Publications by authors named "Wilfried Wagner"

90 Publications

Clinical long-term and patient-reported outcomes of dental implants in oral cancer patients.

Int J Implant Dent 2021 Jul 13;7(1):93. Epub 2021 Jul 13.

Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany.

Background And Purpose: The aim of this clinical study was to investigate the clinical long-term and patient-reported outcome of dental implants in patients with oral cancer. In addition, analysis of the influence of radiation therapy, timing of implant insertion, and augmentation procedures on implant survival was performed.

Material And Methods: This retrospective study investigated the clinical outcome of 711 dental implants in 164 oral cancer patients, inserted by experienced surgeons of the Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Germany. Oral health-related quality of life (OHRQoL) was evaluated.

Results: Cumulative 5-year and 10-year implant survival rates for all included implants were 87.3% and 80.0%. Implants placed straight after ablative surgery (primary implant placement) and implants placed after completing the oncologic treatment (secondary implant placement) showed a comparable implant survival (92.5% vs. 89.5%; p = 0.635). Irradiation therapy had no significant influence on implant survival of secondary placed implants (p = 0.929). However, regarding implant site (native bone vs. augmented bone) and radiation therapy (non-irradiated bone vs. irradiated bone), implants inserted in irradiated bone that received augmentation procedures showed a statistically significant lower implant survival (p < 0.001). Patients reported a distinct improvement in OHRQoL.

Conclusions: Promising long-term survival rates of dental implants in patients after treatment of oral cancer were seen. In addition, patients benefit in form of an improved OHRQoL. However, bone augmentation procedures in irradiated bone may result in an impaired implants' prognosis.
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http://dx.doi.org/10.1186/s40729-021-00373-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8276905PMC
July 2021

Clinical and radiographic performance of self-locking conical connection implants in the posterior mandible: Five-year results of a two-centre prospective study.

Clin Oral Implants Res 2021 Jun 11. Epub 2021 Jun 11.

Department of Oral and Maxillofacial Surgery, Johannes Gutenberg-University Medical Centre, Mainz, Germany.

Objective: This prospective study aims to assess the 5-year clinical performance of implants with internal conical connection and platform-switched abutments in the posterior mandible.

Material And Methods: Healthy adults missing at least two teeth in the posterior mandible and with a natural tooth mesial to the implant site received two or three adjacent implants. After a transmucosal healing period single crown restorations were cemented on platform-switched abutments. Changes in marginal bone levels were investigated in standardized periapical radiographs from surgery and loading (baseline) to 60-months post-loading.

Results: Twenty-four patients received 52 implants. Bone remodelling took place between surgery and loading (mean:-0.5, SD:±0.4 mm). From loading to 60 months, there was a mean bone change of 0.27 (SD:±0.47 mm) which stabilized 24 months after prosthesis delivery (mean:0.2, SD:±0.46 mm). 71.7% of all implants presented bone preservation at 60 months irrespective of the initial insertion depth. Two implants were lost after 5 years and the success rate was 95.1%. Patient enquiry revealed high satisfaction.

Conclusion: Internal conical connection implants with platform-switched abutments presented a high success rate and preservation of marginal bone levels at the implant shoulder after 5 years of loading.
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http://dx.doi.org/10.1111/clr.13794DOI Listing
June 2021

Does the Modification of the Apical Geometry of a Dental Implant Affect Its Primary Stability? A Comparative Ex Vivo Study.

Materials (Basel) 2021 Apr 1;14(7). Epub 2021 Apr 1.

Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany.

(1) Background: Primary stability-one fundamental criterion for the success of dental implants-is influenced by implant geometry even if the effect of apical shape modifications on implant primary stability has not yet been examined. Therefore, the aim of the ex vivo study was to compare primary stability of implants differing in apically located screw threads (J-line) or a flat tip (K-line) only. (2) Methods: 28 implants of each group of the same diameter (4.3 mm) were randomly inserted into porcine bone blocks. The first group (9, 11 and 13 mm) was inserted into "hard", the second (11 mm) into "soft" bone, here using a normal and an undersized drilling protocol. Insertion torque (Ncm), Periotest value, resonance frequency (implant stability coefficient, ISQ) and push-out force (N) were measured. (3) Results: In "hard" bone, primary stability increased with increasing length in both groups but it was significantly higher in J-line ( < 0.03). An undersized preparation of the implant bed in "soft" bone resulted in a significant increase in primary stability in both groups. Here, J-line also showed a significantly increased primary stability when compared to equally prepared K-line (insertion torque: 37 Ncm vs. 26 Ncm; Periotest: -6.5 vs. -4.3; push-out force: 365 N vs. 329 N; < 0.05 each). (4) Conclusions: Primary stability is significantly higher with increasing implant length and apically located screw threads as well as with undersized drilling protocols. When preparing the implant site and subsequently selecting the implant system, modifying factors such as implant geometry (also at the tip) should be taken into account.
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http://dx.doi.org/10.3390/ma14071728DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036940PMC
April 2021

Alloimmune Myositis as Paraneoplastic Complication of an Oral Squamous Cell Carcinoma After Severe Chronic Graft vs Host Disease or a Manifestation of Chronic Graft vs Host Disease? A Case Report and Literature Discussion.

Transplant Proc 2021 May 19;53(4):1365-1368. Epub 2021 Jan 19.

Hematology, Oncology and Pneumology, UCT, University Medical Center Mainz, Mainz, Germany.

