OBJECTIVES:The aim of Working Group 3 was to address the influence of both material- and anti-resorptive drug- related factors on clinical and biological outcomes and complications in implant dentistry. Focused questions were addressed on (a) implant materials other than titanium (alloy)s, (b) transmucosal abutment materials and (c) medications affecting bone metabolism were addressed.MATERIALS AND METHODS:Three systematic reviews formed the basis for discussion in Group 3. Consensus statements and clinical recommendations were formulated by group consensus based on the findings of the systematic reviews. Patient perspectives and recommendations for future research were also conveyed. These were then presented and accepted following further discussion and modifications as required by the plenary.RESULTS:Zirconia is a valid alternative to titanium as material for implant and transmucosal components, allowing soft and hard tissue integration with clinical outcomes-identified by implant survival, marginal bone loss and peri-implant probing depths-up to 5-years comparable to titatnium. However, most of the evidence for zirconia implants is based on 1-piece implants limiting the indication range. Furthermore, based on expert opinion, zirconia transmucosal components might be preferred in the esthetic zone. In patients receiving low-dose bisphosphonate therapy, the rate of early implant failure is not increased, while the long-term effects remain poorly studied. Although it has not been sufficiently addressed, similar outcomes can be expected with low-dose denosumab. A drug holiday is not recommended when considering implant placement in patients treated with low-dose ARD. However, the specific therapeutic window, the cumulative dose and the administration time should be considered. Access to peri-implant supportive care is mandatory to prevent peri-implantitis-related medication-related osteonecrosis of the jaw (MRONJ) or implant-related sequestra (IRS). In patients receiving low-dose anti-resorptive drugs (ARD) therapy, the risk of complications related to implant placement is high, and implant procedures in this specific population should be strictly treated in a comprehensive multidisciplinary center. Finally, healthy dental implants should not be removed before low or high-dose ARD.CONCLUSIONS:Zirconia implants can be an alternative to titanium implants in selected indications. However, the current state of evidence remains limited, especially for 2-piece implant designs. Administration of low-dose ARD did not show any negative impact on early implant outcomes, but careful follow-up and supportive care is recommended in order to prevent peri-implant MRONJ and IRS. Implant placement in high-dose patients must be strictly considered in a comprehensive multidisciplinary center.

OBJECTIVE:Test the hypothesis of no difference in bone regeneration after maxillary sinus floor augmentation (MSFA) with different ratios of iliac or mandibular autogenous bone (AB) graft and deproteinized bovine bone mineral (DBBM).MATERIALS AND METHODS:Forty minipigs were randomly allocated to bilateral MSFA using: (A) 100% AB, (B) 75% AB and 25% DBBM, (C) 50% AB and 50% DBBM, (D) 25% AB and 75% DBBM, or (E) 100% DBBM. The animals were euthanized 12 weeks after surgery. Percentage of bone, non-mineralized tissue, and residual DBBM were estimated by histomorphometric analysis in a randomly selected region of interest and summarized as mean percentage with 95% confidence interval (CI).RESULTS:Mean percentage of bone following MSFA with iliac or mandibular AB graft was: (A) 55.5% and 64.2%, (B) 60.3% and 61.6%, (C) 54.4% and 52.1%, (D) 51.8% and 53.1%, and (E) 47.6%, respectively. There was a significant trend toward a higher percentage of bone, with a higher ratio of AB within the graft (p < .01), regardless of the origin of AB graft (iliac or mandible).CONCLUSIONS:The hypothesis was rejected since percentage of bone was significantly increased with larger proportions of AB within the graft. Consequently, AB or a mixture of AB and diminutive quantities of DBBM seem to be the preferred graft for MSFA based solely on histomorphometric assessment. However, it should be emphasized that newly formed bone and residual AB graft particles could not be distinguished by the applied histologic procedure.

This review describes the role of modern preprosthetic surgery. The atrophic edentulous jaw can cause severe functional impairment for patients, leading to inadequate denture retention, reduced quality of life, and significant health problems. The aim of preprosthetic surgery is to restore function and form due to tooth loss arising from congenital deformity, trauma, or ablative surgery. Alveolar bone loss is due to disuse atrophy following tooth loss. The advent of dental implants and their ability to preserve bone heralded the modern version of preprosthetic surgery. Their ability to mimic natural teeth has overcome the age-old problem of edentulism and consequent jaw atrophy. Controversies with preprosthetic surgery are discussed: soft tissue versus hard tissue augmentation in the aesthetic zone, bone regeneration versus prosthetic tissue replacement in the anterior maxilla, sinus floor augmentation versus short implants in the posterior maxilla—interpositional bone grafting versus onlay grafts for vertical bone augmentation. Best results for rehabilitation are achieved by the team approach of surgeons, maxillofacial prosthodontists/general dentists, and importantly, informing patients about the available preprosthetic surgical options.

