Dental Implants Articles

XX Congress - European Association for Osseointegration - 2011

2011-10-18T00:01:00.003-03:00

The XX Congress of the European Association for Osseointegration took place from October 12^thto October 15^th, 2011, in Athens, Greece, where I had the opportunity to present an investigation about surgical treatment of peri-implant bone loss.

It has been a magnificent event, where we enjoyed science and friendship.

Cesar Luchetti

Follow @LuchettiCesar

Peri-implant Bone Lesions and Re-osseointegration

2011-03-01T22:48:00.014-03:00

César Luchetti

Article published in the December 2010 issue of Maxillaris (Spain). Article in Spanish.

Download it by clicking the image below. Also, you can access at http://www.maxillaris.com/

DOWNLOAD FILE

Note: Alternative download option: click here

Follow @LuchettiCesar

.

XIX Congress – European Association for Osseointegration

2010-11-05T22:04:00.007-03:00

The XIX Congress of the European Association for Osseointegration took place from October 6^thto October 9^th in Glasgow, where I had the opportunity to present an investigation about immediate dental implants in infected sockets.

It has been a magnificent event, where we enjoyed science and friendship.

Cesar Luchetti

Follow @LuchettiCesar

3er Meeting Internacional de Implantodontia - Florianopolis, June 2010

2010-06-19T03:24:00.003-03:00

The meeting was a great success. Some photos below.

Venue: Costao de Santinho, Florianópolis, Brazil

Opening ceremony

Surgery round table

Lecture about immediate implants after extraction.

Follow @LuchettiCesar

Successful Management of a Severe Case of Bisphosphonates Related Osteonecrosis of the Jaw in a Multiple Myeloma Patient

2010-01-28T02:11:00.011-03:00

Cesar Luchetti, Sebastian Yantorno, Julian Barrales, Juan Napal, Jorge Milone, Alicia Kitrilakis.

Article published in the October 2009 issue of the Journal of Implants and Advanced Clinical Dentistry.

Download it by clicking the image below. Also, you can access at www.jiacd.com

DOWNLOAD FILE

Note: Alternative download option: click here

Follow @LuchettiCesar

XVIII Congress – European Association for Osseointegration

2009-11-01T02:02:00.008-03:00

The XVIII Congress of the European Association for Osseointegration took place from September 30^th to October 3^rd in Monaco, where I had the opportunity to present an investigation about osteoporosis and dental implants.

It has been a magnificent event, where we enjoyed science and friendship with old friends and with new ones.

Cesar Luchetti

Follow @LuchettiCesar

All Ceramic Crowns for the Upper Incisors

2009-06-14T07:37:00.018-03:00

Cesar Luchetti

Follow @LuchettiCesar

Immediate Implant Placement in Maxillary Molars using Threaded Expanders

2009-06-14T07:12:00.011-03:00

Cesar Luchetti, Gregori Kurtzman and Alicia Kitrilakis

Download it by clicking the image below. Also, you can access at www.jiacd.com

DOWNLOAD FILE

Note: Alternative download option: click here

Follow @LuchettiCesar

Immediate Dental Implants After Extraction - Video

2009-01-28T13:13:00.012-02:00

Cesar Luchetti

Department of Implant Dentistry. National University of La Plata. Argentina

This case is from a middle age woman with periodontal compromise in the anterior teeth. The video shows the immediate implant placement for the upper anterior area. The lower anteriors, two implants at laterals, were done in the same surgery but are not presented here.

Please, click on SEE ON HD (High Definition) option to see the video better. Or HQ button from the menu on the lower right.

Follow @LuchettiCesar

Flapless Surgery and Immediate Loading. Definitive Crown

2008-07-05T04:01:00.014-03:00

Cesar Luchetti

Department of Implant Dentistry. National University of La Plata. Argentina

Here we are presenting the final pictures of the case that was showed in video sometime ago.