A 53-year-old female patient with acute myeloid leukemia developed severe chronic graft vs host disease (cGVHD) of the oral mucosa after allogeneic hematopoietic stem cell transplantation with leukoplakia and relapsing oral squamous cell carcinoma (SCC) of the tongue. cGVHD needed long-lasting immunosuppressive therapy; SCC was treated with radiation and surgery. Acute myeloid leukemia remained in complete remission. The patient developed a myositis with pain of all muscles as well as paraparesis with elevated creatine kinase and C-reactive protein and detection of antiskeletal muscle autoantibodies 3500 days after hematopoietic stem cell transplantation. No other clinical features of chronic GVHD were apparent at this time. Symptoms disappeared after treatment with corticosteroids but relapsed while tapering. Weekly therapy with the B-cell-depleting antibody rituximab was started and administered for 6 weeks. Symptoms disappeared again but partly returned after some weeks, so therapy with azathioprine was started. During therapy with azathioprine slow tapering of corticosteroids was possible and clinical symptoms remained absent. Here we present a case report and review of the literature on alloimmune myositis as paraneoplastic complication of an oral SCC of the tongue after severe chronic GVHD or as late manifestation of chronic GVHD itself.
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http://dx.doi.org/10.1016/j.transproceed.2020.11.010DOI Listing
May 2021

Peri-implant defect grafting with autogenous bone or bone graft material in immediate implant placement in molar extraction sites-1- to 3-year results of a prospective randomized study.

Clin Oral Implants Res 2020 Nov 22;31(11):1138-1148. Epub 2020 Sep 22.

Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany.

Objectives: To evaluate the survival rate, the orobuccal bone resorption and stability of peri-implant hard and soft tissues following immediate implant placement of wide diameter implants in molar extraction sites and peri-implant defect grafting with autogenous bone (AB) or biphasic bone graft material (BBGM) with 1- to 3-year follow-up examinations.

Material And Methods: Fifty wide diameter implants were placed in 50 patients immediately into molar extraction sockets by a flapless approach. Peri-implant defect augmentation was performed randomized with either AB or BBGM. Primary outcome variable was implant survival. Marginal bone level changes, orobuccal width of the alveolar crest, probing depths, and implant success were considered as secondary parameters.

Results: One implant of the BBGM group was lost, 1 patient withdrew from the study (drop-out). The remaining 48 patients were still in function at a follow-up period up to 31 months after implant insertion. Interproximal marginal bone level regenerated from -7.5 mm to the level of the implant shoulder (AB + 0.38 mm, BBGM + 0.1 mm) at final follow-up. The width of the alveolar crest changed by -0.08 mm (AB) and +0.72 mm (BBGM) at 1 mm, -0.36 mm (AB) and +0.27 mm (BBGM) at 3 mm, -0.36 mm (AB) and +0.31 mm (BBGM) at 6 mm apical to implant shoulder level. Success rate was 87.5% in the AB and 56.3% in the BBGM group (p = .058).

Conclusions: Medium-term results prove a high survival rate, a favorable amount of bone generation in both groups and a low amount of orobuccal resorption in immediate molar implant insertion.
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http://dx.doi.org/10.1111/clr.13660DOI Listing
November 2020

[Medicine and Economy: Measures for a Science Based, Patient-Centred and Resource Conscious Care. The Association of Scientific Medical Societies' (AWMF) Strategy Paper].

Dtsch Med Wochenschr 2019 07 16;144(14):990-996. Epub 2019 May 16.

Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, Berlin.

The AWMF and its medical societies perceive an increasing dominance of economic targets in the hospital health care sector, leading to impairment of patient care. While resource use in health care should be appropriate, efficient and fairly allocated, "economization" creates a burdensome situation for physicians, nurses and other health care professionals.The AMWF and the medical societies studied causes and developed measures for a scientific, patient-centred and resource-conscious medical care. Disincentives due to the remuneration system, number and equipment of hospitals resp. specialist departments and their basic funding need to be overcome. Proposed actions relate to the patient-doctor-level, the management level of hospitals and the level of planning and financing hospitals including compensation of hospital care. To place patients and their health in the forefront again, joint efforts of all stakeholders in health care are needed.
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http://dx.doi.org/10.1055/a-0891-3940DOI Listing
July 2019

Peri-implant marginal bone loss reduction with platform-switching components: 5-Year post-loading results of an equivalence randomized clinical trial.

J Clin Periodontol 2019 06;46(6):678-687

Faculty of Medicine, University of Coimbra, Coimbra, Portugal.

Aim: To compare the clinical performance and marginal bone levels of implants restored with platform-switching (PS) or platform-matching (PM) abutments.

Materials And Methods: Adult patients missing two or more adjacent teeth in the posterior mandible received 2-4 CAMLOG SCREW-LINE implants and were randomly allocated to the PM or PS group, receiving the corresponding prosthetic components from surgery onwards. Implants were conventionally loaded with single cemented crowns. Patients were followed annually for 5 years. Outcome measures were marginal bone level changes, implant survival, performance of the prosthetic components and clinical parameters plaque index, sulcus bleeding index and pocket probing depth.

Results: Thirty-three patients received 72 implants in the PM group, and thirty-five patients received 74 implants in the PS group. Sixty patients attended the final appointment, 31 had received PS components and 29 had received PM components with 65 and 63 implants, respectively. Global survival rate was 96.6% with no differences between groups (p = 0.647). After 5 years of functional loading, PS restored implants presented 0.23mm (95% CI: [0.03, 0.43], p = 0.025) lower marginal bone level changes. The two groups were declared non-equivalent.

Conclusion: Patients requiring implant supported restorations in healed bounded or free end edentulous gaps of the mandible benefit from the use of PS components in terms of peri-implant marginal bone level maintenance, though it may not be clinically noticeable.
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http://dx.doi.org/10.1111/jcpe.13119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6594132PMC
June 2019

Retrospective cohort study of a tapered implant with high primary stability in patients with local and systemic risk factors-7-year data.

Int J Implant Dent 2018 Dec 17;4(1):41. Epub 2018 Dec 17.

Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center, Johannes Gutenberg University of Mainz, Augustusplatz 2, 55131, Mainz, Germany.

Objectives: This retrospective study examined the mid- to long-term clinical and radiographic performance of a tapered implant in various treatment protocols in patients with local and systemic risk factors (RFs).

