The edentulous ridge expansion (ERE) technique an experimental study in the dog

Objective: To compare the healing and bony crest resorption at implants installed conventionally or applying an edentulous ridge expansion (ERE) technique in the maxilla.Material and methods: In six Labrador dogs, the first and second maxillary incisors were extracted bilaterally. In the left side of the maxilla (Test), the flaps were elevated and the buccal plate of the alveoli and septa was removed. After 3 months of healing, partial-thickness (split) flaps were dissected and the residual alveolar bone was exposed. In the right side of the maxilla, an implant was installed conventionally (Type IV; Control) while, in the left side, the ERE technique was adopted. Hence, an expansion of the buccal bony crest was obtained, and the implant was subsequently installed (Test). After 3 months of healing, biopsies were obtained and ground sections were prepared for histological analyses.Results: A buccal vertical resorption of the bony crest of 2.2 +/- 1.2 mm and 1.6 +/- 0.7 mm was found at the test and control sites, respectively. The difference, however, did not reach statistical significance. The coronal level of osseointegration at the buccal aspect was located at 3.1 +/- 1.0 mm and 2.2 +/- 0.7 mm from the implant shoulder at the test and control sites, respectively, the difference being statistically significant. The mean values of the mineralized bone-to-implant contact (MBIC%) ranged from 43% to 48% at the buccal and lingual sites. No differences reached statistical significance.Conclusions: Implants installed by applying an ERE technique may osseointegrate similarly to conventional implant installation. However, vertical and horizontal resorption of the displaced buccal bony wall occurred as well.

Influence on alveolar resorption of the buccal bony plate width in the edentulous ridge expansion (ERE) - an experimental study in the dog

Objective: To compare the hard tissue changes at implants installed applying edentulous ridge expansion (E.R.E.) at sites with a buccal bony wall thickness of 1 or 2 mm.Material and methods: In six Labrador dogs, the first and second maxillary incisors were extracted, and the buccal alveolar bony plates and septa were removed. After 3 months of healing, partial-thickness flaps were dissected, and the E.R.E. was applied bilaterally. Hence, an expansion of the buccal bony crest was obtained in both sides of the maxilla with a displacement of either a 1- or a 2-mm-wide buccal bony plate at the test and control sites, respectively. After 3 months of healing, biopsies were obtained for histological analyses.Results: A buccal vertical resorption of the alveolar crest of 2.3 +/- 0.8 and 2.1 +/- 1.1 mm, and a coronal level of osseointegration at the buccal aspect of 2.7 +/- 0.5 and 2.9 +/- 0.9 mm were found at the test (1 mm) and control (2 mm) sites, respectively. The differences did not reach statistical significance. The mean values of the mineralized bone-to-implant contact (MBIC%) ranged from 62% to 73% at the buccal and lingual sites. No statistically significant differences were found. Horizontal volume gains of 1.8 and 1.1 mm were observed at the test and control sites, respectively, and the difference being statistically significant.Conclusions: Implants installed using the E.R.E. technique yielded a high degree of osseointegration. It is suggested that the displacement of buccal bony plates of 1 mm thickness is preferable compared with that of wider dimensions.

Evaluation of a new experimental model to study bone healing after ridge expansion with simultaneous implant placement--a pilot study in minipigs.

OBJECTIVE To evaluate the suitability of a minipig model for the study of bone healing and osseointegration of dental implants following bone splitting and expansion of narrow ridges. MATERIAL AND METHODS In four minipigs, the mandibular premolars and first molars were extracted together with removal of the buccal bone plate. Three months later, ridge splitting and expansion was performed with simultaneous placement of three titanium implants per quadrant. On one side of the mandible, the expanded bone gap between the implants was filled with an alloplastic biphasic calcium phosphate (BCP) material, while the gap on the other side was left unfilled. A barrier membrane was placed in half of the quadrants. After a healing period of 6 weeks, the animals were sacrificed for histological evaluation. RESULTS In all groups, no bone fractures occurred, no implants were lost, all 24 implants were osseointegrated, and the gap created by bone splitting was filled with new bone, irrespective of whether BCP or a barrier membrane was used. Slight exposure of five implants was observed, but did not lead to implant loss. The level of the most coronal bone-to-implant contact varied without being dependent on the use of BCP or a barrier membrane. In all groups, the BCP particles were not present deep in the bone-filled gap. However, BCP particles were seen at the crestal bone margin, where they were partly integrated in the new bone. CONCLUSIONS This new minipig model holds great promise for studying experimental ridge splitting/expansion. However, efforts must be undertaken to reduce implant exposure and buccal bone resorption.

