A Minimally Invasive Technique for Short Spiral Implant Insertion with Contextual Crestal Sinus Lifting in the Atrophic Maxilla: A Preliminary Report

The most recently reported techniques for the rehabilitation of the atrophic posterior maxilla are increasingly less invasive, as they are generally oriented to avoid sinus floor elevation with lateral access. The authors describe a mini-invasive surgical technique for short spiral implant insertion for the prosthetic rehabilitation of the atrophic posterior maxilla, which could be considered a combination of several previously described techniques based on the under-preparation of the implant site to improve fixture primary stability and crestal approach to the sinus floor elevation without heterologous bone graft. Eighty short spiral implants were inserted in the molar area of the maxilla in patients with 4.5–6 mm of alveolar bone, measured on pre-operative computed tomography. The surgical technique involved careful drilling for the preparation of implant sites at differentiated depths, allowing bone dislocation in the apical direction, traumatic crestal sinus membrane elevation, and insertion of an implant (with spiral morphology) longer than pre-operative measurements. Prostheses were all single crowns. In all cases, a spiral implant 2–4 mm longer than the residual bone was placed. Only two implants were lost due to peri-implantitis but subsequently replaced and followed-up. Bone loss values around the implants after three months (at the re-opening) ranged from 0 to 0.6 mm, (median value: 0.1 mm), while after two years, the same values ranged from 0.4 to 1.3 mm (median value: 0.7 mm). Clinical post-operative complications did not occur. After ten years, no implant has been lost. Overall, the described protocol seems to show good results in terms of predictability and patient compliance.

Giant Cell Tumour of the First Cuneiform: Case Study

Giant cell tumours (GCT) are usually benign, locally aggressive tumours. They tend to occur in long bones and rarely in small bones, with an incidence rate of 1.2 to 2.4% in the bones of the foot. The objective is to present a unique case in the literature of a GCT that only affected the first cuneiform. We present the case of a 35-year-old male patient seen at Hospital General de México (HGM) with seven months history of pain and increased volume in the medial region of the right foot, with X-ray and MRI images consistent with GCT in first cuneiform of the right foot. The excisional biopsy confirmed GCT. The definitive treatment consisted of curettage, cryotherapy with nitrogen and heterologous bone graft placement. Evolution was satisfactory, with no pain, no volume increase, normal gait and radiographic bone graft integration. Follow-up was at six years.

A New Tooth Processing Apparatus Allowing to Obtain Dentin Grafts for Bone Augmentation: The Tooth Transformer

Introduction:Human dentin matrix could be considered an excellent alternative to autologous or heterologous bone graft. Autologous tooth graft has been proposed since 1967 when the osteoinduction properties of autogenous demineralized dentin matrix were discovered.Methods:The preparation technique to transform autologous teeth in suitable grafting material still represents the fundamental step of the whole procedure.Aim:The aim of the present study was to test an innovative medical device that could obtain tooth graft materials starting from the whole tooth of the patient. 15 consecutive cases of tooth grafting procedures were performed with a mean follow up period of 18 months.Results:In all cases, after 6 months of healing, the defects were almost completely filled by newly formed hard tissue. The new tissue was examined after 6 months, both from a radiological point of view by CBCT scans and from a clinical observation. It showed a compactness similar to the medium-density bone. No signs of inflammations were observed. No infective complications were recorded during the post-operative healing. No graft particles or grains were visible in the regenerated bone structure that appeared homogeneous and uniform.Discussion:The results of the present study showed favorable bony healing in guided regenerative surgery procedures using autologous tooth graft. Future studies with long follow up period are needed in order to better evaluate the potential of demineralized dentin autografts.

The use of Totally De-Proteinized Heterologous Bone Graft in non-Union of the Scaphoid

In an attempt to avoid the complications associated with taking autologous bone graft for use in the treatment of non-union of the scaphoid, a clinical trial of the use of totally de-proteinized heterologous bone graft has been carried out. Ten patients with established non-union of the scaphoid were treated with internal fixation and grafting using one such commercially available material, Pyrosp®. The clinical and radiological results in eight patients about one year later are reported. The operative use of this material proved difficult because of its poor mechanical properties and it is not recommended as a substitute for the patient’s own bone.