Material And Methods: Two hundred seven NobelActive implants were inserted in 98 patients in the period from 10/2008 to 02/2015. The subdivision of the cohort was defined by local (n = 40), systemic (n = 6), local and systemic (n = 8), or without any RFs (n = 44) to analyze implant survival and marginal bone levels.

Results: Fifteen implants failed within the follow-up period. The mean follow-up period of the remaining implants was 34 months (range 12 to 77 months). The cumulative survival rate according to Kaplan-Meier was 91.5%. The survival rate for 93 implants in 45 patients with no RFs was 94.8% whereas it was 94% for 83 implants in 48 patients with local RFs (p = 0.618), 81.3% for 14 implants in 6 patients with systemic RFs (p = 0.173), and 76.5% for 17 implants in 6 patients with local and systemic risk factors (p = 0.006). The interproximal marginal bone level was - 0.49 ± 0.83 mm at the mesial aspect and - 0.51 ± 0.82 mm at the distal aspect in relation to implant shoulder level and showed no relevant difference in the various risk factor groups.

Conclusions: It can be assumed that the negative effects of the local or/and systemic risk factors were partially compensated by the primary stability and grade of osseointegration of the NobelActive implant.

Clinical Relevance: The use of this system in patients with risk factors and immediate loading procedures.
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http://dx.doi.org/10.1186/s40729-018-0151-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6295441PMC
December 2018

Influence of soft tissue grafting, orofacial implant position, and angulation on facial hard and soft tissue thickness at immediately inserted and provisionalized implants in the anterior maxilla.

Clin Implant Dent Relat Res 2018 Oct 9;20(5):674-682. Epub 2018 Aug 9.

Department of Oral and Maxillofacial Surgery, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany.

Background: Resorption of hard and soft tissues following immediate implant insertion is frequently reported. Data regarding the influencing factors on facial tissue thickness are rare.

Purpose: This retrospective study investigated the impact of connective tissue grafting, the orofacial angulation and position of immediately inserted and provisionalized implants on the facial hard and soft tissue thickness in the anterior maxilla within a 1- to 5-year follow-up.

Material And Methods: Implants with the prerequisite of having preoperative and postoperative cone beam computed tomography (CBCT) and a follow-up of 1 to 5 years were included. Facial bone deficiencies were grafted flaplessly with autogenous bone in all sites. In a subgroup of implants additional connective tissue grafting was performed, whereas the remaining implants were not grafted with soft tissue. The orofacial tooth and implant angulation, the change of horizontal position and the facial bone thickness were measured by CBCT, the facial mucosa thickness by an ultrasonic device.

Results: In total, 76 implants were placed in 55 patients. Sixty-nine sites showed a facial bone defect. Thirty-eight received a connective tissue graft additionally. All implants were still in function after a mean follow-up of 36 months. The mean thickness of the facial mucosa was 1.72 mm at 1 mm, 1.63 mm at 4 mm, 1.52 mm at 6 mm, and 1.66 mm at 9 mm apically to mucosal margin. The bone thickness was 0.02, 0.25, and 0.36 mm initially and 1.32, 1.26, and 1.11 mm finally at 1, 3, and 6 mm apically to implant shoulder level. Mixed model analysis revealed an impact of the preoperative bone status on the facial bone increase. The facial soft tissue thickness was significantly influenced by the gingival biotype.

Conclusions: The results indicate that an initial severe hard tissue defect allows for significant bone regeneration. The facial soft tissue thickness is primarily influenced by the gingival biotype.
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http://dx.doi.org/10.1111/cid.12643DOI Listing
October 2018

Clinical and esthetic outcome with immediate insertion and provisionalization with or without connective tissue grafting in presence of mucogingival recessions: A retrospective analysis with follow-up between 1 and 8 years.

Clin Implant Dent Relat Res 2018 Jun 24;20(3):285-293. Epub 2018 Mar 24.

Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center, Johannes Gutenberg University of Mainz, Germany.

Background: Recessions following immediate implant insertion are frequently reported in the literature. Data regarding implant installation in presence of mucogingival recessions are rare.

Purpose: This study observes soft tissue level changes following immediate implant insertion and provisionalization of implants with or without connective tissue grafts in the anterior maxilla in patients with initial mucogingival recession within a follow-up period between one and eight years.

Materials And Methods: Twenty-six patients with marginal gingival recessions, which were designated for extraction and immediate implant insertion in the anterior zone of the maxilla (13-23), were included. Out of a larger group of immediate implants only single tooth replacements with 1 to 3 mm recession and a pre- and post-op CB-CT were selected. Facial bone deficiencies were grafted flaplessly with autologous bone in all sites. In a group of 13 patients the recessions (mean 2.3 ± 0.7 mm, range 1.0-3.0 mm) were grafted additionally by connective tissue (ABG + CTG), in the remaining 13 patients no soft tissue grafting (mean recession 1.8 ± 0.6 mm, range 1.0-3.0 mm) was performed (ABG). The marginal hard and soft tissue level, the width of the keratinized mucosa, the PES, and implant success were evaluated.

Results: After a mean follow-up period of 45 months the recessions were significantly reduced in the ABG group from 1.8 to 0.9 mm. The improvement was even more pronounced in the ABG + CTG group (from 2.3 to 0.5 mm). The PES improved significantly in both groups. At final examination all implants were still in function. Within the observational period, in 5 of 13 implants a marginal bone loss of more than 1 mm was noticed in the ABG, but in none of the ABG + CTG group.

Conclusions: These clinical results provide evidence that immediate implant placement might improve the facial soft tissue level. This was more evident in cases with a greater recession and an additional treatment with connective tissue grafts.
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http://dx.doi.org/10.1111/cid.12595DOI Listing
June 2018

Immediate and flapless implant insertion and provisionalization using autogenous bone grafts in the esthetic zone: 5-year results.

Clin Oral Implants Res 2018 Mar;29(3):320-327

Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany.

