Rajiv Gandhi University of Health Sciences, Karnataka s38

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA ,

BANGALORE

ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 NAME OF THE DR. HIMANSHU CHAUHAN CANDIDATE AND POST-GRADUATE, ADDRESS DEPARTMENT OF ORAL & (In Block Letters) MAXILLOFACIAL SURGERY, COLLEGE OF DENTAL SCIENCES, DAVANGERE - 577004 KARNATAKA.

2 NAME OF THE COLLEGE OF DENTAL SCIENCES, INSTITUTION DAVANAGERE - 577004

3 COURSE OF THE MASTER OF DENTAL SURGERY - STUDY AND THE ORAL & MAXILLOFACIAL SURGERY SUBJECT

4. DATE OF ADMISSION 1ST AUGUST 2013 TO COURSE

5 TITLE OF THE TOPIC “COMPARISON BETWEEN IMMEDIATE VS DELAYED LATERAL EXPANSION TECHNIQUE TO AUGMENT NARROW ALVEOLAR RIDGES FOR PLACEMENT OF IMPLANTS - A PILOT STUDY ” 6. BRIEF RESUME OF THE INTENDED WORK:

6.1 Need for study :-

The use of endosseous implants for partial or complete dental restoration has gained

popularity in the past few decades, with reliable long-term stability. On the other

hand, there are minimum requirements for vertical and horizontal dimensions for

implant placement1.Narrow alveolar ridges remain a serious challenge for the

successful placement of endosseous implants2. Alveolar ridge widening before

implant placement is indicated in cases of crest thickness of < 4mm 1.

The advantages of immediate implant placement after lateral ridge expansion

technique have been reported to include reduction in the amount of surgical trauma

and in the treatment time required3-4, but It has also been suggested that it can lead to

lack of initial stability of the implants, fracture of buccal segmented bone &

compromised implant placement in the bucco-lingual and apico-coronal direction5.

whereas a 2 stage approach of delayed placement of implant after distraction

osteogenesis though being time consuming , allows for subsequent evaluation of the

expanded ridge and avoidance of complications5 .

This study is to evaluate and compare between immediate and delayed techniques

of lateral expansion of atrophic narrow ridges for the placement of implants. 6.2 Review of Literature sSohn DS, Lee HJ, Heo JU, Moon JW, Park IS, Romanos GE

The lateral ridge expansion technique is used to expand the narrow edentulous ridge for implant placement. The staged approach can be used to split the mandibular ridge to decrease the risk of malfracture during osteotomy. The present study reports the clinical results of a surgical technique that expands a narrow mandibular ridge using an immediate and a delayed lateral expansion technique.

A total of 32 patients with a narrow edentulous posterior mandibular ridge of 2 to 4 mm were included in the present study, and 84 implants were placed. Of the 32 patients, 23 were treated with an immediate lateral expansion technique and 9 with a delayed lateral expansion technique. Of the 23 patients who underwent the immediate lateral expansion technique, a malfracture of the thin buccal cortical plate occurred during ridge splitting in 5 patients. All buccal segments of the 9 patients who underwent the delayed lateral expansion technique fractured as planned at the inferior horizontal corticotomy line favorably. After 4 to 5 months, all implants were stable and surrounded by bone, and ossification of the osteotomy line was obvious.

The authors concluded that the lateral ridge expansion technique is effective for horizontal augmentation in the severely atrophic posterior mandibular ridge. The delayed lateral ridge expansion technique can be used more safely and predictably in patients with high bone quality and thick cortex and a narrower ridge in the

Mandible5. Chiapasco M, Ferrini F, Casentini P, Accardi S, Zaniboni M A study was designed to evaluate the capability of a new surgical device (Extension

Crest) to widen narrow edentulous alveolar ridges and to allow correct placement of endosseous implants in horizontally atrophied sites. Forty-five patients, 20 males and 25 females, aged 20-66 years, affected by edentulism associated with horizontal resorption of the ridges, were treated by means of a sagittal osteotomy and expansion of the ridge with a new surgical device (Extension Crest) to obtain a wider bony base for ideal implant placement . The authors concluded that within the limits of this study, this technique appeared to be reliable and simple, with reduction of morbidity and times of dental rehabilitation as compared with other techniques such as autogenous bone grafts and guided bone regeneration. Survival and success rates of implants placed in the treated areas are consistent with those placed in native bone.6

