Tạp chí implant tháng 11 2009 nâng xoang hàm trên Một tạp chí chuyên ngành răng hàm mặt với chủ đề về implant nha khoa. Trong tạp chí có nhiều bài miêu tả về ghép xương và phẩu thuật trong cấy ghép nha khoa
Volume 1, No NoVember 2009 The Journal of Implant & Advanced Clinical Dentistry Maxillary Sinus Augmentation Histologic and Histomorphometric Analysis Single Surgery Comprehensive Gingival Grafting Technique 2H r u o s C of E d e r C it B3i_1245_JIACD_Encode_Ad.qxd:B3i_1245_JIACD_Encode_Ad 11/3/09 1:55 PM Page Say Goodbye To Impression Copings Introducing The Encode ® Impression System Ask Your Surgeon To Place Encode Healing Abutments Available Exclusively Through BIOMET 3i Call Your BIOMET 3i Representative Today In The USA: 1-800-342-5454 Outside The USA: +1-561-776-6700 Or Visit Us Online At www.biomet3i.com Encode is a registered trademark of BIOMET 3i LLC BIOMET is a registered trademark and BIOMET 3i and design are trademarks of BIOMET, Inc ©2009 BIOMET 3i LLC All rights reserved Free CPS kit with every implant! A* B* C* The Complete Prosthetic Set has been designed to enable an easy impression and transfer technique It combines solutions for both bridges and single crowns and enables a simple restorative process without necessary adjustments, nor additional elements The Complete Prosthetic Set ensures an accurate fit for the final restoration MIS offers a wide range of innovative kits and accessories that provide creative and simple solutions for the varied challenges encountered in implant dentistry To learn more about MIS visit our website at: misimplants.com or call us: 866-797-1333 (toll free) Order 10 implants of your choice and get a Free CPS Kit with each implant * Abutment (A), Abutment Analog (B), Impression Transfer (C) The Journal of Implant & Advanced Clinical Dentistry Volume 1, No • NoVember 2009 Table of Contents 13 Case of the Month Biologic Shaping Daniel Melker 19 JIACD Continuing Education Management of the Actively Bleeding and Hypovolemic Dental Patient Dan Holtzclaw, Nicholas Toscano 29 Single Surgery Comprehensive Gingival Grafting Utilizing Palatal Donor Tissue M Thomas Wilcko, William M Wilcko 49 Maxillary Sinus Floor Augmentation: A Histologic and Histomorphometric Human Grafting Study Comparing Two Anorganic Bovine Bone Minerals Aron Gonshor, Yoon-Je Jang The Journal of Implant & Advanced Clinical Dentistry • The Journal of Implant & Advanced Clinical Dentistry Volume 1, No • NoVember 2009 Table of Contents 59 Preservation of Buccal Bone Plate after Immediate Implant Placement/Function with the Flapless Approach: A Case Report Arthur B Novaes Jr., Rafael R de Oliveira, Valdir A Muglia 69 Subperiosteal Dental Implants: A 25 Year Retrospective Survival Evaluation Antonio T Di Giulio, Giancarlo Di Giulio, Enrico Gallucci 77 Dental 3D Imaging Centers - Usage and Findings: Part III – Bifid Canals and Other Deviations of the Inferior Alveolar Nerve Alan Alan A Winter, Kouresh Yousefzadeh, Alan S Pollack, Michael I Stein, Frank J Murphy, Christos Angelopoulos The Journal of Implant & Advanced Clinical Dentistry • The Journal of Implant & Advanced Clinical Dentistry Volume 1, No • NoVember 2009 Publisher SpecOps Media, LLC Design Jimmydog Design Group www.jimmydog.com Production Manager Stephanie Belcher 336-201-7475 Copy Editor JIACD staff Digital Conversion NxtBook Media Internet Management InfoSwell Media Subscription Information: Annual rates as follows: Non-qualified individual: $99(USD) Institutional: $99(USD) For more information regarding subscriptions, contact info@jiacd.com or 1-888-923-0002 Advertising Policy: All advertisements appearing in the Journal of Implant and Advanced Clinical Dentistry (JIACD) must be approved by the editorial staff which has the right to reject or request changes to submitted advertisements The publication of an advertisement in JIACD does not constitute an endorsement by the publisher Additionally, the publisher does not guarantee or warrant any claims made by JIACD advertisers For 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Media, LLC, Saint James, New York, USA The Journal of Implant & Advanced Clinical Dentistry • Giulio et al mately 10 years, respectively.9-12 Although these survival rates are less than those typically reported with endosseous dental implants, one must remember that most cases treated with subperiosteal dental implants have osseous structures of an often compromised nature In many of these cases, treatment with endosseous dental implants was neither a feasible nor a safe option It is worth noting that in some patients who showed chrome-cobalt allergy or severe osteoporosis, their implants lasted a mean of 5.0 ± 2.3 years after surgery Complications due to chromecobalt allergy were overcome by the use of titanium, which has excellent biocompatibility and high corrosion