Publications by authors named "Michael S Block"

73 Publications

Preliminary Results Using a Friction-Fit Crown to Abutment Connection.

Int J Periodontics Restorative Dent 2021 Mar-Apr;41(5146):217-224

One of the chronic problems with traditional cement or screw retention of crowns to implants is the development of biologic and technical complications, including soft tissue complications, bone loss, screw loosening, loss of retention, and veneering material fractures. The purpose of this case series report is to document preliminary results, specifically crown retention, using a friction-fit connection of crown to abutment. A sample composed of patients who had one or more implants restored between July 1, 2019, and October 30, 2019, were enrolled in this retrospective case-control series. Each patient had their crown connected to the implant abutment using a friction-fit system. Patients were seen for routine follow-up for documentation of crown retention, and 24 crowns were followed. After 6 months of follow-up, 100% of the crowns retained retention and did not become loose under normal masticatory function. The use of a friction-fit connection provided excellent retention of the crown to the abutment over the 6-month follow-up period.
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http://dx.doi.org/10.11607/prd.5146DOI Listing
April 2021

Porous Bone Increases the Risk of Posterior Mandibular Implant Failure.

J Oral Maxillofac Surg 2021 Mar 2. Epub 2021 Mar 2.

Assistant Professor, Department of Oral & Maxillofacial Surgery, LSU School of Dentistry, New Orleans, La.

Purpose: Our recent study indicated that patients with osteoporosis had an increased risk for early and late implant failure perhaps due to a large cancellous space. Therefore, the purpose of the article is to explore the relationship between the amount of cancellous space in an implant site and implant failure.

Patients And Methods: The authors conducted a retrospective cohort study on patients who received dental implants in the posterior mandible at the senior author's practice from January 1, 2008 to October 1, 2019. The primary outcome variable was time to implant failure. The primary predictor variable was the amount of cancellous bone between the buccal and lingual cortices (cancellous space). Other study variables included demographic variables, medical history variables, and implant site measurements. Statistical analysis was performed using descriptive statistics, chi-squared tests, single variable and multiple Cox proportional hazard analyses.

Results: The study cohort (n = 220) was composed of 62.3% women and the average age was 58.2 years. The median follow-up time was 3.5 years (range: 1-12). Five-year survival rates for patients with a cancellous space of <4 mm was 100%, with a cancellous space of 4-6 mm was 95.3%, with a cancellous space of 6-8 mm was 88.2%, and with a cancellous space of >8 mm was 64.1%. In the final multivariate Cox proportional hazard model adjusting for age, gender, smoking status, site and buccal cortex width, cancellous space remained significantly associated with time to implant failure (aHR 1.7 per millimeter change [1.4 - 2.2], P < .0001).

Conclusions: The width of the cancellous space and subsequent gap between implant and cortical bone should be considered when placing implants into the mandibular molar sites. When the patient presents for an implant in the mandibular molar region, if the cancellous space is large, the patient should be informed of the risk.
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http://dx.doi.org/10.1016/j.joms.2021.02.039DOI Listing
March 2021

Coronavirus Disease 2019 May Affect Dental Implant Integration.

Authors:
Michael S Block

J Oral Maxillofac Surg 2021 Feb 2. Epub 2021 Feb 2.

Clinical Professor, Department of Oral & Maxillofacial Surgery, LSU School of Dentistry, Private Practice, Metairie, La. Electronic address:

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http://dx.doi.org/10.1016/j.joms.2021.01.033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046341PMC
February 2021

The Author's Commentary on "Use of Tissell, a Fibrin Sealant, for Particulate Graft Stabilization".

Authors:
Michael S Block

J Oral Maxillofac Surg 2020 10;78(10):e1

Department of Oral and Maxillofacial Surgery, Louisiana State University School of Dentistry, Metaine, LA. Electronic address:

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http://dx.doi.org/10.1016/j.joms.2020.07.023DOI Listing
October 2020

What Factors Are Associated With Implant Failure?

