Factors Affecting Survival and Usefulness of Implants Placed in Vascularized Free Composite Grafts Used in Post–Head and Neck Cancer Reconstruction

Background: Bone‐containing vascularized grafts have been used successfully to reconstruct post‐cancer surgical defects. Dental implants can be placed in these bone‐containing grafts to allow implant‐supported prosthodontic reconstruction of these patients. Purpose: The aim of this study was to evaluate the survival of dental implants used in the rehabilitation of subjects treated with bone‐containing vascularized grafts to compare usability of implants placed at the time of reconstruction and after healing. Materials and Methods: A cross‐sectional study was undertaken to examine survival rates of implants placed in vascularized bone‐containing grafts either immediately at the time of surgical reconstruction or after 3 months healing. Other factors such as graft type, whether radiation therapy was given, and implant type were recorded. Results: A total of 41 patients had 145 implants placed in 47 vascularized bone‐containing flaps. Increased failure rate of implants was seen in immediately placed implants. There was also a significant increase in the number of osseointegrated implants that were prosthodontically unusable or sub‐optimally placed in the immediate placement group. Radiation therapy was associated with a significant increase in failure rate. Modern implant surfaces appeared to perform better than machined/turned surfaces. Graft donor site did not influence implant survival. Conclusion: This study demonstrated the difficulties encountered with immediate placement of dental implants at the time of post‐cancer reconstructive surgery.     

The use of fresh frozen allogeneic bone for maxillary and mandibular reconstruction.

The use of fresh frozen bone (FFB) alone, or in combination with autogenous bone (AB), for bony augmentation of the maxilla and mandible in preparation for dental reconstruction with endosseous implants has been studied. Ten patients received FFB +/- AB for augmentation of a severely atrophic mandible (n = 6) or for reconstruction of a jaw defect secondary to trauma or tumor resection (n = 4). Average follow-up was 26.3 +/- 5.4 months. At the time of implant placement, the bone grafts were found to be firm in consistency, well incorporated, and well vascularized in all 10 patients. Twenty-nine endosseous implants were placed an average of 8.3 +/- 3.1 months following bone grafting. One implant failed and was replaced, and one implant remains buried as a nonfunctional unit. All patients have been restored prosthetically by means of 28 of the 29 implants. This preliminary study indicates that FFB may be used alone or in combination with autogenous bone for augmentation or reconstruction of the atrophic maxilla and mandible. The resultant ridge is adequate to support loaded endosseous implants. A potential disadvantage is the minimal risk of disease transmission.     

Behavior of implants in bone grafts or free flaps after tumor resection

The authors compared bone resorption of autogenous bone grafts and revascularized free flaps used for the reconstruction of mandibular continuity defects following resection for tumors, before and after the placement of endosseous implants. Ten patients (group 1) were treated with autogenous bone grafts taken from the fibula or the anterior iliac crest; 8 patients (group 2) were treated with iliac or fibula revascularized flaps. Four to 8 months later, 72 endosseous implants were placed in the reconstructed areas. After a further healing period of 4-6 months, patients were rehabilitated with implant-borne prostheses. The following parameters were evaluated and compared between the two groups: 1) bone resorption of grafts and free flaps before and after implant placement; 2) peri-implant bone resorption mesial and distal to each implant, immediately after prosthetic rehabilitation and then during yearly follow-ups. Bone resorption before implant placement showed mean values of 3.53 mm in group 1, and 0.96 mm in group 2. Peri-implant bone resorption was: 0.49 mm (39 implants) in group 1, and 0.45 mm (30 implants) in group 2, at time of prosthetic rehabilitation; 0.78 mm (39 implants) in group 1, and 0.89 mm (30 implants) in group 2, 12 months after prosthetic load; 1.16 mm (24 implants) in group 1, and 1.02 mm (13 implants) in group 2, 24 months after the prosthetic load. A significant difference in bone resorption before implant placement was found between the two groups, whereas it was not found after implant placement and prosthetic load. The failure rate according to Albrektsson criteria was 4.9% (2/41 implants) in group 1, and was 3.2% (1/31) in group 2.     

