Feasibility and needs for simultaneous or staged bone augmentation to place prosthetically guided dental implants after extraction or exfoliation of first molars due to severe periodontitis

Abstract

Background The aim of this study was to retrospectively assess bone volumes, healed ridge topography and possibility to plan prosthetically guided implants (PGI) at least 6 months after extraction or exfoliation of first molars as a consequence of terminal periodontitis (EEFMP). Materials and Methods 45 subjects with stage III‐IV periodontitis providing 74 extraction sites (maxillary = 51 and mandibular = 23) were included. The degree of residual periodontal support on each root was assessed by combining periodontal and radiographic data. Digital planning of PGI with 4.8/4.1 mm diameter, 8 mm long, root‐form dental implant and need for bone augmentation (BA) were performed using CBCT with a radiographic stent. Possibility of standard implant placement (STANDARD) and need for simultaneous or staged BA were assessed. Results Planning PGI placement was possible in all cases. For a 4.8 mm diameter implant, STANDARD was possible in 37.8% of the sites, 33.8% required BA at the time of implant placement, and 28.4% required staged BA before PGI. The use of 4.1 mm rather than 4.8 mm diameter implant allowed STANDARD in an additional 8.1% of cases that originally required simultaneous BA/osteotome sinus floor elevation (OSFE). The level of periodontal bone loss did not predict the complexity of implant placement, but significant differences were observed comparing maxillary with mandibular sites. Conclusion PGI planning at sites with first molar loss due to terminal periodontitis is possible but poses great challenge to rehabilitation, often requiring advanced augmentation procedures and sinus augmentation.

Increased local concentrations of growth factors from leucocyte‐ and platelet‐rich fibrin do not translate into improved alveolar ridge preservation: An intra‐individual mechanistic randomized controlled trial

“…The position of a standard size (Straumann bone level implant 8 mm in length, 3.3 mm in diameter with screw retained restoration) PGI was determined by a single calibrated assessor based on CBCT data, diagnostic wax‐up (or pre‐extraction intraoral scanning showing the original coronal structure), and intraoral digital scanning with the Panmeca Romexis software, version 4.6.2.R (Appendix Figure S5). The possibility of standard PGI placement, the need for simultaneous bone augmentation, or the need for staged PGI placement was determined as previously described (Fok et al, 2020). In brief, the choice was based upon the endosteal portion of the implant being fully planned in native bone with a residual thickness of at least 1.5 mm.…”

“…Areas with no changes during the follow-up period (e.g., the walls of maxillary sinuses, palatine process of maxilla, nasal septum, and mandibular bone) were used as references to superimpose the two datasets. Linear changes were quantified as described by Jung et al (Jung et al, 2013) The possibility of standard PGI placement, the need for simultaneous bone augmentation, or the need for staged PGI placement was determined as previously described (Fok et al, 2020). In brief, the choice was based upon the endosteal portion of the implant being fully planned in native bone with a residual thickness of at least 1.5 mm.…”

Recent Advances in Scaffolds for Guided Bone Regeneration

“…Frequently, the insufficient alveolar bone volume occurring from local factors including periodontitis, trauma, and localized alveolar process resorption, may be challenging to restore [ 44 ]. To overcome this issue, various methods have been employed such as GBR combined with bone grafts and barrier membranes [ 45 ]. While autogenous bone grafting may have a limited capacity to restore larger bone defects, the utilization of allografts and xenografts could overcome the challenges in bone augmentation [ 46 ].…”

Resorbable GBR Scaffolds in Oral and Maxillofacial Tissue Engineering: Design, Fabrication, and Applications

“…However, in clinical surgeries, a common challenge is encountering insufficient alveolar bone volume, caused by factors like periodontitis and local alveolar process absorption [38]. To tackle this issue, various approaches such as distraction osteogenesis, autografts, and GBR have been employed [39]. Despite its potential, distraction osteogenesis may lead to unwanted tissue scars due to its immature development [38].…”