J Oral Maxillofac Surg 2021 Jan 27;79(1):91-97. Epub 2020 Aug 27.

Assistant Professor, Department of Biostatistics, LSU School of Public Health, New Orleans, LA.

Purpose: Recognition of patient-specific risk factors should reduce implant failure. The purpose of this study was to identify risk factors associated with implant failure and to determine if these factors differ over time after implant placement.

Methods: The investigators implemented a retrospective case-controlled study and enrolled a sample composed of patients who had 1 or more implants removed from December 1, 2007 to February 29, 2020. Risk factors were grouped into demographic, medical history, and treatment-related variables. The primary outcome variable was whether the patient's implant failed, with control patients including those without implant failure. The duration was recorded for follow-up from the time of implant placement to the last visit or implant removal. Backward variable selection was used to predict whether an implant failed within 1 year, 1 to 4 years, or after 4 years in 3 multivariable logistic regressions.

Results: Of 224 patients in this cohort, 82 experienced an implant failure. The mean age was 58.6 ± 15.3 years, and 53.1% were females. Patients with osteoporosis had an increased risk of failure in each period. Alcohol use, smoking, depression, and penicillin allergy were all associated with an increased probability of failure within 1 or more of the periods considered.

Conclusions: This study has identified multiple discrete risk factors for implant failure and has demonstrated that these factors are associated with implant failure at different periods after placement.
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http://dx.doi.org/10.1016/j.joms.2020.08.023DOI Listing
January 2021

Digital assisted soft tissue sculpturing (DASS) technique for immediate loading pink free complete arch implant prosthesis.

J Prosthodont Res 2021 Feb 9;65(1):119-124. Epub 2020 Sep 9.

Department of Oral & Maxillofacial Surgery, UCLA School of Dentistry, Los Angeles, CA.

Purpose: To introduce a digitally assisted technique to achieve the ideal soft and bone tissue interface for anatomic-driven pink free implant supported fixed prosthesis, and prefabricate an interim prosthesis to be used the day of the surgery as a prosthetic scaffold to condition the healing.

Methods: The digital assisted soft tissue sculpturing (DASS) technique allows the previsualization of the ideal soft and bone tissue interface and fabricate a computer aided design computer aided manufacturing (CAD-CAM) anatomic-driven pink free complete arch interim prosthesis for the immediate loading. Bone and soft tissue interface as well as the interim prosthesis design are performed in a segmented multiple standard tessellation language (STL) file embedding the bone anatomy, the intraoral surface anatomy (dental and soft tissue), the digital wax-up and the implant positioning. The interim prosthesis is used as a prosthetic scaffold to guide the soft and bone tissue surgical sculpturing and regeneration.

Conclusions: The DASS technique is a predictable integrated digital workflow that simplifies the achievement of a scalloped tissue interface for pink free fixed implant prosthesis, reestablishing the mucosal dimension required for the protection of underlying bone while maintaining tissue health. The surgical sculpturing and maturation of the soft and bone tissue is driven and enhanced by the xenogeneic collagen matrix grafting and prosthetic scaffold effect of the digitally prefabricated interim prosthesis delivered the day of the surgery.
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http://dx.doi.org/10.2186/jpr.JPOR_2019_386DOI Listing
February 2021

Hypochlorous Acid: A Review.

J Oral Maxillofac Surg 2020 09 25;78(9):1461-1466. Epub 2020 Jun 25.

Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University School of Dentistry, New Orleans, LA.

The surgeon needs to have an inexpensive, available, nontoxic, and practical disinfectant that is effective in sanitizing against the COVID-19 (Coronavirus Disease 2019) virus. The purpose of this article was to review the evidence for using hypochlorous acid in the office setting on a daily basis. The method used to assemble recommendations was a review of the literature including evidence for this solution when used in different locations and industries other than the oral-maxillofacial clinic facility. The results indicate that this material can be used with a high predictability for disinfecting against the COVID-19 (Coronavirus Disease 2019) virus.
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http://dx.doi.org/10.1016/j.joms.2020.06.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315945PMC
September 2020

Does the Use of High-Temperature-Processed Xenografts for Ridge Augmentation Result in Ridge Width Stability Over Time?

