Implant Dentistry - Science topic

Firstly, congratulations on the survey on artificial intelligence in dentistry being scored in a discussion group. For some time now, we have been using artificial intelligence processes in decision-making by collecting images using rasterization equipment, cell counting equipment, fault identification processes, etc. This, as a consequence, helps us identify the percentage of choice for a certain procedure. I understand that today what is being publicized and alarmed is that AI will make decisions for us, without taking human beings into account. The justification is that, AI would rank the processes of past experience by analyzing the possibility of errors and as a consequence these would be smaller. Of course, at the beginning there would be a gigantic exhibition of procedures that work in the hands of some professionals and are not possible to be reproduced on a large scale and this could cause creativity and the ability to improvise to be eliminated and disappear, causing the In the long term, the ability to create would be delegated to AI. @motta

Mainly mini-implant success in orthodontics depends to a large extent on primary stability and bone structure at the insertion site. There are a host of factors responsible for success and failure of mini-implants, however the purpose of using a mini-implant will determine the location of the mini-implant. An important factor is the location of the mini-implant insertion. Most studies have found that palatal mini-implants have better success rates than other sites.

We can use different lines of protection to decrease exposure to covid 19 infection..

I mention it in my page on research gate as presentation ..ppt.. ..you can getback and read it carefully.

Best regard

Please have a look at the following link:

Removing smear layers with Er:YAG to allow closer adaptation of fixture to bone helps with earlier integration and therefore allow earlier loading.

following

Yes

Prepare Models with deep flange impression trays to include maximum depth of mandible and reduce the dimensions of soft tissue to get dimensions of available bone at the minimum thickness of edentulous area

Hi!

Question of stability i believe..... Primary stability is operator specific, subjective .

Any element in the universe be it living , non living has a in built mechanism to stabilize it self in terms of gravity and the forces that rationalize the gravity . Lets refer a case of trauma , where an maxillary anterior tooth has avulsed from its socket , whats the protocol .. place back and STABILIZE(with RCT /Without RCT) ,What is important here is time factor on to how much time the tooth has spent out of the socket . The healing of such stabilized treated tooth is ankylosis, similar to implant bone interface.. on to achieve this result or to achieve the microscopic mating- osseointegration the environment should be conducive and consistently stable. This is the very essence of the contemporary Dental implant concept of TWO PIECE .. delt as surgical and prosthetic .... surgical just because to achieve the Endosseous implant body stability in terms of strength ,against compressive ,rotational and stress causal forces, if possible the prosthetic loading to be passive for next 48 weeks , to avoid crestal bone loss....

Stability is demanded all the time , we could assess the stability primarily at radiographic assessment of bone .. especially the hounsfield units giving you a sense of the density of bone u are dealing with along other detrimental factors .

Hence primary stability is skill sensitive and a subjective matter,

Implant dentistry demands in depth considerations of micro forces acting on the implant to be success..... now other question is when do u call a implant success ? , thats for another day :).

regards

I suggest you to read our chapter, I wish your find it useful.

sure blood coagulation is important and but as Dr Elhadi said we have important thing will happen during ablation of tissue , photobiomodulation

and also remember that if you not use accurate parameters special with diode laser and co2 laser thermal damage id very dangerous for implant eosteointigration   

for that i recomended work in pulse mode with time off triple time on ( at least )

Perfect.

Really, everyday more and more cases we monitore and didn`t find answer for such changes. The progressive adjustment of occlusion associated to wear, also may cause vertical dimension reduction. I really agree that occlusal factors isolated can`t cause disease process.

Concerning to the method to oclusal adjustment, I think it is the more difficult point of discussion. We treat people. The perception is completelly subjective. Even when we use digital equipment or articulating paper, our feelling and the patient perception are  deteminant to estabilish the "correct" occlusion. We follow the academic principles, very well described above, but the "personal touch" is given by the professional perception.

When we look through the occlusal stand point, almost all single restoration will be transformed in a total rehabilitation, mainly in anterior cases when we look for mutually protected occlusion.

