The aim of this study was to determine the proximity of the nasopalatine canal (NPC) to the maxillary central incisor root (MCIR). The study included 120 cone beam computed tomography scans obtained from the Center for Implant Dentistry, Loma Linda University, between June 2006 and September 2009. They were equally distributed into six groups: (1) 21- to 40-year-old men, (2) 21- to 40-year-old women, (3) 41- to 60-year-old men, (4) 41- to 60-year-old women, (5) 61- to 80-year-old men, and (6) 61- to 80-year-old women. The closest distances between the NPC and the MCIR (NPC-to-MCIR) were measured at the midroot (bisecting palatal cementoenamel junction to root apex) and the apex levels. Differences between the groups were analyzed using a t test and 1-way analysis of variance at a significance level of α = .05. The overall mean NPC-to-MCIR distances at the midroot and apex levels were 3.05 ± 1.64 and 5.22 ± 1.56 mm, respectively. The modes of the NPC-to-MCIR distances at the midroot and apex levels were in the range of 1.01–2.00 mm and 4.01–5.00 mm, respectively. The mean NPC-to-MCIR distance was significantly greater in men than in women at the midroot level ( P < .05) but not at the apex level ( P > .05). The mean NPC-to-MCIR distance was significantly shorter for the youngest age group than the other two age groups at the midroot level ( P < .05). However, at the apex level, the youngest age group had a significantly shorter distance compared with the oldest age group ( P < .05) but not the middle age group ( P > .05). The results of this study suggest that, to avoid NPC penetration, more care must be exercised during immediate implant placement at the midroot level of a maxillary central incisor in women and younger patients because of the root proximity to the NPC. Tapered implants may also be beneficial in such situations.

This clinical case report describes and demonstrates successful use of recombinant human platelet-derived growth factor (rhPDGF-BB) in conjunction with autogenous bone, anorganic bone mineral, and barrier membranes to reconstruct severe alveolar bone defects. A combined sinus augmentation and vertical alveolar ridge augmentation was successfully performed. In addition, a significant amount of periodontal bone gain was achieved in close apposition to a previously denuded root surface, which is significant from a periodontal standpoint, given the possibility of vertical periodontal regeneration.

Demineralized freeze-dried bone allografts (DFDBA) have been successfully used alone or in composite grafts for many decades. Little research has been done on the effect of retaining the mineral content of bone allografts. This study histologically and histomorphometrically evaluated a new mineralized bone allograft material placed in human atrophic maxillary sinuses. Seven partially edentulous patients requiring sinus grafts before implant placement were selected for this study. Their age range was 56 to 81 years (mean 67.7 years). Test grafts consisted of a mineralized solvent-dehydrated cancellous bone allograft, and control grafts were a composite of DFDBA and deproteinized bovine bone xenograft (1:1). Bilateral cases (n = 3) received both test and control grafts on opposite sides, and unilateral cases received either a test (n = 3) or control (n = 1) graft only. At 10 months, core biopsies were taken from each graft site, and dental implants were placed into the augmented bone. All bone grafts resulted in new bone formation and all implants osseointegrated. Test grafts resorbed and were replaced by newly formed bone significantly faster and in greater quantities than were control grafts. No complications with grafts or implants were noted. Both test and control grafts achieved excellent results. The faster bone formation observed with the test graft may be due, in part, to its smaller particle size compared with the bovine portion of the control graft. Test grafts were either replaced by new bone or displayed new bone-to-particle surface contact in higher percentages than did control grafts. No differences in osseointegration or graft stability were noted 2 years after the study.

Recently, platelet-rich plasma (PRP) has been proven to be an effective regeneration adjunct when combined with autogenous bone in the reconstruction of mandibular defects. However, little is known about the effect of PRP when combined with a bone allograft in the maxillary sinus. The purpose of this study was to quantitatively evaluate the ability of PRP to enhance bone regeneration in the maxillary sinus of sheep when combined with demineralized freeze-dried bone allograft (DFDBA) and cortical cancellous freeze-dried bone allograft (CCFDBA). Ten sheep were selected for bilateral sinus augmentation DFDBA + CCFDBA + PRP (test) and DFDBA + CCFDBA (control). Five were sacrificed at 3 months and the other 5 at 6 months. Hematology tests were performed for platelet count, and histology slides were obtained for histomorphometric analysis taking 2 measures of interest: total area (square millimeters) and percentage of bone fill. Student t tests showed no significant difference between test and control groups for total area ( P > .25) and percentage of bone fill ( P > .80) at either 3 or 6 months. The control group showed no statistical difference for total area ( P < .095) and percentage of bone fill ( P < .60) between 3- and 6-month healing times. The test group, however, showed a significant increase in total area ( P < .025) but not in percentage of bone fill ( P < .40) for the 2 healing periods. When the treatments were compared for interactions within the animal model, no clear tendency was evident for the test group to perform in relation to the control group regarding total area ( r = .766, P < .01). A moderate tendency existed between the percentages of bone filled ( r = .824, P < .005). Platelet-rich plasma showed higher platelet count than did the whole blood (2 to 5 times). However, no correlation was found between the log ratio and the bone measures. Within the limitations of this study, PRP failed to enhance or accelerate bone regeneration in the maxillary sinus of sheep when combined with bone allograft.

Classic guidelines in osseointegration for root-form dental implants include a long healing period, during which functional load should be avoided. However, the long healing period might impose an intolerable situation on some patients, especially in the completely edentulous situation. Subperiosteal dental implant guidelines demonstrate that the implant upon insertion can be put into immediate function and be restored with the final prosthesis soon after surgery. Studies on immediately functional loaded implant-supported prostheses in patients who are completely edentulous have been reported, exhibiting high success rates comparable with conventionally loaded implants. This article describes the surgical and prosthodontic procedure for the immediately functional loaded mandibular implant overdentures in 2 different dental implant modalities, as well as its clinical rationale.

The uses of cytokine growth factors in soft tissue applications has been reported on. The scientific background and various processing techniques to prepare the autologous materials are reviewed here. An ongoing research project to study grafting of the maxillary sinus for bone regeneration and implant site preparation with the growth factor Platelet Rich Plasma is outlined.

Alveolar ridge resorption and soft tissue recession after tooth extraction inevitably disrupted the harmonious pre-existing periodontal complex, compromising clinicians’ ability to recreate successful aesthetic restorations. Although numerous surgical procedures had been advocated for the augmentation of both the alveolar ridge and its soft tissue to ideal contours, questions remain regarding viability and predictability of these procedures. This is especially critical in the maxillary anterior region, where a the condition of the soft tissue complex and its relationship to the implant restoration and its adjacent dentition often determines the implant’s success. The described technique of retaining the root remnant and inducing the proliferation of the surrounding tissue in conjunction with immediate implant placement results in the preservation of existing soft and hard tissue, thus minimizing the necessity of grafting procedures and facilitating primary flap closure during implant placement.

This paper discusses a modified surgical and prosthodontic protocol to place implants in the completely edentulous patient. Methods for presurgical, prosthodontic workup, impression transfer technique, provisionalization, and attachment placement are also discussed.

The successful results of endosseous root form implants in the treatment of partially and completely edentulous patients has been made possible by the application of standardized surgical and prosthetic protocols. Different techniques have been published in the literature with the purpose of reducing implant prosthetic rehabilitation times. This clinical case report describes a new surgical concept and a technique to fabricate screw-retained provisional crowns for immediate loading of free-standing single tooth implants. Further clinical and histologic studies are necessary in order to promote routine clinical application of this technique.