction of the bone related genes osteocalcin
used in sinus floor augmentations, and human histologic reports on their (BGLAP) and osteoblast transcriptional factor (RUNX2). The comparison between
performance are available, although limited in number. Histologic analysis of sandblasted and Plus® disks showed a slight induction of all the genes examined
the regenerated tissues will provide useful information regarding the nature (RUNX2, ALPL, COL1A1, COL3A1, ENG, FOSL1, SPP1, and SP7); only the
and amount of newly formed bone. Aim of the present study was a histological expression of BGLAP remained stable. Conclusions The present study
and histomorphometrical evaluation, in humans, of specimens retrieved from demonstrated that implant surface topography affects osteoblast gene
sinuses augmented with five different biomaterials. Methods The maxillary expression. Indeed, Plus surface produces an effect on PB-hMSCs in the late
sinuses were filled with phycogene hydroxyapatite (Algipore®, DENTSPLY- differentiation stages. The obtained results contribute to the understanding
Friadent, Mannheim, Germany), macroporous biphasic calcium phosphate of the molecular mechanism of implant osseointegration, the molecular events
(MBCP®) (Leone, Firenze, Italy), calcium carbonate (Biocoral®, Biocoral®, Leader- related to the differentiation of stem cells into osteoblasts and as a model for
Novaxa, Milan, Italy), collagenized porcine cortical/cancellous bone (Apatos comparing dental implants with different surface topography.
Cortical, Tecnoss, Coazze, Turin, Italy), anorganic bovine bone (Geistlich Bio-
Oss®, Geistlich, Wohlhusen, Switzerland). In every case, 100% biomaterial was P111
used. A total of 15 patients, undergoing 30 sinus augmentation procedures
with 6 biomaterials, participated in this study. A total of 82 bone cores were The Use of Free Fat Tissue Graft to Enhance Primary Soft Tissue Closure
retrieved and processed for histology after healing period of 6 months. Results during Socket Preservation and to Improve Ridge Contour at the
In all biomaterials, many grafted particles were lined and, sometimes, bridged Extraction Site.
by newly formed bone. Some biomaterials particles appeared to be partially
resorbed and substituted by newly formed bone. Histomorphometry showed F.K. Kablan* upper Galilee, Israel.
that, in all biomaterials, newly formed bone and residual grafted material
particles represented about 30.0 %. The high interconnecting microporosity Introduction:Tooth extraction is followed by ridge contour deformation due
allowed, in all the present biomaterials, the ingrowth of newly formed bone to alveolar bone resorption and soft tissue contracture. Socket preservation is
and vessels in the pores of the partially resorbed particles. Conclusions In considered to achieve esthetic and functional results. In addition to hard tissue
conclusion, within the limitations of the present study, the data provided volume, sufficient soft tissue architecture is essential. several techniques have
support the fact that all these biomaterials can be used, successfully, in sinus been used to improve soft tissue coverage at the extraction site. This
augmentation procedures. presentation introduce a simple technique utilizing the use of free fat tissue
graft(FFG) from the buccal fat pad (BFP) during socket preservation procedure
P109 for primary closure and improving ridge contour at the extraction site. Materials:
12 patients,7 females,5 males, mean age 39 years were treated during the last
X-ray Synchrotron Study of a Human Retrieved Direct Laser Metal two years. They underwent 22 tooth extractions and socket preservation with
Formed (DLMF) Titanium Implant. allograft/xenograft bone and primary closure of the extraction site with free
fat tissue graft harvested from the BFP. Follow up was hold every 2-3 weeks.
G. Luongo*, C. Mangano, A. Giuliani, A. Piattelli, F. Mangano, J.A. Shibli, Reentry after 4-6 months, evaluation of the soft and hard tissue volume, biopsy
G. Iezzi, F. Rustichelli Naples, Italy. for histological study and implants insertion. Results: It is known from the
cosmetic surgery that fat tissue survive well its free transfer and heals by fibrosis.
Direct laser metal sintering (DLMF) is a timesaving metal forming procedure In all our patients the free fat tissue graft enabled primary closure, survived
in which an high power laser beam is directed on a metal powder bed and well, prevented dehiscence of the bone graft at the extraction site and improved
programmed to fuse particles according to a CAD file, thus generating a thin the ridge contour. The healing phase was uneventful both in the donor and the
metal layer. Apposition of subsequent layers gives shape to a desired 3D form recipient sites. The healing steps were: first; after 2-3 weeks the FFG remnants
with the need of minimal post-processing requirements. With DLMF, it is now still seen, second; after 4-6 weeks complete epithelialization (immature fibrosis
possible to fabricate dental implants directly from CAD models. A screw-shaped in histology) of the FFG was seen without any dehiscence of the extraction site.
micro-implant (2.5 mm in diameter and 6.0 mm long) (TixOsR, Leader-Novaxa, Thick soft tissue and adequate bone volume were revealed 4-6 month post
Milan, Italy) was manufactured with this technique and inserted in the posterior socket preservation at the reentry for implants insertion. Histological
maxilla of a 58-year-old patient. The Ethics Committee for Human Clinical Trials examinations show fibrosis healing of the free fat tissue graft. The final outcome
at Guarulhos University approved the study protocol. The porous titanium is thick soft tissue at the extraction site and thereafter around the dental
implant was retrieved after a 2 months healing time. The specimen was scanned implants that were inserted at these sites. Conclusions: Free graft of fat tissue
using X-ray synchrotron radiation and its structural characteristic was calculated from the BFP is an easy procedure that enhances primary closure of extraction
using 3D digitized images. Higher resolution was achieved with synchrotron- site during socket preservation. It improves ridge contour,long term soft tissue
based x-ray microscopy, with an excellent spatial resolution with good sample thickness at the recipient site due to fibrosis healing.
penetration and depth of focus. In conclusion, 3-D data, made possible due
to the hard x-ray penetration and depth of focus, greatly enhance the biological
imaging and reveal the relative arrangement of structures that is not easily
determined from 2-D imaging.

96

Poster Presentation Abstracts

P112 Figure 1 (top) DBM placed in a socket (left) and a membrane draped over the
augmented ridge (right); (bottom) representative Group 1 (left) and Group 2 (right)
Demineralized Bone Matrix in Autologous Putty: Clinical and histologies (20X).
Histopathologic Case Series in Extraction Sockets.
P113
E. El Chaar*, H. Wen New York, NY.
Minimally Invasive Sinus Lift by Buccal Approach M.I.S.B.A Retrospective
Introduction: Demineralized bone matrix (DBM) putty has been used to Study Comparing the Conventional Sinus Lift Technique with the Novel
augment ridge defects, but outcomes have not been widely documented. This Minimally Invasive MISBA Approach.
case series was undertaken to evaluate DBM efficacy and predictability in fresh
extraction sockets. Methods: Materials were DBM putty with and without D.G. Morales Schwarz* Valladolid, Spain.
mineralized cortical and cancellous bone chips (size=250µ-1000µ). Each material
lot (DBM + putty ± bone chips) was made from the long bones of the same Retrospective study to compare the clinical outcome of the standard sinus
tissue donor; the only excipient material was sterile water. A single failing tooth lift procedure(lateral window approach with crestal and vertical releasing
was atraumatically extracted from each of 12 subjects and sockets were incisions) with a new minimally invasive sinus lift procedure with buccal incision
debrided. Intact sockets were grafted with DBM putty (Group 1, n=6), and sites (MISBA).. A sample of 526 patients with a total of 658 standard sinus lift
with buccal defects were grafted with DBM putty with bone chips (Group 2, (Caldwell-Luc) were performed. Three different approaches were used,
n=6). Grafted sites were covered with a bovine pericardium membrane (Fig.1), conventional approach with crestal incision (TSL), minimally invasive lateral
and tension-free primary closure was obtained. After 6 months of healing, a approach with vertical incision (MISBA-V), and minimally invasive lateral
trephine biopsy was taken from the center of each graft. The osteotomy was approach with horizontal incision (MISBA-H). Fewer post-operatory
then enlarged and a dental implant was placed. Results: Two subjects were complications such as inflammation, hematomas and infections were reported
withdrawn from the study (1 moved and 1 had infection that prevented primary when any of the minimally invasive protocols were used. Using a minimal
closure), and histopathologic data could not be obtained from 2 other subjects incision in the depth of the buccal fold for lateral window sinus surgery can
(1 ridge was too narrow for biopsy and 1 poor quality bone core could not be be an acceptable, less invasive alternative to the conventional crestal approach.
analyzed). One subject provided 2 biopsy samples (1 per tooth root location)
from a large grafted molar site. Both Group 1 (n=5) and Group 2 (n=4) sites
achieved adequate bone fill for implant placement in 6 months. New bone
mineralized from the socket rim and moved inward at approximately 1mm per
month. The centers of the large graft sites were still remodeling, as evidenced
by mean new bone fill of 40.28%, with 7.92% residual graft material, 46.81%
marrow and 4.99% fibrous tissue, for DBM putty (n=5) and 44.60%, with 8.04%
residual graft material, 39.38% marrow and 7.98% fibrous tissue, for DBM putty
with bone chips (n=4) (Fig. 1). The outer locations of the grafted sockets were
fully mineralized for successful dental implant placement. Conclusion: Both
preparations preserved or restored ridge dimensions with newly mineralized
bone that permitted implant placement at 6 months.

97

Poster Presentation Abstracts

P114 related to a different mode of resorption. Conclusion: Prolonged resorption and
higher vascularization with tissue integration rates of non-chemically cross-
Clinical Evaluation of CAD/CAM Custom Zirconia Abutments for the linked collagen membranes with intact fibers could be clinically beneficial for
Esthetic Zone in Implant Dentistry. guided bone and tissue regeneration.
K.W. Sawyer*, Y. Inomata Malden, MA.
Figure 1. Collagen membrane thickness values measured over time. Test (TA1=0.3mm;
Objective: The purpose of this study was to evaluate the frequency and TA2=0.5mm; TA3=0.8mm) and control (0.2mm) were significantly different (P<0.05, ANOVA
causes of remakes of CAD/CAM Zirconia abutments for the esthetic zone and Bonferroni; *P<0.001, **P<0.001).
delivered by a dental laboratory to demonstrate anecdotal improvement since
the development of CAD/CAM technology in Implant Dentistry. Methods: Total P116
of 380 CAD/CAM Zirconia implant abutments (253 Procera; 127 Atlantis) for
cement retained crowns and bridges were fabricated from January 2005 to June Abutment Selection in Implant Prosthodontics and Clinical
2011. The majority of these abutments were fabricated for the esthetic zone Characteristics of CAD CAM and Prefabricated Implant Abutments.
from first premolar to first premolar. A few second premolars and molars were M. Dhima*, S. Koka, A.B. Carr, S.E. Eckert, T.J. Salinas Rochester, MN.
also included. Annual remake totals were collected using a laboratory-managing
software database over six years during which tooth number, cause of remake Purpose The use of implant supported cemented restorations in edentulous
and implant type were defined and analyzed. Results: Chart data (see “Clinical and partially dentate patients can be accompanied by a number of biologic
Evaluation and Remake Ratio of ZR Abutments”) showed 11 remakes for Procera and mechanical complications. The purpose of this study was to assess the use
ZR abutments and 2 remakes for Atlantis abutments were performed. 11 out of various titanium and ceramic abutments to elucidate complications
of 13 abutments were returned for remake prior to definitive cementation: 2 associated with specific abutment systems to assist in treatment and decision-
abutments were returned for remake after definitive cementation, 1 abutment making of patients with implant prosthodontics. Materials and Methods This
was returned for remake after 24 months and 1 after 28 months. Remake retrospective review includes patients treated with prefabricated, cast and
reasons included 5 zirconia abutment issues (4 fractures and 1 structural defect), custom abutments for single and multiple implant supported restorations in
3 gum recessions, 1 implant failure, 1 rotation, 1 design issue, and 2 unknown. a prosthodontic practice. The qualitative and quantitative factors were evaluated
The last recorded fracture was in May 2009. All fractures occurred prior to by outcomes of interest related to short and long term follow up of these
cementation during try-in when the screw was tightened. The thickness of restorations including: abutment fracture, screw loosening, porcelain fracture,
the fractured abutment showed an area of thinness. Conclusion: Since 2008, dislodgement, peri-implant soft tissue reaction, and any other pertinent
there has been a rise in the use of Zirconia abutments due to wide use of complications related to the screw joints in these implant patients. Results
CAD/CAM technology, advanced design experience, and an increase in gold The types and frequency of mechanical and biologic complications associated
prices. Data indicates higher incidence of remake ratios within the first 3 years with various types of prefabricated and custom abutments were determined.
studied than the following 3.5 years. The improvement in performance is due
to Zirconia and its inherent material characteristics such as thickness.

P115

Resorption of Collagen Membranes Implanted in Rat Subcutaneous
Tissues.
M. Collins*, J. Lee, M. Hall, D. Cheung Carlsbad, CA.

Introduction: Collagen membranes have been widely used as epithelial
barriers in guided bone regeneration, so that the bone growth can occur where
it is intended. Study objectives were to determine the resorption rate and tissue
response of fibular bovine collagen membranes in a rat model. Methods: Study
membranes were chemically cross-linked (Control: 0.2mm thickness) and non-
chemically cross-linked (Test: 0.3, 0.5 and 0.8mm in thickness) bovine type I
collagen. Four membranes (0.5x2.0cm) (1 test sample in each thickness and 1
control sample) per animal were subcutaneously implanted in 28 rats. On day
5 and weeks 2, 4, and 8 postoperative, rats were sacrificed and membrane
regions were explanted. Results: In spite of swelling phenomena in the
physiological condition, membrane thickness was chosen to quantify the
collagen resorption rate, followed by histological evaluation. Resorption rates
of all test samples were slower than that of the control group. All membranes
varied in thickness throughout the study, but reductions in membrane thickness
were first evident after 2 weeks in test and 4 weeks in control samples, and
significantly decreased between 4 and 8 weeks for both groups (Figure 1).
Comparison of membrane resorption from 5 days to 8 weeks revealed that
the test samples maintained 6%, 24% and 22% of their original 0.3mm, 0.5mm
and 0.8mm thicknesses, respectively, whereas control samples resorbed to
nearly 0mm in thickness by week 8. Histologic assay revealed a higher degree
of vascularization and tissue integration in the test as compared to the control
samples. Blood vessel formation first occurred at 2 weeks post-implantation
in both groups, but became more manifest at 8 weeks for test samples as
compared to controls. Implanted collagen was degraded by collagenolytic
enzyme action primarily present in inflammatory cells, which seems to be

98

Poster Presentation Abstracts

P117 Figure 1. Reverse-torque values over time.