I attached main articles that show the surgical techniques related to increasing the amount of keratinized tissue around the implants by using free gingival graft. The other two articles show the the importance of increasing soft tissue thickness and the amount of keratinized tissue surrounding the implant.

Increasing soft tissue thickness and the amount of keratinized tissue surrounding the implant have recently raised an attention in Implant dentistry. Soft tissue thickness has a significant influence on marginal bone stability around implants. Linkevicius et al found that if the tissue thickness is less than 2 mm up to 1.45 mm of crestal bone loss might be anticipated, which can be avoided by increasing the tissue thickness to more than 2.5 mm. Thick vs thin biotype, represents thicker bony architecture with rich blood supply and vasculature and more resistance to bone loss at the time of inflammation.

Systematic reviews have shown that inadequate keratinized tissue around dental implants is related to more plaque accumulation, tissue inflammation, marginal soft tissue recession, and attachment loss.

First, you must determine the implant material has not been altered during the process of re-sterilizing, if so the results may be in question.

This was just in the news... it was in lettuce...but you know...

Dear Edres Ali

pls check the link.

There are many solutions which permit the use of implants even in the severely atrophic mandible, including submandibular cadaver grafting.

At Pi Dental center we have enjoyed great clinical success with over 42,000 Branemark external hex implants.  The external hex is more prosthetically friendly when using tilted implants, such as in the ALL ON 4 treatment concept.  It allows the angulated abutments more accurat alignment for prosthetic screw access.

It is also the best connection for zygomatic implants.

Load distribution is ideal with the external hex.

Dear Dr!!!!

Complete and interesting information provided by Dr. Abu-Hussein Muhamad.

Once the implant comes in contact with biological eviroment ( for eg. blood, plasma etc.| the implant surface becomes althered permanently. However if  the asepsis is nor disrupted shouldn't be a problem to place it in a new site. The effect of flushing with  saline could be discussed as it may affect the fibrin contact with the implant surface in a negative way.

Dear Dr. Saway;

A Maryland bridge would be better as it is fixed, so no chance of loss and also cheeper if you compare it with many time loss and fabrication of new ones.

Implants do not have 100% success...ten year data tends to show that success is possibly in the low 80%...why do you think we now see text books and articles published on dealing with implant failures...and how about those that are not in any report and the patient just has them taken out or the bone loss is so great they fall out. Remember, implants are evaluated as to survival not success or failure. 

Thanks Sir for opening a window about the anterior esthetic fixed appliance. I am performing such an appliance for children for whom & their parents the esthetic is of big concern. But what do you think about the effect of Nance on maxilla growth? 

Chair-side intra-oral pickup is such a simple and time saving technique with good serviceability, I used it in a study to pick up O-ring attachments for four implant retained maxillary over-dentures while patients were biting in centric.

Dr. Eckert has clearly stated the correct answer to what would seem to be a simple question. Careful analysis and critical appraisal of the literature can be daunting even for the informed reader. Hopefully the peer review process used by journals would bring these critical issues to the surface so that the reader and clinicians can properly interpret and provide the best care possible for the patient. This benefits everyone.

Hello, Haroon!

It is quite complex maxillo facial rehabilitation of patients with major loss in this area, but dental implants are one of the best options for fixing these prostheses.

Best regards!

Here a study although with a small number of implants that covers an observation period of 10 to 20 years. Various reconstructions

 

Clin Oral Implants Res. 2001 Jun;12(3):252-9.

Long-term evaluation of non-submerged hollow cylinder implants. Clinical and radiographic results.

Merickse-Stern R1, Aerni D, Geering AH, Buser D.