Guillermo Cabanes-Gumbau1, Francisco Javier Silvestre2

The authors described a low-morbidity surgical technique for the horizontal augmentation of highly atrophic alveolar ridges in which first surgical step implant placement is contraindicated. The aim of this case report was to present an alternative treatment for the rehabilitation of the atrophic maxilla. The technique involved a crestal corticotomy with transverse expansion of the vestibular and lingual cortical layers, followed by the placement of threaded titanium space maintainers between the expanded bone tables. The resulting surgically created biological space within the residual socket is completely filled with blood of marrow origin and great osteogenic potential. Due to the preserving effect of the titanium maintainers, they avoided partial collapse of the ridge widening initially obtained, which tends to occur to one degree or other as a consequence of reabsorption during the physiological tissue repair process.

They concluded that this type of bone regeneration requires no autologous bone harvesting from other intra- or extraoral donor zones, thereby avoiding the increased morbidity associated with such procedures. It appears that alveolar ridge augmentation through corticotomy and threaded space maintainers may be a viable treatment approach for the implants placement in the severely atrophied maxilla.7

Andrea Enrico Borgonovo, Rachele Censi, Virna Vavassori, Marcello Dolci, Josè Luis Calvo-Guirado, Rafael Arcesio Delgado Ruiz, and CarloMaiorana

The aim was to evaluate survival and success rates, soft tissue health, and radiographic marginal bone loss (MBL) of zirconia implants placed in the esthetic and posterior areas of the jaws and in association withmultiple or single implant restorations after at least 6 months of definitive restoration. 35 one-piece zirconium implants were utilized for single or partially edentulous ridges rehabilitation. All implants received immediate temporary restorations and six months after surgery were definitively restored. Every 6 months after implant placement, a clinical- radiographic evaluation was performed. For each radiograph, the measurements of

MBL were calculated. The results showed that the meanMBL at 48-month followup was 1.631 mm. The mean MBL during the first year of loading was not more significant for implants placed in the first molar regions than for those positioned in other areas. Moreover, no differences in marginal bone level changes were revealed for multiple and single implants, whereas MBL in the first year was observed to be slightly greater for implants placed in the maxilla than for those placed in the mandible. Zirconia showed a good marginal bone preservation that could be correlated with one-piece morphology and characteristics of zirconia implants.8

6.3 Objectives of the Study:

 A pilot study will be conducted to evaluate and compare between

immediate and lateral expansion techniques of atrophic narrow ridges on the

success and survival rate of implants placed.

 Criteria to be evaluated are:

1) Preoperative width of edentulous alveolar ridge (T0) (using surgical

caliper).

2) Postoperative width of alveolar ridge at the end of expansion and implant

placement(T1)

3) Width of alveolar ridge at the time of abutment connection(T3)

 Implant success criteria

1) Presence /absence of mobility 2) Presence / absence of paresthesia

3) Presence / absence of peri-implant radioluscency

 Implant survival criteria

1) Loaded functionalized asymptomatic implants

7. MATERIALS AND METHODS :

7.1 Source of Data :

A pilot study will be conducted in the Department of Oral & Maxillofacial Surgery,

College of Dental Sciences, Davangere. Ten consecutive patients of either sex, who

require implant supported prosthesis for single tooth, partial/complete edentulism

having horizontal alveolar ridge defects will be included in the study. Selected

patients will be divided into two groups (immediate lateral expansion followed by

placement of implant, delayed lateral expansion followed by placement of implant).

Only those patients who meet the inclusion criteria will be selected. The following

are the criteria for selection of patients for the study.

Inclusion criteria:

1. Patients who desire implant supported prosthesis for replacement of single

tooth or partial/complete edentulism with inadequate width of horiontral

alveolar ridge (< 4mm)

2. Patients of either sex and classified as American Society of

Anesthesiologists Grade I or II.

Exclusion criteria: 1. Extremely atrophic ridges (2mm or less) with no interposition of cancellous

bone between the buccal and palatal/lingual plates

2. A concomitant vertical defect

3. Tobacco abuse more then 15 cigarettes/day

4. Severe renal or liver disease

5. History of radiotherapy in the head and neck region

6. Cheamotherapy for treatment of malignant tumours at the time of surgical

procedure

7. Non compensated diabeties

8. Patients suffering from systemic diseases such as bleeding and clotting

disorders, cardiovascular diseases hypertension, history of psychiatric illness.