resistance.13-16 Additionally, the recent addition of demineralized bone allograft to the subperiosteal implant procedure has improved survival rates at the year benchmark Further evaluation at the 20 year benchmark will provide additional data for long term survival of contemporary use of subperiosteal dental implants The successful delivery of subperiosteal dental implants is aided by three-dimensional computed tomography reconstructions enabling the precise reconstruction of the patient’s osseous profile upon which the subperiosteal implant is to be placed Particular mention should be made of the stereolithographic technique, which enables a model to be created from a CT data set This template of the mandible and/ or maxilla provides precise guidance for subperiosteal implant design and delivery in vivo CONCLUSION For patients with severe inadequacies of mandibular and/or maxillary bone, treatment with endosseous dental implants is not always feasible and the subperiosteal dental implant offers 74 • Vol 1, No • November 2009 a viable alternative treatment option Over a 24 year retrospective evaluation, the survival rates of subperiosteal dental implants seen in this and other studies prove this treatment modality to be a feasible treatment option in select patient populations The most important aspect for long term success of subperiosteal dental implants is precise manufacturing of the implant to fit the patient’s osseous profile Additionally, proper prosthetic restoration and periodic follow up visits are required All of the patients seen in this study profess complete satisfaction with their implants in terms of improvements to their social life and stomatognathic functionality This is of considerable importance owing to the relatively young age of our patients Indeed, to paraphrase Brånemark’s famous remark, “nobody should have to live a nightly bedtime drama with his/her overdentures in a glass of water.” ● Correspondence: Dr Enrico Gallucci Dipartimento Farmaco-Biologico Università degli Studi di Bari via E Orabona 4, 70126 Bari, Italy Tel/Fax: +39 0805442796 Email: gallucci@farmbiol.uniba.it Giulio et al Disclosure The authors report no conflicts of interest with anything mentioned in this article Acknowledgements The authors would like to thank their colleague Anthony Green for proofreading and providing linguistic advice The following collaborators: Engineer F Davolio, Radiologist A Zerbi, Technician E Puntieri are gratefully acknowledged for their collaboration References Brånemark P Available at: http://en.wikipedia.org/wiki/Dental_ implant#cite_ref-2 Dahl G Dental implant and superplants Rassegna Trimestrale Odontoiatria 1956; 4: 25-36 Goldberg N, Gershkoff A Implant lower denture Dent Dig 1949; 55: 490494 Linkow L, Wagner J, Chanavaz M Tripodal mandibular subperiosteal implant: basic sciences, operational procedure, and clinical data J Oral Implantol 1998; 24:16-36 Moore JD, Hansen PA A descriptive 18-year retrospective review of subperiosteal implants for patients with severely atrophied edentulous mandible J Prosthet Dent 2004;92:145-150 Kaplan EL, Meier P Nonparametric estimation from incomplete observations J Amer Stat Assoc 1958; 53: 457-48 Kurtzman G, Schwartz K The subperiosteal implant as a valuable long-term treatment modality in the severely atrophied mandible: a patient’s 40-years case history J Oral Impantol 1995; 21: 35-39 Kusek E The use of laser technology (ER;CR:YSGG) and stereolithography to aid in the placement of a subperiosteal implant: A case study J Oral Implantol 2009; 35: 5-11 James R Subperiosteal implant design NY J Dent 1983; 53: 407-14 10 Golec T, Krauser J Long-term retrospective studies on hydroxyapatite coated endosteal and subperiosteal implants Dent Clin North Am 1992; 36: 39-65 11 Yanase R, Bodine R,Tom J, White S The mandibular subperiosteal implant denture: a prospective survival study J Prosthet Dent 1994; 71: 369-74 12 Bodine R, Yanase R, Bodine A Forty years of experience with subperiosteal implant dentures in 41 edentulous patients J Prosthet Dent 1996; 75: 33-44 13 Albrektsson T, Hansson H, Ivarsson B Interface analysis of titanium and zirconium bone implants Biomaterials 1985; 6: 97-101 14 Steinemann S, Eulenberg J, Maeusli P, Schroeder A Biological and Biochemical Performance of Biomaterials, 1st edition, Elsevier, Amsterdam 1986; 409-414 15 Rae T The biological response to titanium and titanium-aluminiumvanadium alloy particles I Tissue culture studies Biomaterials 1986; 7: 30-36 16 Lindigkeit J Titanium and titanium alloys: Fundamentals and Applications, Wiley-VCH Verlag GmbH & Co KGaA 2005; 453-466 The Journal of Implant & Advanced Clinical Dentistry • 75 st ed / Be grat am for te Be n k In ne lutio 00 Co So r $1 n e Pa Und Go digital today 3D tomorrow Winter et al Introducing Suni3D – All New 3-in-1 System! 