Authors:
Michael S Block

J Oral Maxillofac Surg 2020 Oct 12;78(10):1717-1725. Epub 2020 Jun 12.

Private Practice, Metairie; and Clinical Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University School of Dentistry, New Orleans, LA. Electronic address:

Purpose: Alveolar ridge augmentation is often required before implant placement. The purpose of the present study was to determine whether maxillary and mandibular ridge augmentation with a high-temperature xenograft remains stable over time.

Materials And Methods: A retrospective case series was performed of subjects who had undergone maxillary anterior or posterior ridge augmentation with a high-temperature xenograft (HTX). The primary predictor variable was the HTX. The primary outcome variable was the ridge width, measured T0 (before augmentation), T1 (immediately after augmentation), T2 (4 to 6 months after augmentation), and T3 (>4 years after augmentation). The secondary outcome variable was implant success. Analysis of variance and linear regression analysis were used to determine significance. A P value < .05 was considered statistically significant.

Results: A total of 31 patients (age, 52.4 ± 18 years; 61.3% women) were identified who had undergone ridge width augmentation performed using HTX. Of these, 23 had cone-beam computed tomography scans available 4 to 10 years after augmentation had been performed. At the anterior maxilla, the initial ridge augmentation (T1) was 4.7 ± 1.3 mm, which had decreased to 3.7 ± 1.0 mm within 6 months of augmentation (T2) and to 3.3 ± 1.1 mm after an average of 7 years (T3) of follow-up (P < .05). At the posterior mandible, the initial ridge augmentation was 5.4 ± 0.9 mm, which had decreased to 4.1 ± 0.7 mm within 6 months of augmentation and to 3.5 ± 1.0 mm at an average of 7 years of follow-up. A total of 61 implants had been placed in these 23 patients, 3 (4.9%) of which had failed to integrate.

Conclusions: The use of HTX does result in long-term stability for ridge augmentation.
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http://dx.doi.org/10.1016/j.joms.2020.06.004DOI Listing
October 2020

Section Editor High Impact Articles - Dental Implants.

Authors:
Michael S Block

J Oral Maxillofac Surg 2020 07;78(7):e15

Dental Implants Section Editor, Private Practice, Metairie, LA. Electronic address:

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http://dx.doi.org/10.1016/j.joms.2020.03.039DOI Listing
July 2020

Use of Tisseel, a Fibrin Sealant, for Particulate Graft Stabilization.

J Oral Maxillofac Surg 2020 Oct 22;78(10):1674-1681. Epub 2020 Feb 22.

Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.

One clinical problem when augmenting a narrow or vertically deficient ridge is maintenance of the graft position during the immediate healing phase and preservation of the augmentation over time. The use of Tisseel (Baxter, Deerfield, IL), a fibrin sealant product, to stabilize particulate grafts, has been reported, and we have reviewed its use. Fibrinogen is converted to fibrin and forms a fibular network that binds the particulate graft. A protease inhibitor is included, which prevents lysis of the coagulum for at least 2 weeks and allows for fibrous ingrowth and graft stabilization. We have reviewed the reported data and included 2 case reports to demonstrate the use of Tisseel.
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http://dx.doi.org/10.1016/j.joms.2020.02.020DOI Listing
October 2020

Bone Levels Are Preserved After Simultaneous Sinus Elevation at Time of Implant Placement.

Authors:
Michael S Block

J Oral Maxillofac Surg 2019 Oct 2;77(10):2019-2026. Epub 2019 Jul 2.

Private Practice, Metairie, LA. Electronic address:

Purpose: The purpose of this study was to confirm that after simultaneous implant placement and vertical bone augmentation in the posterior maxilla, the immediate postoperative bone height is maintained after 2 to 3 years of follow-up.