Author information

 

Abstract

From 1974 various types of hollow cylinder ITI-implants were placed before the new generation of Bonefit ITI-implants was developed in the mid-eighties. The aim of this study was the clinical and radiographic evaluation of hollow cylinder implants that were inserted during the time period of 1978-1987 in partially and completely edentulous patients to support overdentures, fixed partial prostheses and single crowns. Altogether, 71 patients with a total of 132 hollow cylinder ITI-implants still in situ had been followed regularly during the entire observation period of 11.4 to 19.7 years (mean 14.1). Thirteen implants had to be removed before an observation period of 10 years was completed, 4 additional implants were lost after being in function for over 10 years and two further implants were considered to be failures at the time of the examination. Thus 91.4% of the implants were still in situ after 10 years and the survival rate for a mean observation period of 14.1 years was 84.6%. Periimplant parameters were used to assess the clinical conditions of the implants. On the radiographs, horizontal bone loss or angular defects could be detected on 40% of all implants if compared to the base-line situation. The probing depths around these implants were significantly increased compared to implants with an unchanged bone level, however the mean probing depths did not exceed 3.5 mm and 2.8 mm respectively. From this clinical evaluation one may conclude that with the early generation of hollow cylinder ITI-implants favorable long-term results were achieved.

Here another study with an observation period of 10 to 24 years with a limited number of edentulous patients having two interforaminal implants.

Int J Oral Maxillofac Implants. 2011 Mar-Apr;26(2):365-72.

Long-term results of mandibular implants supporting an overdenture: implant survival, failures, and crestal bone level changes.

Ueda T1, Kremer U, Katsoulis J, Mericske-Stern R.

Author information

 

Abstract

PURPOSE:

The present study summarizes the long-term clinical observations of edentulous patients treated with mandibular implant-supported overdentures.

MATERIALS AND METHODS:

From 1984 to 1997, edentulous patients were consecutively admitted to treatment with mandibular implant overdentures. The treatment plan was to connect the dentures to only two implants by means of single ball anchors or bars; in patients with special oral conditions, three implants would be placed. Regular maintenance care was provided at least one time per year. The cumulative implant survival rate was calculated. Implant failures were described according to clinical signs at the time of removal and related to the patient's specific history. Crestal bone measurements were performed using computer software.

RESULTS:

In all, 147 patients with 314 implants were evaluated for 10 to 24 years. Of these, 101 patients were still available; of the 46 patients who were not evaluated, 26 had died or were not ambulatory. Thirteen implants failed during the observation period, resulting in a cumulative survival rate of 85.9% after 24 years. The reasons for removal of implants were peri-implantitis (two implants) and mobility (11 implants). Mean crestal bone loss was 0.54 ± 0.7 mm per implant site after an average observation time of 16.5 ± 3.9 years. The duration of loading had a statistically significant effect on bone loss.

CONCLUSIONS:

The present data exhibit a satisfactory survival rate of implants. An individual analysis of implants with late failures did not reveal a typical failure pattern, but loss of implants without signs of infection was more frequent than loss of implants with signs of peri-implantitis.

Preimplantitis is the inflammation around implant and involves bone tissue. The possible bacteria that involve in such inflammation are red complex members such as Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola. These bacteria are strictly anaerobic. Thus to simulate such condition for in vitro we need to have life bone tissue and implant and the previous complex members and anaerobic condition for the growth and production of toxins that lead to inflammation of bone tissue around implant,

Certainly there is a slight change from the uncured and cured state, in terms of translucency. However, shade transition largely depends on the zone of application and layers applied. Shall look into the refernces and update soon.

Hi Alexandros, thank you for your answer. There are plenty of studies measuring the precision of io-scanners, since that is as easy as it is important to measure. The exactness of any relevant system on the market is (no longer) of any conercen, IMHO. BUT there are huge differences in the handling and workflow. And these differences matter to me as a clinician.

Hi Mohammed. I use the closed tray technique in the following clinical situations:

1. Single implants. 2. two non splinted implants (eg lower overdenture). 3.Limited mouth opening or implants located at the back of the mouth where long screws will not fit. 4. relatively parallel implants (no more than 2 though) and implants with their long axis parallel to the path of removal of the custom tray.

I use the open tray technique in the following clinical situations:

1. two or more splinted implants.2. implants with 15 degrees of divergence or more. 3.  immediate loading protocol.

Hope i answered your question sufficiently.Best regards.

