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ISPRD Abstracts 10/4/07 11:57 AM Page 488 ISPRD abstracts 10/4/07 11:57 AM Page 488 488 The 9th International Symposium on Periodontics & Restorative Dentistry June 7–10, 2007 Boston, Massachusetts Poster Abstracts No. 1 ment. Once the implants were healed, the zirconia implant-fixed Clinical Advantages of Fixed Provisionalization in Atrophic maxillary complete denture was fabricated according to Ridges Utilizing Transitional Implants. W. Kim, A. Koa, S. Villareal, ZirkonZhan protocol. Discussion: Biological or mechanical compli- S. Cho, S. Froum, N. Elian, D. Tarnow (New York, New York) cation may exist during the lifetime of the prosthesis. According to the literature, mechanical complications are the most common Introduction: Ridge deficiencies in the edentulous alveolar ridges in implant prostheses. These mechanical complications may be may preclude ideal implant placement. To solve this problem, a caused by inaccuracy of fabrication or by the characteristics of the variety of ridge augmentation procedures have been proposed. materials used. The ZirkonZhan milling unit device was catego- Regardless of the surgical modality, undisturbed healing for rized as part of the CAD/CAM technology and is believed to be grafted ridges and subsequent implant placement is critical to very accurate. Zirconium oxide has demonstrated less bacterial achieving a successful result. The use of transitional implants (TIs) adhesion and has self-repairing properties, meaning that it pre- before ridge augmentation allows the clinicians to provide stable vents crack propagation by a phenomenon called “transformation fixed temporary prostheses throughout the treatment period, toughening.” Zirconium oxide ceramic has also proven easier to while keeping transmucosal forces from being placed on the repair, even after being in situ for a period of time. New designs grafted ridge. The TI support provisional also maintains soft tissue for implant-supported fixed complete dentures are now possible architecture and ensures that the final implant is in the ideal with new dental technology; however, this technology remains esthetic position. The TIs placed with immediate loading may too new to provide for long-term studies. Conclusions: This novel enhance the quality of surrounding bone. Purpose: The purpose design using CAD/CAM technology and zirconium oxide as a of this report is to retrospectively evaluate the survival rate of restorative material can result in optimum restoration with very fixed provisionals utilizing transitional implants in atrophic ridges good esthetics and long-term durability. Disclaimer: There was no and discuss the clinical advantages of this modality. Materials and commercial support for this study. Methods: Nine consecutive clinical cases with 20 transitional implants were followed for a period of 4 to 36 months. Ridge No. 3 augmentation procedures were performed on each patient, final Bone Healing Following Osteotomy: A Comparison of CO2 implants were placed, and final restorations were delivered. Laser, ER:YAG Laser, Ultrasound, and Saw Techniques. Results: All TIs lasted through the ridge augmentation procedure S. Stübinger, B. von Rechenberg, J. Kuttenberger, P. Hering, H. and the maturation period and until the permanent implants were Zeilhofer, R. Sader (Frankfurt, Germany and Basel, Switzerland) loaded. There was no failure of fixed provisional restorations and also no failure of the final restorations from their initial placement Background and Purpose: Surgical reconstruction of bony defects until the final follow-up. Conclusion: The use of transitional in oral and maxillofacial surgery is often very challenging, as thin implants allows the fixed provisionals to maintain soft tissue archi- and fragile bony structures are especially prone to fracture due to tecture, and, at the same time, ensures that the final implant will massive application of pressure by conventional mechanical instru- be in the ideal esthetic position. ments. Noncontact, blood- and vibration-reduced laser surgery with free choice of cut geometry and the prevention of massive No. 2 bone flour and metal abrasion is to the best advantage in this Zirconia Implant-Supported Fixed Maxillary Complete Denture: regard. The aim of this animal study using sheep was to investi- A Novel Design Using the ZirkonZahn Protocol. E. Grageda gate the bone healing process after the use of two laser systems in (Mexico City, Mexico) comparison to two mechanical osteotomy techniques. Materials and Methods: A midshaft osteotomy of the tibia diaphysis was Introduction: The implant-fixed complete denture is a well-recog- performed on all 44 sheep. In one group of 12, a pulsed Er:YAG nized treatment for the edentulous patient. This type of prosthesis laser (Fidelis