OBJECTIVES:The objective of this study was to evaluate a modified Le Fort I interpositional grafting followed by dental implants for the rehabilitation of edentulous atrophied maxillae (Cawood classes IV and V). The surgical modification was a bilateral sinus floor augmentation prior to the osteotomy. This generated a closed recipient bed which allowed the use of particulated bone grafts (xenogenic bone mineral) and a reduced amount of autologous iliac bone grafts.MATERIALS AND METHODS:A total of 106 patients with maxillary interpositional bone grafts were included in this retrospective analysis between 2006 and 2020. The panoramic radiographs and lateral cephalograms were analyzed to assess the gain and stability of the maxillary bone and the peri-implant bone loss. In addition, the observational period of up to 14 years implant survival and success was evaluated.RESULTS:A stable vertical bone height with mean 0.63 ± 1.41 mm resorption over 5 years after implant loading was observed. A mean of 0.20 ± 0.37 mm marginal bone loss was noted after 5 years. The implant survival was 96.4% after 5 years and implant success can be rated 91.7% in a mean follow-up period of 93 months and 168 months maximal observation time. Perioperative complications included sinus membrane perforation (59.43%), wound healing disturbances (25.47%), and transient primary complications (13.78%). All receded apart from two subtotal graft losses (1.8%).CONCLUSIONS:The modified Le Fort I osteotomy with interpositional bone grafts is a predictable procedure in terms of bone and implant stability. Patients with atrophic maxillae who are fit for surgery should be informed about risks and benefits of this treatment alternative.

Secondary alveolar bone grafting (SABG) using autologous iliac crest cancellous bone is a standard procedure for patients with cleft lip and palate (CLP). The aim of this study was to evaluate patient satisfaction after bone grafting of the alveolar cleft. Patients who underwent SABG between 2000 and 2010 in one surgical centre were included in this cross-sectional study. Three questionnaires were used, one addressing functional and aesthetic outcomes (nine items), the second being the 14-item Oral Health Impact Profile (OHIP-G14), and the third addressing donor site morbidity. A total of 103 patients fulfilled the inclusion criteria, of whom 71 could be contacted, and 52 completed the questionnaires. The majority of the patients (98%) were satisfied with the aesthetic and functional results and reported low donor site morbidity. A significant correlation was found between scores from the patient satisfaction questionnaire and the OHIP-G14. Regarding overall patient satisfaction, the manifestation of the cleft had no significant influence. The questionnaires used allowed the assessment of subjective outcome parameters, but might not be absolutely specific and exclusive for the SABG procedure in the framework of comprehensive CLP therapy. Nevertheless, SABG using autologous iliac crest cancellous bone can be considered a highly satisfactory procedure.

The aim of this study was to perform a timewise meta-analysis of randomized clinical trials (RCTs) comparing the outcomes of short implants (≤6 mm) versus lateral sinus floor augmentation followed by regular implants (≥10 mm) in the deficient posterior maxilla. Eleven RCTs with 1, 3, and 5 years of follow-up were reported in 21 articles. There was no significant difference in the implant loss rate at the patient level after 1 and 3 years between the two groups (risk ratio 0.50, P = 0.17; risk ratio 1.71, P = 0.51). After 5 years, the risk ratio was in favour of regular implants with augmentation and approached significance (3.28, P = 0.06). Excluding the results of two studies on ultrashort implants, the risk ratio for complications was in favour of short implants, but without significance (0.33, P = 0.08). Mean marginal bone loss was significantly lower at 1, 3, and 5 years for the short implants when compared to regular implants with augmentation. The residual osseointegration length of implants was between 3.4 mm and 5.9 mm in the short implants group and between 10.1 mm and 12.5 mm in the regular implants group after 5 years. In conclusion, short implants in the atrophic posterior maxilla demonstrate comparable outcomes to regular implants within the first 5 years. Patients who are fit for surgery should be informed about the risks and benefits of both options.