Dental implant treatment with different techniques for sinus floor elevation--a case report

A 60-year-old man with missing maxillary molar teeth received dental implant therapy for reconstruction of occlusion. Sinus floor elevation with autogenous bone graft consisting of iliac bone block and particulate cancellous bone and marrow (PCBM) was performed in the bilateral maxillary sinuses for implant placement. On the right side, bone height in the molar region was less than 2mm. Therefore, a delayed protocol was applied, and 2 implants were placed 4 months after bone grafting. Bone graft resorption occurred during the healing period of 4 months. On the left side, 3 implants were placed simultaneously with sinus floor elevation, as bone height in the molar region was more than 4-5mm. The bone graft was carried out at the same time as implant placement. After implant placement, resorption of the bone graft stopped, and the superstructures were delivered on both sides. The tissues around the implants were clinically healthy at one year after examination. Sinus floor elevation with autogenous bone graft is an acceptable option for implant treatment in the maxillary molar region where there is adequate height of existing bone. In postoperative care, it is important to undertake adequate follow-up to ascertain occurrence of bone graft resorption.     

Efficacy of Cancellous Block Allograft Augmentation Prior to Implant Placement in the Posterior Atrophic Mandible

Background: The present study evaluated the outcome of ridge augmentation with cancellous freeze‐dried block bone allografts in the posterior atrophic mandible followed by placement of dental implants. Materials and Methods: A bony deficiency of at least 3 mm, horizontally, vertically, or both, according to computerized tomography (CT) para‐axial reconstruction served as inclusion criteria. Implants were inserted after a healing period of 6 months. Bone measurements were taken prior to bone augmentation, during implant placement, and at second‐stage surgery. Marginal bone loss and crown‐to‐implant ratio were also measured. Results: Twenty‐nine cancellous allogeneic bone blocks were placed in 21 patients. The mean follow‐up was 37 months. Bone block survival rate was 79.3%. Mean horizontal and vertical bone gains were 5.6 and 4.3 mm, respectively. Mean buccal bone resorption was 0.5 mm at implant placement and 0.2 mm at second‐stage surgery. A total of 85 implants were placed. Mean bone thickness buccal to the implant neck was 2.5 mm at implant placement and 2.3 mm at second‐stage surgery. There was no evidence of vertical bone loss between implant placement and second‐stage surgery. Implant survival rate was 95.3%. All patients received a fixed implant‐supported prosthesis. At the last follow‐up, the mean marginal bone loss was 0.5 mm. The mean crown‐to‐implant ratio was 0.96. Conclusion: Implant placement in the posterior atrophic mandible following augmentation with cancellous freeze‐dried bone block allografts may be regarded as a viable treatment alternative.     

Frontal sinus augmentation: Preliminary results of a new approach in prosthetic orbital reconstruction

PurposeReliable application of endosseous implants for prosthetic facial reconstruction depends on the bone volume available at the defect site. Regarding the orbit, sufficient bone presentation in the medial superior orbital rim is limited due to the frontal sinus. The aim of this article is to report for the first time on the augmentation of the frontal sinus for gaining bone volume for supraorbital implant placement.Materials and methodsBetween 2007 and 2014, five patients with orbital exenteration were treated by frontal sinus augmentation using autogenous cancellous bone graft from the ilium. Extraoral implants for prosthetic orbit reconstruction were placed 4–7 months later. In advance, cadaver surgery was performed to prove the feasibility of the method. Surgical technique is described, and intraoperative images are provided.ResultsThe frontal sinus was successfully augmented in all five patients. No major complications related to the procedure were observed. A total of nine orbital implants were inserted in the augmented bone, thereof one sleeping implant. Six implants were restored prosthetically, two implants were lost at exposure. The observation period ranged from 6 to 97 months (mean: 52.8 months). Mean time for patient rehabilitation was 13 months. High patient satisfaction was achieved with the implant-retained orbital prosthesis.ConclusionThe augmentation of the frontal sinus allows implant placement by providing sufficient bone volume in the medial supraorbital rim. Considering the surgical success of this method and patient satisfaction, this new approach is concluded to be a viable option in a unique subset of patients.     