Crack Resistance of Multiple Veneering Porcelains with Y-TZP with P119
Various Surface Treatments.
A.S. ArRejaie*, R. Giordano, R. Pober Riyadh, Saudi Arabia. Role of Hyperlipidemia in Implant Osseointegration.

Objectives: - Evaluate crack resistance of conventional veneering porcelains A. Keuroghlian*, O. Bezouglaia, Y. Tintut, S. Tetradis, P. Moy, F. Pirih, T. Aghaloo
fired onto Y-TZP with various surface treatments. - Evaluate the effect of revising Glendale, CA.
the peak firing temperature of Lava™Ceram (3M/ESPE) on its crack resistance
with Y-TZP. Materials and methods: 200 Y-TZP tiles (Lava™ 3M/ESPE) were An ideal implant site is central for implant placement and success. Currently,
randomly divided into 20 groups. Four different surface treatments were the literature lacks sufficient evaluation of atherosclerosis and hyperlipidemia
conducted: 1. As sintered. 2. Grinding using a 120 grit resin bonded diamond with respect to implant osseointegration and long-term success. Interestingly
disc. 3. Grinding followed by heat treatment of 1000°C for 15 minutes. 4. hyperlipidemia and atherosclerosis have been linked to a several diseases
Sandblasting using 50 microns Alumina oxide. - Five conventional veneering including periodontal disease and osteoporosis. In bone, hyperlipidemia directly
porcelains were used: VITA VM®9 (Vita-Zahnfabrik), Noritake Cerabien ZR inhibits osteoblast differentiation and increases osteoclast differentiation. In
(Noritake), NobelRondo™ Zirconia (Nobel Biocare), Lava™ Ceram (3M/ESPE), addition, it decreases bone mineral content and bone mineral density in vivo.
Revised firing chart for Lava™ Ceram. The thermal shock test was done with a Because of the deleterious effects of hyperlipidemia, we hypothesize that
vertical tube furnace (Poper’s shock model A, Boston University, Boston, MA, hyperlipidemia negatively affects implant osseointegration. Our short-term goal
USA). The test started at 90°C and specimens were quenched into an ice water is to evaluate early implant site healing and osseointegration in hyperlipidemic
bath. Specimens were then dried, and placed back into the furnace at 90°C mice. One month-old C57B6 male mice were placed on a control chow diet (6%
again and then slowly cooled at room temperature. Afterwards, tiles were fat) or high fat atherogenic diet (1.25% cholesterol, 15.8% fat, and 0.5% cholate).
examined for failures such as cracks, chipping, and debonding. Increments of After 3 months, serum cholesterol levels were determined and implants were
10°C were added and the process was repeated if failures weren’t detected. placed in the left femur. Micro-CT analyses of the area surrounding the implant
Results: See attached table. Conclusions: Surface and heat treatments of Lava™ was determined at 12µm after 8 weeks. MicroCT analysis showed 70% of the
have a significant effect on the crack resistance with multiple conventional placed implants in mice on normal (chow) diet integrated, while only 29% of
veneering porcelains. Increasing the firing temperature of Lava™ Ceram will the implants that were placed in mice on a high fat diet integrated (p<0.05).
significantly improve its crazing resistance with Lava™ core material. Of the integrated implants in mice on a normal diet, bone to implant contact
was of 79.81%±5.04, while the integrated implants in mice on a high fat diet
Mean temperature of failures (°C) for different conventional veneering porcelains fired had a bone-to-implant contact of 65.6%±7.85. These significant differences
onto Lava™ core material with various surface treatments depict how hyperlipidemia can negatively affect implant osseointegration. Also
understanding the role of hyperlipidemia in implant healing may allow us to
P118 account for this variable when deciding the time to restore the implant and
may require cholesterol optimization before implant therapy is electively
Reverse Torque Testing of Coated Dental Implants in a Transcortical undertaken.
Femur Canine Model.
J. Bassett*, J. Lee, H. Wang, R. Garrett, A. Adams, Z. Lutz-Carrillo Carlsbad, P120
CA.
Evaluation of 358 Mandibular Posterior Implants: A 3-year Retrospective
Introduction Hydroxylapatite (HA), a crystalline calcium phosphate material, Study.
is the primary constituent of bone matrix and teeth. The clinical efficacy of HA-
coated dental implants has been extensively documented in the dental P. Park*, K. Kim, J. Kim Seoul, Republic of Korea.
literature, but HA-coated implant surfaces have not been widely compared with
contemporary grit-blasted (GB) microtextured implant surfaces. The objective Recently, dental implants extensively inserted in edentulous areas show
of this study was to assess the effectiveness of HA and GB surface treatments high clinical success rates. However, clinicians cannot exclude the possibility of
on implant stability in canines. Methods A total of 16 tapered titanium alloy failure and it often unexpectedly occurs. Many possible factors associated with
(Ti-6Al-4V) implants with either HA (n=8) or GB (n=8) surfaces were randomly failure of dental implants have been reported but their influence is still
placed in 4 hound dogs using the transcortical femur model. After 4 and 12 controversial. In this study, we collected 212 patients who had 358 dental
weeks of healing, implant anchorage was macroscopically quantified by implants inserted in the posterior area of mandible from 2005 to 2006. The
measuring the level of reverse torque required to break the implant free from survival rate of fixtures was analyzed according to the age of patients, implant
the surrounding bone. Results Data were statistically analyzed using ANOVA site, implant system, diameter and length of fixtures. Multi-variable analysis
for group comparisons at each time point (p < 0.05). Mean reverse torque values using SPSS chi-square test was performed to verify the relation between each
were greater for HA than for GB at both 4 (120.0Ncm vs. 79.0Ncm, respectively) factor and its survival rate. Accumulative survival rate was 98.3% for 3 years.
(P=0.002) and 12 (235.1Ncm vs. 92.2Ncm, respectively) (P<0.001) weeks (Figure Only the diameter of fixtures was related to the implant survival rate. These
1). Intra-subject comparisons revealed that HA achieved a significant increase results indicate that wide fixtures are considered as ‘the rescue implants’ and
in stability from 4 to 12 weeks as compared to a moderate increase achieved are applied to sites of poor bone quality. Further continuous studies will be
by GB. The difference between the 2 surfaces may be attributable to the material needed for direct guidance associated with the survival rate of implants.
nature of HA, closely resembling the principal mineral phase of nature tooth
and bone. The data is consistent with the findings of a prospective U.S.
government study that evaluated 3,000+ HA-coated and non-coated implants
placed in 32 study centers by nearly 800 dentists. Conclusion HA produced
greater bone apposition at the 4- to 12-week time intervals. This finding is
well correlated with clinical evaluation reports accumulated for years.

99

Poster Presentation Abstracts

Interval/ Cumulative Survival Rate of Implants a compression resistant (collagen/beta-TCP/hydroxyapatite) matrix (CRM)
compared with the benchmark rhBMP-2/ACS (control). Methods: Five male
P121 Hound Labrador mongrel dogs obtained from USDA licensed vendor were used
following a protocol approved by the IACUC, Georgia Health Sciences University,
Bone Healing Capacity of the New Fluorided Hydroxyapatite in the Augusta, GA. Two treatments were explored: 1) 4 mL rhBMP-2 (0.2 mg/mL)
Rabbit Cranium Defect. distributed onto three 1 x 2 inch ACS (total volume 4 cc), and 2) 2 mL rhBMP-2
S. Han* Cheonan, Republic of Korea. (0.4 mg/mL) distributed onto one 4 cc CRM block. The protein was allowed to
bind for 15 min. Using a split-mouth design, the rhBMP-2 constructs were
Background: The bone graft materials are grossly divided into autogenous implanted into routine critical-size, supraalveolar, peri-implant defects (Wikesjö
bone, allogenic bone, xenogenic bone, and alloplastic material. Among the et al. 2006) followed by submerged wound closure for primary intention healing.
various allogenic graft materials, hydroxyapatite(Ca10(PO4)6(OH)2, HA), the The animals were euthanized at 8 weeks for routine histologic/histometric
main inorganic phase of human hard tissue, is widely used as a repair material evaluation. Results: rhBMP-2/ACS and rhBMP-2/CRM both supported local bone
for bones. When HA applied to bony defect, however, it may be encapsulated formation. The area and density of the newly formed bone appeared greater for
with fibrous tissue and floated in the implanted area by the lack of rhBMP-2/CRM than for rhBMP-2/ACS. While bone formation was highly variable
consolidation. Fluoridated hydroxyapatite(Ca10(PO4)6(OH)2, FHA), where F- in sites receiving rhBMP-2/ACS, rhBMP-2/CRM supported bone formation of
partially replaces the OH- in the hydroxyapatite, is considered as an alternative relatively consistent geometry. Woven and lamellar trabecular bone lined with
material for bone repair due toits solubility and biocompatibility. Aim: This study abundant osteoid was observed for all sites. Although cortex formation was
was designed to find out the bone healing capacity of FHA newly produced initiated, it was inconsistent, confirming the immature nature of the newly
as a nanoscale fiber in the laboratory. Methods: We implanted HA and FHA in formed bone. Seroma formation was observed for both treatments appearing
the rabbit cranium defect and histologically analysed the specimen. Results: more prominent for rhBMP-2/ACS. rhBMP-2/CRM treated sites showed residual
The results were as follows. 1. In the 4 weeks, fibrous connective tissue and little ceramic granules undergoing biodegradation in part including accumulation of
bone formation around materials of the experimental group I implanted HA foamy macrophages. Conclusions: Within limitations of study, rhBMP-2/CRM
were observed. In the experimental group II implanted FHA, newly formed bone supports bone formation of clinically relevant geometry. Longer observation
around materials were observed. 2. In the 8 weeks, the amount of newly formed intervals appear necessary to capture the eventual maturation of the newly
and matured bone of the experimental group II was more than the experimental formed bone, elimination of residual ceramic granules, and resolution of seroma
group I and control group. Conclusions and clinical implications: From the formation(s).
results obtained, we suggest that FHA, newly synthesized, is relatively favorable
bone substitute with biocompatibility and has better bone healing capacity P124
than pure HA.
Histological Results of Bone Grafting of Alveolar Processes of Severely
Atrophic Jaws with 2 Different Biomaterials: A Preliminary Report.

P. Falchetti*, A. Piattelli, S. Pelo, G. Iezzi Roma, Italy.

There is a clinical need for improved bone allograft materials, especially
when treating cases of extreme jaw atrophy. Two different techniques were
used in the present histological report: local inlay/onlay in sinus lift procedures
and a combination of local inlay/onlay graft and Le Fort I osteotomy. Two
different biomaterials were used: Plexur P (a biocomposite of cortical fibers
suspended in a resorbable porous polylactide-polyglycolyde scaffold) and
Grafton DBM Flex (a human demineralized bone matrix combined with
glycerol). Four patients were treated (2 with sinus lift procedures and 2 with
Lefort I osteotomies). In 2 patients Grafton was used, in the other 2 patients
Plexur was used. Biopsies were obtained with a trephine bur after 6 months,
and all the specimens were treated to obtain thin ground sections.
Histologically, no differences were present between the 2 biomaterials. It was
possible to distinguish basal bone from newly formed bone. In the area where
the grafted material was placed, it was possible to observe many newly formed
trabeculae in close contact with the biomaterials particles. Osteoblasts
depositing osteoid matrix were present in many fields. No inflammatory cell
infiltrate or foreign body reaction cells were present. Within the limitations of
the present study, both biomaterials seemed to be suitable to be used in bone
regeneration procedures, with no microscopic untoward effects.

P123

Evaluation of a Novel Compression-Resistant Matrix for Recombinant
Human Bone Morphogenetic Protein-2.

S.X. Lu*, T. Fiorini, J. Lee, H. Prasad, A. Buxton, F. Bisch, D. Dixon, C. Susin,
U. Wikesjo Augusta, GA.

