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Restoratively driven planning for implants in the posterior maxilla - Part 1: alveolar bone healing, bone assessment and clinical classifications.

ABSTRACT: Sinus augmentation in conjunction with implant placement is widely considered to be a predictable and successful treatment option for the edentulous posterior maxilla. However, the anatomical changes of the posterior maxilla following tooth extraction (namely alveolar atrophy and pneumatisation of the maxillary sinus) creates unique challenges for implant and prosthodontic rehabilitation. A large volume of literature has been published regarding the surgical indications and treatment planning for implants in the posterior maxilla. In comparison, there is a relative paucity of literature regarding the prosthodontic challenges associated with implants placed in augmented maxillary sinuses. This article describes the scientific background of native and grafted alveolar bone healing in relation to implant rehabilitation. Furthermore, clinical classifications available to assist implant treatment planning are described.

SUBMITTER: M King E

PROVIDER: S-EPMC10611561 | biostudies-literature | 2023 Oct

REPOSITORIES: biostudies-literature

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Restoratively driven planning for implants in the posterior maxilla - Part 1: alveolar bone healing, bone assessment and clinical classifications.

M King Elizabeth E Schofield Jonathon J

British dental journal 20231027 8

Sinus augmentation in conjunction with implant placement is widely considered to be a predictable and successful treatment option for the edentulous posterior maxilla. However, the anatomical changes of the posterior maxilla following tooth extraction (namely alveolar atrophy and pneumatisation of the maxillary sinus) creates unique challenges for implant and prosthodontic rehabilitation. A large volume of literature has been published regarding the surgical indications and treatment planning fo ...[more]

PMID: 37891288

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Project description:BackgroundNumerous clinical variables may influence early marginal bone loss (EMBL), including surgical, prosthetic and host-related factors. Among them, bone crest width plays a crucial role: an adequate peri-implant bone envelope has a protective effect against the influence of the aforementioned factors on marginal bone stability. The aim of the present study was to investigate the influence of buccal and palatal bone thickness at the time of implant placement on EMBL during the submerged healing period.MethodsPatients presenting a single edentulism in the upper premolar area and requiring implant-supported rehabilitation were enrolled following inclusion and exclusion criteria. Internal connection implants (Twinfit, Dentaurum, Ispringen, Germany) were inserted after piezoelectric implant site preparation. Mid-facial and mid-palatal thickness and height of the peri-implant bone were measured immediately after implant placement (T0) with a periodontal probe and recorded to the nearest 0.5 mm. After 3 months of submerged healing (T1), implants were uncovered and measurements were repeated with the same protocol. Kruskal-Wallis test for independent samples was used to compare bone changes from T0 to T1. Multivariate linear regression models were built to assess the influence of different variables on buccal and palatal EMBL.ResultsNinety patients (50 females, 40 males, mean age 42.9 ± 15.1 years), treated with the insertion of 90 implants in maxillary premolar area, were included in the final analysis. Mean buccal and palatal bone thickness at T0 were 2.42 ± 0.64 mm and 1.31 ± 0.38 mm, respectively. Mean buccal and palatal bone thickness at T1 were 1.92 ± 0.71 mm and 0.87 ± 0.49 mm, respectively. Changes in both buccal and palatal thickness from T0 to T1 resulted statistically significant (p = 0.000). Changes in vertical bone levels from T0 to T1 resulted not significant both on buccal (mean vertical resorption 0.04 ± 0.14 mm; p = 0.479) and palatal side (mean vertical resorption 0.03 ± 0.11 mm; p = 0.737). Multivariate linear regression analysis showed a significant negative correlation between vertical bone resorption and bone thickness at T0 on both buccal and palatal side.ConclusionThe present findings suggest that a bone envelope > 2 mm on the buccal side and > 1 mm on the palatal side may effectively prevent peri-implant vertical bone resorption following surgical trauma.Trial registrationThe present study was retrospectively recorded in a public register of clinical trials ( www.Clinicaltrialsgov - NCT05632172) on 30/11/2022.

