Nha khoa cấy ghép Implant đã phát triển vượt bậc trong ba thập kỷ qua và đang nhanh chóng tiến bộ khi các vật liệu và quy trình mới ra đời. Mặc dù vật liệu sinh học và các hướng dẫn lâm sàng từng được cho là sẽ thay đổi sau mỗi 3 đến 5 năm, nhưng những tiến bộ mới hiện đang được đưa vào lĩnh vực của chúng tôi hàng năm. Ngày nay, nha khoa cấy ghép implant có lẽ là chuyên ngành được nghiên cứu rộng rãi nhất trong lĩnh vực của chúng tôi và nhiệm vụ của các bác sĩ là phải cập nhật các xu hướng và quy trình hiện hành. Với số lượng tiến bộ được thực hiện trong phương tiện truyền thông và tiếp thị dựa trên kỹ thuật số, bác sĩ lâm sàng bắt buộc phải có khả năng tách các xu hướng mới khỏi các giao thức dựa trên bằng chứng. Không nghi ngờ gì khi mục tiêu của mọi bác sĩ lâm sàng là mỗi bệnh nhân được điều trị với kết quả tốt nhất có thể trong tâm trí. Do đó, chúng ta nên cố gắng thực hiện các quyết định dựa trên bằng chứng hợp lý dựa trên các tài liệu hiện có để cho phép chúng ta đưa ra các lựa chọn đúng đắn và có thể dự đoán được. Mục tiêu của cuốn sách này là chia sẻ kinh nghiệm lâm sàng của tôi, cả thành công và thất bại, với các đồng nghiệp của tôi để tạo điều kiện học tập thông qua các trường hợp được ghi lại mà tôi đã thực hiện trong hơn 35 năm qua. Để thực hiện điều này, cuốn sách giáo khoa này đã được tách thành sáu chương cốt lõi. Mỗi ca lâm sàng được bổ sung với các ghi chú cá nhân được in nghiêng mô tả kinh nghiệm học được từ từng ca, các thủ thuật lâm sàng và ngọc trai từ ca đó, các ghi chú kỹ thuật hướng tới việc tạo điều kiện cho người đọc khả năng lâm sàng thực hiện các ca kỹ thuật tương tự, cũng như phân tích chuyên sâu và đánh giá quan trọng về cách tôi sẽ thực hiện từng trường hợp hôm nay (nhiều trường hợp đã được thực hiện hơn 10 năm trước). Hai chương dành riêng cho vật liệu sinh học và dụng cụ được sử dụng cho các quy trình nâng xương và tạo cơ sở cho vật liệu sinh học và dụng cụ phẫu thuật được sử dụng trong suốt các chương phẫu thuật. Rõ ràng là số lượng thay đổi được thực hiện trong thiết kế vật liệu thiết bị đo đạc đã tạo điều kiện (và trong nhiều trường hợp được cải thiện) khả năng thực hiện các thủ thuật phẫu thuật của các bác sĩ lâm sàng. Song song với điều này và không kém phần quan trọng, rất nhiều tiến bộ đã được thực hiện trong khoa học vật liệu sinh học. Trong khi vật liệu sinh học từng được coi là vật liệu cấu trúc thụ động nhằm lấp đầy các khoảng trống, ngày nay chúng hoạt động như các phân tử hoạt tính sinh học chịu trách nhiệm kích thích nhanh chóng tái tạo mô mới. Chương 2 trình bày về màng chắn, vật liệu ghép xương, cũng như các yếu tố tăng trưởng được sử dụng cho các quy trình nâng xương và mô tả nền tảng sinh học và ứng dụng lâm sàng của chúng trong nha khoa cấy ghép. Chương 3 là chương phẫu thuật đầu tiên và dành riêng cho việc quản lý ổ chiết. Tổng quan ngắn gọn về những thay đổi kích thước xảy ra sau đoạn văn được trình bày và sau đó sẽ đề cập đến các hướng dẫn lâm sàng với các quy trình từng bước. Thảo luận về việc sử dụng các vật liệu sinh học khác nhau và khả năng giảm thiểu sự thay đổi kích thước của chúng sau khi tiếp nhận ở cả khu vực thẩm mỹ và không gây mê được đưa ra. Hơn nữa, các quy trình bảo tồn sườn núi trong trường hợp không có đĩa đệm ngôn ngữ được bao gồm cũng như giới thiệu về khái niệm và chỉ định lâm sàng cho liệu pháp SOCKET SHIELD”. Chương 4 bao gồm chủ đề về sự tăng sinh của phế nang. Các chỉ định cụ thể và mô tả các tiêu chí lựa chọn bệnh nhân, quy trình phẫu thuật từng bước và các khía cạnh của điều trị sau phẫu thuật được trình bày. Chương này cũng bao gồm thông tin cơ bản về tái tạo xương có hướng dẫn, các kỹ thuật lấy xương trong khoang, các quy trình nâng cao xương sống theo chiều ngang và dọc ở các vùng sau và trước hàm trên hàm dưới, kỹ thuật tách xương sống và tạo hình tiền đình. Nhiều phức tạp phải đối mặt trong bất kỳ quy trình nào nêu trên cũng được thảo luận với các giải pháp cho những khó khăn như vậy. Chương 5 tập trung vào ghép xoang. Đầu tiên, lịch sử ghép xoang được trình bày tổng quan về những cân nhắc giải phẫu. Đánh giá lâm sàng và chụp X quang sau đó được xem xét với thảo luận chi tiết về giao thức cửa sổ bên so với giao thức crestal được sử dụng cho các chỉ định lâm sàng cụ thể. Phần nhấn mạnh trong chương này bao gồm thiết bị đo để ghép xoang, thiết kế đường rạch và quản lý vạt, lựa chọn và đặt mảnh ghép, sử dụng công nghệ thông khí hóa, cũng như các quy trình để sửa chữa màng xoang. Cả hai quy trình một giai đoạn và hai giai đoạn đều được thảo luận với các trường hợp được chỉ định cho các cung răng một hàm, nhiều răng và toàn hàm. Phần cuối cùng của chương này trình bày nhiều biến chứng tiềm ẩn phải đối mặt trong quá trình ghép xoang và cách giải quyết của chúng. Cuối cùng, chương 6 bao gồm việc tái thiết toàn bộ vòm bằng cách sử dụng các giao thức chuyển đổi thông thường và các giao thức tái tạo ngay lập tức được hướng dẫn đầy đủ mới hơn theo cách chi tiết từng bước bằng cách sử dụng công nghệ được cấp bằng sáng chế nSequence. Tôi hy vọng rằng thông qua nhiều trường hợp được trình bày trong cuốn sách này, các bác sĩ lâm sàng sẽ có thể thực hiện tốt hơn các quyết định lâm sàng dựa trên bằng chứng dẫn đến kết quả nâng xương có thể dự đoán được và thành công lâu dài. Chúng ta đang sống trong thời đại mà thông tin có thể được thu thập thông qua mạng xã hội với tốc độ ngày càng cao. Các bác sĩ lâm sàng hiện có thể tự do đăng các trường hợp trực tiếp lên mạng xã hội sau khi phẫu thuật và nhận được phản hồi gần như trực tiếp về công việc của họ. Điều này cung cấp cho bác sĩ lâm sàng và người đọc những phản hồi trực tiếp đối với công việc phẫu thuật của họ; tuy nhiên, với số lượng các kỹ thuật và giao thức mới được sử dụng và quảng bá trực tuyến, vẫn khó để đánh giá và phê bình một cách khoa học nhiều giao thức mới hơn này nếu không có sự theo dõi lâu dài. Đã làm nha khoa cấy ghép implant hơn 35 năm, tôi coi thời gian theo dõi 1 năm, 5 năm và 10 năm là vô cùng quan trọng. Cuốn sách này tập trung hoàn toàn vào các quy trình đã được phát triển trong nhiều năm với những theo dõi lâu dài đã được thiết lập để cung cấp cho người đọc một tập hợp các hướng dẫn và nguyên tắc phẫu thuật với các kết quả dài hạn có thể dự đoán được. Hơn nữa, một loạt video trực tuyến có sẵn tại www.pikosonline.com sẽ bổ sung cho cuốn sách để hướng dẫn thêm cho bác sĩ lâm sàng các biểu diễn phẫu thuật được cung cấp trong thư viện giảng dạy trực tuyến của chúng tôi. Tôi thực sự hy vọng rằng những video này kết hợp với nội dung của cuốn sách này sẽ mang lại trải nghiệm học tập thú vị và tôi mong nhận được phản hồi trong tương lai của bạn.