Background: Previous studies document the osteoinductive potential of
rhBMP-2 in an absorbable collagen sponge (ACS) carrier for several indications
in the axial and appendicular skeleton. Nevertheless, rhBMP-2/ACS does not
comprise sufficient structural integrity to withstand compression to adequately
support bone formation for onlay indications. Objectives: To evaluate local bone
formation and osseointegration following surgical implantation of rhBMP-2 in

100

Poster Presentation Abstracts

P125 Specimens were evaluated histologically and radiographically. Results: Both
groups showed substantial amount of de novo bone in the newly created space
Evaluation of Titanium-zirconium Narrow Diameter Implants: A and soft tissue has been successfully elevated without membrane exposure.
Multicenter Randomized Controlled Clinical Trial. Calvarial bone thickness has shown an average increase 150% in Group 2 and
100% in group 1. Group2 showed more compact and mineralized bone than
M. Mokti*, G. Benic, R.E. Jung, C.H. Hammerle, H. Weber, G.O. Gallucci Group 1. Conclusion: In this new technique bone augmentation has been
Boston, MA. successfully accomplished. Furthermore, the problem of membrane exposure,
which frequently occurs in GBR has been solved. This new technique encourages
Background: Titanium-zirconium (Ti-Zr) alloy showed comparable bone intrinsic regenerative potential of the tissue without applying one of the three
tissue response and presented significantly higher strength than commercially key players in tissue engineering: cells, signal molecules and scaffold. This new
pure titanium (Ti). With these desirable properties, the diameter of Ti-Zr implant technique would clinically provide inexpensive and efficient bone
could be reduced and its indication for use could be broadened. In narrow ridge augmentation.
width cases, invasive surgical procedures such as bone augmentation could be
avoided with the use of this implant. Purpose: The aim of this randomized P127
controlled clinical study is to test whether the clinical performance of Ti-Zr
narrow diameter dental implant placed in single-tooth gaps of anterior and Histological Analysis of Autogenous Block Grafts in Humans.
premolar region is comparable to what is achieved using Ti regular diameter
implants. In this report the findings up to 6 months following implant placement A. Kim*, K. Kar, S. Rich, K. Ahn, H. Nowzari Los Angeles, CA.
will be presented. Material & Methods: 40 patients in need of a single-implant
reconstruction in the anterior or premolar region were enrolled at the Harvard Introduction: The histological outcome and vitality of mandibular onlay
School of Dental Medicine (Boston, USA) and University of Zurich (Switzerland). grafts in humans are not well documented. The purpose of this case series is
All single-tooth gaps presented with at least 7 mm of mesio-distal space. to assess the grafted bone vitality through histological evaluation of the graft.
According to the randomization, one test (Ti-Zr 3.3 mm diameter) or one control Methods: Three patients were consecutively selected who were planned for
(Ti 4.1 mm diameter) bone level implant (Straumann AG, Switzerland) was implant placement after significant augmentation of the residual ridge. The
inserted in each patient, as early or delayed implant placement procedure. The grafts were harvested from the mandibular ramus or symphysis. Bone cores
implants were submerged and abutment connection surgeries were performed were harvested with a trephine bur at the time of implant site preparation for
after three months. Definitive porcelain-fused-to-metal implant-supported histological analysis. Sections were prepared with hematoxylin and eosin stain
crowns were inserted six months following implant insertion. Results: All 40 (H&E stain). Results: Two cases were grafted with mandibular ramus onlay grafts,
patients had their implants placed and no surgical complications were reported and one case was grafted with mandibular symphysis graft. All histological
during the follow-up appointments. The following intrasurgical parameters will samples demonstrated bone vitality with presence of osteocytes inside lacunae,
be compared between the two groups: intraoperative time for implant angiogenesis, and re-organization of haversion systems. Conclusion:
placement, dimensions of the residual buccal bone after implant placement, Autogenous mandibular onlay grafts can lead to vital bone in humans. Further
need for bone augmentation and operator’s perception of the procedure. studies should investigate the sequence and mechanisms of the healing process
Postoperative soft-tissue healing and patients’ morbidity will be evaluated. associated with onlay grafts.
Additionally, the 6-month implant survival and success rates, change of the
radiographic marginal bone level and dimensions of peri-implant soft-tissue
after insertion of definitive crowns will be presented and discussed. Conclusions:
Ti-Zr narrow diameter implants showed similar clinical performance as
compared with Ti regular diameter implants 6 months after implant insertion.

Ti-Zr Implant inserted

P126 P128

Novel Bone Augmentation Technique: The Expansible Guided Bone Progression of Ligature-induced Peri-implantitis around Thin Sputtered
Regeneration. HA-coated Implants.

O. Zakaria*, M. Madi, S. Kasugai Tokyo, Japan. M. Madi*, O. Zakaria, K. Noritake, M. Fuji, S. Kasugai Tokyo, Japan.

Background: Bone augmentation with guided bone regeneration (GBR) is Introduction We have developed thin sputtered HA-coated dental implant,
clinically effective; however, it is not always feasible. This study aim to develop which is advantageous in osseointegration and demonstrated clinical efficacy
and evaluate a new bone augmentation technique in an animal experiment. of this implant; however, HA coated implants have been generally claimed of
Material and Method: A device mainly consists of a thin silicone membrane and enhancing bacterial accumulation and aggravating periimplant infection. The
a titanium elevation plate. Both of them were surgically placed under aim of the present study was to evaluate periimplantitis progression around
periosteum of the calvarias of 8 rabbits. After one week, an activation screw thin sputtered HA coated implants in comparison to other implants of different
of 5 mm length was inserted through the titanium plate. Then, tightening the surface modifications. Material and methods Four different surface modified
elevation screw, soft tissue together with a silicone membrane was implants with the same design were prepared: machined, acid- etched; thin
simultaneously elevated at a rate of 1mm/day for 5 days. After activation sputtered HA coated (1µm) and plasma sprayed HA coated (50-80µm). All
completion, one group of animals (Group 1, n=4) were sacrificed at 2 months mandibular premolars in both sides were extracted in 9 beagle dogs. Three
and another group of animals (Group 2, n=4) was sacrificed at 4 months. Tissue months later, four different surface modified implants were inserted in a

101

Poster Presentation Abstracts

randomized order in both sides of the mandible. Three months after implant retained fiber reinforced acrylic bridge was screwed on the abutments. For the
insertion, experimental periimplantitis was initiated using a silk ligature to allow partial cases, the surgical guide rested on the remaining teeth and implants
plaque accumulation. Radiographic and clinical examination (PD, mGI and BOP) were not immediately loaded. Results: Twenty-six adults were included in this
were performed every month from baseline until the end of the study at 4 clinical trial. The population consisted of 16 males and 10 females. Mean age
months. The data were presented as mean (1SD). Results: All implants showed was 51,84 years (range 20-81). Out of the 26 patients, 9 were current smokers
clinical manifestations of peri-implantitis regardless of the implant type. The (more than 10 cig /day). The total number of implants inserted with computer
mean PD and CAL increased constantly during the experimental period for all aided stereolithographic guides was 114. In total 13/114 implants were lost
implant types. However, a significant increase was found for all the implants within 12 months after surgery, resulting in 88,6% survival at one year. Twelve
after ligature placement (P<0.05). The mean mGI increased abruptly after of those failures occurred in smokers leading to 69,2% implant survival
ligature placement and remained constant during the study for all implant compared to 98,7% in nonsmokers. Implants were lost in 7/26 (73.1%) patients;
types. The radiographic results showed more marginal bone loss for plasma only 1/17 nonsmokers (5.9%) compared to 6/9 (66,7%) smokers lost one or more
sprayed HA coated implant than other implant types after 1 month of ligature implants. In total 38.5% of the subjects with a full immediately loaded bridge
placement. However, significant marginal bone loss was found at 3 and 4 experienced implant failures compared to 15.4% of the partially delayed loaded
months: the plasma sprayed implants 2.5(0.6), 3.3 (0.9)mm and thin sputter HA cases. The overall mean bone loss based on all implants is 0.47mm (SD 0.94).
coated 1.7 (0.8), 1.9 (0.9)mm, acid etched 1.6 (0.7), 1.7 (0.8)mm, machined Mean bone loss is 0.36 mm for nonsmokers and 0.62 mm for smokers.
implants 1.7 (0.8), 1.9 (0.9)mm, respectively. Conclusion Thin sputtered HA Conclusions: On the basis of the current case control study, it is tempting to
coated implants showed a similar periimplantitis progression to acid etched suggest that smoking is an exclusion factor when installing implants using
and machined implants. Thus, it is suggested that the thin (1µm) HA coat does stereolithographic guided surgery in conjunction with immediate loading. In
not represent a contributor to further exacerbation of periimplantitis genereal, there is still not enough scientific evidence to show if this method
progression. is as safe and predictable as the traditional method

P129 Implant survival on implant level in the treatment groups in relation to smoking habits

Immediate Implantation plus Immediate Restoration in the Esthetic Area P131
- Preliminary Results of a Randomized Controlled Clinical Trial.
Gingival Architecture Contouring: The Development of Anatomical
S.M. Heckmann*, D. Rieder, H. Weber, M.G. Wichmann, J. Eggert Erlangen, Healing Abutments and Impression Copings.
Germany.
J. Gonzalez* Dallas, TX.
Enhanced, hydrophilic surface structures have contributed to shorter healing
times, and in selected clinical situations, immediate loading has been Introduction: An implant is characterized by its diameter and classic
performed. In the study at hand, the feasibility of immediate loading plus cylindrical form, which exhibits features that differ from those of a natural tooth
immediate restoration in the maxillary front is being investigated. The root. The cervical diameter of the implant rarely corresponds to that of a tooth,
hypothesis to be tested was whether applying immediate loading/immediate which forces the restorative team to compensate for this discrepancy by
restoration would attain similar esthetic results to delayed approaches. The manipulating the emergence profile and/or locating the implant head at a
patients recruited had an anterior tooth which was to be replaced by a single variable depth according to the diameter difference. Traditionally the
implant while the respective contralateral tooth was healthy and without emergence profile has been manipulated and modified at the second stage
restoration so that it could be used for comparative evaluation. 48 patients were surgery by utilizing machined conventional healing abutments that are round
randomly assigned into 4 groups of 12 patients each. Half of the patients i. e. and do not simulate the normal cross section of anterior teeth. This results in
group 1 and 2 were treated with immediate implantation: Group 1 with an un-natural soft tissue profile which does not easily accommodate the
immediate temporary crown, group 2 with temporary crown after 6 weeks anatomically shaped abutment used in the final implant restoration. Objective:
healing time. In groups 3 and 4, a delayed approach was applied: Implantation To present a simple, predictable technique to contour soft tissue and transfer
followed 4-6 weeks after tooth removal. In group 3 implant placement was these contours to the dental laboratory. This is accomplished by utilizing
performed right after this healing period. In group 4, after implant placement anatomical components and familiar techniques, thereby minimizing the
another 4-6 weeks elapsed before the temporary restoration was delivered. number of components and the size of the armamentarium. Materials and
In all four groups, 10-12 weeks after implant placement i. e. after complete hard methods: Impressions of the gingival third and root of an average tooth were
and soft tissue healing, definitive ceramic crowns were fabricated and done with laboratory putty, and a Nobel Active™ fixture replica was ideally
incorporated. Six months after insertion, standardized photos of the implant placed for implant restoration by locating the flat side of the internal hexagon
area und contralateral healthy region were taken. For soft tissue evaluation towards the buccal surface. A temporary cylinder was placed and onlay wax
around the implant, the pink esthetic score after Fuerhauser (PES) was used. used to capture the anatomical emergence profile. The final wax up closely
The ceramic crown was judged according to the white esthetic score after Belser resembled anatomical contours of a natural tooth. Its beveled design allowed
(WES). Statistics were used to determine whether the results of the 4 groups for easy placement of a provisional removable partial denture. A custom
differed. The preliminary data from the photo evaluation suggest a good result impression coping was fabricated using similar techniques. Wax ups were
from the immediate implantation with the immediate restoration group. It can scanned with the Nobel Procera™ scanner, and files sent to Nobel Biocare™
be forseen that in certain clinical situations this time saving method may be an milling facilities. Results: The technique described allowed customized
alternative to delayed approaches. This project was supported by a grant from development of the soft tissue profile at the time of implant placement. The
the ITI Foundation for the Promotion of Oral Implantology, Switzerland anatomical healing abutment was used as another tool to aid the surgeon in
achieving optimal implant position and depth. The anatomical impression
P130 coping allowed the creation of an accurate master cast that closely resembled
the gingival architecture around the implant. Conclusion: This technique
Clinical and Radiographical Outcome of Implants Placed Using expedites the procedure and generates a more predictable treatment outcome.
Stereolithographic Guided Surgery: A Prospective Monocenter Study.

J. D’haese*, S. Vervaeke, M. Dierens, H. De Bruyn Berlare, Belgium.

Background: The number of clinical reports giving detailed information
on clinical outcome with guided surgery are rather scarce despite its large scale
introduction over the last decade. Aim: To determine implant survival and
success in terms of peri-implant bone loss and evaluate whether smoking affects
the outcome. Material and Methods: In total 26 cases with a partially or totally
edentulous maxilla were selected for implant treatment using the Facilitate™
software system (Astra Tech AB, Mölndal, Sweden. In the totally edentulous
cases, six OsseoSpeed™ implants (Astra Tech AB, Mölndal, Sweden), with a TiO2-
blasted fluoride-modified surface were inserted. Immediately after implantation,
abutments were screwed onto the implants. Within 8 hours, a temporary screw-

102

Poster Presentation Abstracts

increase of 9 ± 1.96 mm, with no statistical differences (F = 2.51, p = 0.33). The
density of bone grafts (Grayscale Units - GU) for PLGA/HA group ranged from
a low of 94.48 GU to a maximum of 428.55 GU (an average of 285.53 ± 134.43);
that of the DBB ranged from a minimum of 805.045 GU and a maximum of
1177, 17 GU (an average of 945.74 ± 161.90). The difference was statistically
significant (P< 0.0003) (Wilcoxon test). The use of PLGAHA has never been
previously evaluated in the human model. PLGA/HA compared to the DBB
showed a lower opacity and lower bone height available at about 7 months
after surgery. This finding may be compatible with a high rate of rearrangement
of the PLGA/HA and with a lower persistence of the graft in the human body
if it is not loaded. These preliminary results need to be supplemented by clinical
and histological assessments.