You do not give enough information, but if you want to know how much excipient you must use in determinate formulation, I suggest you to consult the Pharmaceutical Excipients Handbook. It all depends on your formulation, if its is a Tablet, capsule, suspensión, injectable solution...etc.

Always a rigid connector when splinting implants to natural teeth. 

Dental Implants still follow concepts put forth by Branemark. Interesting thing about Branemark is that he was an Orthopaedic surgeon and the protocols that he instituted were based on the same principles of open joint surgeries and implants done in orthopaedics including the scrubbing, draping and isolation. While this is still important for oral environment, no matter how careful we are, contamination of the surgical site with saliva and the bacteria from saliva is inevitable.

Regarding the antibiotic prophylaxis prior to implant surgery or in the post procedure period, it is highly controversial. A few studies done in this regard concluded that post operative antibiotics would not be required. And that the standard surgical prophylaxis prior to surgery is all that is required. But interestingly some have questioned even the administration of pre procedure antibiotics. (more on this later).

For all practical purposes, I wish to state that while I have routinely seen antibiotics being administered after minor oral surgery by most dentists and even oral surgeons, I have not seen high level evidence supporting the same. Infact, most studies in this regard question the routine use of antibiotics after minor oral surgery. Any patient who is being planned for dental implant is being prepared for the procedure with oral prophylaxis and elimination of active periodontal disease before the procedure itself. In this regard, the oral cavity is presumably in pristine health. We do not use antibiotics even for placement of bone implants (post trauma) and haven't encountered any significant increase in infection rates. Post procedure antibiotics cannot and should not be considered a replacement for sound surgical technique and it cannot protect the patient against failure if the technique is erroneous.

Quoting from the article (1) attached :

"The use of prophylactic antibiotics prior to implant placement is controversial. A systematic review supports the use of 2 g amoxicillin as presurgical prophylaxis while a few other studies conclude that there is no added benefit. There is no evidence that implant failure is prevented by antibiotic usage"

The relevant references are also cited for your references. Though this is not exhaustive, the general recommendation will be that for a single site single implant placement, antibiotic prophylaxis would not be required considering that the entire surgical duration will be short and uncomplicated. For longer durations when the bone is expected to be exposed for longer durations or if combined with graft placements, prophylaxis may be considered but stress must be towards following all sterile precautions to prevent contamination of the surface of the implant for best osseointegration and for meticulous surgical technique with slow drilling combined with copious irrigation to prevent bone damage around the implant placed. These are far more important factors for implant success than antibiotics.

Irrational use of antibiotics should be avoided.

Regards,

Dr. Akilesh. R

India

There are rotary titanium brushes on the market that can be used.  There is a risk of removing thin bone around implants using these brushes.  IMHO, their effectiveness has not been fully evaluated.

It is also possible to use air jet polishing devices such as the Cavi-Jet which uses sodium bicarbonate.  Also, IMHO, their effectiveness has not been fully evaluated.

This is my personal opinion and not an official US FDA opinion.  Mention of any medical device by name is my providing an example and is not, and should not be considered an official US FDA recommendation.

Thank you.

An interesting  question about  a historic  approach . However,in my view,cross arch stabilisation is very much  yesterday's game.

There can be very little ,if any, justification now  for removing 62-73% of sound tooth tissue (Edelhof and sorenson 2002) for multiple preparations to provide one path of insertion for such prostheses.

The concept was founded on the   now discredited  idea that distributing  occlusal load across multiple teeth to provide rigidity  stopped periodontal disease.

Most of  have  not believed that for over forty years (Axelsson and Lindhe). Double abutting as a concept  can contain the seeds of  later failure due to pulpal or structural problems .Splinting teeth  for cross arch stabilisation also makes it more difficult for the average person to keep things clean -hence later failure.

Just ask yourself-"would I have that  destruction done to your own remaining sound teeth if you were missing those teeth"

hi ; Ithink that  this is a Straumann implant

like the one i am showing here which is an actual " Straumann implant"

hope that help

Cheers

prof galil

Thanks

Resorption patterns of buccal-crestal area in posterior make it difficult to locate appropriate place to put implant. So that I always use CBCT to measure the width and find out exact locations. In addition, if we have to do bone graft, there would be a lot of things to be considered. So in my personal opinion, panorama itself is not enough in many cases.