Bone PIKOS ISBN 978-0-86715-825-0 90000> 780867 158250 Pikos Cover-AsiaPacific.indd BONE AUGMENTATION IN IMPLANT DENTISTRY Sinus Augmentation | MICHAEL A PIKOS received his DDS from The Ohio State University College of Dentistry, after which he completed an internship at Miami Valley Hospital and residency training in Oral & Maxillofacial Surgery at the University of Pittsburgh Montefiore Hospital He is a Diplomate of the American Board of Oral and Maxillofacial Surgery, the American Board of Oral Implantology/Implant Dentistry, and the International Congress of Oral Implantologists and a Fellow of the American College of Dentists He is also an adjunct assistant professor in the Department of Oral & Maxillofacial Surgery at The Ohio State University College of Dentistry and Nova Southeastern University College of Dental Medicine Dr Pikos is on the editorial boards of several journals and is a well-published author who has lectured extensively on dental implants in North and South America, Europe, Asia, and the Middle East He is the founder and CEO of the Pikos Institute Since 1990, he has been teaching advanced bone and soft tissue grafting courses with alumni that now number more than 3,400 from all 50 states and 43 countries Dr Pikos maintains a private practice limited exclusively to implant surgery in Trinity, Florida (www.pikosinstitute.com) Augmentation Graft Window IN Implant Dentistry MICHAEL A PIKOS, dds with Richard J Miron, dds, msc, phd Extraction Site A Step-by-Step Guide to Predictable Alveolar Ridge and Sinus Grafting 5/31/19 12:12 PM Bone Augmentation in Implant Dentistry: A Step-by-Step Guide to Predictable Alveolar Ridge and Sinus Grafting www.ajlobby.com Pikos_FM.indd 5/31/19 11:33 AM www.ajlobby.com Pikos_FM.indd 5/31/19 11:33 AM Bone Augmentation IN Implant Dentistry MICHAEL A PIKOS, dds Founder and CEO Pikos Institute Private Practice Trinity, Florida with RICHARD J MIRON, dds, msc, phd Group Leader, The Miron Research Lab Lead Educator, Advanced PRF Education Venice, Florida A Step-by-Step Guide to Predictable Alveolar Ridge and Sinus Grafting Berlin, Barcelona, Chicago, Istanbul, London, Mexico City, Milan, Moscow, Paris, Prague, São Paulo, Seoul, Tokyo, Warsaw www.ajlobby.com Pikos_FM.indd 5/31/19 11:33 AM Library of Congress Cataloging-in-Publication Data Names: Pikos, Michael A., author | Miron, Richard J (Richard John), 1983author Title: Bone augmentation in implant dentistry / Michael A Pikos and Richard J Miron Description: Batavia, IL : Quintessence Publishing Co Inc, [2019] | Includes bibliographical references and index Identifiers: LCCN 2019005043 | ISBN 9780867158250 (hardcover) Subjects: | MESH: Alveolar Ridge Augmentation methods | Bone Regeneration | Bone Transplantation | Dental Implantation methods Classification: LCC RK667.I45 | NLM WU 640 | DDC 617.6/93 dc23 LC record available at https://lccn.loc.gov/2019005043 97% ©2019 Quintessence Publishing Co, Inc Quintessence Publishing Co Inc 411 N Raddant Rd Batavia, IL 60510 www.quintpub.com All rights reserved.This book or any part thereof may not be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, or otherwise, without prior written permission of the publisher Editor: Leah Huffman Design: Sue Zubek Production: Angelina Schmelter Printed in China www.ajlobby.com Pikos_FM.indd 5/31/19 11:33 AM Contents Preface vi INSTRUMENTATION FOR ALVEOLAR RIDGE AUGMENTATION AND SINUS GRAFTING MEMBRANES, GRAFTING MATERIALS, AND GROWTH FACTORS 11 EXTRACTION SITE MANAGEMENT 41 ALVEOLAR RIDGE AUGMENTATION 95 SINUS GRAFTING 169 GUIDED FULL-ARCH IMMEDIATE-FUNCTION TREATMENT MODALITY FOR THE EDENTULOUS AND TERMINAL-DENTITION PATIENT 235 Index 258 www.ajlobby.com Pikos_FM.indd 5/31/19 11:33 AM 6:Guided Full-Arch Immediate-Function Treatment Modality for the Edentulous and Terminal-Dentition Patient Preface Implant dentistry has evolved tremendously over the past three decades and is rapidly progressing as new materials and protocols become available While biomaterials and clinical guidelines were once believed to turn over every to years, new advancements are now being brought to our field every year Today, implant dentistry is perhaps the most widely researched discipline in our field and mandates that clinicians stay updated on current trends and protocols With the number of advancements made in digitally based media and marketing, it is imperative that the clinician be able to separate new trends from evidence-based protocols It is without question that the goal of every clinician is that each patient be treated with the best possible outcome in mind As such, we should strive to implement rational evidence-based decisions grounded on available literature to allow us to make sound and predictable choices.The goal of this textbook is to share my clinical experiences, both successes and failures, with my colleagues to facilitate learning through documented cases that I have performed over the past 35+ years To accomplish this, this textbook has been separated into six core chapters Each clinical case is supplemented with italicized personal notes describing learned experiences from each case, clinical tips and pearls from that case, technical notes geared toward facilitating the reader’s clinical ability to perform similar cases/techniques, as well as in-depth analysis and critical evaluation on how I would perform each case today (many of the cases were performed 10+ years ago).Two chapters are dedicated to biomaterials and instruments utilized for bone augmentation protocols and form the basis for the biomaterials and surgical instrumentation utilized throughout the surgical chapters It is clear that the number of changes made in material design/instrumentation has facilitated (and in many cases improved) the ability of clinicians to perform surgical procedures Parallel to this and equally as important, a great deal of advancement has been made in biomaterial sciences While biomaterials were once considered to act as a passive structural material aimed at filling voids, today they act as bioactive molecules responsible for rapidly stimulating new tissue regeneration Chapter presents barrier membranes, bone grafting materials, as well as growth factors utilized for bone augmentation procedures and describes their biologic background and clinical use in implant dentistry Chapter is the first surgical chapter and is dedicated to extraction socket management A brief overview of dimensional changes occurring postextraction is presented, and thereafter clinical guidelines with step-by-step protocols are covered Discussion of the use of various biomaterials and their ability to minimize dimensional changes postextraction in both the esthetic and nonesthetic zones is provided Furthermore, protocols for ridge preservation in the absence of buccal/lingual plates are included as well as an introduction to the concept and clinical indication for “socket shield” therapy Chapter covers the topic of alveolar ridge augmentation Specific indications and a description of patient selection criteria, step-by-step surgical procedures, and aspects of postoperative treatment are presented This chapter also includes background information on guided bone regeneration, intraoral bone harvesting techniques, horizontal and vertical alveolar ridge augmentation procedures in maxillary/mandibular posterior and anterior regions, ridge split techniques, and vestibuloplasty The numerous complications faced during any of the above-mentioned procedures are also discussed with solutions to such encounters Chapter focuses on sinus grafting First, the history of sinus grafting is presented with an overview of anatomical considerations Clinical and radiographic assessment is then considered with detailed discussion of the lateral window versus crestal protocol utilized for specific clinical indications Emphasis in this chapter includes instrumentation for sinus grafting, incision design and flap management, graft selection and placement, the use of osseodensification technology, as well as protocols for sinus membrane repair Both one- and two-stage protocols are discussed with cases shown for single-tooth, multiple-tooth, and fully edentulous arches The final section of this chapter covers numerous potential complications faced during sinus grafting and their resolution vi www.ajlobby.com Pikos_FM.indd 5/31/19 11:33 AM Guided Full-Arch Immediate-Function Treatment Modality For the Edentulous and Terminal-Dentition Patient 235 Lastly, chapter covers full-arch reconstruction utilizing conventional conversion protocols and newer fully guided immediate-reconstruction protocols in a detailed