Anatomic custom healing abutments and impression copings

P132 Comparison between radiographic density: ReOSS (right) and Bio-Oss (left)

Influence of Emergence Profile in Cone Morse Implant Prosthesis: A P134
Radiographic Study in Dogs.
The Effect of Implant Geometry on Primary Stability as Determined by
A.B. Miranda*, F.H. Stancari, M.R. Araujo, A.R. Souza, R.F. Silva, R.M. Oliveira, Radio-Frequency Analysis.
F.P. Jodas, D.M. Castro, C.P. Araujo Bauru, Brazil.
J. Pi-Anfruns*, M. Chung, K. Shah, T. Aghaloo, P. Moy Los Angeles, CA.
The use of emergence profile prosthetic crowns within the bone tissue may
cause a remodeling of the bone that will follow the shape of abutments as in Background: Rehabilitation of edentulous patients with dental implants has
traditional implant systems. This radiographic study focuses on the comparison become a safe and predictable solution after the introduction of
of different emergence profiles in the Cone Morse implant system and their Osseointegration by Professor Branemark. Primary stability plays a key role in
influence on the alveolar crestal bone. For the purpose of this study, five dogs promoting successful osseointegration of dental implants, and may be
had all lower premolars extracted and, subsequently, had thirty implants influenced by dental implant geometry. Resonance-frequency analysis (RFA)
installed in accordance with immediate placement procedures (six in each dog). has been proposed as a non-invasive technique to predict successful
These implants were placed 3mm subcrestally and the prosthetic crowns had osseointegration of dental implants. Purpose: the purpose of this study is to
different emergence profiles of 1.5, 3.5 and 5.5mm. Using the paralellism determine the effect of dental implant geometry on primary stability, measured
technique, the radiographs were taken during the first and the final steps of by means of RFA. Materials and Methods: Polyurethane foam blocks
the study and were analyzed using AutoCad software. Student’s t-test was representing various bone densities were used as a substitute for human bone.
applied to independent samples with level of significance p<0.05. The results 50 dental implants (Southern Implants; Tri-Nex, Parallel and Tapered External
revealed no statistically significant difference between the different groups of Hex) of varying lengths, diameters and geometric configuration were placed
abutments with different gingival heights,neither when compared the groups according to protocol for this test. Smartpegs for RFA readings were torqed at
of 1.5mm versus the 3.5mm (p=0.51); when compared group of abutments of a constant value of 20Ncm utilizing a torque wrench. ISQ measurements derived
3.5 versus 5.5mm (p=0.11), nor even the abutments of 1.5 versus 5.5mm from RFA readings were taken at placement. Results: Variations in length and
(p=0.07). Consequently, the study shows that the utilization of abutments with diameter did not show a statistically significant difference on primary stability
different emergence profiles of 1.5mm, 3.5mm and 5.5mm do not change the for both the straight and parallel design implants. Tapered implants showed
crestal bone behavior around Cone Morse implants. statistically significant higher primary stability than parallel-wall implants. The
highest primary stability measured by RFA was seen with the MAX implants.
P133 The results of this study show better primary stability of tapered implants versus
parallel-wall implants. Length and diameter did not influence primary stability.
Comparison between Two Biomaterials used for Sinus Lift Procedure:
CBCT Radiographic Evaluation. P135

R. Rodriguez y Baena*, S.M. Lupi, L. Adduci, S. Rizzo Pavia, Italy. A Guided Bone Regeneration Membrane with Bonding to Heal the Rat’s
Skull Defect.
This work presents the radiographic results of an ongoing RCT (University
of Pavia, Italy, Ethics Committee permission) designed to compare two different L. Wang*, Y. Ge, H. Feng, S. Kasugai Beijing, China.
biomaterials used in maxillary sinus lifting procedure: Poly(lactic-co-
glycolic)acid/Hydroxyapatite (PLGA/HA)(ReOSS®, Intra-lock System Europe S.p.A., Guided bone regeneration (GBR) techniques are commonly used and greatly
Salerno, Italy) and deproteinized bovine bone (DBB)(Bio-Oss®, Geistlich useful for dental implant surgery, especially in immediate implant options.
Biomaterials Italia S.r.l, Thiene, Italy). Eight patients were enrolled in this study For nowadays, many kinds of GBR membranes have been developed. The
and 11 sinuses underwent augmentation procedure. The enrolled patients’ biological, mechanical and operatable features are focused by the researchers.
maxillary sinuses were randomized and treated through a lateral approach In this study, we tested a novel absorbable GBR membrane in rat. This
protocol. Six months after sinus surgery each patient underwent a CBCT scan membrane (named as DG) was designed by a corporation and was able to stick
(3D SCANORA, SOREDEX, Tuusula, Finland) for evaluation of the radiographic to the bone surface when applied with blood. This can help membrane fixed
healing before the biopsies retrieving and the implant placement. The CBCT to its place. The critical sized defect in rat’s skull bone was made and treated
scan was conducted wearing a radiopaque template to locate the site for in such groups: (A1) unfilled defects, (A2) Bio-Oss grafts, (B1) DG membrane,
biopsies. The image elaboration was conducted with ImageJ software (version (B2) Bio-Gide membrane, (C1) DG membrane + Bio-Oss grafts, (C2) Bio-Gide
1.44p, National Institutes of Health, USA, http://imagej.nih.gov/ij). A region of membrane + Bio-Oss grafts. Bio-Oss (BO) and Bio-Gide (BG) were taken as
interest with a cylindrical volume of 3 mm x 7.7 mm 2, containing approximately control. These animals were sacrificed at 2, 4, 8 and 12 weeks after the operation.
1.36 x 10 3 voxels, was analyzed in the zone of the expected biopsies. The CTCB The new bone formed in the defect was examined by direct observation, X-ray,
examination was performed an average of 204 days after sinus surgery, with and the histologic examination. The bone morphogenetic protein-2 (BMP-2)
no statistically significant differences between the two groups (F = 3.29, p = was exanimated by IHC (immunohistochemistry). Results: (1)The X-ray
0.98). All PLGA/HA grafts showed a bone increase in the vertical dimension
(an average 7.79 ± 3.10 mm), while the DBB leaded to an average vertical

103

Poster Presentation Abstracts

examination showed that at 12 weeks after operation, DG and BG group according to Cawood and Howell classification) were reconstructed with
exhibited more new bone formation than CSD blank group;BG group exhibited calvarial bone grafts. Autologous block grafts were used for combined vertical
more new bone formation than DG group (t=5.240, P=0.035), BG+BO group and horizontal onlay grafting. After a 3-month healing period, patients received
showed no significant differences in bone formation compared with DG+BO a total of 52 dental implants (OsseoSpeed, Astra Tech AB, Mölndal, Sweden).
group (t=1.246, P=0.339). IHC results showed that at 4 weeks, each group Implants were left to heal in submerged positions for 3 months before
exhibited more new bone formation than they did at other weeks, and DG+BO prosthetic implant-based rehabilitation was performed. Patients were followed
group compared with DG group(t=3.48, P=0.008), BG+BO group compared with up clinically and radiographically for an average observation period of 30
BG group(t=3.37, P=0.01)exhibited more new bone formation. Conclusion: It months. Results: At the intraoral recipient sites two infections occurred, causing
can be suggested that BG membrane achieved better effects in guided bone partial loss of the bone grafts. Implant placement, however, was possible at
regeneration compared with DG membrane. No significant differences were all sites. Two of 52 implants were lost in two patients prior to prosthetic loading.
found between the two membranes in their bone healing ability when they Implant survival rate was 96.27%, and a mean marginal bone loss of 0.5 mm
are used with BO. Therefore, DG membrane shows clinical effectiveness, but (SD 0.6 mm) was documented. Discussion: Patients with severe bone atrophy
should be used in combination with bone substitute. of the edentulous maxilla can be successfully reconstructed with calvarial bone
grafts and dental implants. The use of such grafts, however, is frequently
Quantitative radiographic analysis for the each group(gray value) associated with bone resorption as possible late complication. The analysed
procedure is a treatment alternative to free bone grafts from the iliac crest which
are most used commonly used for extensive alveolar ridge reconstructions.

Mean value ± standard deviation

P136 P138

Maintenance of Marginal Hard and Soft Tissue Support at Immediately Predictability of the Treatment of Atrophic Maxilla with Zygomatic
Provisionalized OsseoSpeed Profile Implants. Fixtures Based on Evidences: Literature Review.

R. Noelken*, M. Kunkel, W. Wagner Mainz, Germany. A.R. Ferreira*, W.C. Bonachela, C.G. Brene Salvador, Brazil.

Background: To overcome the disadvantages of staged implant surgery and The zygomatic fixtures offer a well established therapeutic solution for
treatment, immediate loading concepts as well as flapless surgery approaches treating severely atrophic maxillae. Its major advantages are: patient’s
have been introduced in recent years. Specifically, promising results in terms rehabilitation with no need for bone grafting procedures, less morbidity, lower
of high success rates and remarkable esthetic outcomes have been reported cost and less treatment time, and a possibility of prosthesis utilization while
for implants placed in extraction sockets and immediately loaded via provisional healing. This article aims as a purpose to evaluate the predictability of such
crowns and prostheses. Aim: In the anterior maxilla the extraction socket zygomatic implants via evidence found in literature from prospective and
anatomy is sloped in a lingual to buccal direction and the placement of a regular retrospective studies.
implant is not optimal. A dental implant with a sloped marginal contour,
OsseoSpeed Profile (Astra Tech AB, Moelndal, Sweden), has been developed P139
to optimize implant placement in such situations. The study examined the
clinical performance of Astra Tech OsseoSpeed Profile implants and its The Use of the CEREC AC 3 System in Rehabilitation Implant-Prosthetic.
transgingival components in a one-stage procedure with immediate insertion
and provisionalization in the anterior maxilla. Methods: 22 OsseoSpeed Profile F.E. Kayatt*, D.D. Perez, O.L. Mosele, D.L. Kayatt, O.L. Mosele Junior, J.B. de
implants were inserted in 17 patients. All implants were placed immediately David Campo Grande, Brazil.
into extraction sockets. Facial bony defects (2 total, 8 partial losses of facial
lamella) were reconstructed immediately with autogenous bone chips without The scientific and technical evolution have taken to great advances in all
raising a flap. All patients received immediate prosthetic restorations. Primary areas of our society. In Dentistry and in Prosthodontics in particular, the search
outcome variables were implant success, marginal bone levels and Pink Esthetic for better materials, looking for function and aesthetics is not an exception.
Score. Results: Mean primary stability at time of implant insertion was 23 Ncm; From the development of computer systems, originally used in engineering
3 further implants had to be excluded because of insufficient primary stability and today used to advantage in the dentistry through prosthetics attended
for immediate provisionalization (below 15 Ncm). Mean follow-up was 18 and manufactured by computer-assisted (CAD / CAM - computer assisted design
months (range 12 to 23 months). There was one implant loss. Cumulative / computer assisted manufacturing) has become a reality. Thus, our goal is to
survival rate according to Kaplan-Meier was 95.5 %. Marginal bone level illustrate a clinical case of a patient where the extraction was carried out of the
remained stable from the time of implant insertion to the final follow-up. In maxillary central incisor with the immediate installation of an external hexagon
80% of the implant sites it was possible to keep the gingival esthetics stable implant immediate loading with the use of their own making dental crowns.
or even to improve it from the pre-operative examination to the final follow-
up. Conclusions and clinical implications: Results of survival rate, marginal bone
stability and esthetic improvement suggest proof of principle for immediate
provisionalization of Astra OsseoSpeed Profile implants.

P137

Reconstructing Atrophic Edentulous Maxillae with Calvarial Bone Grafts
and Dental Implants.

C. Mertens*, H.G. Steveling, R. Seeberger, J. Hoffmann, K. Freier Heidelberg,
Germany.

Objective and Aim: Different treatment approaches are used to allow for
implant placement in cases of severe bone atrophy of the edentulous maxilla.
Centripetal resorption of the edentulous ridge may lead to discrepancies
between maxilla and mandible resulting in a reversed maxillomandibular
relationship. This situation and severe atrophy with strong horizontal and
vertical bone loss require extraoral bone grafts for reconstruction. Most
commonly bone grafts from the iliac crest are used. In this study, patients were
reconstructed with bone grafts from the calvarium. Patients and Methods: Nine
patients with severe bone atrophy of the edentulous maxilla (class V and VI

104

Poster Presentation Abstracts

After 13 years of follow up, was held the replacement of the crown, since the decreased significantly. The highest value was at the smooth neck (11.5 MPa)
personalization of abutment to confection of prosthetic aesthetics, using the followed by almost the same value for all thread sizes of about 5 MPa. Based
CEREC AC system (Sirona) with the resource of software InLab 3.85 and MC on the previous results it can be concluded that the presence of the thread in
XL milling machine. the neck of the osseointegrated case has almost no effect while it has prominent
effect in the immediately loaded case regardless of the thread size.
P140
P142
Use of Autogenous and Synthetic Bone Graft Substitutes in the Repair
of Bone Defects. Use of Porous Titanium Granules in the Regeneration of Bone Defects
in Rat Calvaria: A Histologic Study.
E. Ferreira*, J. Gulinelli, M. Kuabara, R. Gomes, B. Vieira, R. Okamoto, T. C.G. Brene*, A.R. Ferreira, A.D. Salvoni, T. Wassal Salvador, Brazil.
Queiroz Londrina, Brazil.
Grafting is the technique used when the capacity of alveolar bone is not
The bone tissue has a high a regenerative and reparative capacity, and sufficient for the installation of osseointegrated implants.The autogenous bone
can restore its structure and function in most situations. However, large bone is considered, among them, the “gold standard” due to lack of immune rejection
defects may not repair completely. Autografts, homografts xenografts and in the host and especially for its properties: osteogenic, osteoinductive and
synthetic bone substitutes can be used to minimize this limitation, especially osteoconductive. In fact, the biggest drawback to the frequent practice of
in cases where the quality of the new formed bone tissue is low. In this study, grafting with autogenous bone is just the harvesting process that requires
the repair of surgically created bone defects in calvaria of rabbits filled with additional surgery at another location, which can lead to postoperative
blood clot, autogenous bone and carbonate-calcium phosphate cement morbidity. Therefore, there is a constant scientific study that can be applied for
(Norian® - CRS®) was examined by histological and immunohistochemical bone treatments with grafting to replace autogenous bone, to prevent the
analyses. Ten adult male New Zealand rabbits (Oryctolagus cunilicus) were used. removal of the graft from another location. Most bone substitutes, known as
Three bone defects were prepared parietal region of each animal with an 8- biomaterials, used in dental implants, have hydroxyapatite (HA) as main product.
mm-diameter trephine bur and filled with blood clot (Group BC), autogenous It should be remembered that all materials used in grafting are more or less
bone (Group AB) and Norian® CRS® calcium phosphate-carbonate bone cement resorbable, and this resorption difficult the process of bone formation. A
(Group CPC). The animals were killed 40 and 90 days postoperatively. substitute who is absolutely resistant to resorption and also has good properties
Hematoxylin and eosin (HE)-stained sections were subjected and histologically viable coagulation has been expected, especially for
histomorphometrical analysis of the new bone formed inside the calvarial reconstruction of defects moderate such as sinus lifting and also for the
defects and sections adjacent to the H&E-stained sections were used for treatment of peri-implantitis. The objective of this study was to investigate
immunohistochemical staining to determine the expression of OP the porous titanium granules (PTG - NatixTM, Tigran Technologies AB, Malmö,
(osteopontine), OC (osteocalcine) and TRAP (tartrate-resistant acid phosphatase) Sweden) measuring 700-1000 mm in diameter, inserted into surgically created
proteins. Histomorphometric data were analyzed statistically by ANOVA and defects in rat calvaria, using the principle of bone grafting in 30 male Wistar
Tukey’s post hoc test at 5% significance level. At 40 days, Group AB differed rats (Rattus norvegicus albinos) weighing between 400 to 500g. The defects
significantly from the other groups with respect to the area of newly formed were made in left and right parietal bones, one being filled with the biomaterial,
bone, but no significant difference was observed at 90 days. The called test, and the other with autogenous bone particles, called control. After
immunohistochemical analysis revealed expression of OP, OC and TRAP proteins four and eight weeks, the rats were induced to death to study histologically the
in all groups. In the Group AB there was a predominance of OC and OP and possible viability of this biomaterial as a bone substitute and even if they had
lower TRAP expression. In spite of being biocompatible, the calcium phosphate osteoinductive properties to allow bone growth. The results achieved in the
bone cement evaluated in the present study did not accelerate the protein histological samples concluded that there is bone formation around the
expression dynamics during bone healing and did not stimulate greater bone granules without adverse effects (areas of inflammation) that suggest its use
tissue formation compared with the other groups. in human alveolar bone and justify further clinical studies of them, especially,
its action in vivo, for use defects in bone inlay (higher condition for stabilization
P141 of the biomaterial) and for the treatment of peri-implantitis.