Patients And Methods: Consecutive patients treated with implant placement in the posterior maxilla were evaluated. Cone-beam scans were taken preoperatively; immediately after implant placement; and for the sinus-grafted cases, 2 to 3 years after surgery. Crestal bone heights were measured. Patients were grouped according to the use of sinus augmentation or no sinus augmentation at the time of implant placement.

Results: The increase in bone height was significant in the graft group when we compared immediate and 3-year follow-up measurements (P < .00001). In the graft group, there were no significant differences in bone height when we compared the immediate and 3-year follow-up periods (P = .31).

Conclusions: Simultaneous sinus floor elevation with grafting at implant placement results in stable bone levels after 2 to 3 years' follow-up.
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http://dx.doi.org/10.1016/j.joms.2019.06.177DOI Listing
October 2019

Single-Implant Treatment.

Authors:
Michael S Block

Oral Maxillofac Surg Clin North Am 2019 May 2;31(2):251-258. Epub 2019 Mar 2.

Private Practice, 110 Veterans Memorial Boulevard, #112, Metairie, LA 70005, USA. Electronic address:

The replacement of one tooth using one implant involves a set of unique criteria for long-term success. Successful therapy should be based on long-term function and health of the adjacent tissues. Sections of this article examine these critical criteria that when working together can result in successful long-term tooth replacement.
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http://dx.doi.org/10.1016/j.coms.2018.12.004DOI Listing
May 2019

The Processing of Xenografts Will Result in Different Clinical Responses.

Authors:
Michael S Block

J Oral Maxillofac Surg 2019 Apr 12;77(4):690-697. Epub 2018 Oct 12.

Center for Dental Reconstruction, Metairie, LA. Electronic address:

Purpose: Clinicians might decide to use a xenograft to reconstruct an osseous defect. Xenografts are processed differently depending on the manufacturer. The purpose of this article is to review the processing methods and clinical ramifications of these processing methods on the behavior of xenografts.

Materials And Methods: Differences in surface morphology of xenografts based on processing, xenografts used for sinus augmentation, onlay grafting using particulate xenografts, and available clinical trials are reviewed.

Results: When used for grafting the extraction socket or preserving or reconstructing the ridge contour, xenografts can result in different resorption rates over time.

Conclusion: Based on the available information gleaned from the literature, clinical recommendations are included for specific clinical applications.
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http://dx.doi.org/10.1016/j.joms.2018.10.004DOI Listing
April 2019

The Crestal Window Approach for Sinus Floor Grafting With Delayed Implant Placement: A Preliminary Report.

Authors:
Michael S Block

J Oral Maxillofac Surg 2018 11 9;76(11):2319-2330. Epub 2018 Jul 9.

Private Practice, Metairie, LA. Electronic address:

This technical note addresses a method to increase the height of the posterior maxilla using a crestal window approach. This approach decreases the need for use of the lateral window approach and provides clinicians with an alternative with less morbidity. An island of crestal bone is mobilized superiorly and the site is grafted, resulting in 4 to 10 mm of vertical bone augmentation in a thin crest. A small case series is presented with implants integrated into these grafts.
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http://dx.doi.org/10.1016/j.joms.2018.06.171DOI Listing
November 2018

Dental Implants: The Last 100 Years.

Authors:
Michael S Block

J Oral Maxillofac Surg 2018 01 13;76(1):11-26. Epub 2017 Oct 13.

Private Practice, Metairie, LA. Electronic address:

The present article on the history of dental implants spans beyond the past 100 years of the American Association of Oral and Maxillofacial Surgeons. It was not until the materials and methods became less traumatic to the bone that implants could become firmly attached to the surrounding bone. This phenomenon is now used to replace single and multiple teeth and restore the patient to function and well-being. Many of the methods used to increase denture function are still used with modifications to augment the environment for an implant. These technological changes have allowed patients to be treated efficiently, with the same need for a good treatment plan and physical evaluation by the clinician.
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http://dx.doi.org/10.1016/j.joms.2017.08.045DOI Listing
January 2018

Closed Approach for Horizontal Augmentation of the Maxilla.