Now, the question that needs to be addressed is what do you classify as mini implants ?

Regular implants usually are 3.2 mm diameter or more. I am going on the definition that these mini dental implants are those that less than 3.2 mm. Also there are these narrow diameter implants of 1.8 mm diameter as well, which are also increasingly used.

The largest implant possible needs to be used. One benefit of implant supported denture is that the implant placement is not bound by adjacent tooth structure but by the bone support and vital structures (inferior alveolar nerve / mental nerve).

Mini implants are best used as temporary bone anchorage devices or for exceptional circumstances where the space is less for placement of regular implants either in height or in width. As for implant supported mandibular prosthesis, it should ideally be replacing a canine and / or a premolar tooth as these are the most common teeth used as tooth supported over dentures.

But 4 Mini Dental implants are being used for support dentures with success. So, why not ? This is not the ideal solution but acceptable compromise in old patients or in other patients who are not candidates for regular implants or in those who require grafts but cannot tolerate the procedure or refuse it. Even though the mini dental implants were initially used as temporary / transitional implants, increasingly we see them used long term as well.

They come cheap but they come in one piece! This means that if the ball attachment of the implant gets worn out in say 5-8 years, the entire implant will need to be replaced. In regular implants, only the prosthetic attachment (ball attachment) can be replaced. This is an important consideration. Removing an osseointegrated implant from the bone is not easy and even if it is done, there is considerable bone loss. So this aspect needs to be considered while using mini implants for removable complete denture support.

Regards,

Dr. Akilesh R

Consultant Oral and Maxillofacial Surgeon

If you look at Esposito's articles published by The Cochrane Collaboration since 2008 or so, you will find that they also agree that there is no evidence based data to support one design over others. Therefore I completely agree with the distinguished previous colleagues who wrote to you.

However, there are some pros and cons to specific implant designs that is based on over two decades of working in this field as a Dental Educator, although NOT SCIENFITIC, these hints may give you an idea of some things to think about:

1. Cylindrical implants with mild threads *like the old Branemark design) may be tricky in soft bone conditions when used by beginners. This is due to the fact that when placed without care, these implants may start rotating when their apex riches the end of the osteotomy, Conical shaped implants (regardless of their connection type) with more aggressive thread designs may be easier for use by beginners in these conditions.

2. Implants with a rounded (non-active) apex may be safer for use when you get close to vital organs (such as the mandibular canal), since they would not proceed beyond your osteotomy. Implants with an active apex may go beyond the osteotomy and therefor require more care during placement procedures,

3. In immediate placement situations, implants with sharp apical threads may engage bone instantly, allowing easier placement into the desired position.

As I said before, these are NOT SCIENTIFIC, but clinical observations and insights. Please also note that there is a good chance that other doctors may not agree with me, and therefor I propose these insights only as my own opinion.

All the best, Nachum

I agree with Dr Eckert BUT to simplify the matter for the General Practitioner who is making a chairside clinical decision, the suggested parameter is a good rule to follow. 

The initial polymerization contraction is 1.5-3.5%, which causes problems with bulk fillings shrinking away from margins, but has little effect on layered build-ups. Wear resistance and flexibility are built into the composite, but do not necessarily directly relate to polymerization shrinkage.

Occlusal concepts are still just concepts derived from complete denture practice. To add a little, 99.99% of all clinicians make their first steps having their patients seated comfortably in the dental chair to find the vertical dimension. Also, muscle relaxation is important because most patients lost their oral motor skills (stereognosis) over the years and you will have to manipulate the mandible in centric relation, which takes time.