Bone loss after ridge expansion with or without reflection of the periosteum.

OBJECTIVE To evaluate the role of the periosteum in preserving the buccal bone after ridge splitting and expansion with simultaneous implant placement. MATERIAL AND METHODS In 12 miniature pigs, the mandibular premolars and first molars were removed together with the interdental bone septa and the buccal bone. Three months later, ridge splitting and expansion of the buccal plate was performed with simultaneous placement of two titanium implants per quadrant. Access by a mucosal flap (MF) was prepared on test sides, while a mucoperiosteal flap (MPF) with complete denudation of the buccal bone was increased on control sides. After healing periods of six and 12 weeks, the animals were sacrificed for histologic and histometric evaluation. RESULTS In the MF group, all 16 implants were osseointegrated, while in the MPF group, four of 16 implants were lost. Noticeable differences of bone levels on the implant surface and of the bone crest (BC) were found between the MF and the MPF group. Buccally after 6 weeks, the median distance between the implant shoulder (IS) and the coronal-most bone on the implant (cBIC) was for the MF group -1.42 ± 0.42 mm and for the MPF group -4.80 ± 2.72 mm (P = 0.15). The median distance between the IS and the buccal BC was -1.24 ± 0.51 mm and -2.78 ± 1.98 mm (P = 0.12) for the MF and MPF group, respectively. After 12 weeks, median IS-cBIC was -2.12 ± 0.84 mm for MF and -7.19 mm for MPF, while IS-BC was -2.08 ± 0.79 mm for MF and -5.96 mm for MPF. After 6 weeks, the median buccal bone thickness for MF and MPF was 0.01 and 0 mm (P < 0.001) at IS, 1.48 ± 0.97 mm and 0 ± 0.77 mm (P = 0.07) at 2 mm apical to IS, and 2.12 ± 1.19 mm and 1.72 ± 01.50 mm (P = 0.86) at 4 mm apical to IS, respectively. After 12 weeks, buccal bone thickness in the MF group was 0 mm at IS, 0.21 mm at 2 mm apical to IS, and 2.56 mm at 4 mm apical to IS, whereas complete loss of buccal bone was measured from IS to 4 mm apical to IS for the MPF group. CONCLUSIONS In this ridge expansion model in miniature pigs, buccal bone volume was significantly better preserved when the periosteum remained attached to the bone.

Implant removal by means of an expansion of the alveolar bony crest: Report of a clinical technique

Aim: To describe the adaptation of the Edentulous Ridge Expansion (E.R.E.) technique for implant removal. Material and Methods: The E.R.E. technique for the removal of failed implants is described in detail. A clinical case is also reported. In a patient carrying a full arch removable prosthesis in the upper jaw, sustained by two bars, two out of five implants were found to be fractured. Bucco-lingual partial-thickness flaps were used to access the fractured implants. The implants were subsequently removed applying the E.R.E. technique. Two recipient sites were prepared in the same position, using bone expanders, and two new implants were installed. Results: After 4 months of healing, the implants were integrated and a new bar was fabricated, and the old prosthesis readapted. Conclusion: The ERE technique may be successfully applied for the removal of failed implants, and the immediate or delayed reinstallation of new implants. © 2012 John Wiley & Sons A/S.