Dental Implants. Flapless Surgery and Immediate Loading

Follow @LuchettiCesar

Ridge Splitting, Nasal Cavity Lift and Simultaneous Dental Implants Placement

2008-03-22T00:52:00.027-03:00

Cesar Luchetti

Department of Implant Dentistry. National University of La Plata. Argentina
Ridge splitting is a procedure used to expand the bone by separating the buccal and palatal plates.

Nasal cavity lift associated with implant placement is not a common procedure. However, is useful in some cases with ridge atrophy and a low nasal floor.

In this case, we use both approaches together, in order to have the possibility to place the implants.

Preoperatory situation.

Flap raised. An extremely atrophied ridge is observed.
Also, the nasal cavity is shown. (Black arrows)

Doing the pituitary membrane lift using a curette.

Diamond disk used to perform the cut of the ridge to initiate

the splitting.

Making the cut using the disk.

Initial ridge split.

Ridge split after using the chisels.

Final expansion using threaded expanders.

Surgical sockets.

Implants placed.

Graft placed in the nasal cavity. (Black arrows)

Graft placed between the expanded plates.

Suture.

Follow @LuchettiCesar

Maxillary Sinus Lift in a Case with a Complete Partition Wall and Simultaneously Placement of Dental Implants

2008-03-20T03:20:00.011-03:00

Cesar Luchetti

Department of Implant Dentistry. National University of La Plata. Argentina

Maxillary sinus usually presents partition wall inside, but normally they are incomplete. When a complete partition wall is present, the sinus lift procedure could be more difficult. In such cases, the lateral wall must be taken out (because it is impossible to move it medially inside the sinus) and create two different access at both sides of the partition wall.

In the following case the technique to do this is showed.

Preoperatory situation

Flap raised.

Maxillary sinus access, after the lateral wall

was retired, showing the partition wall.

First load of the bone graft into the medial

part of the sinus.

Implants placement.

Bone graft is completed.

Suture.

Follow @LuchettiCesar

Dental Implants. Flapless Surgery and Immediate Loading

2008-03-14T02:48:00.006-02:00

Cesar Luchetti

Department of Implant Dentistry. National University of La Plata. Argentina

Implant dentistry is pushing their limits towards less invasive procedures and with results in a day.

Although this is a valid approach, an adequate diagnosis is necessary to perform these cases in a secure way.

Flapless surgery is usually faster and gives more postoperative comfort to the patient. However, the adequate tridimensional position of the implants must not be sacrificed just to avoid a flap, especially in cases when bone reconstruction is needed.

Long term prognosis is influenced by a good tridimensional positioning of the implants which is determined by the biomechanical requirements of the teeth being replaced.

Immediate loading is useful because the patient retrieves the function instantaneously, but it must be done just in cases with a good initial fixation.

The following video shows a case with a flapless approach.

Implant site development was made with threaded expander in order to increase bone density allowing a better initial fixation.

The implant used, B&W CIH (

Argentina

), has an implant carrier who can be adapted as an abutment. A provisory crown was made over it a few moments after surgery.

To see the video in full screen, please click in the link below (opens in a new window). Then, click in the lower right square of the screen.

Dental Implants. Flapless Surgery and Immediate Loading

...

Follow @LuchettiCesar

Treatment of the agenesis of a lateral incisor

2008-03-12T16:16:00.007-02:00

Daniel Ostrowicz - Barcelona, Spain

In multiple situations, the possibility to place implants must face some challenges.

A frequent situation is the limited space between adjacent teeth, which can be due to extractions made long time ago without the proper repositioning or without the use of space maintainers, or in case of a tooth agenesis.

In this article, Dr. Ostrowicz presents a good clinical report on how to manage a case of a lateral incisor agenesis with limited mesio-distal space and with some atrophie of the buccal plate.

Although the article is in Spanish, it has a lot of photos that are self explanatory.

Below, you can access the article.

Click in the image above and a new page will open. Then scroll down and click in “download file”.

I want to thank Daniel for share this article with us.