Staged reconstruction of the severely atrophic mandible with autogenous bone graft and endosteal implants.

PURPOSE: Vastly different surgical techniques have been advocated for osseous reconstruction of the severely atrophic mandible. Endosseous implants placed in autologous bone grafts have been proposed to minimize graft resorption and restore function; however, sufficient bone must exist to support the implants and prevent pathologic fracture. The purpose of this retrospective analysis was to assess the efficacy of autologous bone grafting and the subsequent placement of endosteal implants as a staged procedure in patients with severely atrophic mandibles. MATERIALS AND METHODS: The records of all patients presenting to The University of North Carolina for treatment from 1997 to 1999 with atrophic mandibles (vertical mandibular height <7 mm as measured on panoramic radiographs in at least 1 site at the mandibular midline and at the thinnest portion of the mandibular body) were reviewed. Bone height was assessed preoperatively, immediately postoperatively, at the time of implant placement (4 to 6 months), and again at 12 and 24 months after bone grafting from posterior iliac crest to the mandible via an extraoral approach. Five endosteal implants were subsequently placed in each patient as a delayed procedure 4 to 6 months after bone grafting, and prosthetic rehabilitation was completed with implant supported prostheses. RESULTS: Fourteen consecutive patients were identified with a median preoperative bone height of 9 mm (interquartile range, 25th to 75th percentile [IQ], 7 to 10 mm) in the mandibular midline and 5 mm (IQ, 2 to 5 mm) in the body region. There were no perioperative complications. Median estimated blood loss during the bone graft procedure, as estimated by the surgeon and the anesthesiologist, was 300 mL (IQ, 150 to 1,100 mL), and 1 patient required blood transfusion secondary to symptomatic anemia. The mean loss of vertical bone height after grafting and during the 4 to 6 months before implant placement was 33%. After implant placement and at 12 months, the vertical bone loss was negligible in the implant-supported region and less than 11% in the body region. CONCLUSION: Reconstruction of the severely atrophic mandible using autogenous corticocancellous bone grafts followed by placement of osseointegrated implants in 4 to 6 months can restore and maintain mandibular bone sufficient to support implants and facilitate successful restoration of occlusion. A prospective study is planned to identify predictors of successful outcomes compared with other surgical/prosthetic treatment.     

Peri-implant bone changes following tooth extraction, immediate placement and loading of implants in the edentulous maxilla

The aim of this study was to clinically and radiographically evaluate peri-implant bone level changes after rehabilitation of a fully edentulous maxilla by placement of six implants in either fresh extraction sites or healed edentulous ridges up till 18 months after implant placement. Twenty patients with a terminal dentition in the maxillae (11 men, 9 women) received a total of 120 OsseoSpeed implants; 118 implants could be loaded immediately of which 59 were placed in extraction sockets and 59 were placed in healed sites. Within 24 h after surgery, all patients received a chairside-assembled, fibre-reinforced temporary fixed prosthetic reconstruction in occlusion. Six months post-surgery, final screw-retained CoCr (15) or Ti (5) computer numerical control-milled and acrylic-veneered frameworks were placed directly at implant level without interposing abutments. Intraoral radiographs were taken 6 and 18 months after implant placement. Implant survival rate was 100%. Mean marginal bone level was located on average -0.35 mm below the reference point (standard deviation 0.29, range -1.20 to +0.02 mm) 18 months after loading. Whether implants were placed in healed bone sites or fresh extraction sockets did not significantly affect the bone level changes. Furthermore, the use of either CoCr or Ti at the implant level did not significantly affect marginal bone loss. Within the limits of this prospective clinical trial, results seem to indicate that immediate placement and occlusal loading of five to six implants in the edentulous maxilla can be carried out successfully. Whether or not those implants are placed in fresh extraction sockets does not seem to alter the outcome. The present data show a successful 1-year outcome of a treatment protocol involving tooth extraction immediately combined with implant placement and loading.     