Objectives: As the 2-year results for immediately inserted and provisionalized implants have been reported, it remained an open issue, whether the initially high success rates and the esthetic outcome remain stable for longer observation periods. Therefore, this prospective study examines the 5-year hard and soft tissue changes at implants placed in the anterior maxilla.

Material And Methods: Meanwhile, 37 microthreaded implants were placed in 21 patients into extraction sockets with and without facial bone deficiencies by a flapless approach. Facial gaps and bony defects were grafted with autogenous bone chips. The implants were immediately provisionalized. The primary outcome parameters were the interproximal marginal bone level and the thickness of the facial bony wall. Implant success and Pink Esthetic Score (PES) were considered as secondary outcome parameters.

Results: Two patients with four implants withdrew from the study (dropouts), and the remaining 33 implants were still in function at a follow-up period of 68 months. Marginal bone height averaged 0.04 mm coronal to the implant shoulder. The thickness of the facial bony lamellae increased significantly between pre-op examination and 1-year follow-up (p = .002) and thereafter remained stable. Within 5 years of follow-up, 24 of 33 implants were clinically stable, free of signs and symptoms, and showed bone loss less than 1 mm. The mean PES ratings improved slightly from 10.7 pre-operatively to 11.7 at the last follow-up (p = .02).

Conclusions: Interproximal marginal bone levels, survival rates, and esthetic results remain stable at the 5-year follow-up in implants used in an immediate insertion, reconstruction, and provisionalization concept. Facial marginal bone levels decreased slightly; however, this reduction did not affect the PES so far.
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http://dx.doi.org/10.1111/clr.13119DOI Listing
March 2018

Current concepts in cleft care: A multicenter analysis.

J Craniomaxillofac Surg 2018 Apr 6;46(4):705-708. Epub 2018 Feb 6.

Department for Cranio-, Maxillofacial and Oral Surgery, Medical University Innsbruck, (Head: Prof. M. Rasse, MD, DDS), Austria.

The current surgical techniques used in cleft repair are well established, but different centers use different approaches. To determine the best treatment for patients, a multi-center comparative study is required. In this study, we surveyed all craniofacial departments registered with the German Society of Maxillofacial Surgery to determine which cleft repair techniques are currently in use. Our findings revealed much variation in cleft repair between different centers. Although most centers did use a two-stage approach, the operative techniques and timing of lip and palate closure were different in every center. This shows that a retrospective comparative analysis of patient outcome between the participating centers is not possible and illustrates the need for prospective comparative studies to establish the optimal technique for reconstructive cleft surgery.
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http://dx.doi.org/10.1016/j.jcms.2018.01.014DOI Listing
April 2018

Immediate provisionalization in the esthetic zone: 1-year interim results from a prospective single-cohort multicenter study evaluating 3.0-mm-diameter tapered implants.

Clin Oral Investig 2018 Jul 3;22(6):2299-2308. Epub 2018 Feb 3.

Goethe University, Frankfurt am Main, Germany.

Objectives: The aim of this interim analysis of a 5-year prospective multicenter study is to evaluate clinical and radiological performance of immediately provisionalized 3.0-mm-diameter tapered implants.

Materials And Methods: Patients needing implant rehabilitation of maxillary lateral incisors or mandibular lateral and central incisors were treated with 3.0-mm-diameter implants placed in extraction or healed sites and immediately provisionalized. Clinical and radiographic examinations were performed at implant insertion, 6 months thereafter, and are ongoing. Marginal bone levels and changes, complications, the papilla, plaque, and bleeding indices, and the pink esthetic score (PES) were evaluated at each follow-up visit.

Results: Of 112 enrolled patients, 77 patients (91 implants) met the inclusion criteria. Seventy-one patients with 82 implants completed the 1-year follow-up. Three implants failed yielding a CSR of 96.7%. All failures occurred within the first 3 months after implant insertion. Marginal bone level changes from insertion to 6 months was - 0.57 ± 1.30 mm (n = 75) and from insertion to 12 months - 0.25 ± 1.38 mm (n = 72). Fifteen non-serious complications were recorded. Papilla index score and PES improved at the 1-year follow-up. Plaque formation and bleeding-on-probing showed no statistically significant differences between the 6-month and the 1-year visit.

Conclusions: This 1-year analysis demonstrated high survival, stable bone levels, and healthy soft tissue with 3.0-mm-diameter implants.

Clinical Implications: Narrow diameter implants are a safe and predictable treatment option in patients with limited bone volume and/or limited interdental space and eligible for immediate loading protocols.
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http://dx.doi.org/10.1007/s00784-017-2329-2DOI Listing
July 2018

Implants in free fibula flap supporting dental rehabilitation - Implant and peri-implant related outcomes of a randomized clinical trial.

J Craniomaxillofac Surg 2016 Nov 9;44(11):1849-1858. Epub 2016 Sep 9.

Department of Oral and Maxillofacial Surgery-Plastic Surgery, University Medical Center of Johannes Gutenberg University, Mainz, Germany. Electronic address:

Objectives: The objective of this study was to assess the difference in success rates of implants when using two or four implant-supported-overdentures following segmental mandibular reconstruction with fibula free flap.

Methods And Designs: This prospective, parallel designed, randomized clinical study was conducted with 1:1 ratio. At baseline, all participants already had segmental reconstruction of mandible with free fibula flap. The participants were randomized into two groups: Group-I received implant-supported-overdentures on two tissue-level implants and Group-II received implant-supported-overdentures on four tissue-level implants. Success rates of the implants were evaluated at 3 months, 6 months and 12 months following implant loading using marginal bone level changes as well as peri-implant indices (Buser et al., 1990).

