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Mosaddad SA, Talebi S, Keyhan SO, Fallahi HR, Darvishi M, Aghili SS, Tavahodi N, Namanloo RA, Heboyan A, Fathi A. Dental implant considerations in patients with systemic diseases: An updated comprehensive review. J Oral Rehabil 2024; 51:1250-1302. [PMID: 38570927 DOI: 10.1111/joor.13683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/27/2023] [Accepted: 03/02/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Various medical conditions and the drugs used to treat them have been shown to impede or complicate dental implant surgery. It is crucial to carefully monitor the medical status and potential post-operative complications of patients with systemic diseases, particularly elderly patients, to minimize the risk of health complications that may arise. AIM The purpose of this study was to review the existing evidence on the viability of dental implants in patients with systemic diseases and to provide practical recommendations to achieve the best possible results in the corresponding patient population. METHODS The information for our study was compiled using data from PubMed, Scopus, Web of Science and Google Scholar databases and searched separately for each systemic disease included in our work until October 2023. An additional manual search was also performed to increase the search sensitivity. Only English-language publications were included and assessed according to titles, abstracts and full texts. RESULTS In total, 6784 studies were found. After checking for duplicates and full-text availability, screening for the inclusion criteria and manually searching reference lists, 570 articles remained to be considered in this study. CONCLUSION In treating patients with systemic conditions, the cost-benefit analysis should consider the patient's quality of life and expected lifespan. The success of dental implants depends heavily on ensuring appropriate maintenance therapy, ideal oral hygiene standards, no smoking and avoiding other risk factors. Indications and contraindications for dental implants in cases of systemic diseases are yet to be more understood; broader and hardcore research needs to be done for a guideline foundation.
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Affiliation(s)
- Seyed Ali Mosaddad
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
- Department of Conservative Dentistry and Bucofacial Prosthesis, Faculty of Odontology, Complutense University of Madrid, Madrid, Spain
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
- Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
| | - Sahar Talebi
- Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seied Omid Keyhan
- Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
- Department of Oral & Maxillofacial Surgery, Gangneung-Wonju National University, Gangneung, South Korea
- Department of Oral & Maxillofacial Surgery, College of Medicine, University of Florida, Jacksonville, FL, USA
- Iface Academy, Istanbul, Turkey
| | - Hamid Reza Fallahi
- Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
- Department of Oral & Maxillofacial Surgery, Gangneung-Wonju National University, Gangneung, South Korea
- Department of Oral & Maxillofacial Surgery, College of Medicine, University of Florida, Jacksonville, FL, USA
- Iface Academy, Istanbul, Turkey
| | - Mohammad Darvishi
- Faculty of Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Seyedeh Sara Aghili
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Narges Tavahodi
- Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Artak Heboyan
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
- Department of Prosthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Fathi
- Department of Prosthodontics, Dental Materials Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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Abstract
There are few absolute contraindications to dental implant placement. Relative contraindications include cognitive decline, American Society of Anesthesiology patient status IV or higher categories, or medical conditions that may jeopardize the life or lifespan of the patient. Precautions for placing dental implants should be viewed with respect to the evidence-based exposures that can contribute to risk of failure, including but not limited to local, behavioral, and medical factors. Risk for dental implant failure increases in association with (1) past history of periodontal disease, (2) bruxism, (3) smoking, and (4) radiation therapy.
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Affiliation(s)
- Amritpal S Kullar
- Division of Oral Diagnosis, Oral Medicine, Oral Radiology, MN324 College of Dentistry, University of Kentucky, 800 Rose Street, Lexington, KY 40356-0297, USA
| | - Craig S Miller
- Division of Oral Diagnosis, Oral Medicine, Oral Radiology, MN324 College of Dentistry, University of Kentucky, 800 Rose Street, Lexington, KY 40356-0297, USA.
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Fu L, Liu Y, Zhou J, Zhou Y. Implant-Retained Overdenture for a Patient With Severe Lichen Planus: A Case Report With 3 Years' Follow-Up and a Systematic Review. J Oral Maxillofac Surg 2019; 77:59-69. [DOI: 10.1016/j.joms.2018.07.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 11/29/2022]
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Chatzopoulos GS, Wolff LF. Patients' Socio-Economic Status, Tobacco and Medical History Associated with Implant Failure. Acta Stomatol Croat 2018; 52:175-183. [PMID: 30510293 PMCID: PMC6238874 DOI: 10.15644/asc52/3/1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To examine the potential association between patients’ characteristics that experienced implant failure and those who had successful implant treatment. Materials and methods This retrospective case-control study is based on 186 dental records of implant failure and 186 age and gender matched successful treatments for a total of 372 patients. Age at the time of the procedure, gender, medical history, tobacco use, dental insurance status, ZIP code and type of treatment provided (implant failure/successful implant treatment) were recorded. Results The population consisted of 47.6% females, 48.9% individuals with dental insurance and 9.7% self-reported tobacco users. A statistically significant association (p≤0.05) was found between implant failure and successful implant treatment in regards to tobacco use, socio-economic status and medical history. Insurance status and implant location (region, arch) did not affect significantly (p>0.05) the outcome of implant therapy. Conclusions Within the limitation of this retrospective case-control study, individuals with high socio-economic status, no history of tobacco use and history of heart attack were more likely to have a successful implant treatment than those with a low socio-economic status, tobacco users and without history of heart attack.
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Affiliation(s)
- Georgios S Chatzopoulos
- Advanced Education Program in Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Larry F Wolff
- Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN USA
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Vissink A, Spijkervet FKL, Raghoebar GM. The medically compromised patient: Are dental implants a feasible option? Oral Dis 2018; 24:253-260. [DOI: 10.1111/odi.12762] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 08/09/2017] [Accepted: 08/09/2017] [Indexed: 12/17/2022]
Affiliation(s)
- A Vissink
- Department of Oral and Maxillofacial Surgery; University of Groningen and University Medical Center Groningen; Groningen The Netherlands
| | - FKL Spijkervet
- Department of Oral and Maxillofacial Surgery; University of Groningen and University Medical Center Groningen; Groningen The Netherlands
| | - GM Raghoebar
- Department of Oral and Maxillofacial Surgery; University of Groningen and University Medical Center Groningen; Groningen The Netherlands
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Manor Y, Simon R, Haim D, Garfunkel A, Moses O. Dental implants in medically complex patients—a retrospective study. Clin Oral Investig 2016; 21:701-708. [DOI: 10.1007/s00784-016-1937-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 08/08/2016] [Indexed: 12/28/2022]
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Tadinada A, Jalali E, Al-Salman W, Jambhekar S, Katechia B, Almas K. Prevalence of bony septa, antral pathology, and dimensions of the maxillary sinus from a sinus augmentation perspective: A retrospective cone-beam computed tomography study. Imaging Sci Dent 2016; 46:109-15. [PMID: 27358818 PMCID: PMC4925647 DOI: 10.5624/isd.2016.46.2.109] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 02/06/2016] [Accepted: 02/17/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Sinus elevation procedures have become a routine and reliable way to gain bone volume in the edentulous maxilla for dental implant placement. Presence of bony septations and pathology in the maxillary sinus often cause complications leading to graft or implant failure or both. The aim of this study was to retrospectively evaluate the prevalence of pathology, direction of the septa, and sinus width measured at 2 mm, 5 mm, and 10 mm from the sinus floor in maxillary sinuses using cone-beam computed tomography (CBCT). MATERIALS AND METHODS Seventy-two sinuses from 36 random preoperative CBCT scans referred for implant therapy were retrospectively evaluated for the number, prevalence, and direction of bony septations and presence of pathology. Width of the sinus was also measured at 2 mm, 5 mm, and 10 mm from the sinus floor to account for the amount of bone available for implant placement. RESULTS Maxillary sinus septa were found in 59.7%. Presence of a single septum was noted in 20 sinuses (27.7%), followed by two septa in 17 sinuses. The most common direction of the septum was the transverse direction. Retention pseudocyst and mucosal thickening were the most commonly seen abnormality/pathology. CONCLUSION Based on the high prevalence of septa and sinus pathology in this sample, a preoperative CBCT scan might be helpful in minimizing complications during sinus augmentation procedures for dental implant therapy.
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Affiliation(s)
- Aditya Tadinada
- Department of Oral and Maxillofacial Radiology, University of Connecticut, School of Dental Medicine, Farmington, CT, USA
| | - Elnaz Jalali
- Department of Oral and Maxillofacial Radiology, University of Connecticut, School of Dental Medicine, Farmington, CT, USA
| | - Wesam Al-Salman
- Section of Periodontology, University of Connecticut, School of Dental Medicine, Farmington, CT, USA
| | - Shantanu Jambhekar
- Department of Prosthodontics, University of Connecticut, School of Dental Medicine, Farmington, CT, USA
| | - Bina Katechia
- Department of Pediatric Dentistry, University of Connecticut, School of Dental Medicine, Farmington, CT, USA
| | - Khalid Almas
- Division of Periodontology, University of Dammam, College of Dentistry, Dammam, Saudi Arabia
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Sununliganon L, Peng L, Singhatanadgit W, Cheung LK. Osteogenic efficacy of bone marrow concentrate in rabbit maxillary sinus grafting. J Craniomaxillofac Surg 2014; 42:1753-65. [PMID: 25052732 DOI: 10.1016/j.jcms.2014.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 04/29/2014] [Accepted: 06/05/2014] [Indexed: 12/23/2022] Open
Abstract
Maxillary sinus grafting is required to increase bone volume in the atrophic posterior maxilla to facilitate dental implant placement. Grafting with autogenous bone (AB) is ideal, but additional bone harvesting surgery is unpleasant. Alternatively, bone substitutes have been used but they limit new bone formation. The strategy of single-visit clinical stem cell therapy using bone marrow aspirate concentrate (BMAC) to facilitate new bone formation has been proposed. This study aimed to assess bone regeneration capacity of autologous BMAC mixed with bovine bone mineral (BBM) in maxillary sinus grafting. Twenty-four white New Zealand rabbits were used and their maxillary sinuses were randomly assigned for grafting with 4 different materials. Rates of new bone apposition in augmented sinuses were measured and bone histomorphometry were examined. Significant increase in the quantity of nucleated cells and colony forming unit-fibroblasts were confirmed in BMAC. Mesenchymal stem cells in BMAC retained their in vitro multi-differentiation capability. Higher rates of mineral appositions in the early period were detected in BBM + BMAC and AB than BBM alone, though they are not significantly different. Graft volume/tissue volumes in BBM and BBM + BMAC were found to be higher than those in AB and sham.
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Affiliation(s)
- L Sununliganon
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, China; Faculty of Dentistry, Thammasat University, Thailand
| | - L Peng
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, China
| | | | - L K Cheung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, China.
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Pterygomaxillary implants: a graftless solution to deficient maxillary bone. J Indian Prosthodont Soc 2013; 12:182-6. [PMID: 23997469 DOI: 10.1007/s13191-012-0121-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 05/10/2012] [Indexed: 10/28/2022] Open
Abstract
Edentulism is one of the common dental problems in the aging population. Implant therapy has emerged as one the valid and effective solutions to this problem. However in the maxilla, posterior part presents with several anatomic obstacles in the form of bone quality, quantity, size of maxillary antrum and poor accessibility. There are various options like sinus lift with graft and pterygomaxillary implant options available. Option like ptergomaxillary implants requires lot of skill of technic sensitivity and skill of the surgeon and also is proven to be statistically superior. Case reports of pterygomaxillary implants for both partially edentulous and fully edentulous conditions are hereby described in the article.
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Geckili O, Bilhan H, Ceylan G, Cilingir A. Edentulous Maxillary Arch Fixed Implant Rehabilitation Using a Hybrid Prosthesis Made of Micro-Ceramic-Composite: Case Report. J ORAL IMPLANTOL 2013; 39:115-120. [DOI: 10.1563/aaid-joi-d-10-00040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
The prosthetic treatment of patients with an edentulous maxilla opposing mandibular natural teeth is one of the most challenging endeavors that face clinicians. Occlusal forces from the opposing natural teeth may cause fractures in the maxillary prosthesis and also result in advanced bone loss of the edentulous maxilla. With the presence of extreme gagging reflex, the treatment may become more complicated. This article describes and illustrates the 2-stage surgical and prosthetic treatment of a patient with an edentulous maxilla opposing natural teeth. In the beginning, the patient was treated with 4 implants and a maxillary implant-supported overdenture. The extreme gagging reflex and the occlusal forces from the mandibular natural teeth obligated the team a second stage surgical and prosthetic treatment, which included increasing the number of implants after bilateral sinus lifting in the posterior maxilla and fabricating a maxillary fixed hybrid prosthesis made of micro-ceramic composite that yielded a satisfactory result.
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Affiliation(s)
- Onur Geckili
- Faculty of Dentistry, Department of Prosthodontics, Istanbul University, Istanbul, Turkey
| | - Hakan Bilhan
- Faculty of Dentistry, Department of Prosthodontics, Istanbul University, Istanbul, Turkey
| | - Gulsum Ceylan
- Faculty of Dentistry, Department of Prosthodontics, Istanbul University, Istanbul, Turkey
| | - Altug Cilingir
- Faculty of Dentistry, Department of Prosthodontics, Istanbul University, Istanbul, Turkey
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Diz P, Scully C, Sanz M. Dental implants in the medically compromised patient. J Dent 2013; 41:195-206. [PMID: 23313715 DOI: 10.1016/j.jdent.2012.12.008] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 12/03/2012] [Accepted: 12/27/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE It has been suggested that some local and systemic factors could be contraindications to dental implant treatment. The objective of this paper was to evaluate whether success and survival rates of dental implants are reduced in the medically compromised patient. DATA/SOURCES An extensive literature search was conducted using PubMed/Medline, Scopus, Scirus and Cochrane databases up to November 8, 2012. CONCLUSIONS There are very few absolute medical contraindications to dental implant treatment, although a number of conditions may increase the risk of treatment failure or complications. The degree of systemic disease-control may be far more important that the nature of the disorder itself, and individualized medical control should be established prior to implant therapy, since in many of these patients the quality of life and functional benefits from dental implants may outweigh any risks.
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Affiliation(s)
- Pedro Diz
- Grupo de Investigación en Odontología Médico-Quirúrgica (OMEQUI), School of Medicine and Dentistry, University of Santiago de Compostela, Spain.
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Vertical Bone Augmentation Using a Polytetrafluoroethylene Nonporous Barrier for Osseointegrated Implants Partially Inserted in Tibiae of Rabbits. IMPLANT DENT 2009; 18:182-91. [DOI: 10.1097/id.0b013e318198e6e3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schlegel KA, Schultze-Mosgau S, Wiltfang J, Neukam FW, Rupprecht S, Thorwarth M. Changes of mineralization of free autogenous bone grafts used for sinus floor elevation. Clin Oral Implants Res 2006; 17:673-8. [PMID: 17092226 DOI: 10.1111/j.1600-0501.2006.01186.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
For augmentations before implant placement in areas of minor bone quantity, autogenous bone is considered the reference to all bone substitutes used alternatively. Autogenous bone transplants originate from various donor areas and can be prepared in different ways before augmentation. They may either be used as block grafts or may be milled to granules that can be used solitarily or in combination with a bone substitute. In a prospective study, 61 patients of the Maxillofacial Surgery Department of our University receiving two-stage sinus floor elevation because of insufficient bone supply were randomly selected. At first-stage surgery, the local augmentation procedure, monocortical probes were obtained on the site of bone harvesting. At second-stage surgery, the implant insertion 6 months after the elevation procedure, bone cores were harvested in the areas of implant placement. Donor regions were the following three areas: the posterior (N=28) and anterior pelvic region (N=15) and the chin region (N=18). The implanted bone in all three groups was particulated to granules of 2-3 mm(2) using a bone mill. All biopsies were analyzed by means of microradiography. The anterior pelvic bone grafts showed a mineralized tissue grade of 35.1+/-7.6% before milling and augmentation. The posterior pelvic bone grafts exhibited a mineralization of 30.7+/-9.5% and the chin bone grafts 74.6+/-8.6%. At second-stage surgery after 6 months, the mineralization was 36.1+/-7.59% in the areas where bone grafts from the anterior pelvic crest were used. Probes harvested from sites with posterior pelvic bone augmentations showed a mineralization rate of 34.5+/-6.5%, and sites were chin bone grafts were applied expressed a mineralization of 54+/-8.6% (P=0.003 compared with the pre-operative value). The comparison of the microradiographical results demonstrated significant differences in the mineralization grades depending on the origin of the graft. The origin of the grafts and their remodeling influenced the mineralization rates found at 6 months. How these data may influence the long-term clinical outcome considering implant survival and bone resorption has to be examined in further long-term studies.
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Affiliation(s)
- Karl Andreas Schlegel
- Department of Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
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Thorwarth M, Srour S, Felszeghy E, Kessler P, Schultze-Mosgau S, Schlegel KA. Stability of autogenous bone grafts after sinus lift procedures: a comparative study between anterior and posterior aspects of the iliac crest and an intraoral donor site. ACTA ACUST UNITED AC 2006; 100:278-84. [PMID: 16122653 DOI: 10.1016/j.tripleo.2004.12.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2004] [Revised: 11/26/2004] [Accepted: 12/23/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Autologous bone is the standard material used for augmentations in oral-maxillofacial surgery. Depending on the origin of the graft, subsequent bone resorption may vary. STUDY DESIGN This prospective study evaluated 57 patients receiving 2-stage sinus floor augmentations. Monocortical samples were taken at the site of bone harvesting, including the posterior (n = 28) and anterior pelvic (n = 15) and retromolar (n = 14) regions. At second-stage surgery, 6 months after the implant insertion, bone cores were harvested at the site of implant placement. All samples were analyzed by microradiography. RESULTS Mean retromolar mineralization was 68.7% +/- 8.75%; 35.1% +/- 7.6% in the anterior and 30.7% +/- 9.5% in the posterior iliac crest. Areas augmented with grafts originating from the retromolar region showed a significant decrease to 53.0% +/- 5.15% (P = .001). A stable mineralization of 36.1% +/- 7.59% was found in sites where bone grafts from the anterior pelvic crest were used. Grafts from the posterior pelvis showed a slight increase to 34.5% +/- 6.5%. CONCLUSION This prospective clinical study demonstrates the differences in mineralization depending on the origin of autogenous bone. Even after 6 months, these values could still be correlated to the transplants origin.
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Affiliation(s)
- Michael Thorwarth
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
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Affiliation(s)
- Daniel van Steenberghe
- Department of Periodontology, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Catholic University Leuven, Belgium
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