牙种植体—血管化髂骨移植修复下颌骨缺损的临床评价

目的　评价血管化髂骨移植一期植入种植体修复下颌骨缺损的临床效果。方法　采用临床观察、摄X线片 ,并对种植义齿修复后进行咀嚼效率及咬合力测定。结果　种植义齿修复后 ,患者的咀嚼效率可恢复至正常人咀嚼效率的 6 0 7%～ 96 6 % ,说明种植体应用于血管化骨移植修复下颌骨缺损 ,可早期恢复患者的咀嚼功能。结论　种植体应用于血管化骨移植修复下颌骨缺损可早期恢复患者的咀嚼功能     

Use of HTR synthetic bone grafts in conjunction with immediate dental implants

Immediate placement of dental implants in fresh extraction sockets is associated with remaining voids around the implants and often a partial dehiscence or thinning of the facial alveolar plate. Nine patients had Bioplant HTR synthetic bone used as a ridge preservation/augmentation material in conjunction with immediate placement of 10 implants. Hard tissue replacement (HTR) was used to fill the remaining socket void and enhance the facial ridge width, and the wound closed as completely as possible. Dental implants were uncovered at approximately 6 months. Measurements taken of the internal socket width and total ridge width at the implant placement and uncovering showed the mean internal socket width was maintained (7.2 mm vs 6.9 mm), and the total ridge width exhibited a mean change from 9.6 mm to 8.8 mm. Of the 10 implant sites, 7 showed a net increase, 2 no change, and 1 a decrease in overall ridge width. All 10 implants were restored for at least 6 months. These clinical results suggest that HTR is a useful adjunct in the placement of immediate dental implants for the preservation of ridge width and provides a good base for functional and esthetic prosthetic reconstruction.     

Bio-Oss骨粉在上颌窦提升牙种植术中的临床应用

目的：评价上颌窦提升，植Bio-Oss骨粉在上颌后牙种植的方法和效果。方法：对11例牙槽骨高度不足的上颌后牙种植进行上颌窦提升，植Bio-Oss骨粉，同期种植7例，延期种植4例。结果：6个月后，X线片显示Bio-Oss骨粉改建形成了新骨，增加了牙槽骨高度，满足了种植要求，7例同期种植可见种植体与Bio-Oss诱导的新骨形成紧密的骨性结合，种植体植入9个月后进行二期修复。结论：Bio-Oss骨粉植入提升上颌窦增加了上颌后牙区的牙槽骨高度，拓展了种植的适应证，免疫除了自体取骨手术，方法简单，值得临床推广。     

Immediate non-occlusal vs. early loading of dental implants in partially edentulous patients: a multicentre randomized clinical trial. Peri-implant bone and soft-tissue levels

Objectives: To compare peri‐implant bone and soft‐tissue levels of immediately non‐occlusally loaded vs. non‐submerged early loaded implants in partially edentulous patients up to 14 months after placement. Material and methods: Fifty‐two patients were randomized in five Italian private practices: 25 in the immediately loaded group and 27 in the early loaded group. To be immediately loaded, single implants had to be inserted with a torque of ≥30 N cm, and splinted implants with a torque of ≥20 N cm. Immediately loaded implants were provided with non‐occluding temporary restorations within 48 h. After 2 months, the provisional restorations were placed in full occlusion. Implants were early loaded after 2 months. Final restorations were provided 8 months after placement. Blinded assessors evaluated peri‐implant bone and soft‐tissue levels. Results: Fifty‐two implants were immediately loaded and 52 were early loaded. No drop‐out occurred. One single immediately loaded implant failed 2 months after placement. Both groups gradually lost peri‐implant bone in a highly statistically significant manner at 2, 8, and 14 months. After 14 months, patients of both groups lost an average of 1.1 mm of peri‐implant bone. There were no statistically significant differences between the two loading strategies for peri‐implant bone and soft‐tissue level changes (P>0.05). After 14 months, the position of the soft tissues did not change significantly from baseline (delivery of the final restorations 8 months after placement). Conclusions: There were no statistically or clinically significant differences between immediate and early loading of dental implants with regard to peri‐implant bone and soft‐tissue levels as evaluated in the present study.     

