Hard-tissue augmentation for the placement of anterior dental implants

Dental implants have become a popular alternative for replacing missing teeth in every region of the oral cavity. In the anterior zone, special esthetic concerns require not only a stably anchored implant for long-term success, but also the presence of adequate hard and soft peri-implant tissues. Anterior tooth loss is often accompanied by considerable loss of alveolar bone, so augmenting hard tissue before or in combination with implant placement becomes a critical part of therapy. One of the most successful augmentation techniques is guided bone regeneration (GBR). Thus far, augmentation procedures using expanded polytetrafluoroethylene membranes (ePTFEa) have proved to be the most efficient and predictable surgical technique to enhance deficient bone sites. This article discusses some critical biological and clinical/technical aspects of GBR and describes techniques for anterior hard-tissue augmentation with the photographic documentations of three clinical cases.     

New evolution of the technique in trasaxillary augmentation mammaplasty: subpectoral-subglandular implant

Transaxillary subpectoral augmentation mammaplasty combines the advantages of an axillary located scar with those of a submuscular pocket. However, according to the classical technique, the caudal extension of the pectoral fascia prevents the prosthesis from filling completely the inferior breast pole, thus creating a double submammary fold and/or an excessive fullness of the superior quadrants. In order to overcome this limit Barnett (1990) proposed to disrupt the caudal extension of the pectoral fascia along with its insertions to the submammary fold, thus allowing the implant to lie in a submuscular plane superiorly and in a subglandular/subcutaneous one inferiorly. In this paper the authors present their clinical experience with this new surgical technique.     

Local anesthesia in breast augmentation

The Authors report their experience in the application of local anesthesia during breast prosthesis implantation.     

A meta-analysis of implants in partial edentulism

A meta-analytic technique was used to estimate the survival of implants supporting bridges or single crowns in partially edentulous patients. A survey of the literature revealed 66 studies, published between 1986 and 1996. Nine studies on single implants and 10 studies on fixed partial dentures met the inclusion criteria for the meta-analysis. Data from a total of 2686 implants, 570 single crowns (SC) and 2116 in fixed partial dentures (FPD), were analyzed. In order to calculate annual survival rates for individual studies a life-table analysis was conducted. Maximum follow-up time ranged between 1 and 8 years. After 1 year the success rate was calculated to be at least 85.7% for FPD and 97.2% for SC. When the results from the FPD studies were pooled the survival rate was 93.6% after 6-7 years. The corresponding value for SC was 97.5%.     

Health risks for women with breast implants

Women who have undergone implantation of a breast prosthesis have been exposed to a variety of health risks, many of which were unknown to them at the time of surgery. Recognition of health hazards has prompted the Food and Drug Administration to restrict implantation of these devices while study of safety and efficacy are undertaken. Capsule contracture, or the contraction of the fibrous tissue surrounding the prosthesis, is the most frequently occurring complication. Exposure to an implant does not appear to heighten the risk for breast cancer, but the opacity of a prosthesis substantially reduces the diagnostic capability of mammography. Silicone, used in the manufacture of implants, is linked to immunologic changes that result in connective tissue disorders. Most often this condition is scleroderma. Damaging effects from toluenediamine, a disintegration product of the polyurethane coating, have been reported. Whether the concentration of this chemical reaches toxic levels in women with prostheses remains to be clarified by current investigations.     

Wide polytef (Gore-Tex) implants in lip augmentation and nasolabial groove correction

OBJECTIVE: To describe a new technique of polytef (Gore-Tex) implantation into the upper and lower lips and nasolabial grooves by using large implants as a method that achieves effective cosmetic improvement. SETTING: A private cosmetic surgery center. PARTICIPANTS: Thirty-three (female) patients who desired fuller lips and 62 patients (52 female and 10 male) who requested less prominent cheek lip grooves. MAIN OUTCOME MEASURE: Significant patient satisfaction after 12 to 54 months. RESULTS: Conspicuous aesthetic effect that related to both lip and nasolabial groove correction was documented. All patients but 4 (2 in each group) were pleased with the final outcome of the treatment. CONCLUSIONS: In the opinion of the authors, the threading technique of polytef implantation creates inconspicuous improvement-both in lip augmentation and nasolabial groove correction. Large polytef implants that were inserted through a tunneling technique produced consistently good results. Implants (lip augmentation: width, < or = 10 mm, and thickness, 4 mm; nasolabial groove correction: width, 8 mm, and thickness, < or = 8 mm) were found to be safe, simple, and effective.     

Button versus buttonless castings for removable partial denture frameworks

Casting removable partial dentures (RPDs) without completely filling the sprue channels and generating casting buttons would result in saving metal and making more defect-free castings. This investigation tested whether a complete and sound RPD casting can be obtained when a minimal amount of metal is used. A factorial experimental design, three spruing methods, two metal feeding directions, and two different weights of metal were used to cast 60 Kennedy class II, modification 1 RPDs. The metal used to cast each framework was either enough to result in a full button or in no button. Visual and radiographic examinations and counting of defects were made by two independent operators who were unaware of the spruing method, feeding direction, or amount of metal used to make the framework. The completeness of the casting and the presence of porosities were evaluated for clasps, major connectors, and meshworks. The use of minimal metal to cast RPDs was equally as successful as using enough for a full button, provided that the appropriate spruing arrangement and metal feeding direction were chosen. Indirect metal feeding for maxillary RPDs was successful with the proper spruing arrangement.     