step-bystep manner utilizing the nSequence patented technology My hope is that through the numerous cases presented throughout this textbook, clinicians will be better able to implement evidence-based clinical decisions that will lead to predictable bone augmentation results and long-term success.We live in an age where information can be obtained through social media at an ever-increasing speed Clinicians are now free to post cases directly to social media following surgery and obtain nearly live feedback on their work This provides the clinician and reader with direct responses to their surgical work; however, with the number of new techniques and protocols being utilized and promoted online, it remains difficult to assess and scientifically critique many of these newer protocols without proper long-term follow-up Having practiced implant dentistry for more than 35 years, I consider follow-up times of year, years, and 10 years to be immeasurably important This book focuses exclusively on the protocols that have been developed over numerous years with established long-term follow-ups to provide the reader with a set of surgical guidelines and principles with predictable long-term documented outcomes Furthermore, an online video series available at www.pikosonline.com will supplement the book to further guide the clinician with surgical demonstrations provided within our online teaching library I sincerely hope that these videos in conjunction with the content of this book will provide an enjoyable learning experience, and I look forward to your future feedback Acknowledgments My fellow clinicians and staff whom I have had the honor of working with during my 36 years of private practice The thousands of clinicians whom I have had the honor and privilege to meet both at my Institute and from main podium lectures throughout the world The thousands of patients for entrusting me with their implant surgical care over all these years Rick Miron, an awesome, highly intelligent, yet so humble colleague and friend without whose help this book would definitely not be possible The entire team at Quintessence Publishing, including Leah Huffman (Senior Editor), Angelina Schmelter (Digital & Print Production Specialist), Bryn Grisham (Director of Book Publications), and especially William Hartman (ExecutiveVice President & Director).This book certainly has been improved many times over, and I thank each of you for your dedication, patience, and helpfulness leading to its completion And Almighty God for blessing me with a profession that I have had such great passion for, and more importantly for giving me the skill sets necessary to help transform people’s lives on a daily basis Although the acknowledgments are typically found in the first pages of a book, they are usually the last piece to be written And for good reason, as they allow the author to reflect on those individuals who have contributed in one way or another to its completion For the development and production of this book, I owe a deep sense of gratitude to the following people: My incredible and selfless wife Diane, daughter Lindsey, and son Tony for sacrificing our time together and for their unconditional love, support, and encouragement during all these years My beloved mother Mary, and to the joyous memory of my father Anthony, both of whom provided for me a sound spiritual-based and loving environment with solid core values from which to grow The many teachers and mentors who have so impacted my life and career, with special thanks to Carl Misch, Tom Golec, Leonard Linkow, Hilt Tatum, P.D Miller, and Pat Allen My Institute team—Alison Thiede, Kali Kampmann, Mark Robinson, and Roger Hemond—for their unconditional commitment to excellence vii www.ajlobby.com Pikos_FM.indd 5/31/19 11:33 AM chapter Instrumentation for Alveolar Ridge Augmentation and Sinus Grafting www.ajlobby.com Pikos_CH01.indd 5/31/19 11:35 AM T he use of various instruments for alveolar bone augmentation and sinus grafting has played a pivotal role in modern regenerative dentistry Many tools such as cone beam computed tomography (CBCT) have greatly improved the clinician’s ability to diagnose and treatment plan cases with optimal accuracy and predictability in implant dentistry Other devices such as Osstell’s implant stability quotient (ISQ) tool can be utilized to accurately monitor implant stability over time Furthermore, radiofrequency, Piezosurgery (Mectron), and osseodensification (OD) burs have greatly improved surgical outcomes for the clinician This chapter provides an overview of the various instruments most frequently utilized by the author on a daily basis within his private practice and institute Furthermore, a brief overview of their technologies and uses in alveolar ridge augmentation and sinus grafting is presented a Fig 1-1 (a) CBCT imaging system (Carestream [CS] 9600) (b) Notice the capability to create 3D reconstructions of bone and teeth with excellent resolution CBCT In the last decade, the use of 3D CBCT has dramatically increased.1,2 When computed tomography was first introduced (mainly in implantology), its use was limited to a small number of specialists, due primarily to its limited indications, high costs, and elevated dose of radiation In the late 1990s, a new technology using a “cone beam” and a reciprocating detector, which rotates around the patient 360 degrees, entered the dental implant field, making high-definition 3D scans easily accessible to dentists and their patients By 2005, I began utilizing CBCT technology in my own private practice and teaching institution Because my practice has been limited to implant reconstruction for the past 25 years, I require ALL of my patients to have a CBCT scan, as this 3D technology plays an integral role in overall diagnosis and treatment planning CBCT has seen widespread use in all fields of dentistry, including implantology, oral surgery, endodontics, and orthodontics.1,2 One of the major breakthroughs in CBCT technology was the ability to use significantly smaller doses of radiation when compared to conventional films.1,2 The establishment of sensitive radiographic techniques for assessing b dentoalveolar structures led to its more frequent use owing to its higher safety standards Today, all patients within my practice requiring implant dentistry or bone augmentation procedures must have a CBCT image taken prior to implant therapy, bone augmentation, or sinus augmentation in order to fully characterize anatomical features/abnormalities and diagnose potential pathology Furthermore, the use of CBCT for postgraft evaluation prior to implant placement has become routine Carestream Dental provides a high-quality CBCT system with state-of-the-art features3 (Fig 1-1) Advantages of the www.ajlobby.com Pikos_CH01.indd 5/31/19 11:35 AM Digital Dentistry Bone foundation guide Monostrut index a b Fastener pins c d e f g h Fig 6-6 Fully guided full-arch immediate implant reconstruction with nSequence prosthetic protocol (a) Placement of bone foundation guide with monostrut index (b) Verification of proper bone foundation guide placement with bite index prior to osteotomies for pin fixation (c) Securing of bone foundation guide in place with pin fixation (d to f) Removal of monostrut fastener pins and monostrut index (g to i) Bone reduction with large round fissure bur This is done level with the bone foundation guide Rongeurs are used to harvest bone initially for use in grafting residual extraction sites and defects, followed by a large round bur i 251 Pikos_CH06.indd 251 5/31/19 2:30 PM 6:Guided Full-Arch Immediate-Function