Publications (37) View all
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Article: Effect of Maxillary Sinus Membrane Perforation on Vital Bone Formation and Implant Survival: A Retrospective Study.
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ABSTRACT: Background: The maxillary sinus augmentation procedure (SAP) using the lateral window technique has been documented to be a highly predictable procedure. However, the most common intraoperative complication has been reported to be membrane perforation. The present study evaluated the percentage of vital bone and implant survival in sinuses that had perforations repaired during surgery vs. a non-perforated sinus group. METHODS: Data was obtained retrospectively from an IRBA approved anonymous database at New York University, Kreiser Dental Center, Department of Periodontology and Implant Dentistry from 23 patients who had undergone SAP with a total of 40 treated sinuses. Sinuses were grafted with mineralized cancellous bone allograft, anorganic bovine bone matrix, or biphasic calcium phosphate. Perforation complications occurred in 15 sinuses with 25 non-perforated sinuses. All perforations were repaired during surgery with absorbable collagen membrane barriers. Histological cores were taken from all treated sinuses 26-32 weeks post-surgery. The implant success rate of 79 placed implants were recorded. RESULTS: The average percentage of vital bone was 26.3± 6.3% in the perforated/ (repaired) sinuses vs. 19.1 ± 6.3% in the non-perforated sinuses. The differences were statistically significant (SS). The implant success rate was 100% (0/35) compared to 95.5% (2/45) in the non-perforated sinuses. There was no SS difference in implant failure rates. CONCLUSION: The augmented sinuses in this study which exhibited membrane perforations that occurred during the SAP (which were treated during surgery) showed SS greater vital bone percentages compared with the non-perforated sinus group. There were no SS differences in implant survival in the perforated vs. non-perforated groups. In this study, sinus membrane perforations, when properly repaired during surgery, did not appear to be an adverse complication in terms of vital bone production or implant survival.Journal of Periodontology 11/2012; · 2.60 Impact Factor -
Article: Radiological and micro-computed tomography analysis of the bone at dental implants inserted 2, 3 and 4 mm apart in a minipig model with platform switching incorporated.
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ABSTRACT: BACKGROUND: The purpose of this study was to assess the effect of inter-implant distance on interproximal bone utilizing platform switching. Analysis of interproximal bone usually depends on traditional two-dimensional radiographic assessment. Although there has been increased reliability of current techniques, there has been an inability to track bone level changes over time and in three dimensions. Micro-CT has provided three-dimensional imaging that can be used in conjunction with traditional two-dimensional radiographic techniques. METHODS: This study was performed on 24 female minipigs. Twelve animals received three implants with an inter-implant distance of 3 mm on one side of the mandible and another three implants on the contra-lateral side, where the implants were placed 2 mm apart creating a split mouth design. Twelve other animals received three implants with an inter-implant distance of 3 mm on one side of the mandible and another three implants on the contra-lateral side, where the implants were placed 4 mm apart creating a split mouth design too. The quantitative evaluation was performed comparatively on radiographs taken at t 0 (immediately after implantation) and at t 8 weeks (after termination). The samples were scanned by micro-computed tomography (μCT) to quantify the first bone to implant contact (fBIC) and bone volume/total volume (BV/TV). Mixed model regressions using the nonparametric Brunner-Langer method were used to determine the effect of inter-implant distance on the measured outcomes. RESULTS: The change in bone level was determined using radiography and its mean was 0.05 mm for an inter-implant distance of 3 and 0.00 mm for a 2 mm distance (P = 0.7268). The mean of this outcome was 0.18 mm for the 3 mm and for 4 mm inter-implant distance (P = 0.9500). Micro-computed tomography showed that the fBIC was always located above the reference, 0.27 and 0.20 mm for the comparison of 2-3 mm (P = 0.4622) and 0.49 and 0.34 mm for the inter-implant distance of 3 and 4 mm (P = 0.1699). BV/TV inside the defined parallelepipedic masks reached 82.38% for the 2 mm inter-implant distance and 85.00% for 3 mm, P = 0.8432. For the comparison of the 3-4 mm inter-implant distance, the means were 84.69% and 84.38%, respectively, P = 0.8401. Non-inferiority tests for the smaller inter-implant distances for both comparisons showed similar differences and similar tolerance ranges. CONCLUSION: The effect of a smaller interproximal distances between implants on bone level, fBIC and BV/TV assessed by two convergent investigation methods, radiology and μCT, was similar to that of larger distances. Implants can potentially be placed 2 mm apart instead of 3 mm and 3 mm apart instead of 4 mm when platform switching is utilized. Further research with a conventional platform is warranted.Clinical Oral Implants Research 10/2012; · 2.51 Impact Factor -
Article: Maxillary sinus elevation by lateral window approach: evolution of technology and technique.