Project description:ObjectivesTo compare the use of short implants (≤6 mm) in atrophic posterior maxilla versus longer implants (≥10 mm) with sinus floor elevation.DesignA systematic review and meta-analysis based on randomised controlled trials (RCTs).Data sourcesElectronic searches were conducted in PubMed, Embase and the Cochrane CENTRAL. Retrospective and prospective hand searches were also performed.Eligibility criteriaRCTs comparing short implants (≤6 mm) and longer implants (≥10 mm) with sinus floor elevation were included. Outcome measures included implant survival (primary outcome), marginal bone loss (MBL), complications and patient satisfaction.Data extraction and synthesisRisks of bias in and across studies were evaluated. Meta-analysis, subgroup analysis and sensitivity analysis were undertaken. Quality of evidence was assessed according to Grading of Recommendations Assessment, Development and Evaluation.ResultsA total of seven RCTs involving 310 participants were included. No significant difference in survival rate was found for 1-3 years follow-up (RR 1.01, 95% CI 0.97 to 1.04, p=0.74, I²=0%, moderate-quality evidence) or for 3 years or longer follow-up (RR 1.00, 95% CI 0.97 to 1.04, p=0.79, I²=0%, moderate-quality evidence). However, short implants (≤6 mm) showed significantly less MBL in 1-3 years follow-up (MD=-0.13 mm, 95% CI -0.21 to 0.05; p=0.001, I²=87%, low-quality evidence) and in 3 years or longer follow-up (MD=-0.25 mm, 95% CI -0.40 to 0.10; p=0.001, I²=0%, moderate-quality evidence). In addition, short implant (≤6 mm) resulted in fewer postsurgery reaction (RR 0.11, 95% CI 0.14 to 0.31, p<0.001, I²=40%, moderate-quality evidence) and sinus perforation or infection (RR 0.11, 95% CI 0.02 to 0.63, p=0.01, I²=0%, moderate-quality evidence).ConclusionsFor atrophic posterior maxilla, short implants (≤6 mm) are a promising alternative to sinus floor elevation, with comparable survival rate, less MBL and postsurgery reactions. Additional high-quality studies are needed to evaluate the long-term effectiveness of short implants (≤6 mm).Trial registeration numberThe protocol has been registered at PROSPERO (CRD42018103531).

Project description:Bone sialoprotein (BSP) is an extracellular matrix (ECM) protein associated with mineralized tissues, particularly bone and cementum. BSP includes functional domains implicated in collagen binding, hydroxyapatite nucleation, and cell signaling, although its function(s) in osteoblast and osteoclast differentiation and function remain incompletely understood. Genetic ablation of BSP in Ibsp knockout (Ibsp-/-) mice results in developmental bone mineralization and remodeling defects, with alveolar bone more severely affected than the femurs and tibias of the postcranial skeleton. The role of BSP in alveolar bone healing has not been studied. We hypothesized that BSP ablation would cause defective alveolar bone healing. We employed a maxillary first molar extraction socket healing model in 42-d postnatalIbsp-/- and wild-type (WT) control mice. Tissues were collected at 0, 7, 14, 21, and 56 d postprocedure (dpp) for analysis by micro-computed tomography (microCT), histology, in situ hybridization (ISH), immunohistochemistry (IHC), and quantitative polymerase chain reaction (qPCR) array. As expected, alveolar bone healing progressed in WT mice with increasing bone volume fraction (BV/TV), bone mineral density (BMD), and tissue mineral density (TMD), transitioning from woven to mature bone from 7 to 56 dpp. Ibsp messenger RNA (mRNA) and BSP protein were strongly expressed during alveolar bone healing in parallel with other osteogenic markers. Compared to WT, Ibsp-/- mice exhibited 50% to 70% reduced BV/TV and BMD at all time points, 7% reduced TMD at 21 dpp, abnormally increased Col1a1 and Alpl mRNA expression, and persistent presence of woven bone and increased bone marrow in healing sockets. qPCR revealed substantially dysregulated gene expression in alveolar bone of Ibsp-/- versus WT mice, with significantly disrupted expression of 45% of tested genes in functional groups, including markers for osteoblasts, osteoclasts, mineralization, ECM, cell signaling, and inflammation. We conclude that BSP is a critical and nonredundant factor for alveolar bone healing, and its absence disrupts multiple major pathways involved in appropriate healing.

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Restoratively driven planning for implants in the posterior maxilla - Part 1: alveolar bone healing, bone assessment and clinical classifications.

Publications

Restoratively driven planning for implants in the posterior maxilla - Part 1: alveolar bone healing, bone assessment and clinical classifications.

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