A randomized clinical trial to evaluate and compare implants placed in augmented versus non-augmented extraction sockets: 3-year results

Background: The alveolar ridge undergoes reabsorption and atrophy subsequent to tooth removal and thus exhibits a wide range of dimensional changes. Preservation of the alveolar crest after tooth extraction is essential to enhance the surgical site before implant fixture placement. The aim of this randomized clinical study is to investigate and compare the need for additional augmentation procedures at implant insertion, as well as the success rate and marginal bone loss for implants placed in the grafted sites versus those placed in naturally healed sites. Methods: Forty patients with ≥1 hopeless tooth were randomly allocated to: 1) a test group, receiving extraction and grafting corticocancellous porcine bone; and 2) a control group, receiving extraction without any graft. After 7 months of healing, implants were inserted in each of the sites. The implants were submerged and loaded after 4 months with metal–ceramic rehabilitation. The follow‐up included evaluation of implant diameter and length, the need for additional augmentation procedures at implant placement, implant failure, and marginal bone level changes. All patients were followed over a 3‐year period. Results: One implant failed in the control group at the second stage of surgery (6 months after placement); one implant failed in the test group after 2 years of loading. The cumulative implant success rate at the 3‐year follow‐up visit reached 95% for both groups. No statistically significant differences were detected for marginal bone changes between the two groups. Conclusions: It was concluded that implants placed into grafted extraction sockets exhibited a clinical performance similar to implants placed into non‐grafted sites in terms of implant survival and marginal bone loss. However, grafted sites allowed placement of larger implants and required less augmentation procedures at implant placement when compared to naturally healed sites.     

Staged protocol for resection, skeletal reconstruction, and oral rehabilitation of children with jaw tumors.

PURPOSE: The purpose of this study was to evaluate a staged protocol for resection of jaw tumors and reconstruction including implants in pediatric patients. PATIENTS AND METHODS: Nine children were evaluated retrospectively. Data included age at resection, tumor type, use of adjuvant therapy, type of bone graft, and number of implants. Occurrence of postoperative infection, tumor margins, recurrence, plate fractures, number of bone grafts, implants restored, and failures were recorded. RESULTS: Ages ranged from 3.5 to 16 years with 2 maxillary and 7 mandibular tumors. Diagnoses included giant cell lesion (n = 3), osteosarcoma (n = 2), myofibroma (n = 1), ossifying fibroma (n = 1), desmoplastic fibroma (n = 1), and ameloblastoma (n = 1). No patients experienced postoperative infection, wound dehiscence, or jaw instability after en bloc resection. One patient had recurrence of a giant cell lesion. To date (mean, 56 months; range, 24 to 93 months), there have been no additional recurrences. There was 1 plate fracture. Eight patients underwent iliac bone grafts (stage 2), and in 1 patient, the mandible regenerated. There were no graft infections or wound dehiscences. Three patients required additional bone grafting for implant placement. Twenty-three implants were placed in 7 patients without complications, and 21 implants have gone to second stage. One implant failed to osseointegrate. Six patients have had prostheses placed and loaded for a mean of 26 months (range, 5 to 64 months). One patient is scheduled for prosthetic restoration and 2 for implant placement. CONCLUSION: Pediatric maxillofacial tumors can be successfully treated by resection, rigid fixation, and delayed reconstruction with minimal morbidity and a high success rate.     

Implant treatment without bone grafting in severely resorbed edentulous maxillae.