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The value leader in digital imaging Call now for a demo | 800 438 7864 | www.suni.com Winter et al Dental 3D Imaging Centers - Usage and Findings: Part III – Bifid Canals and Other Deviations of the Inferior Alveolar Nerve Alan A Winter, DDS1 • Kouresh Yousefzadeh, DDS2 • Alan S Pollack, DDS3 Michael I Stein, DMD4 • Frank J Murphy, DDS5 Christos Angelopoulos, DDS6 Abstract Background: This is part of a part study evaluating data obtained from dental referral usage of radiological labs for three dimensional (3D) anatomical scans The purpose of this current study was to gather data on bifid mandibular canals and other deviations of the inferior alveolar nerve (IAN) Methods: Data from 500 consecutive patients sent to i-dontics dental radiological centers from centers locations in states were evaluated Of these patients, the current study evaluated 296 mandibles for the following: the incidence of bifid branches of the inferior alveolar canal, the number of branches present when the IAN was observed to split, laterality of the bifid canals, and the location of the bifid canal in relation to the mental foramen (anterior, equal to, or posterior) Results: 296 mandibular scans were included in the study Of these scans, 186 patients (62.84%) did not demonstrate evidence of a bifid canal In contrast, 110 patients (37.16%) had one or more bifid canals Of the 110 patients demonstrating bifid canals, 56 (50.9%) had one bifid canal, 37 (33.6%) had two canals, and 17 (15.45%) had three or more canals Slightly more than half (55.45%) of bifid canals were unilateral Two thirds (67%) of the unilateral bifid canals were on the right side of the mandible; one third (33%) of the unilateral bifid canals were on the left side of the mandible bifid canals (8.18%) were located at the mental foramen, 94 (85.45%) were posterior to the mental foramen, and (6.36%) continued anterior to the mental foramen Conclusions: The incidence of bifid mandibular canals (37%) from the current study was greater than that reported in other studies Presurgical identification of bifid canals reduces risk of damage to vital structures and may explain difficulty in obtaining local anesthesia in certain situations KEY WORDS: Cone beam computed tomography, inferior alveolar nerve, bifid canals mandible, dental implants Assistant Clinical Professor, Department of Periodontics and Implant Dentistry, New York University College of Dentistry Private practice, New York, USA Private practice, New York, USA Private practice, New York, USA Private practice, New York, USA Director Maxillofacial Dental Radiology and Associate Professor of Clinical Dentistry, Columbia School of Dental Medicine The Journal of Implant & Advanced Clinical Dentistry • 77 Winter et al IntRODuCtIOn The recent advent of cone beam computed tomography (CBCT) technology has vastly increased the diagnostic options for dental treatment While this technology is continually improving in terms of quality, equipment size, and cost, most dental offices not own CBCT scanners at this time Accordingly, many practices currently refer patients to freestanding dental radiological labs for three dimensional (3D) anatomical scans The purpose of this series of studies was to determine how and for what reason dentists currently utilize dental 3D imaging centers Part one of this study series evaluated demographic data and the reasons why patients were referred for 3D evaluation Part two of this study series evaluated anatomical features of the lingual artery in relation to dental implant treatment The purpose of this current study was to gather data on bifid mandibular canals and other deviations of the inferior alveolar nerve (IAN) A bifid mandibular canal is a relatively uncommon anatomical variation typically seen in less than 1% of the population The incidence of bifid canals has been evaluated with both conventional panoramic and computed tomography (CT) images Findings indicate that the canals may split in different positions along the length of the IAN and one branch may be smaller than the other.1,2 Langlais et al3 reported a 0.95% prevalence of bifid mandibular canals while Sanchis4 reported an incidence of 0.4% in an evaluation of 2,012 mandibles Multiple studies agree that the bifid anatomical variations need to be identified when surgical procedures such as removal of impacted third molars, insertion of dental implants, and osteotomies, are to be performed.5-9 Once bifid canals are identified, the local 78 • Vol 1, No • November 2009 Figure 1: Prevalence of bifid canals in 296 patients Figure 2: Of the mandibles demonstrating bifid canals, 50.9% had one branch, 33.6% had branches, and 15.45% had three or more branches anesthetic injection technique, prosthetic design, and surgical procedures