Results: 52 patients were randomized into two treatment groups (26 each), out of which 18 patients (36 implants) of Group-I and 17 patients (68 implants) of Group-II were evaluated. One implant in Group-I was lost due to infective complications and one patient in the same group had superior barrel necrosis. There was a statistically significant increase at both time points (p = 0.03, p = 0.04 at 6 months, 12 months) in the amount of marginal bone loss in Group-I (0.4 mm, 0.5 mm at 6 months, 12 months) as compared to Group-II (0.1 mm, 0.2 mm at 6 months, 12 months). There were no clinically significant changes peri-implant parameters between both groups. Peri-implant soft tissue hyperplasia was seen in both groups, 32% of implants at 3-months, 26% at 6-months and 3% at 12-months follow-up.

Conclusion: The results of this study show that patients with 2-implant-supported-overdentures had higher marginal bone loss as compared to patients with 4-implant-supported-overdentures. There were no clinically significant differences in peri-implant soft tissue factors in patients with 2- or 4-implant-supported-overdentures. Hyperplastic peri-implant tissues are common in the early implant-loading phase and tend to decrease over time under appropriate management.
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http://dx.doi.org/10.1016/j.jcms.2016.08.023DOI Listing
November 2016

Guest Editorial.

Eur J Oral Implantol 2016 ;9 Suppl 1:S3

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March 2019

Implant supported dental rehabilitation following segmental mandibular reconstruction- quality of life outcomes of a prospective randomized trial.

J Craniomaxillofac Surg 2016 Jul 16;44(7):800-10. Epub 2016 Apr 16.

Department of Oral and Maxillofacial Surgery-Plastic Surgery, University Medical Center of Johannes Gutenberg University, Mainz, Germany. Electronic address:

Purpose: The primary objective of this study was to assess the difference in quality of life (QoL) in patients with dental rehabilitation using two or four implant-supported overdentures following segmental mandibulectomy defect reconstruction with fibula free flap.

Material And Methods: This prospective, parallel designed, randomized clinical study was conducted with a 1:1 ratio. At baseline, all participants already had fibula flap reconstruction for segmental defects of the mandible and rehabilitation with conventional (non-implant supported) removable partial dentures. The participants were then randomized into two groups. Group I received implant supported overdentures on two implants, and Group II received four implants. QoL outcomes were evaluated using standardized questionnaires (EORTC_QLQ c30, H&N35, OHIP, DSI). Outcomes of treatment were evaluated at 6 months (T1) and 1 year (T2) following rehabilitation.

Results: A total of 52 patients were randomized into two treatment groups (26 each). After accounting for the loss to lack of follow-up, 22 patients in Group I and 24 patients in Group II were evaluated for QoL at the end of the study. There was a significant improvement in QoL with implant-assisted dental rehabilitation. However there were no significant differences in QoL between the two-implant and four-implant groups.

Conclusion: Implant-supported removable overdentures improve QoL outcomes in patients with reconstructed mandibles. This study showed no significant difference in QoL outcomes in patients with two- or four-implant supported removable prostheses.
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http://dx.doi.org/10.1016/j.jcms.2016.04.013DOI Listing
July 2016

Effect of platform switching on crestal bone levels around implants in the posterior mandible: 3 years results from a multicentre randomized clinical trial.

J Clin Periodontol 2016 Apr 30;43(4):374-82. Epub 2016 Mar 30.

Faculty of Medicine, University of Coimbra, Coimbra, Portugal.

Objective: Evaluation of differences in the clinical performance and crestal bone levels between implants restored with single crowns with platform-matched or platform-switched abutments after 3 years.

Material And Methods: The study enrolled adult patients missing two or more adjacent teeth in the posterior mandible with natural teeth mesial to the implant site. Randomization followed open-flap implant insertion and the corresponding matching or switching healing abutments placed at surgery. Conventional loading was made with cemented crowns. Clinical follow-up took place annually after loading up to 3 years. Bone level changes were measured in standardized radiographs as the variation in crestal bone from one evaluation to the next.

Results: Sixty-three patients with a total of 135 implants (66 platform matching, 69 platform switching) were analysed. From surgery to 36 months, mean bone loss was 0.28 ± 0.56 mm for the platform-switching group and 0.68 ± 0.64 mm for the platform-matching group. A statistically significant difference was found between groups (p = 0.002) with an estimate of 0.39 mm (0.15-0.64, 95% CI) in favour of platform switching.

Conclusions: After 3 years, platform-switching restorations showed a significant effect in the preservation of marginal bone levels compared to platform-matching restorations.
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http://dx.doi.org/10.1111/jcpe.12522DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5071662PMC
April 2016

Vital Life-Threatening Hematoma after Implant Insertion in the Anterior Mandible: A Case Report and Review of the Literature.

Case Rep Dent 2015 18;2015:531865. Epub 2015 Oct 18.

Department of Oral and Maxillofacial Surgery, Johannes Gutenberg University Medical Centre, Augustusplatz 2, 55131 Mainz, Germany.

Dental implant insertion is considered a safe and reliable surgical procedure and severe complications are seldom reported. However, we present a case of a 52-year-old patient who attended our Department of Oral and Maxillofacial Surgery, Johannes Gutenberg University Medical Center, Mainz, with spreading hematoma in the floor of the mouth and acute airway obstruction after insertion of a dental implant in the anterior mandible. The hematoma was removed and submentally drained by a silicon drainage. However, the progressive swelling of the tongue and the floor of the mouth necessitated a temporary tracheotomy for three days. The review of the literature summarizes guidelines for prevention and management of this life-threatening complication.
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http://dx.doi.org/10.1155/2015/531865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4628691PMC
November 2015

Oral Health-Related Quality of Life in Edentulous Patients with Two- vs Four-Locator-Retained Mandibular Overdentures: A Prospective, Randomized, Crossover Study.

Int J Oral Maxillofac Implants 2015 Sep-Oct;30(5):1143-8

Purpose: To compare the oral health-related quality of life (OHRQoL) in a prospective, randomized crossover trial in patients with mandibular overdentures retained with two or four locators.