This review article discusses interpositional osteoplasties for vertical augmentation of the atrophic alveolar ridge, modified mandibular interforaminal sandwich osteoplasty, and modified maxillary Le Fort I interposition. The results of 106 patients in the maxilla showed implant survival of 96.4% with 0.2 mm marginal bone loss and 20 patients in the mandible showed implant survival of 95.1% with 1.0 mm bone loss, both measured over 5 years. Augmentation height gain was 7.4 mm in the maxilla and 8.3 mm in the mandible after initial remodeling. Long-term stability was 1.5 mm augmentation height loss over 5 years in the maxilla and 0.3 mm height loss in the mandible. Complications occurred in 32% of patients in the maxilla. Except for 2 augmentation losses due to infection (1.8%), no permanent complications were present. In the mandible, the complication rate was 45% transient complications and 100% augmentation success. Vertical augmentation of edentulous jaws by interpositional osteoplasty is a safe and accepted procedure. Therefore, especially younger patients should be informed about the benefits and risks of vertical jaw augmentation before transitioning to third teeth or before extensive prosthetic rehabilitation of an edentulous jaw.

The advent of three dimensionally (3D) printed customized bone grafts using different biomaterials has enabled repairs of complex bone defects in various in vivo models. However, studies related to their clinical translations are truly limited. Herein, 3D printed poly(lactic-co-glycolic acid)/β-tricalcium phosphate (PLGA/TCP) and TCP scaffolds with or without recombinant bone morphogenetic protein -2 (rhBMP-2) coating were utilized to repair primate's large-volume mandibular defects and compared efficacy of prefabricated tissue-engineered bone (PTEB) over direct implantation (without prefabrication). 18F-FDG PET/CT was explored for real-time monitoring of bone regeneration and vascularization. After 3-month's prefabrication, the original 3D-architecture of the PLGA/TCP-BMP scaffold was found to be completely lost, while it was properly maintained in TCP-BMP scaffolds. Besides, there was a remarkable decrease in the PLGA/TCP-BMP scaffold density and increase in TCP-BMP scaffolds density during ectopic (within latissimus dorsi muscle) and orthotopic (within mandibular defect) implantation, indicating regular bone formation with TCP-BMP scaffolds. Notably, PTEB based on TCP-BMP scaffold was successfully fabricated with pronounced effects on bone regeneration and vascularization based on radiographic, 18F-FDG PET/CT, and histological evaluation, suggesting a promising approach toward clinical translation.

The aim of this study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the outcomes of short dental implants (≤7 mm) versus vertical bone augmentation followed by regular dental implants (>7 mm) in the deficient posterior mandible. In total, eight RCTs (six using interpositional sandwich grafting and two using a guided bone regeneration technique) were reported in 17 articles at different time points. In the meta-analysis of the sandwich group, the relative risk (RR) for implant loss at 1 year was in favour of short implants (RR 0.41, P = 0.02), while no significant difference was found at 3 years (RR 0.65, P = 0.43), 5 years (RR 1.08, P = 0.86), or 8 years (RR 1.53, P = 0.52). The risk of complications was in favour of short implants (RR 0.34, P = 0.0002), as was the mean difference in marginal bone resorption after 1 year (−0.09 mm, P = 0.17), 3 years (−0.32 mm, P < 0.00001), 5 years (−0.65 mm, P < 0.00001), and 8 years (−0.88, P < 0.00001). The mean residual osseointegration length of the implants was between 2.94 mm and 4.44 mm in the short implants group and between 7.97 mm and 8.62 mm in the regular implants group after 5 years. In conclusion, in the deficient atrophic posterior mandible, short implants and regular implants demonstrate comparable outcomes within the first 5 years. Patients who are fit for surgery should be informed about the risks and benefits of both options.

The last 20 years has seen a shift in medical education from printed analogue formats of knowledge transfer to digital knowledge transfer via media platforms and virtual learning environments. Traditional university medical teaching was characterised by lectures and printed textbooks, which to a degree still have an important role to play in knowledge acquisition, but which in isolation do not engage the modern learner, who has become reliant on digital platforms and 'soundbite' learning. Recently, however, traditional methods of teaching and learning have been augmented by, and indeed sometimes replaced by, the alternative learning methods such as: problem-based learning; a greater integration of basic science and clinical considerations; smaller teaching groups; the 'flipped classroom' concept; and various technological tools which promote an interactive learning style. The aim of these new teaching methods is to overcome the well-documented limitations of traditional lectures and printed material in the transfer of knowledge from expert to student, by better engaging the minds of more visual learners and encouraging the use of diverse resources for lifelong learning. In this commentary paper, we share the concept of video animation as an additional educational tool, and one that can help to integrate molecular, cellular and clinical processes that underpin our understanding of biology and pathology in modern education. Importantly, while they can provide focused and attractive formats for 'soundbite' learning, their aim as a tool within the broader educational toolbox is to direct the interested reader towards more traditional formats of learning, which permit a deeper dive into a particular field or concept. In this manner, carefully constructed video animations can serve to provide a broad overview of a particular field or concept and to facilitate deeper learning when desired by the student.