can be modified to prevent pain and discomfort during treatment procedures10 and ultimately improve final outcomes MAtERIALS AnD MEtHODS CBCT scans of the dental arches from 500 consecutive patients taken in centers located in states were uploaded to the main pro- Winter et al tinuous with the main inferior alveolar canal in each slice For consistency, all studies were examined by a single examiner (KY) RESuLtS Figure 3: 55% (61/110) of bifid canals were unilateral while nearly 46% (49/110) were identified bilaterally The majority of unilateral canals were located on the right side of the mandible (41/61) cessing center of a single dental radiological practice (i-dontics, llc., New York, N.Y.) which is limited to taking and processing 3D CT images for the dental community Scans were taken on either i-CAT scanners (8 centers) or on a (1) NewTom 3G scanner All studies were converted to SimPlant™ (Materialise, Glen Burnie, MD) When not specified, the data was converted to SimPlant™ version 10 In the current study, 296 of the 500 scans were of the mandible These scans were evaluated for the following: the incidence of bifid branches of the inferior alveolar canal, the number of branches present when the IAN was observed to split, laterality of the bifid canals, and the location of the bifid canal in relation to the mental foramen (anterior, equal to, or posterior) All CBCT studies were made into 1.0 mm slides and viewed both in the coronal and transaxial planes To be counted as a bifid canal, each offshoot had to be con- number 296 mandibular scans were included in the study Of these scans, 186 patients (62.84%) did not demonstrate evidence of a bifid canal In contrast, 110 patients (37.16%) had one or more bifid canals Of the 110 patients demonstrating bifid canals, 56 (50.9%) had one bifid canal, 37 (33.6%) had two canals, and 17 (15.45%) had three or more canals Laterality Slightly more than half (55.45%) of bifid canals were unilateral Two thirds (67%) of the unilateral bifid canals were on the right side of the mandible; one third (33%) of the unilateral bifid canals were on the left side of the mandible Location of the Bifid Canal bifid canals (8.18%) were located at the mental foramen, 94 (85.45%) were posterior to the mental foramen, and (6.36%) continued anterior to the mental foramen DISCuSSIOn The incidence of bifid canals has been reported at less than one percent3,4 and the split of the mandibular nerve may be of unequal sizes.1,2 Regardless of the frequency of identifying bifid canals, various authors have identified the surgical risks and complications that may be experienced when they are encountered, including an inability to obtain profound anesthesia using a local anesthetic.5-9 The Journal of Implant & Advanced Clinical Dentistry • 79 Winter et al Figure 4: The majority of the bifid canals (85%) ended posterior to the mental foramen, while percent terminated at the mental foramen, and 6% extended anterior the mental foramen In order to achieve standardization and consistency, the authors agreed as to what constitutes a bifid canal as identified on the 3D image: any branch that appeared as a continuous radiolucent canal extending from the inferior alveolar nerve All slices were 1mm in thickness and all bifid canals were viewed and appeared to emanate from the IAN in three planes: axial, coronal, and sagittal Once the parameters were defined, one researcher (YK) examined and identified all of the bifid canals noted in this study, which 80 • Vol 1, No • November 2009 were then verified by a second author (AW) The significance of the findings in this study matters relative to the size and location of the bifid canals, and what clinical procedure is anticipated Concerning operative dentistry, it has been postulated that bifid nerves may explain why anesthesia is not as profound as it should be when employing a local anesthetic When encountered, infiltration of the local anesthetic to anesthetize these extra branches of the IAN may help achieve greater local anes- Winter et al Figure 5: Arrow indicates a small bifid canal that starts and ends distal to tooth #31 A larger canal can be seen anterior to tooth #18 Figure 6: The left bifid canal is highlighted in red, illustrating bifid canals thesia When planning implant surgery, it is helpful to identify if any bifid canals exist in the surgical site Encountering these extra canals may not only contribute to unwanted local paresthesias, but may also explain unusual bleeding that emanates from the alveolar bone.10-11 Figures and illustrate an example of multiple canals as they were identified in this study While the widest branch, which is anterior to tooth #18, is evident on the panoramic slice, smaller canals are highlighted in Figure Note the arrow in Figure that highlights a bifid canal Careful inspection