Authors:
Michael S Block

J Oral Maxillofac Surg 2018 03 12;76(3):521-527. Epub 2017 Aug 12.

Private Practice, Metairie, LA. Electronic address:

The narrow ridge in the anterior maxilla often requires horizontal augmentation for ideal implant placement. This article reviews the historical use of a closed, tunnel approach to augment deficient alveolar ridges and describes its application for augmentation of the narrow ridge in the anterior maxilla. The use of a tunnel approach through a vertical incision in the unattached mucosa provides access to the ridge while maintaining crestal attachments without displacement of the crestal attached gingiva. This approach is atraumatic and provides excellent access for placement of graft material for ridge augmentation.
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http://dx.doi.org/10.1016/j.joms.2017.08.011DOI Listing
March 2018

Implant Placement Is More Accurate Using Dynamic Navigation.

J Oral Maxillofac Surg 2017 Jul 14;75(7):1377-1386. Epub 2017 Mar 14.

Software Engineer, X-Nav Technologies, LLC, Lansdale, PA.

Purpose: The purpose of this prospective study was to measure and compare the accuracy and precision of dynamic navigation with freehand (FH) implant fixture placement. The authors hypothesized that the evaluated dynamic navigation system would have high accuracy and precision and would be superior to FH methods.

Materials And Methods: The authors designed and implemented a prospective cohort study and enrolled patients who had implants placed from December 2014 through December 2016. The predictor variable was implant placement technique comparing fully guided (FG) and partially guided (PG) dynamic navigation with FH placement. The outcome variables were accuracy measured as deviation from the virtual plan, and precision was represented as the standard deviation of the measurements. Analysis of variance (ANOVA) was used to compare measurements. Virtual implant placement was compared with post-implant placement using mesh analysis. Deviations from the virtual plan were recorded for each implant for each surgeon. FH implant placement was evaluated by comparing a virtual plan with postoperative scans for patients who did not have the navigation system used for their implant placement. One-way ANOVA was performed to determine within-group and between-groups differences to determine whether there were meaningful differences among surgeons and methods (FG, PG, and FH) of placement.

Results: Prospective data from 478 patients involving 714 implants were evaluated. There were no demographic differences among surgeons. The sample size differed by the number of implants placed by each surgeon. Within each method group, the only difference among surgeons was angular deviation. All surgeons' data were combined. For FG navigation, the mean angular deviation was 2.97 ± 2.09°, the mean global platform position deviation was 1.16 ± 0.59 mm, and the mean global apical position deviation was 1.29 ± 0.65 mm. For PG navigation, the mean angular deviation was 3.43 ± 2.33°, the mean global platform position deviation was 1.31 ± 0.68 mm, and the mean global apical position deviation was 1.52 ± 0.78 mm. For FH placement, the mean angular deviation was 6.50 ± 4.21°, the mean global platform position deviation was 1.78 ± 0.77 mm, and the mean global apical position deviation was 2.27 ± 1.02 mm. Differences in measurements comparing FG and PG navigation with FH indicated significantly less deviation from the virtual plan (P < .05) using navigation.

Conclusions: Accuracy and precision for implant placement were achieved using dynamic navigation. The use of this type of method results in smaller deviations from the planned placement compared with FH approaches.
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http://dx.doi.org/10.1016/j.joms.2017.02.026DOI Listing
July 2017

Improvements in the Crestal Osteotome Approach Have Decreased the Need for the Lateral Window Approach to Augment the Maxilla.

Authors:
Michael S Block

J Oral Maxillofac Surg 2016 Nov 14;74(11):2169-2181. Epub 2016 Jun 14.