Materials And Methods: In 30 patients with edentulous mandibles, four implants (ICX-plus implants [Medentis Medical]) were placed in the intraforaminal area. Eight weeks after transgingival healing, patients were randomly assigned to have two or four implants incorporated in the prosthesis. After 3 months, the retention concepts were switched. The patients with a two-implant-supported overdenture had four implants incorporated, whereas patients with a four-implant-supported overdenture had two retention locators taken out. After 3 more months, all four implants were retained in the implant-supported overdenture in every patient. To measure OHRQoL of the patients, the Oral Health Impact Profile 14, German version (OHIP-14 G), was used.

Results: A considerable increase in OHRQoL could be seen in all patients after the prosthesis was placed on the implants. Also, a statistically significant difference of OHRQoL could be seen in the OHIP-14 G scores between two-implant and four-implant overdentures. Patients had a higher OHRQoL after incorporation of four implants in the overdenture compared with only two implants.

Conclusion: Patients with implant-retained overdentures had better OHRQoL compared with those with conventional dentures. The number of incorporated implants in the locator-retained overdenture also influenced the increase in OHRQoL, with four implants having a statistically significant advantage over two implants.
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http://dx.doi.org/10.11607/jomi.3987DOI Listing
May 2016

International Brainstorming Meeting on Etiologic and Risk Factors of Peri-implantitis, Montegrotto (Padua, Italy), August 2014.

Int J Oral Maxillofac Implants 2015 Sep-Oct;30(5):1093-104

The emerging literature has recently reported an alarming increase in peri-implantitis. This disease is typically described as the result of an imbalance between host response and bacterial load, supported by gram-negative anaerobic microflora. The current literature on the prevention and treatment of peri-implantitis does not allow for the extraction of applicable clinical information. In fact, the lack of efficacy of the current treatment methods may be a result of insufficient understanding of the biology. The aim of this position paper was to try to reevaluate the etiopathogenesis of peri-implantitis, highlighting the principal clinically induced triggering factors of the disease. The consensus conference provided strong evidence to suggest that a different microbiologic flora (slightly different from that collected around teeth affected by periodontitis) could support peri-implantitis. However, the evidence to support a consensus statement regarding clinically triggering factors (surgical, prosthetic, and biomechanical) for peri-implantitis is only of moderate strength (cohort studies or consistent results from long-term, well-populated case series). Expert opinion led the consensus group to support the following: rectifying the number of peri-implant inflammatory situations caused by surgical, restorative, or material complications may lower the number of infections to a more realistic figure and may suggest different and more appropriate treatment plans. At the same time, it can be stated that implant material, shape and surface characteristics, procedures and biomaterials used for bone augmentation, and incorrect prosthetic procedures and biomechanical plans could also be risk factors for the occurrence and progression of periimplantitis.
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http://dx.doi.org/10.11607/jomi.4386DOI Listing
May 2016

Immediately provisionalized OsseoSpeed(™) Profile implants inserted into extraction sockets: 3-year results.

Clin Oral Implants Res 2016 Jun 24;27(6):744-9. Epub 2015 Aug 24.

Department of Oral and Maxillofacial Surgery, Johannes Gutenberg University of Mainz, Mainz, Germany.

Objectives: A sloped shoulder might improve the congruence between extraction socket and dental implant and may add to a better circumferential support of the peri-implant structures. Therefore, this study evaluates the 3-year clinical outcome (survival and success rates, marginal bone levels, and Pink Esthetic Score (PES)) of immediately inserted and provisionalized OsseoSpeed(™) Profile implants in the anterior maxilla.

Material And Methods: Twenty-one implants were inserted in 16 patients. All implants were immediately placed into extraction sites with and without facial bone deficiencies. A flapless procedure was utilized, and the implants were provisionalized immediately. Facial gaps were grafted with autogenous bone chips from the mandibular ramus. Implant survival and success, the interproximal bone levels, the thickness of the facial bony wall, and the PES were evaluated.

Results: After a mean follow-up period of 43 months, 19 implants were still in function. One patient with 1 implant did not follow the study protocol (dropout) and 1 implant was lost at 10 weeks. Interproximal marginal bone levels measured -0.2 ± 0.4 mm (range, -1.0-0.4 mm) apical to the implant shoulder. The mean PES ratings were 11.9 ± 1.4 (range, 8-14) at the final examination.

Conclusions: Clinical and radiographic results provide evidence that sloped implants can preserve the marginal bone circumferentially and are able to maintain soft tissue esthetics when inserted and provisionalized immediately, even in the presence of facial bony wall defects.
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http://dx.doi.org/10.1111/clr.12651DOI Listing
June 2016

A bar-retained overdenture as an external fixator device in a three-dimensional CAD/CAM-based surgical reconstruction of the mandible.

J Craniomaxillofac Surg 2015 Oct 27;43(8):1447-51. Epub 2015 Jun 27.

Department for Oral & Maxillofacial Surgery - Plastic Surgery, University Medical Centre, Mainz, Germany.

Large defects of the human face often cause esthetic as well as functional disorders. We present a new technique for reconstruction of the mandible with prosthodontic rehabilitation in a single surgery, using the implant-supported, bar-retained overdenture as an external fixator. A 58-year-old patient presented with a near total defect of the mandible after cancer resection. For rehabilitation, the mandibular condyles were virtually positioned in the centre of the fossae, and four dental implants were planned. The position of the fibula segments as well as their angulation and lengths were adapted to the implant position. To transfer this plan into surgery, a combined cutting/implant drilling guide was computer-aided printed. To provide the correct angulation of the fibula segments, a CAD/CAM dental arch-bar was made from titanium, fulfilling three functions: to bear the provisional prosthesis; to stabilize the molded fibula as an external fixator; and to position the complete fibula with the prosthesis in a correct relation to the upper jaw and occlusion, as indicated by the prosthesis. This innovative approach of combined prosthodontic and reconstructive rehabilitation could shorten the total reconstruction/rehabilitation time and avoid the need for additional extended surgeries.
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http://dx.doi.org/10.1016/j.jcms.2015.06.019DOI Listing
October 2015

Radiographic evaluation of conical tapered platform-switched implants in the posterior mandible: 1-year results of a two-center prospective study.