I hope you it find interesting.

...

Dental Implants. Flapless Surgery and Immediate Loading

2007-11-28T22:52:00.002-03:00

Cesar Luchetti

Department of Implant Dentistry. National University of La Plata. Argentina

Implant dentistry is pushing their limits towards less invasive procedures and with results in a day.

Although this is a valid approach, an adequate diagnosis is necessary to perform these cases in a secure way.

Long term prognosis is influenced by a good tridimensional positioning of the implants which is determined by the biomechanical requirements of the teeth being replaced.

Immediate loading is useful because the patient retrieves the function instantaneously, but it must be done just in cases with a good initial fixation.

The following video shows a case with a flapless approach.

Implant site development was made with threaded expander in order to increase bone density allowing a better initial fixation.

The implant used, B&W CIH (

Argentina

), has an implant carrier who can be adapted as an abutment. A provisory crown was made over it a few moments after surgery.

To see the video in full screen, please click in the link below (opens in a new window). Then, click in the lower right square of the screen.

Dental Implants. Flapless Surgery and Immediate Loading

...

Bone Expansion by means of Ridge Splitting

2007-11-21T03:03:00.009-03:00

Cesar Luchetti and Alicia Kitrilakis

Department of Implant Dentistry. National University of La Plata. Argentina

Ridge splitting is a procedure used to expand the bone by separating the buccal and palatal plates.

It is normally performed in the maxilla using chisels, osteotomes and a mallet.

It could be done also in the mandible, but is a little bit more complicated due to the denser bone. In this case, is recommended to use a cutting disk or piezoelectric devices and threaded expanders, because these are less traumatic.

It is indicated when:
-The bone is less than 3 mm wide. (If we have more we normally can expand it just by means of osteotomes or expanders)
-The bone is enough to place an implant but we want to expand it for esthetics reasons.

Typically, the procedure is initiated by thin chisels, followed by wider ones and then osteotomes.

Residual spaces are filled with a bone graft.

A clinical case is showed below.

Preoperative x-ray.

Preoperative situation. A fistula is

observed at canine level due to a

root fracture.

Flap raised. A longitudinal fracture of

the canine root is observed.

View of the narrow ridge after the extraction.

Start of the ridge splitting with thin chisels.

Ridge splitting with chisels.

Initial ridge splitting.

Continuation of the procedure by means of

osteotomes to prepare the implants sites and

to get the final expansion.

Continuation of the procedure by means of

osteotomes to prepare the implants sites and

to get the final expansion.

Final expansion.

Comparison between the initial aspect of the

ridge and the situation after the expansion.

Implants placed.

Bone graft filling the residual spaces.

Suture.

Abutments in place.

Definitive crowns.

Pre and post operative comparison.

Post operative x-ray.

Follow @LuchettiCesar

Bone Expansion Using Threaded Expanders

2007-11-14T04:56:00.004-03:00

Cesar Luchetti

Department of Implant Dentistry. National University of La Plata. Argentina

In the previous post, a group of instruments for bone expansion was analyzed.

Bone atrophies must be treated adequately to allow the implant placement in optimal position, according to the biomechanical requirements, and also to achieve better esthetics of the future crowns.

Here we are presenting a case, where there is bone atrophy and a low insertion of the frenulum.

The therapeutic approach was to make a bone expansion together with a frenectomy.

Bone atrophy and a low insertion of the frenulum.

After raising the flap, the bone atrophy is

observed, which is more important in the

anterior part.

Expander number 3 in position.

Expander number 4 in position. With this one

is enough to place a 4 mm diameter implant.

Bone expansion achieved.

Implants in place.

Implants in place from another view.

Suture of the flap.

In the buccal aspect the suture associated

with the frenectomy is observed.

Pre and post operatory comparison.

...

Instruments for Bone Expansion: Threaded Expanders

2007-11-14T04:23:00.002-03:00

Cesar Luchetti
Department of Implant Dentistry. National University of La Plata. Argentina

Threaded expanders are another group of instruments for bone expansion. They work by rotation, which differentiate them from the osteotomes, which work by impactation.