Private Practice, Metairie, LA. Electronic address:

The use of the crestal approach to augment vertical height of the posterior maxilla for dental implant placement is reviewed in this article. The review of the literature documents the success of using a procedure that has minimal complications associated with it when performed correctly. An algorithmic approach is presented to guide surgeons on using the crestal osteotome approach for posterior maxillary augmentation.
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http://dx.doi.org/10.1016/j.joms.2016.06.008DOI Listing
November 2016

Implant Placement Accuracy Using Dynamic Navigation.

Int J Oral Maxillofac Implants 2017 Jan/Feb;32(1):92-99. Epub 2016 Sep 19.

Purpose: The aim of this prospective study was to determine platform and angle accuracy for dental implants using dynamic navigation, a form of computer-assisted surgery. Three hypotheses were considered: (1) the overall accuracy for implant placement relative to the virtual plan is similar to that of static tooth-borne computerized tomography (CT)-generated guides; (2) the dynamic system is more accurate than freehand methods; and (3) there is a learning curve associated with this method.

Materials And Methods: This study involved three surgeons placing implants in the mandible and maxilla of patients using a dynamic navigation system (X-Guide, X-Nav Technologies). Virtual implants were placed into planned sites using the navigation system computer. Post-implant placement cone beam CT scans were taken on all patients. For each patient, this scan was mesh overlayed with the virtual plan and used to determine platform and angular deviations to the virtual plan. The primary outcome variables were platform and angular deviations, comparing the actual placement to the virtual plan. Secondary analyses included determination of accuracy related to case experience and freehand placement of implants. Comparisons to published accuracy studies were made for implant placement using static guides.

Results: Accuracy deviations from the virtual plan were similar to those reported for static tooth-based guides using literature references as the comparison. The accuracy of dynamic navigation was superior compared to freehand implant placement. The three surgeons had similar accuracies after their learning curve was achieved. Proficiency based on case series was achieved by the 20th surgical procedure.

Conclusion: Dynamic navigation can achieve accuracy of implant placement similar to static guides and is an improvement over freehand implant placement. In addition, there was a learning curve to achieve proficiency.
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http://dx.doi.org/10.11607/jomi.5004DOI Listing
September 2016

Static and Dynamic Navigation for Dental Implant Placement.

Authors:
Michael S Block

J Oral Maxillofac Surg 2016 Feb;74(2):231-3

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http://dx.doi.org/10.1016/j.joms.2015.12.002DOI Listing
February 2016

Accuracy Using Static or Dynamic Navigation.

Authors:
Michael S Block

J Oral Maxillofac Surg 2016 Jan;74(1):2-3

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http://dx.doi.org/10.1016/j.joms.2015.11.002DOI Listing
January 2016

Static or Dynamic Navigation for Implant Placement-Choosing the Method of Guidance.

J Oral Maxillofac Surg 2016 Feb 30;74(2):269-77. Epub 2015 Sep 30.

Private Practice, Washington, DC.

The purpose of the present report is to contrast and compare 2 methods of dental implant placement. One method uses computed tomography data for computer-aided design and computer-aided manufacturing to generate static guides for implant placement. The second method is a dynamic navigation system that uses a stereo vision computer triangulation setup to guide implant placement. A review of the published data was performed to provide evidence-based material to compare each method. Finally, the indications for each type of method are discussed.
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http://dx.doi.org/10.1016/j.joms.2015.09.022DOI Listing
February 2016

Dental Extractions and Preservation of Space for Implant Placement in Molar Sites.

Authors:
Michael S Block

Oral Maxillofac Surg Clin North Am 2015 Aug 13;27(3):353-62. Epub 2015 Jun 13.