Effect of Neck Thread Sizes versus Smooth Neck on Stress Distribution
in Immediately and Delayed Loading Dental Implants: Finite Element
Study.

M.T.I. Elwakad*, M.Z. Bendjaballah Cairo, Egypt.

Introduction: Some studies states that stress concentration occurred around
the smooth neck of threaded and cylindrical implants while others revealed
that a smooth implant neck induces high stress peaks in bone at the retention
elements. Therefore, threads were extended along the implant neck to alleviate
the stress concentration at the neck. In case of immediately loaded implants,
it has been suggested to use micro-thread into the neck to improve the
biomechanical environment for maintenance of bone/implant system.
Therefore, the aim of this study is to compare the stress distribution in bone
surrounding neck designs with different thread size versus smooth neck in both
the immediately loaded and delayed loaded (osseointegrated) implants.
Method: Four axisymmetric 3D models of an implant and the surrounding bone
are developed using finite element software. One model has smooth neck while
the other three have different neck thread configurations (coarse, medium and
fine threads). Each model was tested in a delayed loaded case and in
immediately loaded case. Results: Under a load of 100N results in the
osseointegrated case showed that the presence of the threads caused slight
increase in Von-Mises stresses at the cortical bone of 4% and 14% in the fine
and medium thread respectively while it decreased in the coarse threads by
5% when compared to smooth neck. On the other hand, Von-Mises stresses
in the cancellous bone of the osseointegrated case did not change significantly
(about 2.7 MPa). In the immediate loading case, the Von-Mises stresses in the
cortical bone was lowest in the smooth neck (7.8 MPa) and increased
significantly with the thread size as follows: in the fine (28.9 MPa), followed
by the medium (30.0 MPa) and finally the coarse (30.1 MPa). On the other hand,
Von-Mises stresses in the cancellous bone of the immediate loading case

105

Poster Presentation Abstracts

P143 This bone foramen must be eliminated to avoid risk of constriction of the
nervous pedicle during the lateralization of the nerve.The use of the ultrasonic
Novel Technique for Fabrication of Radiographic and Surgical Guide for lancet is very interesting in this situation because it allows a secure bone cut
Implant Placement in Partially Edentulous Patients. and an easy access to and release of the nerve. The ultrasonic vibrations make
the cortical plate cleavage easier from the soft structures that are underneath.
S.M. Zemse*, S. Arias, K. Stern, G. Maze Augusta, GA. This is the only true difficulty of the inferior alveolar nerve lateralization gesture,
and it is raised as a matter of course with the ultrasonic lancet.
Introduction: Various techniques for fabrication of implant radiographic
guide and surgical guide have been documented. Thermoplastic material (Essix P145
appliance) has been used in various ways for fabrication of fluoride trays,
occlusal guard and surgical guides, to facilitate optimal implant placement. In Localized Ridge Augmentation using a Mandibular Bone Block
this technique, we fabricate a radiographic and surgical guide using patients Harvested with a Bone Trefine Bur for a Single Post-extraction Socket
existing partial denture. Since occlusion, bucco-lingual position and vertical Prior to Implant Placement: A Case Report.
dimension are maintained in the existing partial denture, it provides as an
essential reference for radiographic and surgical guide fabrication. Our M. Montaño Olvera*, R. Neria Maguey México, D.F, Mexico.
technique provides an easy and quicker alternative for radiographic and surgical
guide fabrication. Materials and methods: Accurate mandibular/maxillary pickup Implants have become a predictable surgical procedure for replacing single
impression made using irreversible hydrocolloid impression material and or multiple teeth.However,tooth loss, periodontal disease, traumatic defects,
poured in Type III dental stone. Essix appliance is used to adapt on master endodontic perforations leave an inadequate volume of alveolar bone for
cast tissues with partial denture. Partial denture removed and the Essix is placed implant placement resulting in insufficient alveolar dimension.The ideal solution
on the cast to evaluate the teeth in relation to the edentulous site. Using lies in reconstructing the lost bone volume using regeneration procedures as
Surveyor, cast with Essix appliance is mounted on a drill press and perforations bone block to achieve an ideal prosthetic desing.Alveolar bone grafting from
are made at appropriate position in the appliance. Perforations made around a mandibular donor site offers a treatment option to augmented the
2 mm wide to allow passage of gutta percha (GP) points and eventually 2 mm deficiencies from the ridge.Autologous bone grafts are considered the gold
twist drill. The Essix appliance is removed, orthodontic resin is prepared and standard for augmentation of deficient alveolar ridges.The aim of this study
poured on the internal surface of the Essix appliance on edentulous site only was rebuild and restored the deficiencies on the atrophic alveolar ridge to
and is seated on the cast. Gutta percha points are passed through the obteined the conditions for the position of the implants.Case report:A 25-year
perforations created and aligned appropriately. Once set, this appliance acts old woman systemically healthy presented with internal root resorption with
as a radiographic guide. The radiographic guide can then be converted in a buccal perforation at the right maxillary canine and absence of first premolar.
surgical guide by removing the gutta-percha points. If implant placement is Examinations resulted in a diagnosis of vertical and horizontal bone loss with
decided at a different position than GP points, perforations can be placed in oclusal trauma complicated by periodontitis, along with endodontic perforation,
those alternate locations. Results: This technique is a quick alternative to this tooth was determined to be hopeless and was scheduled for extraction
prefabricated radiographic and surgical guide obtained from outside laboratory. and planned to place an implant, prior to the implant placement, an autologous
Conclusion: Tissue/tooth supported radiographic and surgical guides are an bone block graft is harvested from the chin with a trefine bur, the implants were
ideal alternative for extensive laboratory procedures for fabrication of the same. placed in a second stage 6 months later. Results:No complication was observed
Our technique provides similar results with reduced cost and time. Although during the surgical procedure o extensive bleeding after removal of the bone
it is good alternative for other laboratory made surgical and radiographic guides, graft there was no infection or bone graft exposure.The volume of tissue gained
bone supported guides still outclass this technique. was sufficient for placement an implants in optimal position.Examination of
the periodontal status revealed neither gingival retaction or periodontal
pockets.Grafting in this patient resulted in approximately about 5 mm of
horizontal and 7 mm of vertical augmentation.No implants was lost during the
osseointegration period. No postoperative alterations in chin contours was
noted.The gains in the vertical and horizontal dimensions conferred the benefit
of an esthetic end result with a two single-tooth crown.Conclusions:Thanks
to the techniques of localized bone regeneration using autogenous block graft
was achieved satisfactory the placement of dental implants

Step 1: Diagnostic Cast
Step 2: Partial denture seated
Step 3: Essix appliance on partial denture
Step 4: Essix appliance on cast
Step 5: Ortho resin in essix appliance with guttapercha points
Step 6: Completed radiographic guide

P144 P146

Treatment of the Atrophic Posterior Mandible with Intraoral WITHDRAWN
Piezosurgery and Lateralization of the Inferior Alveolar Nerve with
Simultaneous Implant Placement: A Clinical Report.

C.M. Menezes*, A.R. Ferreira, W.C. Bonachela, C.G. Brene Salvador, Brazil.

There are several methods to prostheticaly solve the problem of edentulous
atrophic posterior mandible. In certain situations the lateralization of the inferior
alveolar nerve (IAN) with simultaneous implants placement serves as an
alternative to other solutions (inlay and onlay bone grafting, short implants,
distraction osteogenesis, tilting of the implants, removable dentures).The
lateralization of the IAN is a very delicate operation that is reserved for extreme
clinical situations. Its main difficulty remains in the initial release of the nerve:
it is necessary to decorticate it, without any damage, up to the mental foramen.

106

Poster Presentation Abstracts

P147 P148

Reconstruction of Alveolar Ridge in the Vertical and Horizontal Post- A Radiographic and Clinical Review: Dental Implants Placed from 2002-
extraction Dental Implant Replacement Allograft: 50 Cases Reported. 2009 in an Advanced Specialty Education Program in Periodontics.

P. Cervantes*, F. Guerrero, H. Tellez, A. Brambila, O. Pineda, E. Tudon, M. De L. Frisbie-Teel*, J. Haynes, Y. Choi, S. Hokett Portland, WA.
La Rosa Tampico, Mexico.
Dental implants have revolutionized the treatment of edentulous dental
Background: Clinics studies shows a better rate of success of the implant sites, demonstrating excellent success and survival outcomes. Few studies have
that were collocated on the anterior region, with a good quality and quantity analyzed implant outcomes by radiographic survey in the academic setting.
bone, is for that reason that we have to do a valoration of these two The primary objectives of this study are to evaluate the cumulative survival rate
characteristics of the bone. The characteristic of the material with (CSR) of implants placed from 2002- 2009 by periodontal residents and to assess
biocompatibility, osteoconductivity and time of reabsortion are very important bone height changes around these implants, including residual radiographic
to obtain a better quality and quantity of the bone tissues formation, we have bone height (RRBH) and radiographic crestal bone loss (RCBL.) Secondary aims
to provide a tridimensional space for the formation of the new blood vessels of this study are to determine whether demographic or health parameters of
in could confine and stimulate the migration of the cells osteoprogenitories. the patient or postdoctoral experience level affects radiographic bone height
The Biphasic Calcium Phosphate (βCP) are produced by sintering Hidroxiapatite and survival of dental implants. A retrospective chart review was performed for
(HA) and Tricalcium Calcium Phosphate (TCP) to a chemically composite material patients who had implants placed by periodontology residents over a nine year
where the TCP part will dissolve and the HA part remain, and resulting in a rigid period. Subjects were invited to participate in a recall examination, at which
space available for the cells invasion. Methods: The treatment of 50 patients time a clinical assessment was performed, a digital periapical radiograph was
who come at the Graduate Periodontics Clinic of the University Autonomus taken of each implant and a patient satisfaction survey was conducted.
of Tamaulipas, during the six months period, with different background of Demographic, health, and implant data were collected from the chart review.
traumatic dental and alveolar dental. In order to preserve and increase the edge Radiographs were analyzed by two calibrated and independent evaluators.
itself, by the method of guided bone regeneration. The implantation of different Combined RRBH and cumulative RCBL were calculated and data analysis was
biomaterials for the regeneration of the bone (HTA natural and synthetic, bone performed. The study cohort included 167 dental implants. The mean follow-
cortical desmineralized dry, phosphate calcium biphasic, bovine bone and up period was 5.11 years. More implants were placed in females than males
bioactive glass) with the combination of a collagen membrane. Results: Clinically (56% vs. 44%, respectively.) The ages of subjects ranged from 17 to 85 years
the biomaterial we mention before show a clinical answer positive in the (mean age 60.3 years old.) Combined RRBH as per dental implant fixture length
preservation of the edges alveolar from trauma returning the characteristics was 90.7%. Females retained 90% and males 91%; healthy patients retained
structures for the future rehabilitation of the prosthesis or implantation. We 91% while diabetics retained 88% of the combined RRBH. Combined RRBH per
could not observe the exposition association process inflamatories or severe dental implant fixture length was 91% for never smokers, compared with 89.4
infections, with a radiographic control post surgery immediately at 3 and 6 and 89.6% for current and historical smokers respectively. Cumulative RCBL was
months. Conclusions: 1.The different types of biomaterial used returning the 1.03 mm (s = 0.882; range 0 – 5.5). CSR over the nine year period was 96.8%.
characteristic anatomic of the process alveolar traumatize. 2.We cannot see the Implants placed by residents in this study fall within accepted standards.
collapse alveolar after the collation of the biomaterials. 3.Radiographically we Demographic and health factors did not significantly affect the combined RRBH
can observe the integration of the biomaterial in their zones respective. 4.The or the survival rate of the dental implants. There was slightly less RRBH for dental
reconstructive of the process alveolar has a final and inmediate rehabilitation implants placed in diabetics and smokers. Finally, the level of experience of the
posterior of the prosthesis and implantation. resident did not have a significant impact on implant survival.

P149

Evaluation of Pro-inflammatory Mediators around Titanium and
Zirconium Oxide Dental Implant Abutments.

C.A. Barwacz*, E.N. Recker, L.M. Thomann, C.C. Kummett, D.V. Dawson,
K.A. Brogden, C.M. Stanford, D.R. Blanchette Iowa City, IA.