PURPOSE: This article describes the surgical technique for implant treatment in severely resorbed edentulous maxillae without any alveolar reconstruction before or combined with implant placement. PATIENTS AND MATERIAL: Fifteen patients with severely resorbed edentulous maxillae were treated with osseointegrated implants and fixed dental prostheses. All patients were initially considered to be treated with bone grafting because of a lack of sufficient bone volume for conventional treatment. Preoperative radiographic examinations showed that the height of the alveolar crest was on average 7.4 mm at the 4-mm-width level (Classes V to VI). RESULTS: By fenestration of the maxillary sinus and uncovering the nasal floor, the maxillary bone could be visualized and used maximally for installation of implants. By angulation of the implants and permitting two to five uncovered fixture threads on the palatal aspect, implants of optimal length could be installed. Eighty-six implants were placed (four to six implants in every patient). One implant was lost during the observation time (range, 36 to 54 months; mean, 45 months). All patients had stable fixed prostheses at the end of the observation time. CONCLUSION: This cost-effective surgical technique may be considered as an alternative to more resource-demanding techniques such as bone grafting in patients with severely resorbed edentulous maxillae. However, further prospective comparative studies are necessary for full evaluation.     

Clinical Outcomes of an Osteotome Technique and Simultaneous Placement of Neoss Implants in the Posterior Maxilla

Background: Insufficient bone volume often hamper placement of dental implants in the posterior maxilla. Purpose: The aim of the present clinical study was to evaluate retrospectively the clinical outcome of implant placement in the resorbed posterior maxilla using an osteotome technique without adding any grafting material. Materials and Methods: Twenty patients with 5 to 9 mm of residual alveolar bone height in the posterior maxilla received twenty‐nine implants (Neoss Ltd., Harrogate, UK) using an osteotomy technique without bone grafts. Intraoral radiographs were taken before and after implant placement, at the time of loading and after 11 to 32 months of loading (mean 16.4 months), to evaluate bone formation below the sinus membrane and marginal bone loss. Implant stability measurements (Osstell^TM, Gothenburg, Sweden) were performed after implant installation and at abutment connection 5 months later. All implants were installed with the prosthetic platform level with the bone crest. Results: No implant was lost giving a survival rate of 100% after a mean follow‐up time of 16.4 months. The average vertical bone height was 7.2 ± 1.5 mm at placement and 10.0 ± 1.0 mm after 11 to 32 months. The average increase of 2.8 ± 1.1 mm was statistically significant. There was a statistically significant improvement in implant stability from 70.7 ± 9.2 implant stability quotient (ISQ) at placement to 76.7 ± 5.7 ISQ at abutment connection, 5 months later. The mean marginal bone loss amounted to 0.7 ± 0.3 mm after 11 to 32 months of loading. Conclusion: It is concluded that the osteotome technique evaluated resulted in predictable intrasinus bone formation, firm implant stability, and good clinical outcomes as no implants were lost and minimal marginal bone loss was observed.     

Maxillary alveolar ridge reconstruction with monocortical fresh-frozen bone blocks: a clinical, histological and histomorphometric study

BackgroundThis investigation is a clinical and histological assessment of fresh-frozen bone use in the reconstruction of maxillary alveolar ridges. The study evaluates the effectiveness of this material as a bone filler prior the placement of dental implants.Patients and methodsSixteen patients with atrophic maxillary ridges underwent maxillary reconstruction with fresh-frozen tibial human block grafts prior to implant placement. Sampling procedures were carried out 4, 6 and 9 months later when a bone core was removed from the grafts for histological and histomorphometric analysis.ResultsEighteen blocks were placed, and each patient received either 1 or 2 blocks. During the sampling procedures, all of the grafts were found to be firm in consistency, well-incorporated, and vascularized. A total of 34 implants were placed into the grafts with a minimum of 40-Newton-cm torque in all cases. The follow-up period ranged from 18 to 30 months. No implants were lost. The histological analysis revealed vital bone with mature and compact osseous tissue surrounded by marrow spaces.ConclusionBone allografts can be used successfully as graft material for the treatment of maxillary ridge defects. This type of bone graft can be used safely in the areas of implant placement as a suitable alternative to autogenous grafts.     