Private Practice, 110 Veterans Memorial Boulevard, #112, Metairie, LA 70005, USA. Electronic address:

The clinician is often asked to remove a tooth and place an implant into the site. The implant must be placed with appropriate stability to allow for integration to occur, which requires bone presence. Bone is also necessary to allow for ideal implant positioning within the alveolus for functional and esthetic concerns. The purpose of this article is to discuss the changes in socket dimensions over time and how to promote space maintenance, with an algorithm for treatment based on evidence.
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http://dx.doi.org/10.1016/j.coms.2015.04.001DOI Listing
August 2015

Full-Arch Rehabilitation of a Patient With Cyclic Neutropenia.

J Oral Maxillofac Surg 2015 Sep 11;73(9):1734.e1-10. Epub 2015 Apr 11.

Assistant Professor, Department of Prosthodontics, Louisiana State University School of Dentistry, New Orleans, LA.

The purpose of this report is to discuss the treatment of a patient with cyclic neutropenia. This patient presented with flared teeth, thin alveolar bone, and mobile teeth. A staged approach was used to remove her teeth, augment the bone, use immediate fixed provisional to determine the type of final prostheses, and ultimately to use cone-shaped overdenture attachments to retain her final prostheses. The result was rehabilitation of the patient with esthetic full-arch fixed-removable dentures with no adverse sequelae in this patient with this systemic disease.
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http://dx.doi.org/10.1016/j.joms.2015.03.073DOI Listing
September 2015

Assessment of Bone Width for Implants in the Posterior Mandible.

J Oral Maxillofac Surg 2015 Sep 21;73(9):1715-22. Epub 2015 Mar 21.

Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA.

Purpose: After implants are placed into mandibular molar sites, it is assumed that crestal bone width will not change considerably over time. The purpose of this retrospective study was to determine crestal bone changes for implants placed into mandibular molar locations. The hypotheses for all groups (immediate, delayed, and grafted) were that no major changes in bone width of the posterior mandible would occur in the long term.

Materials And Methods: This is a retrospective cohort study involving 3 groups of patients within the senior author's practice who had at least 4 years of follow-up cone-beam computed tomograms available for measurement. The primary outcome variable, crestal width, was measured at 3 intervals, namely at tooth removal, before implant placement, and 4 to 5 years after placement. Group A underwent tooth extraction with immediate implant placement; group B underwent tooth extraction with delayed implant placement; and group C underwent tooth extraction with socket grafting and implant placement 4 months after grafting. Standardized cross-sectional cone-beam computed tomograms were used to measure ridge width. Two-sample t tests and regression analysis were used to compare crestal width measurements at different periods among groups. Analysis of variance was adapted to check whether ridge widths among groups were confounded by variables, such as age, gender, and medical comorbidities.

Results: Age, gender, medical comorbidities, and smoking were not statistically related to the outcome. Long-term comparisons indicated small yet significant (P = .0124) differences at the crestal level. The greatest change was for the grafted group, with width change from 12.4 ± 2.1 mm before extraction to 9.9 ± 1.8 mm 4 to 5 years after implant placement. Bone width changes 5 and 10 mm inferior to the crest did not change over time.

Conclusion: Within the time course and sample size evaluated, the thickness of the buccal bone seems to be maintained over time, regardless of method used, with small yet important changes from before tooth removal through the long-term.
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http://dx.doi.org/10.1016/j.joms.2015.03.036DOI Listing
September 2015

Maxillary fixed prosthesis design based on the preoperative physical examination.

Authors:
Michael S Block

J Oral Maxillofac Surg 2015 May 8;73(5):851-60. Epub 2015 Jan 8.

Private Practice, Metairie, LA. Electronic address:

The purpose of this article is to illustrate the use of physical examination findings that can be used to determine the design characteristics of a full arch restoration in the maxilla. These anatomic findings include 1) the resting and 2) smile line exposures of the central incisor; 3) the vertical position of the edentulous ridge when smiling; 4) the anteroposterior relation of the teeth to the edentulous ridge; 5) the presence of bone posterior to the premolar region; 6) the anterior height of the alveolar bone in relation to the floor of the nose; and 7) the planned inclination of the maxillary teeth. Based on these physical findings, the final prosthetic plan can be established before surgery. Determination of the final restorative plan determines the surgical procedures to be performed.
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http://dx.doi.org/10.1016/j.joms.2014.12.027DOI Listing
May 2015

Sinus augmentation at the time of molar tooth removal: modification of Jensen technique.