Introduction: Implant dentistry has made significant advancements in
providing predictable osseointegration. Long-term studies suggest that changes
in the peri-implant mucosal environment may lead to clinically significant issues
of unpredictable mucosal changes following delivery of the abutment and
prosthetic rehabilitation. The presence of chronic transmucosal inflammation
due to abutment material selection is therefore of interest when considering
risk factors for mucosal recession around dental implant abutments. Objectives:
To evaluate the production of chemokines, pro-inflammatory cytokines, and
bone mediators present in the peri-implant sulcus fluid (PISF) around pre-
fabricated and custom CAD/CAM abutments of titanium and zirconium dioxide
in patients who have been in function for at least 6 months. Methods: Clinical
and radiographic exams were performed on 46 healthy subjects who had
undergone previous implant therapy. PISF samples were obtained from one
implant site per subject. Each implant site had four sites that were sampled and
pooled into 0.01 M PBS, pH 7.2 containing protease inhibitors. Twenty-two
chemokines and cytokines and seven human bone mediators were examined
using a commercial multiplexed fluorescent bead-based immunoassay
(Millipore, Billerica, MA) in the Luminex 100 IS Instrument (Luminex, Austin, TX).
Results: 1)None of the subjects sampled exhibited clinical or radiographic
evidence of peri-implantitis. Bone levels were stable at recall for all subjects
from initial date of prosthesis delivery. 2)The concentrations of 6 cytokines were
low (10 pg/30 sec (GM-CSF, IFNg, IL-12(p70), IL-17, IL-2, and IL-5). 3)The
concentrations of 14 cytokines and bone mediators were slightly elevated, but
less than 100 pg/30 sec (eotaxin, IL-10, IL-12(p40), IL-13, IL-4, IL-6, IL-7, MCP-1,
MIP-1a, MIP-1b, RANTES, TNFα, ACTH, Leptin, and PTH). 4)8 chemokines,
cytokines, and bone factors (IL-1a, IL-1b, IL-8, IP-10, Insulin, OC, OPG, and OPN)
were elevated and upper ranges varied from 107 pg/30 sec for OPG to 5,330
pg/30 sec for IL-1a. Conclusions: The concentrations of select chemokines and
pro-inflammatory cytokines were elevated, albeit in patients for whom there
was no clinical or radiographic evidence of perimplantitis. At present, it is

107

Poster Presentation Abstracts

unclear if abutment material plays a key role in peri-implant transmucosal of pathology are controversial. Purpose: The purpose of the present study was
inflammation. to evaluate retrospectively the treatment options of large perforations in
schneiderian membrane during the sinus graft procedure in cases with mucosal
P150 thickening > 10 mm. Patients and Methods: Patients were submitted to sinus
augmentation surgery and presented sinus membrane perforation > 10 mm
Sinus Augmentation with a Calcium Phosphosilicate Putty after Cyst with implants placed simultaneously or in a second stage surgery after 6
Resection and Membrane Explantation: A Case Report. months. The surgical techniques used were: iliac autogenous blocks, mandibular
autogenous blocks, and biomaterials graft mixed with platelet rich plasma (PRP)
L. Mahesh*, N. Venkataraman Athens, Greece. combined with a buccal fat pad flap. Results: From March 2001 to December
2009, 18 patients (12 men and 6 women) were studied, on whom 25 sinus floor
Background: A 50-year old male patient presented with an edentulous ridge augmentation with a total of 54 dental implants were placed under repaired
in the upper right quadrant. Pre-operative Cone Beam CT (CBCT) (Figure 1) membrane perforations. Eighteen sinuses presented mucosal thickening > 10
shows the expansion of the sinus and inadequate bone height (1.75mm) in the mm and seven mucosal thickening < 5 mm, previously detected in a CT scan.
sinus floor for implant placement as a result of a cystic lesion. The best prognosis In eleven sinuses were used iliac blocks, in five mandibular blocks and in nine
involved removal of the cyst along with the infected sinus membrane in the biomaterials mixed with PRP combined to buccal fat pad flap. Three sinuses
area and augmenting the sinus floor with a bone graft using the lateral window with iliac blocks presented complications and the blocks were removed and a
technique followed by a delayed implant placement. Methods: A 5mm lateral total of three implants presented failure. Patients were followed up in a period
window was created to access the sinus. The cyst was resected including the of 20 to 120 months. Conclusions: Sinus augmentation procedures with large
affected sinus membrane using grasping forceps (Figure 2A-B). The membrane membrane perforations in a presence or not of antral pathology may be
was repaired with a collagen membrane (BioMend, Zimmer Dental) and Calcium adequately reconstructed and covered, and therefore are not an absolute
Phosphosilicate putty (NovaBone Dental Putty, NovaBone Products, Alachua, contraindication to the continuation of surgery, provided that they do not allow
FL) was placed into the sinus floor incrementally with autogenous bone the passage of graft material inside the maxillary sinus.
collected from creating the lateral window (Figure 2C). About 3cc of NovaBone
putty was used to augment the area. The lateral window was closed with a P153
membrane (BioMend, Zimmer Dental, Carlsbad, CA) and the mucosa sutured.
The explanted cyst was sent for histopathological evaluation and the patient Effectiveness of Bone Regenerative Collagen-Polyvinylpyrrolidone
was recalled after a week for post-operative follow-up. Results: Biopsy report Sponge in Alveolar Post-extraction for Implant Therapy.
confirmed the lesion to be a polyp (Figure 3). 6 month Post-op CBCT shows
good bone fill (Figure 4). The bone height was measured to be approximately A. Rodriguez*, F. Guerrero, H. Tellez, J. Torres, E. Tudon, R. Oliver Tampico,
6 mm indicating a gain of 4mm. The trabecular pattern and the radiolucency Mexico.
in the regenerated area suggest the remodeling of the bone graft Putty into
bone. Background: The loss of bony contour occurs mostly from first to third
month after tooth extraction. It is an accelerated loss in the first 6 months
followed by gradual modeling (changing size and shape) and remodeling
(restructuring existing bone), with a loss of approximately 40% of alveolar height
and width 60% of bone in these first 6 months . The collagen-
polyvinylpyrrolidone (collagen-PVP) in lyophilized form by way of dressing,
composed of γ-irradiated mixture of collagen type I pepsinizada extracted from
pig and polyvinylpyrrolidone of low molecular weight material is completely
absorbed and has shown hemostatic capacity and inducing healing. Results:
We could not observe the exposition association process inflamatories or severe
infections, with a radiographic control post surgery at 1, 3 and 6 months.
Clinically the biomaterial we mention before show a clinical answer positive
in the preservation of the alveolos postextracción for the future rehabilitation
con implantes dentales. We Could not see the exposition association or severe
inflammatory process Infections, With A radiographic control post surgery at
1, 3 and 6 months. Clinically we mention Before the biomaterial to show positive
clinical answer in the preservation of the extraction sockets for the future
rehabilitation with dental implants. Conclusions: 1.-The PVP collagen sponge
biomaterial is a safe and easy application in the region of the extraction sockets.
2.Clinicamente showed a greater control of the local inflammatory process in
the experimental group in Comparison with the control group. 3 .- Histologically
confirmed the presence of newly formed bone tissue at 6 months
postoperatively, allowing immediate rehabilitation with dental implants.

P151

WITHDRAWN

P152

Treatment of Large Perforations in Schneiderian Membrane during Sinus
Augmentation Surgery: A Retrospective Review of 25 Cases.
E.J. de Moraes*, L. Moraes, N. Moraes Rio de Janeiro, Brazil.

Background: The maxillary sinus augmentation, is an excellent alternative
to oral implantology and present 90% of success level. However, the
complications of sinus lift surgery sometimes perform consequences with very
difficult management and solutions. Perforations of the Schneiderian membrane
represent the major intraoperative complication but are rarely reported in detail
and their effects have been investigated to an even lesser extent. Several
attempts have been made to classify membrane perforations but a preferred
management of large perforations is not clearly defined in the literature. On
the other hand The procedures of sinus with mucosal thickening or presence

108

Poster Presentation Abstracts

implant position/size/brand, single vs. second-staged surgery, time lapse
between MSA and implant placement, ISQ values at placement and post-
operatively, net maxillary sinus bone height gain, crestal bone loss, and bone
density of newly formed bone. A lateral window approach was used in all cases
by the same operator. Dental implants were placed at the time of MSA or up
to 9 months later. Computed Tomography (CT) and Cone Beam CT were used
to determine bone height, bone density, and crestal bone loss. Results: The net
average height of maxillary sinus bone gained over a 6-24 month period
following sinus augmentation with rh-BMP2/ACS was 5.7 mm compared to 9.6
mm in individuals with rh-BMP2/ACS+AL. The peri-implant average bone
density was 399.6 ± 83.1 HU in those with rh-BMP2/ACS versus 373.6 ± 60.8 HU
in those with rh-BMP2/ACS+AL. Finally, crestal bone loss between the mesial
and distal sites was averaged to 2.10 ± 0.84 mm around implants grafted into
sinuses with rh-BMP2/ACS compared to 2.14 ± 1.03 mm in implants grafted
into sinuses with rh-BMP2/ACS+AL. ISQ values averaged 74.8 at the time of
placement and 79.1 at a follow-up visit in implants grafted into rh-BMP2/ACS,
whereas ISQ values averaged 71.5 at the time of placement and 71.3 at a follow-
up visit in implants grafted into rh-BMP2ACS+AL. Conclusions: The addition
of AL to rh-BMP2/ACS improves bone height more so than rh-BMP/ACS alone.
Bone densities were relatively comparable in both methods of MSA, and both
methods are adequate to provide sufficient stability to support an implant in
the posterior atrophic maxilla.

Collagene Spounge Polyvinylpyrrolidone posicionated into the dental socket P157

P154 Histology of Peri-implant Bone in a Failed Implant Retrieved from an
Area of Osteonecrosis of the Jaw (ONJ) in a Patient Suffering from
WITHDRAWN Multiple Myeloma and Treated with Intravenous Bisphosphonates.

P155 S. De Benedittis*, M. Degidi, A. Piattelli, G. Perfetti, C. Marchetti, V. Perrotti,
G. Iezzi Pescara, Italy.
Marginal Bone Loss around Dental Implants in Relation to the Platform
Diameter. Osteonecrosis of the jaw (ONJ) has been reported in the past few years in
M.N. Al Qutub* Riyadh, Saudi Arabia. patients undergoing treatment with bisphosphonates (BP). Few published
histological studies of ONJ can be found in the literature. The aim of the present
The aim of this study was to evaluate the alveolar crestal bone loss around case was to report the histology of the peri-implant bone around an implant
dental implants with various diameters. A total of 120 patients (70 male and 50 retrieved from an area of ONJ. Multiple myeloma was diagnosed in 1995 in a
female) with 150 single Nobel Replace®Select Tapered of different width were 72-year-old male. The patient underwent treatment with intravenous
included in this study. The implants of size 3.5mmX10mm, 4.3mmX10mm, pamidronate for 2 years and with intravenous zoledronic acid for an additional
5mmX10mm were used in this study. For each implant, radiographic 3 years. Five years after the diagnosis, 7 immediately loaded dental implants
measurements of the marginal bone height and its change over time were (XiVE, DENTSPLY-FRIADENT, Mannheim, Germany) were inserted in the
made. Intraoral radiographic examinations of all implants were performed at mandible. A preoperative panoramic radiography did show no pre-existing
baseline, using paralleling technique and was compared to those taken at bone lesions. No healing of the post-extraction sockets of the right third molar
various subsequent post-placement times at the end of 1st year, 2nd year and and of the left second molar was observed. Three years after the implant
3rd year follow-ups to evaluate crestal bone level changes. The regular neck insertion a breakdown of the oral mucosa covering the implants was observed.
and wide neck implants showed relatively higher crestal bone loss compared The one most distal implant was retrieved with a trephine bur, due to mobility.
to the narrow neck implants. All the three groups showed a progressive increase Microscopically, at low power modification, bone was present only around
in bone loss from first year to the 3rd year after implant placement. It can be the apical portion of the implant. In some portions of the interface, this bone
concluded that implant dimension might be one of the factors influencing the was still vital, with a normal structure and normal staining characteristics. A
long term success of the implant. close connection was observed between this bone and the implant surface,
and no gaps were found at the interface; also absent were an inflammatory
P156 infiltrate, connective tissue and an epithelial downgrowth. In other areas, non
vital bone was present at the interface and also at a distance from the metal
Evaluation of rh-BMP2/ACS with and without the Addition of an surface. This latter type of bone did not show a normal staining and a normal
Alloplast. bone. Moreover, this bone appeared to be partially demineralised. No newly-
J.M. Tanner*, J. Pi-Anfruns, N. Hassan, S. Baltayan, T. Aghaloo, P.K. Moy Los formed bone or osteoblasts were present around this bone. In some areas of
Angeles, CA. the interface, it was possible to see the presence of a connective tissue with a
slight inflammatory cell infiltrate. In patients undergoing intravenous treatment
Background: Maxillary sinus augmentation (MSA) makes implant placement with bisphosphonates, clinicians must be aware of the increased risk of implant
possible in the posterior maxilla when atrophy has occurred. In 2007, the FDA failure.
approved the use of Recombinant Human Bone Morphogenic Protein-2 (rh-
BMP2), which over the past five years has been used extensively in MSA. rh- P158
BMP2 is typically delivered to the atrophied area by use of an absorbable
collagen sponge (ACS). To further enhance the success of rh-BMP2/ACS, some The Effect of Human Freeze Dried Corticocancellous Block Onlay Graft
clinicians have advocated adding an alloplast (AL). Purpose: This study will on Bone Formation in Rat Calvarium.
retrospectively investigate the results obtained with rhBMP2/ACS vs. rh-
BMP2/ACS+AL. Materials and Methods: Medical records were reviewed between J. Lee*, H. Chung, J. Hong, E. Pang Seoul, Republic of Korea.
1997-2011 in individuals who had undergone MSA with rh-BMP2/ACS. The
following data was recorded: gender, age, medical comorbidities, type of AL, Background Donor site morbidity associated with autogenous block graft
harvest has turned attention to the use of commercially available block graft
materials. The aim of this study was to investigate the effect of onlay graft of
human freeze dried corticocancellous bone block in bone formation and the
effect of collagen membrane in rat calvarium. Materials and methods Thirty
male Sprague-Dawley rats were used. Animals were treated with either collagen
sponge (CS), human freeze dried corticocancellous bone block (FDBB) or human
freeze dried corticocancellous bone block with collagen membrane (FDBB/CM).
FDBBs trimmed into disk-shape with 8 mm in diameter and 4 mm in height