Treatment Modality for the Edentulous and Terminal-Dentition Patient Surgical guide k j Master cylinder l m n o Index line p Dimple q Fig 6-6 (cont) (j and k) Placement of surgical guide with fastener pins (l) Placement of appropriate keys into master cylinders at each implant site for sequential drill use/osteotomy preparation and implant placement (m) Creation of implant osteotomies using drill and key placement via master cylinders at each implant site (n) Implant placement through master cylinders at each implant site (o and p) Implant placement is completed when the base of the implant mount engages the surgical guide Depending on the implant system used, either a flat surface of the mount or dimple will need to be aligned with the blue line designated on the surgical guide (q) Removal of implant mounts 252 Pikos_CH06.indd 252 5/31/19 2:30 PM Digital Dentistry r s t u v w Carrier center Screw hole Index line x y z aa Fig 6-6 (cont) (r to t) Disarticulation/removal of surgical guide (u and v) Use of curette and no bur to burnish and remove bone that obscures abutment access to implant platforms (w and x) Placement of multiunit abutments (y) Rotation of distal-angled multiunit abutments so that the carrier center and screw hole are aligned with the rotational index line on the bone foundation guide to verify accurate multiunit abutment placement (z and aa) Placement of nonengaging copings 253 Pikos_CH06.indd 253 5/31/19 2:30 PM 6:Guided Full-Arch Immediate-Function Treatment Modality for the Edentulous and Terminal-Dentition Patient Flat sides oriented facially Flat sides oriented facially bb cc dd ee ff gg hh ii Fig 6-6 (cont) (bb and cc) Rotation of copings to orient the flat side to be positioned facially Note: Copings are screw retained with finger pressure (dd) Placement of gasket (ee) Insertion of block-out straws into copings (ff) Placement of maxillary hybrid prosthesis (gg) Injection of luting material into ports and channels followed by light curing and removal of block-out straws (hh) Removal of coping screws and hybrid prosthesis for additional luting and refinement (ii) Removal of gasket (jj) Removal of fixation pins jj 254 Pikos_CH06.indd 254 5/31/19 2:30 PM Conclusion kk ll mm nn Fig 6-6 (cont) (kk and ll) Removal of bone foundation guide (mm) Final bone reduction done with large fissure bur followed by extraction site and residual defect grafting around multiunit abutments Soft tissue closure is then accomplished with resorbable sutures (nn) Placement of hybrid prosthesis with screw fixation (Courtesy of Roger Hemond.) Conclusion Over the past 10 years, the nSequence Guided Prosthetics fully guided system for both edentulous and terminaldentition patients, along with a comprehensive clinical and CBCT-based evaluation, has proven to be a more effective, efficient, and predictable protocol to provide full-arch immediate fixed restorations compared to conventional denture conversion techniques Patient selection, accurate records, and detailed virtual planning are of paramount importance in utilizing this system In total, four base patient appointments are needed from scan to delivery of the final prosthesis: Record taking Surgery and provisionalization with clear duplicate protocol Wax try-ins on titanium milled bars Final delivery of the definitive full-arch implant-retained prosthesis Clinical excellence in dental practice is the result of a sequence of simple repetitive steps performed precisely and sequentially in every patient case As such, the goal for any new technologic and procedural integration in clinical dental implant practice should be to reduce multiple therapeutic modalities to a series of precise reproducible steps that ensure consistency and predictability of the patient’s surgical and prosthetic treatment plan This guided protocol is the practical manifestation of this goal, resulting in a seamless integration of multiple digital diagnostic, surgical, prosthetic, and laboratory modalities to achieve a predictable and consistent reverse-engineered fully guided surgery and immediate full-arch fixed prosthetic result The many advantages of this fully guided protocol over the conventional conversion approach are listed in Box 6-1 255 Pikos_CH06.indd 255 5/31/19 2:30 PM 6:Guided Full-Arch Immediate-Function Treatment Modality for the Edentulous and Terminal-Dentition Patient Box 6-1 Advantages of a fully guided approach over a conventional conversion approach Denture conversion (2D freehand) 2D planning and radiography for immediate denture Suboptimal interdisciplinary treatment planning (restorative, surgical, laboratory) More patient appointments (8–14) More chair time (3–5 hours per arch) Nonreinforced conventional immediate horseshoe denture Less predictable and less patient specific Suboptimal documentation (legal) References Douglass CW, Shih A, Ostry L Will there be a need for complete dentures in the United States in 2020? J Prosthet Dent 2002;87:5–8 Locker D Measuring oral health:A conceptual framework Community Dent Health 1988;5:3–18 Allen PF, McMillan AS A review of the functional and psychosocial outcomes of edentulousness treated with complete replacement dentures J Can Dent Assoc 2003;69:662 Heath MR The effect of maximum biting force and bone loss upon masticatory function and dietary selection of the elderly Int Dent J 1982;32:345–356 Turkyilmaz I, Company AM, McGlumphy EA Should edentulous patients be constrained to removable complete dentures? The use of dental implants to improve the quality of life for edentulous patients Gerodontology 2010;27:3–10 Awad MA, Lund JP, Dufresne E, Feine JS Comparing the efficacy of mandibular implant-retained overdentures and conventional dentures among middle-aged edentulous patients: Satisfaction and functional assessment Int J Prosthodont 2003;16:117–122 Awad MA, Lund JP, Shapiro SH, et al Oral health status and treatment satisfaction with mandibular implant overdentures and conventional dentures:A randomized clinical trial in a senior population Int J Prosthodont 2003;16:390–396 Ioannidou E, Doufexi A Does loading time affect implant survival? A meta-analysis of 1,266 implants J Periodontol 2005;76:1252–1258 Maló P, de Araujo Nobre M, Rangert B Implants placed in immediate function in periodontally compromised sites:A five-year retrospective and one-year prospective study J Prosthet Dent 2007;97(6 suppl):S86–S95 10 Khatami AH, Smith CR “All‐on‐Four” immediate function concept and clinical report of treatment of an edentulous mandible with a fixed complete denture and milled titanium framework J Prosthodont 2008;17:47–51 11 Bellini CM, Romeo D, Galbusera F, et al Comparison of tilted versus nontilted implant-supported prosthetic designs for the restoration of the edentuous mandible: A biomechanical study Int J Oral Maxillofac Implants 2009;24:511–517 12 Del Fabbro M, Bellini CM, Romeo D, Francetti L Tilted implants for the rehabilitation of edentulous jaws: A systematic review Clin Implant Dent Relat Res 2012;14:612–621 13 Nkenke E, Fenner M Indications for immediate loading of implants and implant success Clin Oral Implants Res 2006;17(suppl 2):19–34 Computer-guided (3D preplanned) 3D precision planning and virtual workup Optimal interdisciplinary treatment planning (collaborative accountability) Fewer patient appointments (4–7) Less chair time (1.5–3 hours per arch) Stronger material: Titanium-reinforced PMMA Predictable, patient specific, and affordable Excellent professional documentation (medical, legal) 14 Esposito M, Grusovin MG, Maghaireh H, Worthington HV Interventions for replacing missing teeth: Different