Dental Implants

Contents

Preface: Oral and Craniofacial Implant Reconstruction as Foundation for Restorative

Dentistry ix
Ole T. Jensen

Innovations in Dental Implant Design for Current Therapy 649

Daniel Lesmes and Zvi Laster
The use of osseointegrated dental implants has gained momentum, mainly
in the last 20 years. Research and development in the field of implantology
are constantly focusing on implant redesign to continue to try and improve
implant success. The current aim of implant design is to address situations
prone to failure, such as cases of low bone quality or cases of concomitant
systemic diseases that compromise healing.

Management of the Facial Gingival Margin 663

Michael S. Block
This article discusses the management of the facial gingival margin before
and after tooth removal. Important factors including diagnostic assess-
ment, wound healing, bone resorption and remodeling, gingival thickness,
and gingival margin are reviewed, and key procedures suggested. Gingival
thickness can have a major influence on the maintenance of the facial gin-
gival margin over the longer term.

Bone Grafting the Mandible 673

Patrick J. Louis
Many bone grafting techniques have been used to reconstruct the partially
dentate and edentulous mandible. This article discusses the various bone
grafting techniques to reconstruct mandibular defects. Also included are
issues such as whether autogenous bone is necessary for reconstruction
of the mandibular ridge and the importance of membranes.

Maxillary Autogenous Bone Grafting 697

Craig M. Misch
Reconstruction of the atrophic maxilla for dental implant placement has
many unique considerations. There are several methods available to aug-
ment the atrophic maxilla. Of these, autogenous bone grafting offers
a well-proven predictable method for ridge augmentation and defect repair
for dental implant placement. There are several advantages of using au-
togenous bone grafts. This article primarily focuses on the use of autoge-
nous onlay bone grafts to reconstruct the atrophic maxilla.

Guided Surgery for Implant Therapy 715

Gary Orentlicher and Marcus Abboud
New three-dimensional diagnostic and treatment planning technologies in
implant dentistry have expanded on concepts of a team approach to the
vi Contents

planning and placement of dental implants. The accurate and predictable

placement of implants according to a computer-generated virtual treat-
ment plan is now a reality, taking the virtual plan from the computer to
the patient clinically. Recent advances in three-dimensional imaging in
dentistry, in combination with the introduction of third-party proprietary
implant planning software and associated surgical instrumentation, have
revolutionized dental implant diagnosis and treatment and created an in-
terdisciplinary environment in which communication leads to better patient
care and outcomes.

Rescue Implant Concept: The Expanded Use of the Zygoma Implant in the
Graftless Solutions 745
Edmond Bedrossian
The use of anteriorly or posteriorly tilted implants in a graftless approach
for immediate loading the edentulous maxillae has been well documented
in the literature. This treatment concept allows for rehabilitation of the
edentulous maxillae with a fixed prosthesis. The purpose of this article is
to describe criteria for the use of the zygomatic implant, including the ex-
panded use of the zygoma implant in cases where failure of one of the an-
terior or posterior tilted implants has occurred in the All-on-Four treatment
concept. Zygomatic implant placement becomes a rescue procedure,
which allows for continuity of care without resorting to a removable
denture.

Maxillary All-On-Four Therapy Using Angled Implants: A 16-Month Clinical

Study of 1110 Implants in 276 Jaws 779
Stuart Graves, Brian A. Mahler, Ben Javid, Debora Armellini, and Ole T. Jensen
The maxilla is a challenging area for dental implant restoration. Encroach-
ment of anatomic structures such as the sinus and nasal floor make verti-
cal placement difficult. Implants placed at an angle may be used to avoid
these anatomic structures or eliminate the need for a bone grafting proce-
dure. The question occasionally arises about the possible detrimental
effects of placing implants at an angle. This article reviews relevant litera-
ture, presents two case reports on maxillary angled implants and presents
3 years of data on 276 All-on-Four restorations.

Mandibular All-On-Four Therapy Using Angled Implants: A Three-Year Clinical

Study of 857 Implants in 219 Jaws 795
Caesar C. Butura, Daniel F. Galindo, and Ole T. Jensen
Immediate function with Branemark implants is well established for the
mandible. This article describes a series of 857 implants placed consecu-
tively in which very few implants failed or lost bone despite the dynamic
healing conditions of simultaneous dental extractions and bone leveling.
Though these findings are relatively early, 3 years or fewer, it appears
that the immediate function All-on-Four procedure can be done with
a high degree of confidence for the mandibleputting into question the
need for additional implants.
 Contents vii

Orthognathic and Osteoperiosteal Flap Augmentation Strategies for Maxillary

Dental Implant Reconstruction 813
Ole T. Jensen, Jason L. Ringeman, Jared R. Cottam, and Nardy Casap
In this article, five variations in orthognathic surgery procedures used to
gain bone mass for implants are discussed: Le Fort I downgrafting, Le
Fort I distraction, subLe Fort I interpositional sandwich grafting, segmen-
tal sandwich grafting, and the island osteoperiosteal flap approach.

Craniofacial Implant Surgery 847

Douglas P. Sinn, Edmond Bedrossian, and Allison K. Vest
Extraoral cranial implant-retained prosthetic reconstructions have been
proved to be highly successful. Replacement of the eyes, ears, nose,
and larger areas including combined midface defects, which frequently
have no other option available, has been done successfully. Burn patients
and those with congenital defects are good candidates for this type of re-
construction, especially after autogenous attempts have failed. Cranial im-
plant prosthetic reconstruction should be considered as a viable option for
difficult craniofacial defects.

Dental Implants in Oral Cancer Reconstruction 871

D. David Kim and G.E. Ghali
Endosseous implants have revolutionized dental prosthetic rehabilitation,
providing a reliable, a stable, and an aesthetic option for dental recon-
struction. Dental implants have similarly improved the functionality of
reconstructions following cancer surgery. The use of dental implants in
oral cancer reconstruction can be divided into 2 categories: (1), for reten-
tion of a prosthetic device, for example, palatal obturator, used as the pri-
mary means of maxillary reconstruction, and (2), for dental rehabilitation
after bony reconstruction of the jaws. This article discusses these different
uses of endosseous implants in patients with head and neck cancer.

Dental Implants and the Use of rhBMP-2 883

Daniel B. Spagnoli and Robert E. Marx
Tissue engineering is an emerging field of medicine and dentistry that com-
bines the bodys natural biologic response to tissue injury with engineering
principles. The goal is to replicate or reconstruct the natural form and func-
tion of missing tissues and organs. Tissue-engineered bone with native
qualities will be necessary for implantation or migration of engineered teeth
in the future, and is currently required for the osseointegration of dental im-
plants. This article addresses the role of bone morphogenetic proteins
(BMP) in native bone healing for implant osseointegration and the applica-
tion of BMP for de novo bone regeneration.

Index 909