109

Poster Presentation Abstracts

were placed on the rat calvarium surface without or with collagen membrane surgery device showed a higher performance in terms of accuracy and
covered. The rats were sacrificed at 2 (n=5) and 8 (n=5) weeks after surgery uniformity in quality of osteotomy cut, compared with conventional rotary
for histologic and histomorphometric analysis. At each period, total augmented instruments.
area (mm2), new bone area (mm2), and bone density (%) were measured. Mann-
Whitney and Kruskal-Wallis were used to analyze the effect of time and P161
experimental conditions (p<0.05). Results In FDBB group, the process of
osteogenesis began at the lateral margins of the grafted block and projected Accuracy of Implant Placement with Guided Surgery System: A Pilot
to the central region of the recipient-graft interface. The cancellous portion Study.
of the graft underwent increased resorption with time. FDBB showed significant
decrease in total augmented area between 2 and 8 weeks (p<0.05), regardless H. Yoshihara*, N. Fujii Tokyo, Japan.
of combined use of collagen membrane. FDBB showed significant increase in
new bone formation between 2 and 8 weeks (p<0.05), and collagen membrane Recently, the diagnose with three-dimensional examination prior to the
showed significantly additional effect on new bone formation at 8 weeks implant surgery is getting popular for more accurate implant placement.
(p<0.05). FDBB showed significant increase in bone density between 2 and 8 However, it is still difficult to place the implant as it is simulated with the
weeks (p<0.05). Conclusion Within the limits of the present study, it was software. The guided surgery system has been introduced for more precise
concluded that FDBB graft possess typical osteoconductivity which was implant placement. The aim of this study is to evaluate the vertical error of
characterized decrease in volume and increase in new bone formation with the trial guided surgery system with minimum tolerance. The fixture used for
time, and the outcomes are additionally improved, especially in new bone this study is the SETiO Plus fixture, external type, manufactured by GC
formation, when the collagen membrane is used with the block graft. corporation, and is diameter 3.8mm and the length 12mm. Following
manufacture’s recommended position, 0.5mm lower than the crest of the
P159 alveolar crest, they were inserted into the artificial bone 40/30(Sawbone, Pacific
Research Laboratories)with and without the trial surgical guide, by
Immediate Provisional Restoration with or without Occlusal Loading: A inexperienced surgeon. The trial surgical guide was made using a rapid-
Pilot Study. prototyping three-dimensional printer(EDEN250, Objet Geometries Ltd.). The
vertical distance between the artificial bone surface and platform was measured,
M. Lorenzoni*, S. Platzer, M. Stopper, G. Wimmer, M. Payer, W.A. Wegscheider And the vertical distance measured at segmented platform, four points. Figure1
Graz, Austria. shows the error of the perpendicular and measured points. The vertical error
when trial surgical guide was used measured 0.00±0.02mm(Point 1), -
Objective: Aim of this prospective pilot study was to compare the outcome 0.03±0.04mm(Point 2), -0.01±0.05mm(Point 3) and 0.04±0.01mm(Point 4)
of immediately provisionally restored implants with or without functional whereas without trial surgical guide measured 0.21±0.16mm(Point 1),
loading in partial edentulous patients. Material and methods: 16 patients were 0.18±0.10mm(Point 2), 0.18±0.16mm(Point 3) and 0.26±0.16mm(Point 4). The
treated with 32 screw-type implants replacing mandibular molars and vertical error was controlled, between -0.03mm and 0.04mm, with the guided
premolars. 17 implants (5 patients) were provisionalised immediately after surgery system. On the other hand, without guided surgery system, implant
placement without occlusal loading, 15 implants were fully loaded in maximal was placed about 0.2mm deeper than recommended position. This indicates
intercuspidation. Radiographic coronal bone levels, implant survival and success that guided surgery system leads/achieves more precise implant placement.
were evaluated 6 and 12 months after insertion. Results: Mean marginal bone That means to prevent accidents such as damaging mandibular canal and
levels after 12 months showed no significant differences between test and penetrating maxillary sinus.
control implants and were comparable to previously published data. No
implants were lost in the test group and in the control group, resulting in an
overall survival rate of 100 %. No implants were recorded as failures in the
test group and in the control group, resulting in overall success rates of 100
%. No significant differences in any of the evaluated parameters could be
observed between the two groups. Conclusion: The present data of immediately
loaded implants in partial edentulous jaws demonstrated no difference in
radiographic bone level, survival and success rate between occlusally loaded
and non-loaded implants. Larger long-term RCTs are needed to confirm the
final evidence and predictability of immediate functional loading as a standard
treatment concept for the partially edentulous jaw.

P160 Figure1. The vertical error compared with and without trial surgical guide [N=3].

Comparison of Conventional Drills and Ultrasonic Osteotomy for Dental P162
Implant Site Preparation: A Histological Analysis in Bovine Ribs.
An In Vitro Investigation of Microbial Leakage in Internal Hexagon and
B. Sinjari*, G. Murmura, G. Varvara, A. Scarano Chieti, Italy. Morse Taper Implant-abutment Connections.
D. Berardi*, D. Tripodi, G. Vantaggiato, A. Scarano, V. Perrotti, A. Piattelli,
Ultrasonic surgery is a recently developed system for cutting bone with G. Perfetti, G. Iezzi, S. D’Ercole Chieti, Italy.
microvibrations. The aim of this study was to effectuate a histological
comparison between conventional drills vs ultrasonic surgery devices in implant Leakage at the implant-abutment junction (IAJ) is a major contributing
bed preparation. Materials and methods: Ten bovine ribs were appropriately factor for peri-implant inflammatory reactions. Gaps and cavities between the
removed from soft tissues (connective, cartilage, fat etc)in order to obtain the implant and the abutment acting as a bacteriological reservoir have been
underlying bone, and then stored for 1-2 days at 4°C. Each rib was individuated described. The aim of the present in vitro study was an evaluation of the leakage
in two halves. On each half 5 implant sites were randomly prepared (10 sites observed, in a 28 days observation period, in internal hexagon and Morse taper
per rib). A single cylindrical bur, 13mm height and 2mm width, (Bone System, implant-abutment connections. A total of 20 implants were used in this in vitro
Milano, Italy) at a speed of 400 rpm was used to prepare the implant sites of study, 10 with a screw-retained internal hexagon abutment and 10 with a Cone
group (A) and 5 implant sites was prepare with the piezoelectric device (NSK Morse taper internal connection (Universal II HI and CM, respectively - Implacil,
Variosurgery Dentalica, Milano, Italy) mounted with a diamond-coated De Bortoli, Sao Paulo, Brasil). Ten specimens of each group were tested. Two
cylindrical tip. After implant site prapartion the ribs were stored immediately different bacterial species were used. Pseudomonas aeruginosa (PS) and
in 10% buffered formalin and processed to obtain thin ground sections. The Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) (AA).
specimens were processed using the Precise 1 Automated System (Assing,
Rome, Italy). Results: osteotomy drill (group A) surfaces treated appeared not
very different from those treated with piezoelectric device(group B); A higher
magnification showed the presence of microcracks created on the interface.
The latter appeared numerous for group A and had thickness and depth
amounted to 20-120µ and 500-1000µ, respectively. While they were irrelevant
or completely absent in group B. No statistical significant differences were found
between the two groups on bone marrow (P=0,174). Conclusions: ultrasonic

110

Poster Presentation Abstracts

The inner part of five implants were inoculated with 0.1µl of a viable PS experience in placing and restoring dental implants with over dentures, were
suspension and five implants with the same amount of AA. In the Cone Morse enrolled. The supervising faculty and the AEGD residents evaluated the
implants, bacterial contamination was found in 2 out of 5 implant-abutment competency level after each implant placement and prosthetic reconstruction.
assemblies seeded with the PS, both on the 22nd day. In the assemblies seeded The residents self evaluation and faculty evaluation of resident competency
with AA, no contamination was found. The total of leaked assemblies in this was based on a 5-point scale according to Chambers et al (1994). 45 patients
group was 2 out of 10. In the internal hexagon implants, bacterial contamination were enrolled in the study. The patients were requested to rate their overall
was found in 2 out of 5 implant-abutment assemblies seeded with the PS, satisfaction ( VAS-scale) with their denture at the initial visit, after denture reline,
respectively one on the 16thday, and on the 19th day. In the assemblies seeded two weeks, 3 months, 12 months and 24 months after attaching the denture
with AA, the contamination was found in 3 samples, respectively on the 11th, to the implants. Result: Of the 9 novice AEGD residents who completed the
18th, 20th days. The total of leaked assemblies in this group was 5 out of 10. surgical aspect of the study, one achieved competency after 4 surgeries, 6 after
In conclusion, the results of the present in vitro study showed that bacterial 5 surgeries and two after 6 surgeries. 13 novice AEGD residents completed
contamination occurs in different types of implant-abutment connections. The the restorative aspect of the study. The residents achieved competency after
Cone Morse taper internal connection seemed to be able to resist more to two to four clinical experiences in restoring the implants with an over denture.
the bacteria penetration. It must, furthermore, pointed out that in this type All patients were significantly more satisfied with the implant supported
of connection, the bacterial contamination occurred quite lately during the overdenture compared to a conventional denture (p<0.05). Conclusion: Novice
course of the experiment (on the 22nd day), while the contamination was AEGD residents can achieve competency in placing two dental implants and
always earlier in the butt-joint connection implants. restore them with a mandibular over denture while enrolled in a two-year AEGD
program. Further studies are needed to evaluate what impact other restorative
P163 and surgical training in the AEGD program may have on the ability of the
residents to develop these competencies.
Histological Results in a Human Dental Implant with a Platform Switched
Implant-abutment Connection. Overall Satisfaction

R. Di Stasio*, M. Degidi, V. Perrotti, A. Piattelli, G. Iezzi Foggia, Italy. P166

Peri-implant crestal bone must be stable for aesthetic reasons. This can be Neutral Zone and Lingualized Occlusion Two Concepts Applied to
obtained with the use of platform-switched implants in which an abutment Rehabilitation of the Edentulous Mandibular Arch.
smaller than the implant shoulder is used. Moving the microgap away from the A. Sanchez*, A. Salazar Ecatepec, Mexico.
external edge of the implant shoulder and from crestal bone could help to
reduce the bone resorption, by containing the inflammatory cell infiltrate within Introduction: During the history of prosthetic rehabilitation, it was found
the angle formed at the interfacial away from the adjacent crestal bone. With that occlusal forces, such as interference in lateral movements, as well as spaces
a platform-switched abutment, a 90° step is created, compared to what happens for invasion of muscle activity, leads to failure of the prosthesis in either natural
to implants with a matching implant-abutment diameter, where a 180° step teeth or osseointegrated implants. On the other hand materials such as
is present;the resulting confined area may produce a restriction of the ICT to zirconium and CAD-CAM technology have brought significant progress in the
this region.Aim of this study was a histologic analysis of an implant with a bio integration of prosthetic restorations. The purpose of this case is to combine
platform switched implant-abutment connection. A 32-year-old male patient advances in biomaterials, processing techniques, the artistic contribution of
participated in this study.The patient needed a bilateral mandibular dental technicians with two of the concepts tested in the prosthetic area.
restoration.Four implants were used, and were restored and loaded immediately Methods: For the prosthetic rehabilitation of this case use the articulation of
the same day of insertion.After a 6 weeks healing period, one implant with a teeth based on lingualized occlusion with an occlusal plane of 20 ° obtained
platform-switched abutment was retrieved with trephine.A 1 mm resorption by means of a slide for this purpose and using teeth designed specifically for
of the peri-implant crestal bone was present on one side with the bone was the technique, we obtained contour of the prosthesis through the neutral zone
located at the same height of the shoulder of the implant.A 0.6 mm gap was concept using tissue conditioner, once defined the shape of the prosthesis is
observed, on one side, between implant and bone, at the height of the shoulder reproduced by a CAD-CAM and elaborated in zirconium, ending with details
of the implant.Inside this gap it was possible to observe newly formed bone made by hand to give a concept very natural esthetic. Results: This case report
trabeculae.The location of the first bone to implant contact (fBIC) was found at allows us to integrate the advances and benefits of innovations in materials
about 0.7 mm from the implant shoulder.Inside this gap, there were no and processing techniques of restoration philosophies that we are driven
inflammatory cell infiltrate, osteoclasts or areas of bone resorption. Bone planning from diagnosis to final rehabilitation edentulous arch with predictable
trabeculae were seen 1 mm above the level of the implant shoulder, about 1 and verifiable through electromyographic studies. Conclusion: The use of proven
mm from the implant 0.2 mm gap was present between the shoulder of the concepts prosthesis as a starting point for rehabilitation, combined with the
implant and the newly-formed bone, on the other side of the implant. Inside advantages of new materials and techniques allow us to plan results and
this gap, osteoblasts were depositing osteoid matrix in an apico-coronal and expectations quite safe and predictable.
implantopetal direction. At the level of this portion of the interface, located
near the shoulder of the implant, it was possible to observe only the presence 111
of newly-formed bone. In conclusion,the use of PLS could help to maintain the
height of the peri-implant crestal bone, and the crestal bone remodelling seems
to be partially reduced with the use of a platform-switched abutment.

P164

Patient Satisfaction and Training Needs for Novice AEGD Residents to
Competently Place and Restore Implant Supported Mandibular
Overdentures.