times for loading dental implants Cochrane Database Syst Rev 2013;3:CD003878 15 Sennerby L, Gottlow J Clinical outcomes of immediate/early loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008;53(suppl 1):82S–88S 16 Schnitman PA, Wöhrle PS, Rubenstein JE, DaSilva JD, Wang NH Ten-year results for Brånemark implants immediately loaded with fixed prostheses at implant placement Int J Oral Maxillofac Implants 1997;12:495–503 17 Ericsson I, Randow K, Nilner K, Peterson A Early functional loading of Brånemark dental implants: 5‐year clinical follow‐up study Clin Implant Dent Relat Res 2000;2:70–77 18 Maló P, Rangert B, Nobre M “All‐on‐Four” immediate‐function concept with Brånemark System implants for completely edentulous mandibles: A retrospective clinical study Clin Implant Dent Relat Res 2003;5(suppl 1):2–9 19 Maló P, Rangert B, Nobre M All‐on‐4 immediate‐function concept with Brånemark System implants for completely edentulous maxillae: A 1‐year retrospective clinical study Clin Implant Dent Relat Res 2005;7(suppl 1):88S–94S 20 Maló P, Nobre Mde A, Petersson U,Wigren S.A pilot study of complete edentulous rehabilitation with immediate function using a new implant design: Case series Clin Implant Dent Relat Res 2006;8:223–232 21 Maló P, de Araujo Nobre M, Lopes A The use of computer-guided flapless implant surgery and four implants placed in immediate function to support a fixed denture: Preliminary results after a mean follow-up period of thirteen months J Prosthet Dent 2007;97(6 suppl):26S–34S 22 Rosenfeld AL, Mandelaris GA, Tardieu PB Prosthetically directed implant placement using computer software to ensure precise placement and predictable prosthetic outcomes Part 1: Diagnostics, imaging, and collaborative accountability Int J Periodontics Restorative Dent 2006;26:215–221 23 Pikos MA, Mattia AH Implant surgery interventions In: Jokstad A (ed) Osseointegration and Dental Implants New York: John Wiley & Sons, 2009:197–204 24 Worthington P, Rubenstein J, Hatcher DC The role of cone-beam computed tomography in the planning and placement of implants J Am Dent Assoc 2010;141(suppl 3):19S–24S 25 Rosenfeld AL, Mandelaris GA, Tardieu PB Prosthetically directed implant placement using computer software to ensure precise placement and predictable prosthetic outcomes Part 3: Stereolithographic drilling guides that not require bone exposure and the immediate delivery of teeth Int J Periodontics Restorative Dent 2006;26:493–499 256 Pikos_CH06.indd 256 5/31/19 2:30 PM References 26 Vrielinck L, Politis C, Schepers S, Pauwels M, Naert I Image-based planning and clinical validation of zygoma and pterygoid implant placement in patients with severe bone atrophy using customized drill guides Preliminary results from a prospective clinical follow-up study Int J Oral Maxillofac Surg 2003;32:7–14 27 Sarment DP, Sukovic P, Clinthorne N Accuracy of implant placement with a stereolithographic surgical guide Int J Oral Maxillofac Implants 2003;18:571–577 28 Campelo LD, Camara JR Flapless implant surgery: A 10-year clinical retrospective analysis Int J Oral Maxillofac Implants 2002;17:271–276 29 Parrocha-Oltra D, Candel-Martí E, Ata-Ali J, Parrocha-Diago M Rehabilitation of the atrophic maxilla with tilted implants: Review of the literature J Oral Implantol 2013;39:625–632 30 Francetti L, Romeo D, Corbella S,Taschieri S, Del Fabbro M Bone level changes around axial and tilted implants in full-arch fixed immediate restorations Interim results of a prospective study Clin Implant Dent Relat Res 2012;14:646–654 31 Menini M, Signori A, Tealdo T, et al Tilted implants in the immediate loading rehabilitation of the maxilla: A systematic review J Dent Res 2012;91:821–827 32 Del Fabbro M, Bellini CM, Romeo D, Francetti L Tilted implants for the rehabilitation of edentulous jaws: A systematic review Clin Implant Dent Relat Res 2012;14:612–621 33 Weinstein R, Agliardi E, Fabbro MD, Romeo D, Francetti L Immediate rehabilitation of the extremely atrophic mandible with fixed full-prosthesis supported by four implants Clin Implant Dent Relat Res 2012;14:434–441 34 Hinze M, Thalmair T, Bolz W, Wachtel H Immediate loading of fixed provisional prostheses using four implants for the rehabilitation of the edentulous arch: A prospective clinical study Int J Oral Maxillofac Implants 2010;25:1011–1018 257 Pikos_CH06.indd 257 5/31/19 2:30 PM Index Page numbers followed by “f ” denote figures, “t” tables, and “b” boxes A Absorbable collagen sponge, 31, 59 Acellular dermal matrix, 115, 115f, 136f, 151f Acute sinusitis, 172 ADM See Acellular dermal matrix Age-related bone disorders, 26 Aliphatic polyesters, 16 Allergic rhinitis, 172 AlloDerm See Acellular dermal matrix Allografts barrier membranes with, 43 description of, 23, 24f, 41–43 freeze-dried bone alveolar socket preservation and regeneration using, 90 description of, 41, 47, 48f in extraction socket, 53f, 88f for maxillary sinus augmentation, 178f postextraction dimensional changes minimized using, 41–42 All-on-4 treatment concept, 237–238, 239f–242f, 251f Alloplasts, 24–25, 25f Alveolar ridge defects of, 98 expansion of, 143 extrabony defects of, 98 intrabony defects of, 98 postextraction changes in, 43 splitting of, 143, 144f–147f, 199f Alveolar ridge augmentation in anterior mandible, 131, 132f–133f in anterior maxilla, 138, 138f–142f antibiotics before, 96 autogenous bone block grafts advantages and disadvantages of, 114, 114b biotype of, 114, 115f decortication of, 103 description of, 95 5-mm rule for, 109, 109f harvesting of, 105f, 108–114, 110f–113f, 117, 118f illustration of, 105f–107f implant placement after incorporation of, 114, 114f incisions for, 102–103, 108t leukocyte platelet-rich fibrin at site of, 103 ramus buccal shelf harvesting of, 110f–113f, 110–114 recipient site management, 105f–107f soft tissue augmentation, 115, 116f symphysis harvesting of, 108t, 108–109 timing of, 108t bone graft classification, 97f, 97–98, 98b clot formation, 98–99 complications of block grafts, 155, 157f–160f dehiscence, 155, 157f–159f mandibular fracture, 155, 159f–160f rhBMP-2, 164, 165f titanium mesh particulate graft, 160, 161f–163f, 161t cone beam computed tomography in, 96–97, 97f, 135f contraindications for, 96 of edentulous maxilla, 148, 149f–150f Finger Sweep technique, 103, 104f guided bone regeneration in, 130f–131f history of, 95 horizontal description of, 103 in posterior mandible, 124, 125f surgical intervention recommendations for, 133t implant placement after, 114, 114f incisions for, 98, 99f instruments for, 1–9, 109 keys for, 98–102, 99f–102f medical history before, 96 medications in, 96 peri-implant bone loss, 152–153, 156f in posterior maxilla, 133, 134f–137f preoperative and postoperative medications in, 96 preoperative evaluation, 97, 97f presurgical workup for, 96 principles for, 98–102, 99f–102f soft tissue procedures for, 96 space creation for, 99, 100f success rates for, 95 techniques for, 95 titanium mesh particulate graft with rhBMP-2 for, 117–118, 118f–123f, 127, 134f–135f transosseous anchor suture technique in, 152, 153f–154f vertical, ramus buccal shelf block graft for, 126f vestibuloplasty after, 151, 151f Alveolar ridge preservation description of, 42–44 single-tooth diagnostic criteria for, 59f in esthetic zone, 59–78, 60f–78f mesiodistal tooth position, 60 in nonesthetic zone, 47–59, 48f–589f osseous crest position in, 61 258 Pikos_Index.indd 258 5/31/19 2:24 PM Index periodontium in, 60 relative tooth position in, 60 tooth shape, 60–61 Alveolectomy, 240f Amoxicillin, 96 Amoxicillin/clavulanic acid, 174b Anterior mandible alveolar ridge augmentation in, 