Identification of stability changes for immediately placed dental implants

PURPOSE: To evaluate the changes in stability of immediately placed implants over a 6-month healing period relative to implants placed in native bone and to compare the stability of 2 different implant designs when placed as immediate implants in extraction sites. MATERIALS AND METHODS: This prospective cohort study evaluated 3 implant patient populations. The control group (9 patients, 11 implants) required a single-stage, 1-piece, rough-surface implant (considered a "standard" implant) placed in nongrafted sites at least 6 months postextraction. The 2 experimental groups (25 patients, 28 implants) required extraction and immediate placement of either standard implants (12 patients) or tapered, self-tapping implants (13 patients). Immediate implant placement was carried out at the time of tooth extraction. Resonance frequency analysis (RFA), a measure of implant stability, was performed following implant placement at 2- to 4-week intervals for the first 16 weeks and at 24 weeks for immediate implants. RESULTS: Placement protocol (control versus immediate placement) resulted in significant (P < .001) differences in implant stability, even though there was no difference (P > .90) in initial, mechanical implant stability between these groups. The immediately placed implants had significantly greater reductions in stability, approximately 15%, from baseline to 4 weeks. Immediate implant stability was consistent with that of implants placed in native bone after 12 to 16 weeks. Implant design did not have a significant effect on stability. CONCLUSIONS: This study demonstrates that immediate placement protocols are viable options and that standard-design implants may provide levels of biologic stability similar to a tapered, self-tapping implant design in immediate placement protocols. Most importantly, this study documents high levels of metabolic activity in the supporting osseous tissue following immediate placement, which may extend time to restoration compared with traditional implant placement.     

Endosseous implants and bone augmentation in the partially dentate maxilla: an analysis of 17 patients with a follow-up of 29 to 101 months

PURPOSE: The aim of this study was to analyze the survival rate of endosseous implants placed in the partially dentate maxilla treated with sinus inlay block bone grafts. MATERIALS AND METHODS: Seventeen patients were subjected to bone augmentation procedures prior to or in conjunction with implant placement. Bone volumes were regarded as insufficient for implant treatment unless a bone grafting procedure was performed. The patients were treated with sinus inlay block bone grafts and endosseous implants in a 1- or 2-stage procedure. A total of 69 implants were placed in the patients who were followed for 29 to 101 months (mean, 53.1 months). The retrospective patient group was also prospectively followed using a standardized clinical and radiographic study design. RESULTS: The implant survival rate was 91.3% (63/69). All implants were lost during the period from abutment connection to connection of the definitive prosthesis. All bone grafts were stable. Bone grafts supported 48 implants, of which 5 failed (10.4%). In the residual bone, 21 implants were placed, of which 1 failed (4.8%). All patients received a fixed partial prosthesis, which was stable during the follow-up period. CONCLUSION: The results of this investigation revealed a satisfactory clinical outcome of implant placement in grafted partially dentate maxillae after a mean follow-up of 53.1 months.     

Rehabilitation with dental implants of oral cancer patients.

The aim of this study was to evaluate the risks and complications of rehabilitation with dental implants after tumour surgery and radiotherapy. After a disease-free survival of 18 months, 29 patients who had undergone oral cancer treatment were rehabilitated with dental implants. The complication rate of implants in irradiated, non-irradiated and grafted bone was analyzed at least 3 years after implant placement. In the healing period, 28.6% of the implants in irradiated bone and 8.4% in non-irradiated bone showed soft tissue complications. Of the implants, 26.7% in the irradiated and 14.7% in the non-irradiated mandibular bone were lost in the first 36 months after placement. Thirty-one point two percent of implants inserted in non-irradiated bone grafts were affected and did not osseointegrate. Of 109 inserted implants, 70 were suitable for prosthetic rehabilitation. There are high complication rates after implant placement in oral cancer patients. Irradiation adversely affects soft tissue healing. Osseointegration is frequently disturbed, especially when implants were placed in non-vascularized bone grafts.