Threaded expanders have an aggressive conical shape and penetrate the bone easily. The principal advantage is that they are less traumatic to the patient and that they can be used in the lower jaw. The rotation movement can be done with a wheel inserted in the back part of the expander, or if more resistance is present, with a racket wrench.

The principal disadvantage is that is easier to loose the direction of the preparation compared to the osteotomes. Anyway, in both cases an adequate training is important.

In most usual cases, where the expansion needed is not so important, the expanders can be work well. In more extreme cases, is usually necessary to split the ridge first and the make the expansion.

...

Argentine Society of Hematology 2007

2007-11-14T02:44:00.003-03:00

XVIII Congresss of the Argentine Society of Hematology

Comments: César Luchetti

From October 23rd to 26th, the XVIII Congresss of the Argentine Society of Hematology was held in the city of Salta, Argentina. Here I have been honored by an invitation by Dr. Jorge Milone to lecture about “Bisphosphonates Associated Osteonecrosis of the Jaws” at a round table about Multiple Myeloma.

Also, our group from Bone Marrow Transplant Institute at Italian Hospital of La Plata, integrated by Drs. Sebastian Yantorno, Julian Barrales, Juan Napal, Jorge Milone and me, presented a work with data about our experience in this pathology.

More information about the congress at www.congresosah2007.org

Some insights about our experience in surgical treatment of the Bisphosphonates Associated Osteonecrosis of the Jaws can be read it here.

...

Argentine Society for Dental Research 2007

2007-11-14T02:25:00.003-03:00

XL Annual Meeting of the Argentine Society for Dental Research
Argentine Division of the International Association for Dental Research

Comments: César Luchetti

From October 18th to 20th, the XL Annual Meeting of the Argentine Society for Dental Research was held in the city of Mar del Plata, Argentina.

The meeting had a good attendance and a total of 259 works were presented. Our group presented 3 research works, which are named below:

Block Bone Xenograft: Evaluation of the Properties of a Bovine Substitute at 30 and 120 days.

C.G. LUCHETTI *, M.A. LOPEZ, M. AYALA, A. BAEZ, C. CARBONE, A.E. KITRILAKIS

In Vivo Evaluation of the Properties of a Calcium Sulfate Based Biomaterial for Bone Regeneration

M.A. LOPEZ *, C.G. LUCHETTI, M. AYALA, A. BAEZ, C. CARBONE, A.E. KITRILAKIS

Lower Facial Angle. Correlation with the Height and Depth of the Face in the Determination of the Vertical Dimension.

F.M. VIGO, C.G. LUCHETTI, A.E. KITRILAKIS

Soon we will publish abstracts of these researches.

Victor Sandullo, Mariano Lopez, Alicia Kitrilakis,

Clelia Reynoso and César Luchetti.

....

Dr. Ostrowicz course - National University of La Plata, Argentina - 2007

2007-10-16T02:19:00.020-03:00

Dr. Ostrowicz course - National University of La Plata, Argentina - August, 2007

Comments: Cesar Luchetti

Organized by the Implant Dentistry Department, on August 23rd, 2007 was held a course by Dr. Daniel Ostrowicz from Barcelona, Spain about “Multidisciplinary Aspects in Oral Implantology as a part of the Integrated Dentistry”

Main topics were:

- Narrow ridges surgery and bone expansion

- Piezosurgery

- Implants – orthodontics integration

- Integrated oral rehabilitation

The event had a great attendance.

Theorical part covered different aspects, as ridge cases treated with bone expansion by means of piezosurgery and threaded expansors; cases integrated with orthodontics, both as a mean of mouth preparation as the use of micro implants; all of these in an integrated oral rehabilitation concept.

In the Practical part, we did a workshop about piezoelectric surgery, with piezosurgery device from Mectron, in a small cow head. Here we test the device for extractions, ridge splitting and bone expansion, and for sinus lift, to name a few.