Clin Oral Implants Res 2016 Jun 21;27(6):686-93. Epub 2015 Jun 21.

Department of Oral and Maxillofacial Surgery, Johannes Gutenberg-University, Medical Centre, Mainz, Germany.

Objective: Long-term success of dental implants depends on healthy peri-implant soft tissues and adequate bone levels. This prospective study aims to assess bone level changes around implants with internal conical connection and platform-switching abutments in the posterior mandible.

Material And Methods: Adult patients missing at least two teeth in the posterior mandible and with a natural tooth mesial to the implant site received two or three adjacent internal conical connection implants. After a minimum transmucosal healing period of 8 weeks, single crown restorations were cemented over platform-switching abutments. Changes in marginal bone levels were measured in standardized periapical radiographs from surgery and loading (baseline) to 12 months post-loading.

Results: Twenty-four patients received 52 implants. Bone remodeling took place between surgery and loading (-0.53 ± 0.40 mm). From loading to 12 months, there was a mean bone gain of 0.12 ± 0.42 mm which occurred mainly in the first 6 months after prosthesis delivery (0.11 ± 0.36 mm) and stabilized afterward. A total of 71.7% of all implants presented bone preservation or gain. No implant was lost at 1 year and the success rate was 100%. Patient inquiry revealed high satisfaction.

Conclusion: Internal conical connection implants with platform-switching abutments presented high success rate and enhancement or preservation of marginal bone levels after 1 year of loading.
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http://dx.doi.org/10.1111/clr.12644DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5054904PMC
June 2016

Clinical and Radiological Long-Term Outcome of a Tapered Implant System with Special Emphasis on the Influence of Augmentation Procedures.

Clin Implant Dent Relat Res 2016 Aug 25;18(4):810-20. Epub 2015 Mar 25.

Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany.

Background And Purpose: Tapered implant designs aim to improve primary stability and implant survival in soft bone. However, respective clinical long-term data are scarce. Therefore, a clinical and radiological evaluation of the long-term success of a transgingival-supracrestal inserted tapered implant system with special emphasis on the influence of augmentation procedures was conducted.

Material And Methods: In a retrospective study design, all in the Department of Oral and Maxillofacial Surgery of the University Medical Centre, Mainz, Germany, between May 2002 and March 2012, placed tapered implants (Straumann TE®, Basel, Switzerland) were analyzed. In this time period, a total of one hundred ninety-seven tapered implants were inserted in 90 patients. For patients available for clinical recall, success criteria according to Albrektsson and Buser were evaluated.

Results: The in situ rate was 96.3% after an average time in situ of 62 ± 31 months. In one hundred twenty-seven sites, bone augmentation procedures were performed. Hereof, 96 sites were sinus augmentation procedures and 31 sites were alveolar ridge augmentations. For patients with sinus augmentation procedures, implant survival was 97.9% and for patients with alveolar ridge augmentations, implant survival was 93.5% after 5 years, indicating a higher implant survival for sinus augmentation, however not statistically different (p = .194). Implant diameter and timing of implant placement had no significant impact on implant survival (p > .05). Mean marginal bone loss was -0.50 ± 1.54 mm for patients receiving maxillary sinus augmentation and -1.16 ± 1.13 mm for patients with alveolar ridge augmentations, indicating a lower marginal bone loss in patients receiving maxillary sinus augmentation (p = .046). Implant success rates ranged between 88% and 92% after a mean follow-up of 6 years.

Conclusions: Within the limits of the retrospective character of this study, the tapered soft tissue level implant showed especially in maxillary sinus augmentation promising long-term survival and success rates and a low peri-implant bone resorption compared with the literature.
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http://dx.doi.org/10.1111/cid.12338DOI Listing
August 2016

Retrospective Clinical Study of Marginal Bone Level Changes with Two Different Screw-Implant Types: Comparison Between Tissue Level (TE) and Bone Level (BL) Implant.

J Maxillofac Oral Surg 2014 Sep 11;13(3):259-66. Epub 2013 Jun 11.

Department of Oral and Maxillofacial Surgery, University Medical Centre of Johannes Gutenberg University, 55131 Mainz, Germany.

Aim: The objective of this retrospective cohort study was to compare the amount of marginal bone loss (MBL) in a bone-level and a soft-tissue-level implant system, both of which have similar intra-bony shape and surface composition. A subgroup analysis was done to compare the amount of MBL of each implant type in relation to the different vertical placement within the respective groups of implants.

Materials And Methods: Records of all patients who underwent implantation for replacement of teeth using comparable bone level (BL) and soft tissue level implants (TE) from 1st January 2006 to 31st December 2009 were scrutinized. Initial depth of implant placement (IDIP) was measured for all implants. Marginal bone loss was measured in patients whose records were available at time point corresponding to 12, 24 and 36 months post insertion.

Results: Out of a total of 384 implants, 337 implants were included for study. The mean MBL for the BL implants were 0.3, 0.38, 0.48 and for TE implant were 0.6, 0.54 and 0.93 for time periods 12, 24 and 36 months respectively. Although there was no statistically significant difference between the two groups at time periods at 6-12 months, in later time periods, there was a slightly greater amount of MBL around TE implants as compared to BL implants (p < 0.001). When comparing the IDIP and MBL in the same implant type, there was a statistically significant (p < 0.001) positive correlation between the depth of implant placement and the amount of MBL, with deeper placed implants having more bone loss.

Conclusion: Within the limitations of this retrospective cohort study design, one can conclude that BL implants had statistically significant lesser MBL as compared to TE in time periods above 12 months. Although the difference is statistically significant, the difference may not be clinically significant. The IDIP had an influence on the amount of MBL, with deeper placed implants and screw structure of the implant placed below the bone, having more MBL in the period of study.
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http://dx.doi.org/10.1007/s12663-013-0532-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4082557PMC
September 2014

Guest editorial.