Background: Porcine mesenchymal stromal cells (pMSCs) are considered a valuable research model for bone tissue engineering, which requires adequate amounts of viable cells with sufficient potential for osteogenic differentiation. For isolation and expansion of these cells through long-term culture, appropriate culture conditions are needed. Objective: To study the effect of extended in vitro cultivation on pMSC proliferation and differentiation potential using different osteogenic and adipogenic induction media. Methods: pMSCs were isolated from the bone marrow of adult Göttingen minipigs, cultured, expanded to passage 20 (~160 days) and characterized by their expression of cell surface markers (wCD44, CD45, CD90, SWC9, fibronectin), alkaline phosphatase (ALP), and osteocalcin and their potential for osteogenic and adipogenic differentiation using different induction media. Results: pMSCs retained their capacity for proliferation and osteogenic differentiation, and the number of CD90-positive cells increased significantly over more than 60 population doublings. CD90 expression in uninduced cells correlated strongly with ALP expression following osteogenic induction. Medium enriched with calcium yielded a stronger osteogenic response. Conclusion: The selection of CD90-positive MSCs and adequate levels of calcium seem to enhance the osteogenic phenotype for bone tissue engineering.

The second update of the German S2k guideline "Surgical removal of wisdom teeth" was completed in August 2019. The update incorporates findings from the literature from 2012 to June 2017, the results of an interdisciplinary consensus conference with moderation and methodological guidance from the Association of the Scientific Medical Societies in Germany (AWMF), and additional contributions from a Delphi procedure from February 2018 to April 2019. Specifically, the guideline updates the status of the recommendations on the following aspects: indications for removing and preserving wisdom teeth; significance of CB-CT diagnostics; importance of perioperative antibiotic prophylaxis; significance of piezosurgery; significance of coronectomy; and selecting the time for tooth extraction.

Chapter 22 Interpositional Bone Grafts Sandwich Interposition in the Lateral Mandible and Le Fort I Interposition in the Maxilla Hendrik Terheyden, Hendrik TerheydenSearch for more papers by this author Hendrik Terheyden, Hendrik TerheydenSearch for more papers by this author Book Editor(s):Zvi Artzi DMD, Zvi Artzi DMD Professor of Periodontology Department of Periodontology and Oral Implantology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this author First published: 13 May 2020 https://doi.org/10.1002/9781119427926.ch22Citations: 1 AboutPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShareShare a linkShare onFacebookTwitterLinked InRedditWechat Summary Vertical bone augmentation has the aim of enabling implant placement in severely atrophic edentulous alveolar ridges. According to the atrophy classification for single implant sites interpositional grafts for vertical bone development are applied as sandwich type in 4/4 defects and as a swinging interposition in ¾ defect types. Vertical bone augmentation of the sandwich type can either be achieved by direct elevation of the transport segment and interposition of a graft. Interpositional grafting offers higher vertical augmentation gains and lower resorption rates compared to most types of onlay grafting, at a reduced need for soft tissue stretching and reduced quantities of grafting materials. The sandwich method is indicated to increase the bone height over the nerve in ¾ and 4/4 defects, usually with the aim of placing an implant borne fixed prosthesis. The procedure is usually possible in local anesthesia usually in an outpatient setting. Citing Literature Bone Augmentation by Anatomical Region: Techniques and Decision-Making RelatedInformation

Die zweite Aktualisierung der S2k-Leitlinie „Operative Entfernung von Weisheitszähnen“ wurde im August 2019 abgeschlossen. In die Aktualisierung wurden Erkenntnisse aus der Literatur des Zeitraums 2012 bis Juni 2017, die Ergebnisse einer interdisziplinären Konsensuskonferenz unter Moderation und methodischer Begleitung der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften sowie ergänzende Beiträge im Rahmen eines Delphi-Verfahrens aus dem Zeitraum Februar 2018 bis April 2019 einbezogen. Konkret aktualisiert die Leitlinie den Stand der Empfehlungen insbesondere zu folgenden Aspekten: Indikationen zur Entfernung und zum Belassen von Weisheitszähnen, Stellenwert der DVT-Diagnostik, Bedeutung der perioperativen antibiotischen Prophylaxe, der Piezochirurgie und der Koronektomie sowie Zeitwahl bei der Zahnentfernung.