9. Patients with history of allergy to the drugs used in the study.

10. Patients who do not give informed consent.

Study design:

 This is a pilot study

 study on clinical series of 10 patients.

7.2 Methods of collection of Data :

 Ethical approval will be obtained from Institutional Review Board of

College of Dental Sciences, Davangere.

 A pilot study will be done on 10 patients who require implant supported prosthesis for single tooth, partial/complete edentulism having horizontal

alveolar ridge defects

 The patients will be examined in detail with pertinent clinical history and

thorough physical examination.

 The procedure will be explained to every patient and informed consent will

be obtained.

 These patients will randomly be divided into two groups of 5 each randomly

 Group-A(immediate lateral expansion followed by implant placement)

Group-B(delayed lateral expansion followed by implant placement)

 Duration of the procedure will be noted.

 The patients will be followed for a period of 6 months

7.3 Statistical analysis :-

 Not relevant since it is a pilot study

7.4 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.

Yes. The following procedures will be carried out:

1) Preoperative and postoperative radiographic investigations (OPG, IOPA)

2) Routine blood and urine examination 7.5 Has ethical clearance been obtained from your institution in case of 7.4?

Yes 8 LIST OF REFERENCES:

1. Ibrahim E. Zakhary, Hatem A. El-Mekkawi and Mohammed E. Elsalanty Alveolar ridge augmentation for implant fixation: status review Oral Surg Oral Med Oral Pathol Oral Radiol 2012;114(suppl 5):S179-S189

2. Calvo Guirado JL, Pardo Zamora G, Saez Yuguero MR Ridge splitting technique in atrophic anterior maxilla with immediate implants, bone regeneration and immediate temporisation: a case report. J Ir Dent Assoc. 2007 Winter;53(4):187-90

3. Sethi A, Kaus T Maxillary ridge expansion with simultaneous implant placement: 5-year results of an ongoing clinical study Int J Oral Maxillofac Implants. 2000 Jul-Aug;15(4):491-9

4. Simion M, Baldoni M, Zaffe D Jawbone enlargement using immediate implant placement associated with a split-crest technique and guided tissue regeneration Int J Periodontics Restorative Dent. 1992;12(6):462-73.

5. Sohn DS, Lee HJ, Heo JU, Moon JW, Park IS, Romanos GE Immediate and delayed lateral ridge expansion technique in the atrophic posterior mandibular ridge J Oral Maxillofac Surg. 2010 Sep;68(9):2283-90

6. Chiapasco M, Ferrini F, Casentini P, Accardi S, Zaniboni M Dental implants placed in expanded narrow edentulous ridges with the Extension Crest

device. A 1-3-year multicenter follow-up study.

Clin Oral Implants Res. 2006 Jun;17(3):265-72. 7. Guillermo Cabanes-Gumbau1, Francisco Javier Silvestre2 Modified ridge splitting technique using conical space main-tainers for delayed implant placement in highly atrophic maxillae J Clin Exp Dent. 2010;2(3):e127-32

8. Andrea Enrico Borgonovo, Rachele Censi, Virna Vavassori, Marcello Dolci, Josè Luis Calvo-Guirado, Rafael Arcesio Delgado Ruiz, and CarloMaiorana

Evaluation of the Success Criteria for Zirconia Dental Implants: A Four-Year Clinical and Radiological Study International Journal of Dentistry Volume 2013, Article ID 463073, 7 pages

9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE 11. NAME AND DESIGNATION OF

11.1 GUIDE (In Block Letters) DR. SHUBHA LAKSHMI PROFESSOR DEPARTMENT OF ORAL & MAXILLOFACIAL SURGERY, COLLEGE OF DENTAL SCIENCES, DAVANGERE-577004

11.2 SIGNATURE

11.3 CO-GUIDE ( IF ANY)

11.4 SIGNATURE

11.5 HEAD OF THE DEPARTMENT DR. SIVA BHARANI. K.S.N., PROFESSOR & HEAD DEPARTMENT OF ORAL & MAXILLOFACIAL SURGERY, COLLEGE OF DENTAL SCIENCES, DAVANGERE-577004

11.6 SIGNATURE

12 12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL

12.2 SIGNATURE