131, 132f–133f guided bone regeneration in, 130f–131f Anterior maxilla, alveolar ridge augmentation in, 138, 138f–142f Antibiotics before alveolar ridge augmentation, 96 for sinus grafting, 174, 174b Autogenous bone grafts advantages and disadvantages of, 114, 114b for alveolar ridge augmentation See Alveolar ridge augmentation, autogenous bone block grafts bone formation rates for, 22f collectors for, 22f complications of, 155, 157f–160f contamination of, 230 exposure of, 157f extravasation of, 230 failure of, 158f–159f as gold standard, 20, 25 harvesting of, 20–23, 21f–22f, 117, 118f, 129f history of, 95 mandibular tori as source of, 114, 115f morbidity associated with, 155, 155t ramus buccal shelf harvesting of, 110f–113f, 110–114 smoking effects on, 96 techniques for, 117 B Barrier membranes with allografts, 43 biocompatibility of, 12 cell occlusivity of, 12 cellulose acetate, 11–12 degradability of, 12 development of, 11 expanded polytetrafluoroethylene, 11, 11f, 13t high-density polytetrafluoroethylene, 12, 13t, 14f, 17, 47f history of, 11f mechanical strength of, 12 natural biodegradable, 13t natural materials, 16–17 nonresorbable, 12, 13t overview of, 11 polytetrafluoroethylene, 11f, 11–12, 13t, 14 requirements of, 12–17 resorbable, 14–15, 15f, 43 space-making ability of, 12 summary of, 17 synthetic resorbable, 13t, 16 titanium mesh complications of, 160, 161f, 161t description of, 14, 14f–15f, 17, 99 palatal fixation with, 142f type crosslinked bovine collagen membrane, 15, 15f–17f, 200f Bipolar radiosurgery, 5, 5f Block grafting autogenous See Autogenous bone grafts instrument trays for, 2, 4f BMP-2 See Bone morphogenetic protein Bone augmentation See Alveolar ridge augmentation Bone block autogenous bone grafts from, 20, 21f See also Autogenous bone grafts Piezosurgery block for, 7f Bone graft materials allografts See Allografts alloplasts, 24–25, 25f annual expenditures on, 20 autogenous See Autogenous bone grafts biocompatibility of, 17 classification of, 17, 18f, 97f, 97–98, 98b data regarding, 17, 19t gold standard of, 20, 25 ideal properties of, 20 properties of, 20 regenerative capacities of, 17, 18f summary of, 25–26 surface topography of, 17, 19f xenografts, 24, 24f, 90 Bone loss consequences of, 236–237 postextraction, 43 Bone morphogenetic protein 2, 23, 30–31, 30f–31f, 41 Bone particles, autogenous bone from, 21f Bone resorption materials for minimizing, 41 patterns of, 42f Bone-added osteotome sinus floor elevation, 180, 181f Bony septa, 213, 213f Buccal bone, root membrane technique for, 87–88 Burs osseodensification See Osseodensification burs Versah, 7–8, 7f–8f C CBCT See Cone beam computed tomography CBIT See Crestal bone impacted trap technique CCARD See Cologne Classification of Alveolar Ridge Defects Cefpodoxime proxetil, 174b Cefuroxime axetil, 174b CEJ See Cementoenamel junction Cellulose acetate laboratory filter, 11 Cementoenamel junction, 60, 61f Chronic sinus disease, 228 Chronic sinusitis, 172, 208 Cigarette smoking See Smoking Ciliated columnar epithelial cells, 171 Clindamycin, 96 Collagen barrier membrane, 15, 15f–16f, 118, 119b, 122f, 217 CollaTape, 217 Cologne Classification of Alveolar Ridge Defects, 97, 98b Compaction autografting, 185 Cone beam computed tomography in alveolar ridge augmentation, 96–97, 97f, 135f description of, 1–2, 1f–2f 259 Pikos_Index.indd 259 5/31/19 2:24 PM Index donor site evaluations using, 155 for maxillary sinus augmentation, 173f, 208 for residual bone volume evaluations, 229 single-tooth alveolar ridge preservation applications of, 59 Congenitally missing maxillary lateral incisors, 138f–139f Connective tissue graft, 66f–71f, 71, 77f, 78 Cosci technique, 182 Crestal bone impacted trap technique, 182f–183f, 183 Crestal bone repositioned trap technique, 183, 183f Crosslinked collagen membrane, 15, 15f–17f, 209 CS 9600, 2, 2f, 3b D DBBM See Deproteinized bovine bone mineral Decongestants, 174 Dehiscence, graft, 155, 157f–159f Demineralized fresh-frozen bone, fresh-frozen bone versus, 23 Dentin grinder, 83f Deproteinized bovine bone mineral, 24, 24f Dexamethasone, 174 DFDBA See Demineralized fresh-frozen bone Digital dentistry digital records, 243 long-term provisional, 245 manufacturing, 243 occlusal management, 245 protocol stages of, 243–246 surgical technique, 244–245 Digital records, 243 Digitally Guided Bone Augmentation, 148 Distal-extension sinus augmentation, 201, 201f–205f dPTFE membrane See High-density polytetrafluoroethylene barrier membrane E Edentulism guided full-arch immediate-function implant for See Guided fullarch immediate-function implant maxilla, alveolar ridge reconstruction of, 148, 149f–150f physical effects of, 237 psychologic effects of, 237 Edentulous arch, maxillary sinus augmentation in, 206, 207f Emdogain, 153 ePTFE membranes See Expanded polytetrafluoroethylene membranes Esthetic zone immediate implant placement in, 78–85, 79f–85f peri-implantitis in, 156f root membrane technique for tooth loss in, 85–90, 86f–89f single-tooth alveolar ridge preservation in, 59–78, 60f–78f Expanded polytetrafluoroethylene membranes bone regeneration uses of, 118 description of, 11, 11f, 13t Extraction, tooth assessments before, 44–45 atraumatic, 45 bone loss after, 43, 90 dimensional changes after, 41–43, 59 healing process after, 42f, 42–43 medical history before, 44–45 minimally traumatic, 43, 45f–46f, 45–47, 62f Extraction sites in esthetic zone, 59 healing of, 65f illustration of, 41f management of, 61, 71–72 overview of, 41 postextraction dimensional changes, 41–43, 59 radiographic imaging of, 45 tissue degradation in case reports, 72f–78f, 72–78 connective tissue graft for, 66f–71f, 77f, 78 management guidelines for, 61, 61t mild, 61, 61t, 71, 72f, 72–74 moderate, 61t, 63f–66f, 71, 73f, 74–75 severe, 61t, 66f–71f, 71–72, 74f–76f, 75, 78 Extraction socket freeze-dried bone allograft in, 53f, 88f grafting of with high-density polytetrafluoroethylene barrier, 50f leukocyte platelet-rich fibrin for, 51f immediate implant placement into, 78–85, 79f–85f visual examination of, 46 F FDBA See Fresh-frozen bone FGM See Free gingival margin Finger Sweep technique, 103, 104f Free gingival margin, 60–61 Freeze-dried bone allograft alveolar socket preservation and regeneration using, 90 description of, 41, 47, 48f in extraction socket, 53f, 88f Fresh-frozen bone, demineralized fresh-frozen bone versus, 23 Fully rectified filtered waveform, Fully rectified waveform, Functional matrix theory, 114 G GBR See Guided bone regeneration GEM 21S, 27, 55f, 64f Gingiva scalloping of, 60 thick, 60 thin, 60 Glucocorticoids, 174–175 Goblet cells, 171 Growth factors bone morphogenetic protein 2, 30–31, 30f–31f leukocyte platelet-rich fibrin See Leukocyte platelet-rich fibrin platelet concentrates See Platelet concentrates platelet-derived, 31–32, 32f recombinant human bone morphogenetic protein 2, 30f–31f, 30–32, 55 in regenerative medicine, 26 summary of, 32 GTR See Guided tissue regeneration Guided bone regeneration in anterior mandible, 130f–131f barrier membranes for See Barrier membranes for bone defects, 118 history of, 11 studies of, 11 260 Pikos_Index.indd 260 5/31/19 2:24 PM Index Guided full-arch immediate-function implant advantages of, 256b All-on-4 treatment concept, 237–238, 239f–242f, 251f bone loss, 236–237 case presentation of, 246–249, 247f–248f freehand surgical technique, 250 immediate loading of, 237–238, 239f–242f nSequence, 250, 251f–255f overview of, 235 surgical guide for, 248–249, 252f–253f Guided tissue regeneration, 11 H Hand instruments, 2, 3f–4f Healing postextraction, 42f, 42–43, 65f risk factors that affect, 