I wish to thank Daniel, who was so kind to make a space in his time to dictate the course.

Below there are some photos from the event.

Daniel Ostrowicz.

Partial view of the attendees.

César Luchetti, Daniel Ostrowicz and

Alicia Kitrilakis, Head of our Department.

Workshop.

...

Implantar 2007 Congress - Sao Paulo, Brasil

2007-10-16T02:19:00.019-03:00

Implantar 2007 Congress - Sao Paulo, Brasil

Comments: Cesar Luchetti

From October 4th to 6th, Implantar 2007 congress was held in the city of Sao Paulo, Brazil at the Convention Center of Anhembi. The event had a very good scientific program and a great quantity of attendees, and also a big commercial exhibition.

Our group was represented by Prof. Dr. Alicia Kitrilakis and me (Cesar Luchetti) lecturing about Implants in postmenopausal women and Use of Bone Grafts to treat Bone Atrophies, respectively. Program also included lectures by Sasha Jovanovich, David Garber y Hans van der Elst, to name a few.

As in every congress, this was good to meet colleagues from other parts of the world, exchange ideas, meet again old friends and make new ones, all in a very nice cordiality background.

Convention Center of Anhembi

Program

Dra. Alicia Kitrilakis lecture

Dr. Cesar Luchetti lecture

Samy Tunchel (Brazil), Alicia Kitrilakis

and Cesar Luchetti

Cesar Luchetti, Alicia Kitrilakis

and Hans van der Elst (Germany)

Patrick Hallqvist (old friend and Director of

Bionnvation Biomedical), Alicia Kitrilakis

and Cesar Luchetti

Commercial exhibition

Instruments for Bone Expansion: Osteotomes

2007-07-31T03:54:00.019-03:00

Cesar Luchetti

Department of Implant Dentistry. National University of La Plata. Argentina

In this post we will make a short review of one kind of instruments to expand bone: The osteotomes.

Osteotomes have an active part, slightly conical, which could finish in, basically, two different shapes: Sharpened and concave. Also, they have a handle and a posterior part to apply the mallet. These instruments are used only in the maxilla.

There are different options in the market, however their designs are similar.

Osteotomes with sharpened end are used to perform bone expansion and for ridge splitting. The principal advantage is that we can make the implant site preparation and to expand the bone at the same time. If we use drills for this purpose, we will loose bone instead of expand it. People must have in mind that expansion usually happens towards the buccal plate, because it normally has less resistance. That is why in most cases, it is important to initiate the preparation slightly to the palatal.

Osteotomes with concave end, are used to achieve bone compactation and to make sinus lift via alveolar approach.

In both cases, if the osteotome has too much resistance to go deeper, this technique should be combined with the use of drills.

There is another kind of instrument, the threaded expansors, which are used for the same objective. I will talk about them in a next post.

Osteotomes with sharpened end and a mallet.

Osteotomes with sharpened end in a closer view.

Osteotomes with concave end.

The first one has sharpened end to facilitate

the initial mark of the site.

Osteotomes with concave end in a closer view.

Differences between the two kind

of osteotomes.

Osteotomes use for bone expansion.
The complete case, from which these photos were taken,
can be seen here.

Cemented vs Screwed Prosthesis

2007-05-31T06:29:00.007-03:00

Daniel Ostrowicz - Barcelona, Spain

One of the most common discussions in implant prosthesis is where we should use cemented or screwed restorations. In this article, Dr. Ostrowicz analyzes the different concepts involved in each option and gives fundaments of why cemented prosthesis are in the most cases the best option.

Below, you can access the original article in Spanish.

Click in the image above and a new page will open. Then scroll down and click in “download file”.

I want to thank Daniel for share this article with us.

I hope you find it interesting.

...