Bone Spreading and Standardized Dilation of Horizontally Resorbed Bone: Technical Considerations

The uses of a new bone spreading technique with simultaneous implant placement are discussed. The spreading system is an alternative technique to Summers' osteotome. Specific screw designs (spreader) served to laterally compress the bone to increase the cancellous density adjacent to the site. The spreader achieved a controlled and standardized dilation of horizontal bone. The advantages, material selection, and the application of this new procedure are detailed. (Implant Dent 2009; 18:119-125)

BONE SPREADER TECHNIQUE: A PRELIMINARY 3-YEAR STUDY

The purpose of this study was to observe the clinical outcome of bone spreading and standardized dilation of horizontally resorbed bone during immediate implant placement using a "screw-type" configuration of expansion and threadformers. Fifty-three patients were included in this study, and 41 edentulous areas in anterior and posterior maxillas were treated. Sixty-eight implants were placed using an insertion torque of at least 40 Ncm. Abutments were delivered 4 to 6 months after implant placement. The overall failure percentage was 4.41% (3 failures). A retrieved analysis of I implant removed at 3 years after placement demonstrated bone resorption down to the level of the third thread. The bone spreader technique is different from Summers' osteotome, both in clinical use and in armamentarium. The main advantage of the crest-expanding technique is that it is a less invasive procedure; the facial wall expands after the medullary bone is compressed against the cortical wall. Within the limits of this preliminary study, the cumulative survival rate for this method of implant placement is 95.58% at 3 years. This study confirms that a bone spreader used in the maxilla shows an unusually low failure rate after 3 years.

Spontaneous osteonecrosis of the jaws in the maxilla of mice on antiresorptive treatment: A novel ONJ mouse model

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Piezocirurgia no consultório de Medicina Dentária

A presente Tese de Mestrado em Medicina Dentária tem como tema a Piezocirurgia e, sobre ela, pretende-se saber a sua aplicabilidade no consultório do Médico Dentista, nomeadamente na área da Cirurgia oral. A pesquisa bibliográfica foi realizada através de bases de dados, como a Medline, Science Direct e a Pub-Med, entre outras. Limitou-se a pesquisa, temporalmente, entre 2000 e 2016, e nas línguas Portuguesa e Inglesa. Excluiu-se todas as referências a estudos animais e, todas as que, em nada, contribuiríam para o conteúdo especificado. A cirurgia Piezoeléctrica é uma técnica de osteotomia atraumática, quando comparada a técnicas convencionais, e que revoluciona a área da Cirurgia Oral, através do seu corte preciso e altamente selectivo, mas também através do fenómeno de cavitação que a caracteriza, e que garante um campo operatório livre, uma óptima visibilidade, e, consequentemente, uma maior segurança do operador, culminando tudo isto no sucesso do tratamento. A sua maior desvantagem é o tempo de trabalho que requere, contudo este tende a diminuir, e a ser ainda menor que o tempo de trabalho exigido na cirurgia convencional. Inúmeras são as aplicações da Piezocirurgia, mas na área da Medicina Dentária, nomeadamente na Cirurgia Oral, destaca-se o levantamento do seio maxilar, o aumento da crista óssea, a extracção dos terceiros molares impactados e a cirurgia ortognática.

Compression and expansion index and void ratio of samples from Lomonosov Ridge and Yermak Plateau

With the coupled use of multibeam swath bathymetry, high-resolution subbottom profiling and sediment coring from icebreakers in the Arctic Ocean, there is a growing awareness of the prevalence of Quaternary ice-grounding events on many of the topographic highs found in present water depths of <1000 m. In some regions, such as the Lomonosov Ridge and Yermak Plateau, overconsolidated sediments sampled through either drilling or coring are found beneath seismically imaged unconformities of glacigenic origin. However, there exists no comprehensive analysis of the geotechnical properties of these sediments, or how their inferred stress state may be related to different glacigenic processes or types of ice-loading. Here we combine geophysical, stratigraphic and geotechnical measurements from the Lomonosov Ridge and Yermak Plateau and discuss the glacial geological implications of overconsolidated sediments. The degree of overconsolidation, determined from measurements of porosity and shear strength, is shown to result from consolidation and/or deformation below grounded ice and, with the exception of a single region on the Lomonosov Ridge, cannot be explained by erosion of overlying sediments. We demonstrate that the amount and depth of porosity loss associated with a middle Quaternary (~ 790-950 thousand years ago - ka) grounding on the Yermak Plateau is compatible with sediment consolidation under an ice sheet or ice rise. Conversely, geotechnical properties of sediments from beneath late Quaternary ice-groundings in both regions, independently dated to Marine Isotope Stage (MIS) 6, indicate a more transient event commensurate with a passing tabular iceberg calved from an ice shelf.