Eur J Oral Implantol 2014 ;7 Suppl 2:S87-8

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September 2014

Platform switch versus platform match in the posterior mandible – 1-year results of a multicentre randomized clinical trial.

J Clin Periodontol 2014 May;41(5):521-9

Objective: The purpose of this ongoing randomized study was to assess differences in bone level changes and success rates using implants supporting single crowns in the posterior mandible either with platform matched or platform switched abutments.

Material And Methods: Patients aged 18 and above, missing at least two teeth in the posterior mandible and with a natural tooth mesial to the most proximal implant site were enrolled. Randomization followed implant placement. Definitive restorations were placed after a minimum transgingival healing period of 8 weeks. Changes in crestal bone level from surgery and loading (baseline) to 12-month post-loading were radiographically measured. Implant survival and success were determined.

Results: Sixty-eight patients received 74 implants in the platform switching group and 72 in the other one. The difference of mean marginal bone level change from surgery to 12 months was significant between groups (p < 0.004). Radiographical mean bone gain or no bone loss from loading was noted for 67.1% of the platform switching and 49.2% of the platform matching implants. Implant success rates were 97.3% and 100%, respectively.

Conclusions: Within the same implant system the platform switching concept showed a positive effect on marginal bone levels when compared with restorations with platform matching.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282357PMC
http://dx.doi.org/10.1111/jcpe.12244DOI Listing
May 2014

Soft tissue healing at one-piece zirconia implants compared to titanium and PEEK implants of identical design: a histomorphometric study in the dog.

Int J Periodontics Restorative Dent 2013 Sep-Oct;33(5):669-77

Oral and Maxillofacial Surgery, University Medical Centre of Johannes Gutenberg University, Mainz, Germany.

This study aimed to histomorphometrically evaluate the soft tissue reactions of one-piece zirconia implants versus titanium implants in regard to their insertion depth. Four one-piece implants of identical geometry were inserted on each side of six mongrel dogs: an uncoated zirconia implant, a zirconia implant coated with a calcium liberating titanium oxide, a titanium implant, and an experimental implant made of a synthetic material. Using a split-mouth design, they were inserted in both submerged and nonsubmerged healing modes. After 4 months, dissected blocks were stained with toluidine blue to histologically assess the marginal portion of the implant mucosa, apical extension of the barrier epithelium, and margin level of bone-to-implant contact. The inflammation status at the crestal part of the implant was assessed as well. The histomorphology presented the typical soft tissue configuration of barrier epithelium and connective tissue near the bone-to-implant contact. Histomorphometrically, the length of the barrier epithelium did not differ significantly concerning material type or healing modality. Furthermore, the inflammation signs were higher with nonsubmerged implants. The submerged uncoated zirconia implants, however, showed few signs of inflammation. Within the limits of this study, it is concluded that uncoated and coated zirconia implants are capable of establishing sufficient soft tissue configurations that are comparable to those of titanium implants.
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http://dx.doi.org/10.11607/prd.1043DOI Listing
September 2015

Long-term effect of overdenture bar design on peri-implant tissues.

Int J Oral Maxillofac Implants 2013 Jul-Aug;28(4):1126-31

Polyclinic of Prosthetic Dentistry, University Medical Center, Mainz, Germany.

Purpose: To evaluate factors promoting mucositis and peri-implantitis (plaque accumulation, poor peri-implant soft tissue health, bone loss) with regard to prosthetic attachment systems consisting of implant-supported bar-retained overdentures.

Materials And Methods: Patients who received TiOblast implants to support overdentures retained by either (1) prefabricated bars with or without extensions or (2) cast bars were recalled and examined clinically and radiographically. Plaque Index (PI), Sulcus Bleeding Index (SBI), probing pocket depth (PPD), and peri-implant bone loss were measured. Peri-implant tissue health was assessed, and the presence of mucositis and peri-implantitis was recorded. One-way analysis of variance with the Bonferroni adjustment was used to compare groups (α = .05).

Results: Five to 10 years after prosthetic loading, 107 patients who received 516 TiOblast implants were evaluated; 31 of these patients were treated with 131 implants to support bar-retained overdentures. PI, SBI, PPD, and pathologic bone loss were least common in the group with prefabricated bars, followed by the group with prefabricated bars with extensions, and were most common in the group with cast bars. Plaque accumulation and pathologic bone loss values were higher with implants that supported mandibular bar-retained overdentures than with those supporting maxillary bar-retained overdentures. However, these differences among attachment systems or between maxillary and mandibular implants were not significant (P > .05). Mucositis was observed in one implant in the group with prefabricated bars, four implants in the group with prefabricated bars with extensions, and four implants in the group with cast bars. Peri-implantitis was observed in one implant of the cast bar group.

Conclusions: Five to 10 years after prosthetic loading, no significant difference in PI, SBI, PPD, pathologic bone loss, or peri-implant tissue conditions among the different bar designs tested was observed.
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http://dx.doi.org/10.11607/jomi.2161DOI Listing
May 2014

Long-term bony integration and resorption kinetics of a xenogeneic bone substitute after sinus floor augmentation: histomorphometric analyses of human biopsy specimens.

Int J Periodontics Restorative Dent 2013 Jul-Aug;33(4):e101-10

Department of Oral, Maxillofacial and Plastic Surgery, University Medical Centre of the Johannes Gutenberg-University Mainz, Germany.

In this case series, a systematic histomorphometric analysis of two human bone biopsy specimens was conducted 1 and 5 years after grafting with a xenogeneic bovine bone substitute material (BSM). While the 1-year specimen still showed extensive signs of an active desmal ossification, the specimen after 5 years mainly showed mature lamellar bone without bone turnover or remodeling. A completed bony integration without extensive resorption of the BSM particles could be detected. Altogether, a good integration in the bone with osteoconduction and a high biocompatibility was seen.
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http://dx.doi.org/10.11607/prd.1469DOI Listing
July 2014
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