Restoring a Natural Tooth Adjacent to a Dental Implant

2007-04-29T19:13:00.003-03:00

Cesar Luchetti

Department of Implant Dentistry. National University of La Plata. Argentina

One of the most challenged situations we must face regarding esthetics results is when we must do a crown over a natural tooth adjacent to a crown over a dental implant.

The differences between natural tooth and implant anatomy make difficult to harmonize the two emergency profiles.

Over the last years, slopped implants have proposed to be the solution to this problem. Although this could be true regarding the anatomy, there were some difficulties of some clinicians for the correctly implementation of its use.

We are presenting a case where we must restore a natural upper lateral incisor adjacent to an implant in upper central incisor area.

Pre-operative situation. An acrylic restoration

was present over the lateral with an extension

to the central incisor.

Pre-operative situation after the bridge was

retired. A depression is noticed in the buccal

area together with a loss in papilla height in

the mesial aspect of the lateral.

Implant placement. Incision was made to the

palatal and implant was placed in one stage

approach to maximize the soft tissue in the

buccal aspect and to avoid future

soft tissue manipulation.

Once the implant was integrated, a combined

transfer – natural tooth impression was made.

Note that the implant is slightly placed to the

palatal to achieve better force distribution and

also to allow a bigger amount of soft tissue

in the buccal area.

Metal substructures try in.

Definitive crowns in place.

Pre and post-operative comparison.

...

Maxilary Sinus Lift and Sinus Membrane Reparation with Simultaneous Ridge Augmentation

2007-04-14T18:35:00.006-03:00

Cesar Luchetti

Department of Implant Dentistry. National University of La Plata. Argentina

Sinus lift procedures are common in the atrophic posterior maxilla. However they are more or less complicated depending in what approach we decide to use.

In great atrophies, the lateral window approach is often the most indicated, usually associated with ridge augmentation. Although this is a predictable procedure, sometimes we must face some problems. One of the most common is the perforation of the Schneider membrane.

Here we can have basically three scenarios:

1- Small perforation. In this cases, it is normally occluded itself by just raising it.

2- Medium perforation. Here we can manage it by using collagen membranes or membranes made of PRP.

3- Large perforation. In these situations, there are usually no possibilities of reparation. The recommendable approach is to clean out the affected Schneider membrane, irrigate the sinus a lot and close the flap. Then, wait at least 3 months and re-enter to do the sinus lift.

In this work we will describe and show how to manage a medium perforation during sinus lift together with a ridge augmentation.

Preoperative situation.

Preoperative situation 15 days after

teeth extractions.

Ridge defects are showed after raising the flap

Access to the maxillary sinus and Schneider

membrane elevation.

A perforation is noticed at the center part.

Membrane perforation in a closer view.

Collagen membrane.

Collagen membrane placed to cover

the perforation

Graft placed into maxillary sinus and in the

ridge defects.

In both cases we use Beta Tricalcium Phosphate

(spherical in sinus and irregular particles

in the ridge)

PRP covering the graft and collagen membrane

over the access window. This is not really

necessary in our experience, but we decided to

do it just to help this difficult case in particular.

Suture

Postoperative picture, prior to implant

placement, showing good bone regeneration.

Implants in place following a triangular

distribution to improve load distribution of the

future crowns. Also, a small graft was done to

achieve a better contour in the posterior area.

Suture

Healing abutments 10 days after the

uncover surgery.

Definitive abutments in place.

Metal substructure try in. Notice the depression

created in the anterior implant to achieve better

esthetics. This was done by compression with

the provisionals.

Definitive crowns.

Definitive crowns from a more lateral view.

Definitive crowns from an occlusal view.

Pre and postoperative comparison.

Determination of the Osseointegration of Dental Implants in Postmenopausal Women.

2007-04-05T10:36:00.011-03:00

Alicia Kitrilakis and Cesar Luchetti

Department of Implant Dentistry. National University of La Plata. Argentina

The postmenopause is a state characterized by the estrogen deficiency that can lead to metabolic disorders of the bony weave, osteopenia and osteoporosis. