Radiographic evaluation of a bone substitute material in alveolar ridge preservation for maxillary removable immediate dentures: A randomized controlled trial

STATEMENT OF PROBLEM

Maxillary bone resorption after multiple extractions can jeopardize the success of an immediate denture, but whether bone volume preservation techniques are effective is unclear.

PURPOSE

The purpose of this randomized controlled trial was to evaluate the efficacy of socket grafting with a xenogenic bone substitute in participants receiving maxillary immediate removable complete dentures in terms of bone volume preservation (height and width of the bone ridge).

MATERIAL AND METHODS

The study was a single-blinded, randomized controlled clinical trial with 2 balanced parallel arms. Thirty-six participants who had Kennedy Class I edentulous posterior areas bilaterally for at least 3 months and required maxillary immediate removable complete dentures were enrolled. Duplicates of the removable complete denture were made and converted into radiographic and surgical guides. Participants allocated to the test group received deproteinized bovine bone mineral blended with 10% porcine collagen (DBBM-C) in the extraction sockets, and participants in the control group received no grafting material. With a radiographic guide in place, cone beam computed tomography scans were made 10 days after tooth extraction, when the immediate removable complete denture was delivered (D10, baseline), after 3 months (D90), and after 1 year (D365). The scans were superimposed, and measurements were made on the cross-sectional plane of each extraction site. The influence of various prognosis factors associated with bone volume preservation, including the location of tooth extraction, smoking habits, periodontal disease, and operator team, were analyzed.

RESULTS

Of 36 participants, 3 were lost to follow-up. The mean ±standard deviation loss of height of the buccal crest was 1.2 ±1.8 mm in the control group and 0.3 ±1.2 mm in the test group after 3 months of healing (P<.001) and 2.1 ±2.0 mm in the control group and 0.7 ±1.4 mm in the test group after 1 year of follow-up (P<.001). Mean ±standard deviation horizontal ridge width change was 1.3 ±1.4 mm in the control group and 0.5 ±0.8 mm in the test group after 3 months (P<.001) and 2.2 ±1.4 mm in the control group and 0.9 ±1.1 mm in the test group after 1 year of follow-up (P<.001). None of the other prognostic factors had a significant effect at either time period.

CONCLUSIONS

Grafting DBBM-C into the extraction socket after removing anterior teeth for immediate removable denture therapy resulted in significantly less vertical buccal crest and horizontal ridge resorption as compared with spontaneous socket healing after 1 year of follow-up. This procedure may be useful for preserving bone, especially when a fixed implant-supported prosthesis is planned.

Immediate Loading of Two Unsplinted Implants in Edentulous Patients with Mandibular Overdentures: A 10-year Retrospective Review of Patients from a Previously Conducted 1-year Cohort Study

PURPOSE

This 10-year retrospective study aimed to report implant bone changes in completely edentulous patients after a mandibular immediate loading protocol using two ball attachments.

MATERIALS AND METHODS

This study was initially designed as a prospective 1-year cohort study, then extended with a 10-year retrospective evaluation of implant bone change. In the first part of the study, 43 edentulous patients wearing satisfactory maxillary and mandibular dentures for at least 3 months were included. Two interforaminal implants (Brånemark system, Nobel Biocare) were placed symmetrically in the anterior mandible using a surgical template and a torque greater than 40 Ncm. Immediately following surgery, 2.25-mm-diameter ball abutments were screwed to the implants, and their matrices (Dalbo Plus, Cendres et Métaux) were incorporated in the denture base. In an initial 1-year study, clinical recalls were scheduled 3, 6, and 12 months after implant placement with a team of two investigators. The follow-up consisted of a clinical examination and a standardized radiographic assessment of the vertical bone change. Implant stability was then monitored. The patient satisfaction was evaluated with a questionnaire before and 3 months after loading. The second part of the study occurred 10 years after the inclusion, as patients were recalled for an implant bone change monitoring.

RESULTS

The included patients were 28 to 80 years of age (mean: 61 ± 11.4 years). Three out of 86 implants failed during the healing phase (survival rate of 96.5% [90.1%, 99.2%]). Implant stability was maintained all along the 1-year follow-up (Δ = 73.33, 95% CI [72.39 to 74.26], P = .032). The mean radiographic bone loss was 0.27 ± 0.35 mm at 3 months after surgery, 0.47 ± 0.42 mm after 1 year, and 0.95 ± 0.98 mm after 10 years. General visual analog scale satisfaction was increased by 25 units with the treatment. No patients were lost to follow-up at 1 year, but five were lost at 10 years.

CONCLUSION

This protocol of immediate loading of two unsplinted mandibular implants in overdenture patients using ball attachments is a clinically viable treatment with a high implant success rate and improved satisfaction.

Efficacy of bone substitute material in preserving volume when placing a maxillary immediate complete denture: study protocol for the PANORAMIX randomized controlled trial

BACKGROUND

Bone preservation is an essential issue in the context of last teeth extraction and complete edentulism. The intended treatment, whether a complete denture or an implant placement, is facilitated with a voluminous residual ridge. Bone resorption after multiple extractions has not been as well studied as the bone resorption that occurs after the extraction of a single tooth. Recent advances in bone substitute materials have revived this issue. The purpose of this study is to evaluate the interest in using bone substitute material to fill the socket after last teeth extraction in a maxillary immediate complete denture procedure compared with the conventional protocol without socket filling.

METHODS/DESIGN

A randomized, controlled, clinical trial was designed. The 34 participants eligible for maxillary immediate complete denture were divided into two groups. Complete dentures were prepared despite persistence of the last anterior teeth. The control group received a conventional treatment including denture placement immediately after extractions. In the experimental group, in addition to the immediate denture placement, a xenograft bone-substitute material (Bio-Oss Collagen®) was placed in the fresh sockets. The primary outcome of the study is to compare mean bone ridge height loss 1 year after maxillary immediate complete denture placement, with or without bone-substitute material, in incisor and canine sockets. The secondary outcomes are to compare the average bone ridge height and width loss for each extraction site. An original quantitative evaluation method using cone beam computed tomography was designed for reproducible measurements, with a radio-opaque denture duplicate. Two independent operators perform the radiologic measurements.

DISCUSSION

The immediate complete denture technique limits bone resorption in multiple extraction situations and thus allows better denture retention and better options for implant placement. To compare the benefit of using any bone socket-filling material, we proposed a quantitative evaluation protocol of resorption in the specific case of the last anterior maxillary teeth extraction with immediate denture placement.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02120053 . Registered on 18 April 2014.

Radiographic and surgical guide fabrication for implant-retained mandibular overdenture

A simple technique is presented to make a multipurpose duplicate of the patient's complete denture to plan and fabricate a mandibular implant-retained overdenture. This duplicate serves 3 different functions. It can be used as a radiographic guide, surgical template, and custom tray adapted to the patient's occlusion. Advantages of the technique described are twofold: it is cost effective and makes use of equipment and materials commonly found in dental practices. The use of a single guide allows the clinician to refer to the recorded prosthetic data at each step of implant treatment.

Comparing two different methods of identifying alcohol related problems in the emergency department: a real chance to intervene?

OBJECTIVES

To examine the feasibility of screening for alcohol problems in a representative flow sample of patients attending a busy UK emergency department. To compare two methods of identifying alcohol related problems in the emergency department.

METHODS

Brief interview administered by the same interviewer to a representative flow sample of 429 patients attending a single accident and emergency department over a six week period. Measures included a CAGE questionnaire and assessments by the patient and staff as to whether the attendance was alcohol related.

RESULTS

413 patients (96%) were successfully screened. Of these, 115 (28%) patients were considered to have an alcohol related attendance on the basis of the CAGE questionnaire or the staff assessment. Head injuries and psychiatric presentations were particularly likely to be associated with alcohol misuse. Compared with those identified by staff, patients scoring above threshold on the CAGE were more likely to attend during routine working hours and recognise they had an alcohol problem.

CONCLUSIONS

Emergency departments may provide an opportunity for the early prevention of alcohol related difficulties. However, patients with alcohol problems who present to the emergency department are not a homogenous group. Different screening methods identify different groups of patients, who in turn may respond to different forms of intervention. Further research examining the efficacy and feasibility of different alcohol treatment approaches is needed to enable us to target specific interventions to those patients who might most benefit.

[Scanner placement guide and surgical guide in implantology]

The pre-surgical investigation may provide added information by the wearing of a detection cad-can indicating the axes of the future implants at the time of the cad-can examination. This stent is made, using a polymerised director mounting, equipped with radio-opaque detectors in aluminium or zinc oxyphosphate sealing cement. The resulted illustration facilitates the concentration between the surgeon and the prosthetist in the definitive choice of the site of implantation. The plaster model, used for the making of the detection cad-can, is used to transfer this information. In the clinic, the latter is supported by a surgical stent. This guide includes: an indexed stabilising portion on the remaining teeth or portions of edentated crest not involved in the surgery; guiding tubes with a diameter of 2.1 mm, made of infiltrated aluminium according to the INCERAM* procedure. The detection cad-can and surgical stent unit permit a correlation between the preimplant investigation phase and the surgery.

[Problems of bullous lesions in E.N.T. Based upon two cases (author's transl)]

The authors report two cases of bullous rashes with an ENT onset: 1. a benign mucosal pemphigoid; 2. a pemphigus vulgaris. On the basis of these cases, they indicate the need to consider the possibility of bullous lesions in the presence of any persistent erosion of the nasal or bucopharyngeal mucosa, the diagnosis of which should be dominated by the identification of a possible pemphigus, the prognostic and therapeutic consequences of which remain serious. The clinical onset may be confined for a long period to the E.N.T. musoca. It may present with dysphagia and pain, or sometimes by simple epistaxis. The commonest diagnostic errors are aphthous ulcers and candidiasis which may, in the case of the latter, be associated with bullous lesions. They also report the possible problems which may result from endoscopic manoeuvres in the case of pemphigus. Any persistent erosion of the mucosae in the E.N.T. area should be evaluated by diagnostic cytology which would offer positive identification of pemphigus.