Die Forschung zum Ersatz autologer Materialien durch Fremdmaterialien ist beim Knochenaufbau (Goldstandard: autologer monokortikaler Beckenkammblock) weiter vorangeschritten als beim Weichgewebeersatz (Goldstandard: autologes Gingivatransplantat und Bindegewebetransplantat vom Gaumen). Der Begriff Goldstandard ist dabei nur als tradierte Referenz und nicht als das beste Material seiner Gruppe zu verstehen. Autologe Transplantate sind sowohl für die Knochen- als auch für die Weichteilaugmentation die erste Wahl, allerdings mit Entnahmetrauma verbunden. Bei Einlagerungsosteoplastiken wie Sinuslift und Hohlraumfüllungen wie der „ridge preservation“ sind Knochenersatzmaterialien einsetzbar. Die Zumischung von autologen Chips dient der Beschleunigung der Heilung und der Erhöhung der Sicherheit bei lokalen oder systemischen Risikofaktoren. Auch bei Zwischenlagerungen sind Knochenersatzmaterialien effektiv.

Ageneses exhibit a prevalence of 5.5% and are thus one of the most common congenital anomalies encountered in humans. The incidence of aplasia is often only diagnosed coincidentally in the mixed dentition unless accompanied by additional syndromal ectodermal anomalies phenotypical with the aplasia. In cases of solitary agenesis, it is frequently the second tooth of a group which is affected. Treatment planning and initiation should be carried out at an early stage and interdisciplinary whereby asymmetrical and multiple ageneses are highly complex and involve prosthetic restoration, jaw relationship, functioning and aesthetics. The treatment options for solitary and symmetrical ageneses appear considerably more straight forward and variable.

This perspective article on peri-implantitis and its prevention was produced as a supplement to a 3-D, computer-animated film aiming at presenting key characteristics of peri-implant health, the build-up of a biofilm and the ensuing host-response resulting in peri-implant mucositis and, subsequently, peri-implantitis. Treatment concepts for peri-implantitis were briefly reviewed, and prevention of the condition was brought to attention as a priority in implant dentistry. The overview also highlighted the 2017 World Workshop on Classification of Periodontal and Peri-implant diseases and Conditions, in which new disease definitions and case definitions were presented for peri-implant health, peri-implant mucositis, and peri-implantitis.

OBJECTIVES:The aim of the present retrospective study was to assess the long-term clinical outcome of sandwich osteotomy in pre-implant augmentation of atrophic mandible.MATERIALS AND METHODS:Sandwich osteotomies were performed in partially and fully edentulous mandibles of 63 consecutive patients in the present study. The vertical bone gain, graft stability, and marginal bone loss were measured radiographically. Implant survival and success rates were estimated in the follow-up ranged from 2 to 144 months (mean, 58 months).RESULTS:A total of 75 procedures were reviewed. After an average healing time of 148 days, 220 implants were placed in 74 procedures. Perioperative complications included intraoperative fracture (1/75), transient paresthesia (18/75), wound healing disturbance (18/75), and keratinized tissue deficiency (14/75). The average vertical bone gain was 5.4 mm at the time of implant placement. Significant marginal bone loss occurred during the first 6 months, after which the resorption remained stable. The implant survival rate was estimated as 96.7%, and the success rate was 95.3%. Implant survival and success showed no significant correlation with higher age, anticoagulation therapy, cardiovascular disease, or thyroid disorder. Smoking was correlated with significant lower success rate.CONCLUSION:Sandwich osteotomy is a suitable augmentation procedure for atrophic mandible, allowing for implant placement with promising outcome.

The current surgical techniques used in cleft repair are well established, but different centers use different approaches. To determine the best treatment for patients, a multi-center comparative study is required. In this study, we surveyed all craniofacial departments registered with the German Society of Maxillofacial Surgery to determine which cleft repair techniques are currently in use. Our findings revealed much variation in cleft repair between different centers. Although most centers did use a two-stage approach, the operative techniques and timing of lip and palate closure were different in every center. This shows that a retrospective comparative analysis of patient outcome between the participating centers is not possible and illustrates the need for prospective comparative studies to establish the optimal technique for reconstructive cleft surgery.