Y. Ren*, H.S. Malmstrom, A. Kota, S. Malik, J. Garaicoa, J. Xiao, R. Cacciato,
G. Romanos Rochester, NY.

Introduction: A study by Anderson et al (1995) suggested that a properly
trained general dentist can place and restore a single tooth implant successfully,
but there is no information available regarding the training needed for a novice
general dentist to achieve competency when placing two implants and restore
them with an overdenture in the mandible. The objective of the present study
are: 1)Evaluate the number of clinical experiences, in addition to didactic and
hands-on training, needed for novice Advanced Education in General Dentistry
(AEGD) residents to competently place two dental implants in the mandible
and restore them with an overdenture. 2)Evaluate the patients satisfaction with
implant supported over denture fabricated by the AEGD residents compared
to their conventional denture. Methods: 15 AEGD Residents, with no previous

Poster Presentation Abstracts

P167 mandibular patient model was fabricated with (3) laboratory analogs (BIOMET
3i) placed in each posterior segment at off-axis angles between 10 and 30
Maxillary Anterior Tooth Position in Relation to the Osseous Housing in degrees. Custom trays were used to make (10) impressions using a PVS material
Asian Population: Frequency Distribution and the Influence of Age and following a non-splinted, open tray pick-up impression technique. Impressions
Gender. (n=5) were made using Encode® Healing Abutments and conventional pick-up
impression copings on the right and left sides of the arch, respectively.
C. Cheng*, C. Chen Tainan, Taiwan. Impression techniques were switched to the opposite arch sides and the process
was repeated (n=5). The Encode sites were converted to the fixture-level using
Background and Aim: The relationship of the maxillary anterior teeth to their robotic analog placement (BIOMET 3i). Analog center point (x,y,z) coordinate
respective osseous housings is one of the key factors for immediate implant data was obtained using a laser scanner (3Shape). Vector magnitudes between
placement. The position and angulation of sagittal root position in relation to the (3) analogs on each side of the arch were calculated for the patient and test
the maxillary anterior osseous housing was classified by Kan in 2011. However, models. The average error for the (6) vector magnitudes was determined by
there is no study mentioning about the possible influence of maxillary anterior comparing the test and patient model data. Verification jigs were fabricated on
tooth position by age or gender. Therefore, the purpose of this study was to the patient model to enable a passivity assessment on all master casts. RESULTS:
analyze the relationship of the maxillary anterior teeth and their corresponding The average vector magnitude error for the conventional process ranged from
osseous housings by cone beam computed tomography (CBCT) images and to 14 to 34µ, whereas the Encode process resulted in a range of 23 to 55µ. A t-
evaluate the difference between age, gender, and individual tooth. Materials test was performed to compare the Encode and conventional vector magnitude
and Methods: A retrospective review of CBCT images was conducted on data for each of the (6) locations, and no significant difference (p<0.05) was
patients who received CBCT of maxilla between Jan 2007 and May 2011 in detected between groups. During assembly and final seating, the verification
the Department of Dentistry, Chi-Mei Medical Center, Taiwan. The positions jigs exhibited a clinically acceptable level of passivity. CONCLUSIONS: Although
of the maxillary anterior teeth were recorded as Class I, II, III, IV according to the average vector magnitude error data from the conventional process was
Kan’s classification. Results: A total of 42 patients (20 men, 22 women; mean less than the EIS process, statistically no significant difference was identified.
age, 43.7 years) with 191 maxillary anterior teeth was fulfilled the inclusion Passivity assessment with verification jigs suggested both techniques produced
criteria of this study, including 62 central incisors, 62 lateral incisors, 67 canines. clinically acceptable fixture-level models. The Encode® Impression System can
The frequency distribution of sagittal root position of maxillary central incisors simplify the process of creating accurate implant master casts.
indicated that 96.8% (60/62) and 3.2% (2/62) were classified as Class I and II,
respectively. In the samples of lateral incisors, 88.7% (55/62) and 11.3% (7/62) P169
were classified as Class I and IV, respectively. Of the 67 canines, 98.5% (66/67)
and 1.5% (1/67) were classified as Class I and IV, respectively. And there is no Strain Gauge Analysis: Evaluation of External Hexagon Implants
statistically significant difference between the distribution and age or gender. Positioned in Linear and Offset Configuration under Axial Load.
Conclusion: Within the limitation of this study we can concluded that, most
of the maxillary anterior teeth were Class I relationship in Asian population. A.N. Kojima*, R. Nishioka, A.M. Mesquita, L.O. Vascocellos, O.D. Andreatta
And the relationship of the maxillary anterior teeth and their corresponding Filho São José dos Campos, Brazil.
osseous housings was not influenced by age or gender.
It is postulated that the use of offset configuration and machined copings
improves load distribution. The aim of this study was to evaluate, using strain
gauge, the load distribution surround the implants according differents loading
sites, coping types (plastic and machined) and configuration (linear and offset).
In one polyurethane block, three cylindrical implants with external hexagon
(3.75mm x 13mm) were fixed parallel with 7mm between their centers in a
linear configuration. In another block the midle implant was positioned in a
2mm offset. Micro-units abutments with 3mm of metallic neck were fixed. With
two metallics matrix, it was manufactured 10 wax patterns for each block,
distributed in the following form: 5 for plastic copings and 5 for machined
copings (n=5). After, patterns were casted in cobalt-chromium alloy. Four strain
gauges were positioned on the upper surface of each polyurethane model
around the implants. An axial load of 30kg was applied in five positions (A, B,
C, D, E), with three measurements for data record (in µε) by the multichannel
bridge machine. The datas were submitted to ANOVA and Tukey test (p<0.05).
As result from the obtained data treatment, there was no difference between
the plastic and machined copings, there was no difference between the linear
and offset configuration; there was statistically significant difference only with
the differents loading sites. Conclusion: there was no evidence of the advantage
of offset implant placement in reducing the strain around implants. The results
also revealed that the coping types (plastic and machined) did not reduce the
microstrain around implants.

P168 P170

Implant Level Impressions: Efficacy of the Encode® Impression System Longitudinal evaluation of Autogeneous Bone Graft Prior to Implant
(EIS) vs. the Pick-up Impression Technique. Treatment.

E. Lachner*, E. Kontogiorgos Palm Beach Gardens, FL. M. Sakane*, F. Yoshioka, S. Ozawa, H. Murakami, Y. Tanaka Nagoya, Japan.

OBJECTIVE: To quantitatively compare the analog placement accuracy of Introduction Since the acceptance of dental implants as a valid treatment
the EIS and conventional pick-up impression techniques, and to qualitatively method for edentulous patients, bone grafting has been proposed as a
assess the clinical relevance. MATERIALS AND METHODS: A partially edentulous placement of dental implant. Though several procedure using xenografts and
allografts have been introduced and studied for alveolar ridge augmentation,
112 the use of autogeneous bone remains the gold standard for bone augmentation
procedures. Though a sufficient quality and quantity of bone must be managed
for successful implant placement, the estimation of grafted bone resorption
is the problem which confronts clinicians. This study presents longitudinal
evaluation of autogeneous bone graft site prior to implant using 3-D modeling
system. Material and Method 3 patients who were performed autogeneous
block bone grafting followed by implant placement participated in this study.
Informed consent was obtained prior to the study. Study and Working models
for the prosthodontic treatment were utilized for the evaluation of the bone

Poster Presentation Abstracts

resorption. The impressions were made preoperatively, 3month bone graft and 2011, the 12 patients heve been treated with implants inserted with PRF using
3month after implant placement. CT data were also utilized to confirm this crestal approach sinus augmentation. Patient’ age ranged between 29 and 80
method. A digital images of the models were acquired using the 3D digitigzer years (mean age of 56 years), distribution concentrarion gender was six male
( Rexcan3, Solutionix Co.). The volume of autogeneous bone augmentation and six female. The range of alveolar bone height was 1.4- 9.5 mm. The patient’s
could be presented by calculating the difference of the bone mass before and blood samples (20- 40 ml) were taken prior to the surgery. Immediately after
after bone grafting. Each surface data was converted into the STL data, and blood draw, the dried monovetts (without anticoagulant) were centrifuge at
alined by the BestFit method based on the remaining teeth with 3D image 400g for 10 minutes in a laboratory centrifuge. The PRF clots were recovered
analysis software Geomagic Qualify (Geomagic Co.). The resorption of the bone and were packed tightly in 2 sterile compresses in order to obtain resistant
graft site was analized by requesting the volume of the difference. The fibrin membranes transferable to the schneiderian membrane (to prevent or
calculations of model data were compared with that of CT data. Results The treat perforation). It was filled into the osteotome approaching sockets. Results:
volume of autogeneous block bone was calculated as the difference between The endosinus bone gain was 4.7mm with range of 2.5- 7.6 mm. There were no
pre and post grafted models, and the grafted bone resorption was estimated severe complications, and healings were uneventful. Conclusion: We were able
by comparing the models at each time. Calculated volume of grafted bone or to insert implants safely using crestal approach sinus augmentation with PRF.
resorbed bone had similar tendency between model data and CT data. It offers the advantages of a less invasive surgical entry, more localized
Conclusion In this study, it was suggested that appropriate timing of implant augmentation of the sinus. It may be effective and predictable treatment
placement is possible in the future by the measurement of the resorption method in pnematized maxilla.
amount of the bone graft.
P173
P171
Biological Width of Non-matching Implant-abutment Diameters in a
Different Techniques of Bone Augmentation for an Optimal Canine Model.
Biomechanical Rehabilitation.
L. Mau*, D. Bosshardt, J. Schoolfield, D. Cochran Tainan City, Taiwan.
A. Montaño Gómez*, R. Neria Mexico City, Mexico.
Background: Biological width (BW) components of tissue level implants were
BACKGROUND: Implant therapy in the posterior maxilla constitutes a similar to the same dimensions around teeth. Bone level implants however,
challenging clinical situation. Alveolar bone resorption and pneumatization with matching implant-abutment dimensions (creating a butt joint) always
of the sinus cavity reduce the amount of alveolar bone necessary to maintain resulted in peri-implant inflammation and epithelium apical to the implant-
a predictable implant-supported prosthesis. Many of surgical procedures are abutment interface. Bone level implants with non-matching implant-abutment
used for the reconstruction of atrophic alveolar ridge which finally will use diameters (platform switched implants) are reported to result in less bone loss
for implant-prosthetic rehabilitation. Depending on the anatomical and and, may have different lengths of BW components. The aim of this study was
biomechanical requirements of the implant, the regenerative procedure as well to investigate BW around bone level non-matching implant-abutment
as the type of bone graft is selected. OBJECTIVE: The aim of this publication is diameters placed submerged or nonsubmerged at three levels relative to the
to present the results of different techniques to increase the amount of bone alveolar crest. Materials and Methods: Sixty implants with non-matching
tissue prior or immediately to the placement of dental implants through surgical implant–abutment diameters were placed in the canine mandible 3 months
regenerative procedures, achieve in conjunction with the Department of post extraction bilaterally in five dogs. The implants were placed submerged
Prosthetics Oral Implantology an implant-prosthetic rehabilitation returning or nonsubmerged in the left or the right side of the mandible. Six implants were
function and aesthetics. METHODS: A 50-year-old woman presented to the randomly placed at three levels in each side of the mandible: 1mm above the
Periodontics and Implantology Department, with a chief complaint of cannot crest, even with the crest and 1mm below the crest. After 3 months, 60 crowns
chew. The comprehensive clinical and radiographic examination revealed were cemented and loaded. The animals were sacrificed 6 months after loading.
bimaxillar and bilateral posterior edentulous areas. The treatment planned was Results: Histometric analysis of undecalcified histologic sections included the
the reconstruction of atrophic alveolar bone through regenerative procedures epithelium length (ED), the connective tissue contact length (CTC), and BW
using a combination of different types of grafts, prior or immediate to the composed of the sulcus depth, ED and CTC. Mean BW values after 6 months
placement of implants for future rehabilitation with implant-supported for submerged 1mm above the crest, even with the crest, and 1mm below
prosthesis. RESULTS: It increased the amount of bone tissue prior or immediately the crest group were 1.77mm, 1.98mm, and 2.33mm respectively. Mean BW
to the placement of dental implants through regenerative surgical procedures. values after 6 months for nonsubmerged were 1.83mm, 1.86mm, and 2.64mm
The results were based on preoperative clinical and radiographic measurements. respectively. The main effect of implant placement level was significant for
With the 4 techniques it obtained decrease of collapsed alveolar ridge, which BW (p<0.001), with mean BW significantly greater for implants placed 1 mm
had greater gain was the mandibular bone block graft, both horizontally and below the bone crest compared to the even (p=0.002) and 1 mm above
vertically, reducing also the interocclusal space. CONCLUSION: The different (p<0.001) groups, with no significant mean BW difference observed between
techniques that exist for the reconstruction of an alveolar ridge atrophic, as the even and 1 mm above implants. Conclusions: Bone level implants with non-
well as the types of bone grafts are technical predictable and allow the matching implant–abutment diameters demonstrated an increased BW
placement of implants favoring the Biomechanics of an implant-supported dimension when placed below the alveolar crest compared to implants placed
prosthesis. above or even with the crest. This suggests that the surgical placement of an
implant in an apical-coronal direction can influence the biologic integration
P172 of the implant.

Crestal Approach Sinus Augmentation with Platelet-rich Fibrin (PRF) in P174
Pneumatized Maxilla: A Review of 12 Cases.
Clinical Use of Bone Harvesting Instruments for Ridge Augmentation.
T. Kohgo*, T. Kanayama, Y. Hokimoto, H. Miyamoto, T. Shigetomi, M. Yokoi
Nagoya, Japan. H. Saito*, M. Sousa Menezes, L. Gutierrez, J. Zaky, S. Cho, S. Froum, R. Schoor
New York, NY.
Introduction: Sinus graft approaching through alveolar crest using
osteotome is developed for more simple and easy way for operation. But many The use of osseointegrated implants is a widely used treatment modality
reports that this method has limitation for heightening within 2mm, and also in prosthodontic rehabilitation with high success rates for both the edentulous
this operation gives more chance for membrane injury. Platelet-rich fibrin (PRF) and partially edentulous patient. Clinically, the lack of supporting bone in severe
is a second-generation platelet concentrate which allows one to obtain, staring horizontal and / or vertical bone defects may render the insertion of dental
from an anticoagulant-free blood harvest, fibrin membranes enriched with implants difficult, if not impossible, with aesthetic compromise, due to
platelets and growth factors. The PRF membranes using lateral approach sinus insufficient bone volume, shape and size. Alveolar ridge augmentation
augmentation appear to be able to treat sinus membrane perforation and procedures are used prior to, or in conjunction with implant placement.
permit the surgery to be completed. This fibrin matrix will guide the healing Particulate autogenous bone grafting for guided bone regeneration has been
process. PRF contains platelet growth factors as well, and these cytokines well established as a method of reconstructing these defects. Autogenous bone,
completely usable healing concentrate. The aim of the present study is to in addition to providing an osteoconductive scaffold, has osteoinductive
evaluate clinical effectiveness and safety of the PRF as graft material using properties that are mediated through viable bone forming growth factors
crestal approach sinus augmentation. Methods: Between June 2010 and June released from the graft material. However, the limitations to utilizing intraoral

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