The best resource I was able to find is : Impact of diabetes mellitus and glycemic control on the osseointegration of dental implants: a systematic literature review, J Periodontol. 2009 Nov;80(11):1719-30

Yes it is possible. It depends on the medium on which the laser beam propagates. Each medium can bear a certain density of power. If this density of power is exceeded, the medium is ionised in a plasma, this is called the "breakdown". In air, the maximal density of power before breadown is about 4 GW/cm². Below, there is a partial breadown. When the plasma appears, it block the coming photons and there is nore more energy deposited in the material. The plasma can even reflect the photons in the laser source and it is a possible crash for the laser. In water, the breakdown threeshold is about 8-9 GW/cm². See :

A. Sollier, L. Berthe, and R. Fabbro, Eur. Phys. J. AP 16, 131-139 (2001).

regards

I think a lot will depend on the patient's compliance and his or her willingness to retain their natural dentition...as far as i am concerned i would definitely try 2 save the natural tooth instead of blindly going 4 implant....surgical crown lengthening, root canal treatment, post and core should be done but ultimately it all depends on the patient's will and whether they would be ready to come for so many appointments for saving a tooth..if the answer is no...definitely implant therapy..provided the periodontium is healthy and we have sufficient sound bone to receive an implant...

Yes platelet rich fibrin and platelet rich plasma have been extensively used in periodontal regeneration and excellent results have been achieved.The newer of the two, that is PRF has tremendous potential as it harbours lot of growth factors and are used even by oral surgeons in dental defects.Hence it makes a lot of sense to use them in regeneration procedures n dentistry.

To remove the implant and place a new implant at the desired level.

This is why clinical and radiographical follow-ups are so important in my opinion. If you chose to put implants in a KCOT-free zone and the implants osseointegrate, then close follow-up will allow you to act quickly in presence of a new KCOT before it compromises the osseointegrated implants.

In this end, it's all a matter of weighing the risks for the patient.

This is not a new topic although I agree, most clinicians seem unaware of the possibility of such anatomic variants.

The real question is whether such anatomical distribution affects local anesthesia.

In a review of 2006, accessory innervation from the cervical plexus was listed as a possible cause of anesthesia failure (Boronat & Penarrocha 2006).

I have personally encountered a few cases of such suspected innervation that could be circumvented by local application of anesthesia in the first mandibular molar region.

Boronat A, Penarrocha M. Failure of locoregional anesthesia in dental practice : review of the literature. Med Oral Pathol Oral Cir Bucal 2006 ;11 :E10-3.

Thanks Atiphan, Yes, I'm also overseeing a case with fracture at the implant neck 4.5mm dia. . It's explanted now.

The site is slightly deficient in buccal bone, lower first molar, non-bruxer. Bone loss within 6-12 months after loading. Conventional loading protocol. Implant placed in healed site. Experienced clinician. Middle age female healthy patient. I doubt there was any mishaps with torquing abutment. Material and implant design are aspects to be investigated.

Dear Maria,

yes, I do clearly agree with the article.

The problems we face in dental research are very scarce budgets when compared to medicine. When you do not have money for your research you can hardly engage in high level studies, add of statisticians, extended ethical approval, etc.

Evidence currently gives dental research and systematic review poor marks!

Actually there is no fixed answer for your question. Let me tell you some facts:

1. Bone doesn't grow around implants but it joins titanium in a chemical reaction called osseointegration.

2. We may load the implant immediately after surgery or we may postpone loading (tooth fixation) for up to six months.

3. It depends on the drilling of the implant bed into the jaw bone as well as the amount and type of bone you have.

4. Size and length of the implant is an important factor too.

5. Healing capacity of your body is an important issue.

Finally, your dentist (the one who put the implant) is the only person who can answer your question.

Actually, I am in complete agreement with Dr Agrawal in that bone formation and resorption are a continuous and coupled process. Nevertheless, salivary levels of sRANKL and OPG, more importantly assessing their ratios at different times might provide an insight into the healing. We now have really sensitive ELISA tests that can measure the levels of these substances in saliva upto a few picograms. Matrix Metalloproteinases especially MMP8 and 10 could also be looked into as potential candidates for determining the phase of tooth movement.