External ultrasonic treatment of capsular contractures in breast implants

The association of the syndrome of sleep apnoea and acromegaly was described in the literature. However, so far no satisfactory explanation was given of the more frequent concomitant incidence of these diseases. The authors describe the disappearance of the sleep apnoea syndrome in a female patient after removal of an intrasellar microadenoma of the pituitary with overproduction of growth hormone.     

Bigger is not always better: body image dissatisfaction in breast reduction and breast augmentation patients

This study investigated body image dissatisfaction in breast reduction and breast augmentation patients. Thirty breast reduction and 30 breast augmentation patients completed two body image measures preoperatively. Breast reduction patients reported greater dissatisfaction with their overall body image as compared with breast augmentation patients, part of which can be understood as a function of their increased body weight. When asked specifically about their breasts, reduction patients displayed increased body image dysphoria and maladaptive behavioral change, including embarrassment about their breasts in public areas and social settings and avoidance of physical activity. Results are discussed in the context of ideal body weight cutoffs by third-party payers for reimbursement for breast reduction. Recommendations for reimbursement criteria that de-emphasize the role of body weight are made.     

Treatment outcome with radiation therapy after breast augmentation or reconstruction in patients with primary breast carcinoma

BACKGROUND: Analyses were performed to determine local control and cosmetic outcome of breast carcinoma patients with prosthetically augmented or reconstructed breasts who had received radiation therapy (RT). METHODS: Twenty-one newly diagnosed breast carcinoma patients with prosthetically augmented or reconstructed breasts were treated with external beam RT. All patients received whole breast RT (median dose, 50.4 gray [Gy]) and 19 were boosted to a median dose of 60.4 Gy. A median dose of 50.4 Gy was delivered to the regional lymph nodes in 12 patients. Tissue equivalent bolus material was used in six patients. Seventeen patients received adjuvant systemic therapy. Cosmetic results were evaluated at 3-6-month intervals. RESULTS: With a median follow-up of 32 months, good/excellent cosmetic results were observed in 71% of patients (100% in those with augmented breasts and 54% in those with reconstructed breasts). Four patients (19%) with fair/poor cosmetic outcomes required implant removal and/or revision. Multiple clinical and treatment-related factors were analyzed for their impact on cosmetic outcome. A worsened cosmetic result was observed with increasing stage (P = 0.076), breast reconstruction (vs. augmentation) (P = 0.030), and bolus application (P = 0.016). All patients with fair/poor cosmetic outcomes had time intervals from implant insertion to RT ranging from 53-213 days. Two patients developed an isolated local recurrence within the augmented breast. CONCLUSIONS: Patients with prosthetically augmented breasts can undergo RT and expect good/excellent cosmetic results. Patients with reconstructed breasts are at a significantly greater risk for cosmetic failure. This risk may be related to the higher percentage of patients with advanced disease, those who received bolus application, and those who received earlier delivery of RT (after the cosmetic procedure) in reconstructed breasts.     

Vertical ridge augmentation around dental implants using a membrane technique and autogenous bone or allografts in humans

This study investigated the effect on vertical bone regeneration of the addition of demineralized freeze-dried bone allograft or autogenous bone chips to a membrane technique. Twenty partially edentulous patients with vertical jawbone deficiencies were selected for this study. The patients were divided into two groups of 10 individuals. The 10 patients of Group A received 26 Br?nemark implants in 10 surgical sites. The 10 patients of Group B received 32 implants in 12 surgical sites. Fifty-two out of 58 implants (22 in Group A and 30 in Group B) extended 1.5 to 7.5 mm superior to the bone crest. Titanium-reinforced expanded polytetrafluoroethylene membranes were used to cover the implants and, before complete membrane fixation, demineralized freeze-dried bone allograft particles were condensed under the membrane in Group A, and autogenous bone chips were used in Group B. At the reentry after 7 to 11 months the membranes were removed and a small biopsy was collected from 11 sites comprehending the miniscrews. The clinical measurements from Group A demonstrated a mean vertical bone gain of 3.1 mm (SD = 0.9 mm, range 1 to 5 mm) with a mean percentage of bone gain of 124% (SD = 46.6%). The measurements from Group B showed a mean vertical bone gain of 5.02 mm (SD = 2.3 mm, range 1 to 8.5 mm) with a mean percentage of bone gain of 95% (SD = 26.8%). Histomorphometric analysis of the present study clearly demonstrated a direct correlation between the density of the pre-existing bone and the density of the regenerated bone. The mean percentage of new bone-titanium contact was from 39.1% to 63.2%, depending on the quality of the pre-existing bone. Both the clinical and histologic results indicate a beneficial effect of the addition of demineralized freeze-dried bone allograft or autogenous bone particles to vertical ridge augmentation procedures in humans.     

Loaded and nonloaded titanium versus hydroxyapatite-coated threaded implants in the canine mandible

A commercially pure titanium threaded implant was compared to a hydroxyapatite-coated threaded implant of similar geometric design and dimensions in the canine model. Bilateral posterior implants supported fixed prostheses, and some implants in the same mandibles served as unloaded control implants. Implants were evaluated clinically, radiographically, and histomorphometrically at the light microscope level to detect any differences in bone response to loaded conditions. No statistically significant differences were found between the two implant designs under loaded or nonloaded conditions with regard to mobility, probing depth, percentage of osseointegration, and crestal bone position.