will note additional canals emanating from the right IAN Mention must be made of the value of 3D images identifying normal and abnormal structures when compared to 2D images Figure is a panoramic image (formatted in a 15 mm trough) taken on a patient that was referred to the CT lab after an implant was inserted that resulted in paresthesia in the patient Figure highlights a bifid branch of the IAN The Journal of Implant & Advanced Clinical Dentistry • 81 Winter et al Figure 7: Patient presented after an implanted was inserted in the #30 site resulting in paresthesia Figure 8: A bifid nerve rises from the IAN and was traumatized by the implant insertion that was traumatized by an implant This aberrant branch was not evident in the panoramic view due to the dense cortical bone Traditional 2D imaging, both panoramic and periapical film, is limited in revealing key anatomic structures that are obscured by thick buccal and/or lingual bone In this example, using 3D imaging prior to 82 • Vol 1, No • November 2009 implant insertion would have identified the bifid (aberrant) branch and altered the surgical site COnCLuSIOn The incidence of bifid mandibular canals (37%) from the current study was greater than that Winter et al reported in other studies Presurgical identification of bifid canals reduces risk of damage to vital structures and may explain difficulty in obtaining local anesthesia in certain situations ● Correspondence: Dr Alan Winter a.winter@i-dontics.com Disclosure: Support for this study was generously given by NobelBiocare, Mahwah, NJ and Imaging Sciences Inc., Hatfield, PA References: Mardini S, Gohel A Exploring the Mandibular Canal in Dimensions An Overview of Frequently Encountered Variations in Canal Anatomy AADMRT Newsletter, Fall 2008 Jacobs R, Mraiwa N, vanSteenberghe D, Gijbels F, Quirynen M Appearance, location, course, and morphology of the mandibular incisive canal: an assessment on spiral CT scan Dentomaxillofacial Radiology 2002; 31:322-327 Langlais RP, Broadus R, Glass B Bifid mandibular canals in panoramic radiographs J Am Dent Assoc 1985; 110:923-926 Sanchis JM, Penarrocha M, Soler F Bifid mandibular canal J Oral Maxillofac Surg 2003; 61:422–424 Rouas P, Nancy J, Bar D Identification of double mandibular canals: literature review and three case reports with CT scans and cone beam CT Dentomaxillofacial Radiology 2007; 36:34-38 Naitoh M, Hiraiwa Y, Aimiya H, Gotoh M, Ariji Y, Izumi M, Kurita K, Ariji E Bifid Mandibular Canal in Japanese Clinical Science and Techniques Implant Dentistry 2007; 16:24-32 Claeys V, Wackens G Bifid mandibular canal: Literature review and case report Dentomaxillofacial Radiology 2005; 34:55-58 Auluck A, Ahsan A, Pai KM, Shetty C Anatomical variations in developing mandibular nerve canal: A report of three cases Neuroanatomy 2005; 4:28–30 Dario LJ Implant placement above a bifurcated mandibular canal: A case report Implant Dent 2002; 11:258-261 10 Auluck A, Ahsan A, Pai KM, Mupparapu M Multiple mandibular nerve canals: Radiographic observations and clinical relevance Report of cases Quintessence International 2007; 38:781-787 11 Winter AA Bleeding from a Nutrient Canal: A Case Report NY State Dent J 1980; 46:646 The Journal of Implant & Advanced Clinical Dentistry ATTENTION PROSPECTIVE AUTHORS JIACD wants to publish your 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For complete details regarding publication in JIACD, please refer to our author guidelines at the following link: http://www.jiacd.com/ authorinfo/ author-guidelines.pdf or email us at: editors@jicad.com The Journal of Implant & Advanced Clinical Dentistry • 83 Gonshor et al tion a r a p e Pr Highest torque of any micro motor on the market Widest speed range on the market Compatible will all contra-angles cutting for preservation of soft tissue Selective Accurate irrigation for prevention of bone overheating Handpiece does not overheat and is vibration free Carbon fiber tips for safe maintenance of implants coated and bladed curette tips for perio treatments Diamond Color coding system for easy tip and power selection 124 Gaither Drive, Suite 140 Mount Laurel, NJ 08054 Tel: (800) 289-6367 Fax: (856) 222-4726 info@us.acteongroup.com acteongroup.com ... encountered in implant dentistry To learn more about MIS visit our website at: misimplants.com or call us: 866-797-1333 (toll free) Order 10 implants of your choice and get a Free CPS Kit with each implant. .. Critical hemorrhage in the floor of the mouth during implant placement in the first mandibular premolar position: A case report Implant Dent 2005; 14(2): 117 -24 18 Evans I, Sayers M, Gibbons A, Price... Plate after Immediate Implant Placement/Function with the Flapless Approach: A Case Report Arthur B Novaes Jr., Rafael R de Oliveira, Valdir A Muglia 69 Subperiosteal Dental Implants: A 25 Year