I would suggest so to go through the high-cited article: Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale (Kim et al. 2005 COIR). Hope this may be helpful for you

Thank you Aberto,

This is a very interesting answer. I also agree in that implant angulation taking care not to entry in the orbital cavity and assuring a good stability in the malar bone should be the main goal. Pre-op virtual planning would be a good choice if some anatomical landmarks are fixed for translation into the surgical field.

Dear all, it is clear that what Dr. Lee proposes in its research should be the gold standard for measuring resorption of bone grafts after implant placement. However, the histologic study of bone grafts sections together with the inserted implant is not reliable in clinical practice. Alberto, I agree with you in that measuring distance from the top of the screw should be appropriate enough to control bone resorption, at least in the bucco-lingual direction. Although an immediate post-op CBCT should be more accurate for comparison with delay CBCT, it is not always routinely performed. Go ahead with your clinical research. I would focus on onlay grafting for the anterior upper maxilla.

Dear Alberto, it is a fact that, at the state of knowledge, the absence of an universally accepted measurement method, able to assess the degree of defect correction and the three-dimensional stability over time of the augmented bone, still prevent clinicians to draw significant conclusions about the long-term clinical success of the different augmentation procedures.

Of course, neither open flap caliper measurements nor CT scan can be considered feasible routine methods of monitoring bone stability over time, because of their unreasonable economical and biological costs.

I fully agree with Dr Kashi that “bone sounding” is the technique with the best cost-benefit ratio, but - as rightly pointed out Dr Nakamai about the angulation of the caliper- the reproducibility of position may be an issue, for any chosen instrument for measuring . This problem - for bone sounding - may be partly overcome by using a template customized on the basis of final restoration and pierced at some buccal and lingual/palatal points at each implant site. In this way the holes guide the endo files during bone sounding in a reproducible position and angle, allowing the long-term evaluation of the horizontal stability of the augmented bone.

In this regard, if you think it might worthwhile, please view the article

Horizontal and vertical ridge augmentation in localized alveolar deficient sites: a retrospective case series. Implant dentistry. 06/2012; 21(3):175-85

available at : https://www.researchgate.net/publication/225054009_Horizontal_and_vertical_ridge_augmentation_in_localized_alveolar_deficient_sites_a_retrospective_case_series

Dear Ahmad

I recieved arequest from you asking for a copy of my publication: indirect sinus floor elevation for osseoitegrated dental implants, published in JOI . pls send me your private mail adress to send you a PDF file. I'm not allowed to upload the file to a third party web site.

my mail is

Considering fixed prosthetic restorations, you can see these two:

Int J Prosthodont. 2011 Jul-Aug;24(4):294-302.

Immediate versus delayed loading of dental implants in edentulous maxillae: a 36-month prospective study.

-Tealdo T, Bevilacqua M, Menini M, Pera F, Ravera G, Drago C, Pera P.

Clin Oral Implants Res. 2008 May;19(5):433-41. Epub 2008 Mar 26.

Five-year results from a randomized, controlled trial on early and delayed loading of implants supporting full-arch prosthesis in the edentulous maxilla.

-Fischer K, Stenberg T, Hedin M, Sennerby L.

as regards overdentures, please find these other two but the loading is early, not properly immediate

- Turkyilmaz I, Tozum TF, Fuhrmann DM, Tumer C.

Seven-year follow-up results of TiUnite implants supporting mandibular overdentures: early versus delayed loading.

Clin Implant Dent Relat Res. 2012 May;14 Suppl 1:e83-90. doi: 10.1111/j.1708-8208.2011.00365.x. Epub 2011 Jul 11.

-Mackie A, Lyons K, Thomson WM, Payne AG.

Mandibular two-implant overdentures: prosthodontic maintenance using different loading protocols and attachment systems. Int J Prosthodont. 2011 Sep-Oct;24(5):405-16.

I personally do not know any other

Well, I would discuss this question from anatomical point of view. The ratio of compact bone to that of spongy bone in ramus block graft may be different from that of calvaria block grafts. This might affect the ISQ of dental implants.This if we exclude the accuracy of statistical analysis used.