Authors:
Michael S Block

J Oral Maxillofac Surg 2015 Jun 12;73(6):1078-83. Epub 2015 Jan 12.

Private Practice, Metairie, LA. Electronic address:

When a maxillary molar tooth needs to be removed, the treatment plan often includes subsequent dental implant placement. However, there may be less than 5 mm of bone available in the central fossa region of the proposed implant site. This report describes a technique to use a precise osteotomy within the maxillary molar socket to mobilize a segment of bone and superiorly raise it to provide increased alveolar bone height using grafting. This technique eliminates the need for lateral window surgery.
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http://dx.doi.org/10.1016/j.joms.2014.12.037DOI Listing
June 2015

Prevalence of sinus membrane thickening and association with unhealthy teeth: a retrospective review of 831 consecutive patients with 1,662 cone-beam scans.

J Oral Maxillofac Surg 2014 Dec 27;72(12):2454-60. Epub 2014 Jun 27.

Resident, Department of Oral and Maxillofacial Surgery, Louisiana State Univeristy School of Dentistry, New Orleans, LA.

Purpose: The purposes of this retrospective review of cone-beam computed tomographic (CBCT) scans were to 1) determine the prevalence of sinus membrane thickening in a consecutive series of patients; 2) identify the prevalence of healthy or unhealthy teeth associated with sinus membrane thickening; and 3) document changes of the sinus membrane after the removal of unhealthy teeth.

Materials And Methods: Consecutive patients had CBCT scans examined and the sinuses were graded. Grade 1 represented membrane thickening of 0 to less than 2 mm; grade 2 represented thickening of 2 to 5 mm; grade 3 represented membrane or material thickening greater than 5 mm to the level of the ostium; and grade 4 represented soft tissue material superior to the ostium. Cross-sectional images were examined using software by the manufacturer of the CBCT scanner. Unhealthy teeth were identified. The examiner used a standardized approach in viewing the CBCT scans. Intraexaminer error was determined.

Results: Eight hundred thirty-one patients had 1,662 sinuses evaluated, with thickening of at least 1 sinus membrane in 46.7% (388 patients) and 30.1% (469) of all sinuses evaluated. The prevalence of patients and sinuses with sinus membrane thickening according to the grading criteria was grade 2 for 36.8% of patients and 24.3% of sinuses, grade 3 for 6.0% of patients and 3.7% of sinuses, and grade 4 for 3.6% of patients and 2.2% of sinuses. Unilateral sinus disease was more common than bilateral disease. Of those sinuses with thickening, 80.6% were grade 2, 12.2% were grade 3, and 7.2% were grade 4. Of the 469 sinuses with membrane thickening, 210 were adjacent to unhealthy teeth, 233 were adjacent to healthy teeth, and 26 were in edentulous maxillas. Of the 210 unhealthy teeth, 30 had postextraction CBCT scans available for evaluation. Grade 2 sinus membrane thickening showed a 75% resolution to grade 1 after adjacent tooth removal. Grade 3 sinuses resolved in 25% to grade 1 and grade 2, with 50% remaining at grade 3. There were 2 grade 4 sinuses with follow-up scans, with 1 resolving to grade 2 and the other remaining at grade 4.

Conclusions: Sinus membrane thickening is present in 46.7% of patients presenting to an oral and maxillofacial surgical practice. The prevalence of sinus membrane thickening was almost equal in association with unhealthy and healthy teeth. The removal of unhealthy teeth decreased, but did not completely resolve sinus membrane thickening.
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http://dx.doi.org/10.1016/j.joms.2014.06.442DOI Listing
December 2014