44 High-density polytetrafluoroethylene barrier membrane description of, 12, 13t, 14f, 17, 47f for guided bone regeneration, 47f leukocyte platelet-rich fibrin barrier membrane versus, 54 titanium-reinforced, 56f, 58f Horizontal alveolar ridge augmentation description of, 103 in posterior mandible, 124, 125f surgical intervention recommendations for, 133t I Immediate implant placement in fresh extraction sockets, 78–85, 79f–85f premature loading and, 245 Immediate loading, of guided full-arch immediate-function implant, 237–238, 239f–242f Implant(s) biomechanical stability of, 7, 185 contraindications for, 96 failure of, 227 guided full-arch immediate-function See Guided full-arch immediate-function implant primary stability of, 7, 185 residual bone height and, 184 Implant placement after alveolar ridge augmentation, 114, 114f at alveolar crest, 33 cone beam computed tomography before, delayed illustration of, 62f indications for, 184 root membrane technique with, 87f events after, 185 illustration of, 51f immediate into fresh extraction sockets, 78–85, 79f–85f premature loading and, 245 minimally invasive approach, 70f–71f Pikos MSMR technique and, 212f radiographs in, 191f ridge expansion with, 143 surgical guide for, 123f Implant stability quotient, 1, Implant surface Laser-Lok, 32–33, 33f technology of, 32–33, 33f Implant surgery, instrument trays for, 2, 3f Implant-supported prostheses, 237 Infraorbital artery, 172 Infuse Bone Graft, 31 Instruments See also Burs for alveolar ridge augmentation, 1–9, 109 cone beam computed tomography, 1–2, 1f–2f hand, 2, 3f–4f Piezosurgery, 6, 6f–7f Versah burs, 7–8, 7f–8f ISQ See Implant stability quotient L Labial plate, 46 Lamina propria, 171 Laser-Lok implant surface, 32–33, 33f, 61 Leukocyte platelet-rich fibrin advantages of, 32 autogenous bone blocks and, 103 centrifugation of, 29f clinical uses for, 30 description of, 26 fabrication of, 64f immediate implant placement applications of, 80f–81f leukocytes in, 28–29 platelets in, 28–29 protocols for, 28 regenerative applications of, 27f, 29, 29f socket grafting uses of, 51f for soft tissue healing in esthetic zone, 81f tissue regeneration uses of, 54 Levofloxacin, 174b Loma Linda pouch technique, 216 L-PRF See Leukocyte platelet-rich fibrin M Mandible anterior alveolar ridge augmentation in, 131, 132f–133f guided bone regeneration in, 130f–131f fracture of, 155, 159f–160f posterior horizontal alveolar ridge augmentation in, 124, 125f treatment planning in, 124 Mandibular symphysis, bone block graft harvesting from, 108–109 Mandibular tori, autogenous bone graft harvesting from, 114, 115f Maxilla anterior, alveolar ridge augmentation in, 138, 138f–142f edentulous, alveolar ridge reconstruction of, 148, 149f–150f full-arch rehabilitation in, 239f–240f posterior alveolar ridge augmentation in, 133, 134f–137f distal-extension sinus augmentation in, 201, 201f–205f resorbed, 189f subantral region, Misch classification of, 173–174, 174f Maxillary lateral incisors, congenitally missing, 138f–139f 261 Pikos_Index.indd 261 5/31/19 2:24 PM Index Maxillary sinus anastomoses of, 172 anatomy of, 169–170, 170f autografting of, using osseodensification burs, 186f–187f blood supply to, 172 clinical assessment of, 172–174 development of, 169 epithelial cyst of, 227 goblet cells in, 171 layers of, 170–171 mucosa of, 171 mucus clearance of, 171 pathologies involving, 217f–225f, 217–226 physical evaluation of, 208 physiology of, 170–171, 170f–171f pneumatization of, 174 radiographic assessment of, 172–174, 173f shape of, 170, 170f vascularization of, 172 Maxillary sinus augmentation See also Sinus grafting anatomy of, 169–170, 170f complications of bacterial contamination, 213 bony septa, 213, 213f early, 226–227 flow chart for, 226f infection, 226–230, 227f intraoperative, 209–226 late, 227–228 mucous retention cysts, 218, 220f–225f osteomeatal complex obstruction, 208, 213, 213f overview of, 208 pathologies, 217f–225f, 217–226 polyps, 218, 219f–220f preoperative evaluation to minimize, 208 pseudocysts, 218 sinus membrane perforation See Sinus membrane, perforation of summary of, 230 types of, 209b cone beam computed tomography before, 173f contraindications for, 208 Cosci technique for, 182 crestal bone impacted trap technique for, 182f–183f, 183 crestal bone repositioned trap technique for, 183, 183f crestal approaches for description of, 180, 183–184 osseodensification burs during, 189, 190f–191f distal-extension posterior maxilla, 201, 201f–205f in edentulous arch, 206, 207f graftless approach to, 184 history of, 169 landmarks for, 171f lateral approach description of, 175–178, 176f–178f osseodensification burs for, 187–189, 188f–189f modified osteotome technique for, 181f, 181–182 modified trephine/osteotome approach for, 182 multiple-tooth replacement with, 195, 196f–201f osteotome sinus floor elevation for, 180, 180f–181f physiology of, 170–171, 170f–171f Pikos MSMR technique, 211, 211f–212f, 214f–215f, 216 posterior maxilla, 230 postoperative instructions for, 208 residual bone height, 184 rhBMP-2 with, 191, 193f–195f, 204, 205f ridge splitting with, 199f–200f single-stage protocol for, 178, 179f single-tooth replacement with, 191, 191f–195f sinus alveolar crest tenting technique for, 183 summary of, 230 Summers technique for, 180, 180f–181f two-stage protocol for, 175–178, 176f–178f Medical history, preextraction, 44–45 Metronidazole, 174b, 228 MinerOss, 23, 24f, 54f, 90 Minimally traumatic tooth extraction, 43, 45f–46f, 45–47, 62f Misch classification, 173–174, 174f Modified osteotome technique, 181f, 181–182 Modified trephine/osteotome approach, 182 Mucoceles, 218 Mucous retention cysts, 218, 220f–225f Multiunit abutments, 242f N Nonresorbable barrier membranes, 12, 13t NovaBone, 25, 25f nSequence Guided Prosthetics, 243, 250, 251f–255f, 255 O OMC See Osteomeatal complex Oroantral fistula, 226–227 Oronasal fistula, 226 OSFE See Osteotome sinus floor elevation Osseodensification advantages of, 185–186 description of, 1, 7–8, 185 findings regarding, 186 ridge dimension expanded with, 143, 147f Osseodensification burs advantages of, 185 counterclockwise rotation of, 185 description of, 82f, 84f, 85, 147f indications for, 189 for lateral sinus augmentation procedure, 187–189, 188f–189f for maxillary sinus autografting, 186f–187f, 189, 190f–191f osteotomies created using, 190f Osseointegration, 42, 185 Osseous crest, 61 Osstell IDx, 4f, Osteomeatal complex description of, 170–172, 171f obstruction of, 208, 213, 229 Osteoporosis, 26 Osteoprogenitor cells, 42 Osteotome sinus floor elevation, 180, 180f–181f P PainPack protocol, 175 Palatal plate, 46 Partial extraction therapy, 87–88 Partially rectified waveform, PCL See Poly-epsilon-caprolactone PDGF See Platelet-derived growth factor Periapical abscess, 54 Peri-implant bone loss, alveolar ridge augmentation around, 152–153, 156f 262 Pikos_Index.indd 262 5/31/19 2:24 PM Index Peri-implantitis, 152, 156f Periodontal disease, 26 Periodontal ligament cells, 11 Periodontium biotype of, 60 in single-tooth alveolar ridge preservation, 60 PGA See Polyglycolic acid Piezosurgery description of, device for description of, 6, 6f–7f for lateral sinus augmentation procedure, 187, 198f ramus block graft harvesting using, 111, 112f for ridge splitting, 143, 144f–147f handpiece for, 6f Pikos MSMR technique, 211, 211f–212f, 214f–215f, 216 PLA See Polylactic acid Platelet(s), in leukocyte platelet-rich fibrin, 28–29 Platelet concentrates platelet-rich fibrin, 27–28 platelet-rich plasma, 27–28 regenerative applications of, 26 technical differences in, 27–28 Platelet-derived growth factor, 26–27, 31–32, 32f, 103 Platelet-rich fibrin description of, 26–28 leukocyte- See Leukocyte platelet-rich fibrin liquid layer of, 29, 29f Platelet-rich plasma, 26–28 Poly-epsilon-caprolactone, 16 Polyglycolic acid, 16 Polylactic acid, 16 Polyps, 218, 219f–220f Polytetrafluoroethylene barrier membranes, 11f, 11–12, 13t, 14, 41 Polyvinyl siloxane, 238 Posterior mandible horizontal alveolar ridge augmentation in, 124, 125f treatment planning in, 124 Posterior maxilla alveolar ridge augmentation in, 133, 134f–137f distal-extension sinus augmentation in, 201, 201f–205f maxillary sinus augmentation of, 230 resorbed, 189f Posterior superior alveolar artery, 172 Powertome, 45f Premature loading, 245 PRF See Platelet-rich fibrin Pro-fix Precision Fixation System, 2, 4f PRP See Platelet-rich plasma PSAA See Posterior superior alveolar artery R Radiosurgery device, 5, 5f–6f Ramus buccal shelf graft harvesting of complications associated with, 155 description of, 110f–113f, 110–114 transosseous anchor suture technique with, 154f vertical alveolar ridge augmentation using, 126f RBH See Residual bone height Recombinant human bone morphogenetic protein alveolar ridge augmentation uses of, 131, 132f–133f, 138, 164, 165f complications associated with, 164, 165f description of, 30f–31f, 30–32, 55, 57f, 59 maxillary sinus augmentation with, 191, 193f–195f, 204, 205f titanium mesh particulate graft with, for alveolar ridge augmentation, 117–118, 118f–123f, 134f–135f, 141f Recombinant human bone morphogenetic protein 7, 30 Recombinant human platelet-derived growth factor for alveolar ridge augmentation, 133 description of, 31–32, 32f, 41 Recombinant human platelet-derived growth factor-BB, 32, 55 Residual bone height, 184 Residual bone volume, 229 Resorbable barrier membranes, 14–15, 15f, 43 rhBMP-2 See Recombinant human bone morphogenetic protein rhBMP-7 See Recombinant human bone morphogenetic protein Rhinosinusitis, 228 Root membrane technique, for tooth loss in esthetic zone, 85–90, 86f–89f Root submergence technique, 88 Rotary bone harvester, 20 S SafeScraper, 20 Septa, bony, 213, 213f SFE See Sinus floor elevation Single-tooth alveolar ridge preservation diagnostic criteria for, 59f in esthetic zone, 59–78, 60f–78f mesiodistal tooth position, 60 in nonesthetic zone, 47–59, 48f–589f osseous crest position in, 61 periodontium in, 60 relative tooth position in, 60 tooth shape, 60–61 Single-tooth replacement, with maxillary sinus augmentation, 191, 191f–195f Sinus alveolar crest tenting technique for, 183 Sinus floor elevation crestal approach, 180 description of, 172 mucous retention cyst with, 220f–221f transcrestal, 180 Sinus grafting See also Maxillary sinus augmentation after mucous retention cyst removal, 222f–224f contraindications for, 208 crestal approach, 180 history of, 169 instruments for, 1–9, 4f medications for, 174b, 174–175 postoperative instructions for, 175 sedation for, 175 Sinus membrane perforation of cyanoacrylate adhesive repair of, 216 description of, 209f–213f, 209–213, 229–230 fibrin glue repair of, 217 fixation technique for, 215f incidence of, 214, 230 large, 216 management of, 214 263 Pikos_Index.indd 263 5/31/19 2:24 PM Index repair of, 216 surgical technique for, 214–217, 216f thickening of, 217–218, 218f, 229 Sinusitis, 172, 208 SMAD proteins, 30 Smoking autogenous bone grafts affected by, 96 as maxillary sinus augmentation contraindication, 208 wound healing affected by, 229 Socket, extraction See Extraction socket Socket grafting high-density polytetrafluoroethylene barrier membrane for, 14f materials with, 90 with mineralized allograft, 68f, 72 Socket shield, 87, 90 Soft tissue grafting, instrument trays for, 2, 3f StellaLife recovery packet, 175, 175f Summers technique, 180, 180f–181f Surgical report, 243, 244f Sympathomimetic drugs, 174 Synthetic resorbable barrier membranes, 13t, 16 T Thick gingiva, 60 Thin gingiva, 60 Tissue degradation, in extraction sites case reports, 72f–78f, 72–78 connective tissue graft for, 66f–71f, 77f, 78 management guidelines for, 61, 61t mild, 61, 61t, 71, 72f, 72–74 moderate, 61t, 63f–66f, 71, 73f, 74–75 severe, 61t, 66f–71f, 71–72, 74f–76f, 75, 78 Titanium mesh barrier membranes complications of, 160, 161f, 161t description of, 14, 14f–15f, 17, 99 palatal fixation with, 142f Titanium mesh particulate graft for alveolar ridge augmentation illustration of, 127, 128f with rhBMP-2, 117–118, 118f–123f, 134f–139f, 141f with rhPDGF, 136f complications of, 160, 161f–163f, 161t for congenitally missing right lateral incisors, 139f Titanium-reinforced membranes advantages of, 119b high-density polytetrafluoroethylene, 56f, 58f Tooth extraction See Extraction, tooth Tooth loss causes of, 41 dimensional changes after, 41–43, 59, 124 in esthetic zone, root membrane technique for, 85–90, 86f–89f Torque wrench, 4f Transforming growth factor ß, 26, 103 Transosseous anchor suture technique, 152, 153f–154f Type crosslinked bovine collagen membrane, 15, 15f–17f, 209 V Vascular endothelial growth factor, 26–27, 103 VEGF See Vascular endothelial growth factor Versah burs, 7–8, 7f–8f Vertical alveolar ridge augmentation, ramus buccal shelf block graft for, 126f Vertical dimension of occlusion, 237, 243 Vestibuloplasty, after alveolar ridge augmentation, 151, 151f VPI Cervico emergence profile system, 108f W Wound healing See Healing X Xenografts, 24, 24f, 90 Z Zirconia screw-retained prosthesis, 249 264 Pikos_Index.indd 264 5/31/19 2:24 PM Bone PIKOS ISBN 978-0-86715-825-0 90000> 780867 158250 Pikos Cover-AsiaPacific.indd BONE AUGMENTATION IN IMPLANT DENTISTRY Sinus Augmentation | MICHAEL A PIKOS received his DDS from The Ohio State University College of Dentistry, after which he completed an internship at Miami Valley Hospital and residency training in Oral & Maxillofacial Surgery at the University of Pittsburgh Montefiore Hospital He is a Diplomate of the American Board of Oral and Maxillofacial Surgery, the American Board of Oral Implantology/Implant Dentistry, and the International Congress of Oral Implantologists and a Fellow of the American College of Dentists He is also an adjunct assistant professor in the Department of Oral & Maxillofacial Surgery at The Ohio State University College of Dentistry and Nova Southeastern University College of Dental Medicine Dr Pikos is on the editorial boards of several journals and is a well-published author who has lectured extensively on dental implants in North and South America, Europe, Asia, and the Middle East He is the founder and CEO of the Pikos Institute Since 1990, he has been teaching advanced bone and soft tissue grafting courses with alumni that now number more than 3,400 from all 50 states and 43 countries Dr Pikos maintains a private practice limited exclusively to implant surgery in Trinity, Florida (www.pikosinstitute.com) Augmentation Graft Window IN Implant Dentistry MICHAEL A PIKOS, dds with Richard J Miron, dds, msc, phd Extraction Site A Step-by-Step Guide to Predictable Alveolar Ridge and Sinus Grafting 5/31/19 12:12 PM ... the bone grafting scaffold capable of laying new bone matrix, (2) demonstrate osteoinductive potential by recruiting and inducing mesenchymal cells to differentiate into mature bone- forming osteoblasts,... potential bone resorption over time.86–90 As such, DBBM particles have been utilized in a number of clinical indications, including for contour augmentation in implant dentistry (especially in the... for demineralized bone matrix to induce ectopic bone formation in the late 1960s and early 1970s.169,170 After showing that demineralized bone grafts were osteoinductive by forming ectopic bone,