Manganese concentrations and flux data of sediments from Broken and Ninetyeast Ridge

Decomposition of organic matter combined with density stratification generate a pronounced intermediate water oxygen minimum zone (OMZ) in the northwest Indian Ocean. This zone currently lies between water depths of 200 and 2000 m and extends approximately 5000 km southeast from the Arabian coast. Based upon benthic foraminiferal assemblage changes, it has been suggested that this OMZ was even more extensive during the late Miocene-early Pliocene (6.5-3.0 Ma), with a maximum volume and/or intensity at approximately 5.0 Ma. While this inference may contribute to an understanding of the history of northwest Indian Ocean upwelling, corroborating geochemical evidence for this interpretation has heretofore been lacking. Ocean Drilling Program (ODP) sites 752, 754, and 757 on Broken and Ninetyeast ridges are located within central Indian Ocean intermediate water depths (1086-1650 m) but outside the present lateral dimensions of the Indian Ocean OMZ. High-resolution chemical analyses of sediment from these sites indicate significant reductions in the flux of Mn and normalized Mn concentrations between 6.5 and 3.0 Ma that are most pronounced at approximately 5.0 Ma. Because late Miocene-Pliocene paleodepths for these sites were essentially the same as at present and because extremely low sedimentation rates (0.3-1.3 cm/ky) most likely precluded sedimentary metal oxide diagenesis, we suggest that the observed Mn depletions reflect diminished deposition of reducible Mn oxyhydroxide phases within O2 deficient intermediate waters and that this effect was most intense at approximately 5.0 Ma. This interpretation implies that waters with less than 2.0 mL/L O2 extended at least 1500 km beyond their present limits and is consistent with changes in benthic foraminifera assemblages. We further suggest this expanded Indian Ocean OMZ is related to regionally and/or globally increased biological productivity.

Pleistocene chronology of sediments from the Lomonosov Ridge

Despite its importance in the global climate system, age-calibrated marine geologic records reflecting the evolution of glacial cycles through the Pleistocene are largely absent from the central Arctic Ocean. This is especially true for sediments older than 200 ka. Three sites cored during the Integrated Ocean Drilling Program's Expedition 302, the Arctic Coring Expedition (ACEX), provide a 27 m continuous sedimentary section from the Lomonosov Ridge in the central Arctic Ocean. Two key biostratigraphic datums and constraints from the magnetic inclination data are used to anchor the chronology of these sediments back to the base of the Cobb Mountain subchron (1215 ka). Beyond 1215 ka, two best fitting geomagnetic models are used to investigate the nature of cyclostratigraphic change. Within this chronology we show that bulk and mineral magnetic properties of the sediments vary on predicted Milankovitch frequencies. These cyclic variations record "glacial" and "interglacial" modes of sediment deposition on the Lomonosov Ridge as evident in studies of ice-rafted debris and stable isotopic and faunal assemblages for the last two glacial cycles and were used to tune the age model. Potential errors, which largely arise from uncertainties in the nature of downhole paleomagnetic variability, and the choice of a tuning target are handled by defining an error envelope that is based on the best fitting cyclostratigraphic and geomagnetic solutions.

Expansion program at St. Louis area : project no. 224-5066A : project history and completion report /

"October 1960 [OTI Issuance Date]."