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ABSTRACT: Context: The maxillary sinus elevation procedure has become an important pre-prosthetic surgical procedure for the creation of bone volume in the edentulous posterior maxilla for the placement of dental implants. Research and clinical experience over the past 30 years has increased the predictability of this procedure as well as reduced patient morbidity. Evidence Acquisition: Data on grafting materials and implant survival rates comes from 10 published evidence-based reviews that include all relevant published data from 1980 to 2012. Supporting clinical material comes from the experience of the authors. Evidence synthesis: The evidence-based reviews report and compare the implant survival rates utilizing various grafting materials, implant surfaces, and the use or non-use of barrier membranes over the lateral window. Clinical studies report on complication rates utilizing piezoelectric surgery and compare them to complication rates with rotary instrumentation. Conclusions: The conclusions of all the evidence-based reviews indicate that the utilization of bone replacement grafts, rough-surfaced implants, and barrier membranes result in the most positive outcomes when considering implant survival. Further, the utilization of piezoelectric surgery, rather than rotary diamond burs, for lateral window preparation and membrane separation leads to a dramatic reduction in the occurrence of the intraoperative complications of bleeding and membrane perforation.The journal of evidence-based dental practice 09/2012; 12(3 Suppl):161-71. -
Article: Association between oral bisphosphonate use and dental implant failure among middle-aged women.
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ABSTRACT: To investigate the association between the use of oral bisphosphonate therapy and dental implant failure. The case-control study involved 337 female patients, aged 40 years and older, who had 1181 implants placed at the Department of Periodontology and Implant Dentistry at New York University College of Dentistry between January 1997 and December 2004. Cases, defined as women with one or more implant failures, were identified from the departmental database. Controls were then randomly selected for each case. Adjusted odds ratios were estimated using logistic regression models fitted through generalized estimating equations. After adjusting for selected covariates, the odds of oral bisphosphonate use was 2.69 (95% confidence interval [CI], 1.49-4.86) times higher in women for whom implants failed compared with those for whom implants did not fail. Although no significant interaction was observed (p = 0.41), the stratified analyses suggest that the association between oral bisphosphonate use and dental implant failure was stronger in the maxilla (Odds Ratio [OR] = 2.60; 95% CI, 1.36-4.96) than in the mandible (OR = 1.38; 95% CI, 0.51-3.73). Findings from this study suggest that dental practitioners should be aware of the increased risk of implant failure associated with oral bisphosphonate use in the population.Journal Of Clinical Periodontology 01/2012; 39(4):408-14. · 3.00 Impact Factor -
Article: Survival rate of one-piece dental implants placed with a flapless or flap protocol--a randomized, controlled study: 12-month results.
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ABSTRACT: The purpose of this randomized controlled clinical study was to compare the survival of a one-piece anodically oxidized surface implant when placed with a flapless or flap protocol. Bone loss measurements on radiographs and changes in clinical probing depths 1 year post-definitive restoration placement were recorded and compared. Fifty-two of 60 patients (implants) remained in the study at the 1-year follow-up. At the time of final evaluation, no implant was lost in either group. At the time of placement of the definitive restoration, there was a mean mesial and distal bone gain in both groups compared to bone levels present at the time of implant insertion. There were no significant changes in bone levels between placement of the definitive restoration and those recorded 12 months later, and no significant differences in bone levels between the flap or flapless group at 6 or 12 months were noted. No significant differences were seen either in pocket depth or change in pocket depth at 6 and 12 months in the flapless and flap groups. It was therefore concluded that one-piece anodically oxidized surface implants, 1 year post-definitive restoration insertion, had high survival rates (100%) and stable marginal bone and probing depth levels whether a flapless or flap protocol was used for implant insertion.The International journal of periodontics & restorative dentistry 11/2011; 31(6):591-601. · 1.20 Impact Factor