Plus, Fotona, Ljublijana, Slovenia; pulse energy 1000 can be fabricated using a combination of different designs, tech- mJ, pulse duration 300 µs, pulse frequency 12 Hz) was used. In niques, and materials. Today CAD/CAM technology is replacing another group of 12, an ultrasound device (Piezosurgery, Mectron; the conventional cast gold alloy technique for framework fabrica- saw blade OT7, mode boosted burst C, pump 5) was used. In a tion since it is more accurate, cost effective, and it allows the use third group of 12, practioners used a conventional saw blade of more materials. Zirconium oxide was introduced to dentistry (Synthes, Switzerland). The fourth group consisted of eight sheep because of its excellent chemical stability, high mechanical load- treated using a new computer-assisted prototype CO2 laser (pulse ing, outstanding biocompatibility, and unique esthetic qualities. energy 80-85 mJ, pulse duration 80 µs, pulse frequency 200-400 ZirkonZhan is a new milling unit device that can read and mill all Hz). After 2 and 3 months, specimens were evaluated by radio- types of framework shapes by using its novel “five-axis” system. graphic and histologic analysis. Polychrome sequence labeling and Materials and Methods: A 65-year-old man came to the clinic histomorphometry were also performed. Results: Thermal damage with the chief complaint of mobility of all maxillary teeth. All the at the osteotomy sites was comparable in noncontact laser and teeth were diagnosed with advanced marginal periodontitis and mechanically cut bone fragments. In contrast to former studies, no were considered hopeless. All maxillary teeth were extracted, and severe carbonization and no wound healing impairments resulted an immediate complete denture was given to the patient. After a from the use of the new CO2 laser system. The laser system few months of healing, a computerized planning and virtual fabri- allowed for unprecedented preciseness and cut geometry, cation of the prosthesis was performed for proper implant place- although the system required the most time, and handling had to The International Journal of Periodontics & Restorative Dentistry ISPRD abstracts 10/4/07 11:57 AM Page 489 489 be more intricate in contrast to the other procedures. growth factors and fibrin matrices combined with particulate Osteotomies performed by ultrasound and Er:YAG laser resulted bone allograft. A histological analysis was performed to evaluate in precise and smoothly cut edges with an ingrowth of vital bone- bone quality. Methods: Ten patients (10 maxillary anterior ridge forming tissue into the osteotomy gap after 2 months. Additional defects) were treated utilizing autologous growth factors (FGF, radiologic and fluorescence labeling data supported these find- IGF-I, PDGF, TGF-;98;, EGF, VEGF, HGF) and fibrin matrices ings. However, histologic evaluation demonstrated no significant combined with particulate bone allograft. Soft tissue gain was difference in the amount of newly formed woven bone at the measured at baseline; 7 days; and 1, 3, and 6 months postsurgi- osteotomy site made by Er:YAG laser/Piezosurgery or conven- cally. At 6 months prior to dental implant placement, bone biop- tional saw. In all four groups, defects healed by 12 weeks postop- sies were taken, and the quality of the bone at the regenerated eratively. Conclusion: For use in osteotomies of thin and fragile sites was analyzed histologically. Results: At 7 days postopera- bones in the maxillofacial region, Er:YAG laser irradiation and tively, soft tissue width gain was 3.57 mm (P = .001 with a confi- ultrasound techniques are superior to saw and CO2 laser tech- dence interval of 95% (3.19 ± 3.90 mm), and height gain was 3.2 niques because of their easy handling, efficient bone ablation, and mm (CI 95%, 2.63 ± 3.63 mm). Adequate soft tissue healing and minimal accidental harm to adjacent soft tissue structures. wound closure was also observed. At 1 month, soft tissue width Nevertheless, computer guidance of a laser beam allows newly gain decreased to 2.63 mm (P = .001, CI 95%, 2.32± 2.95 mm), arranged, arbitrary, and self-stabilizing osteotomies, which could and height gain to 2.60 mm (CI 95%, 2.24 ± 2.96 mm). At 3 be enhanced by navigation systems and robotics. months, width gain remained stable at 2.63 mm (CI 95%, 2.32 ± 2.95 mm), and height gain at 2.60 mm (2.24 ± 2.96mm). At 6 No. 4 months these values remained unchanged, and histologic analy- Outstanding Clinical and Human Histologic Outcomes with the ses of bone biopsies showed bone formation with osteocyte lacu- PerioLase Nd:YAG Laser. R. Yukna (Aurora, Colorado) nae, vital osteocytes, thin bone appositional lines, haversian canals, osteoblasts, and osteiod formation. Conclusions: These Introduction: The Laser Assisted New Attachment Procedure results
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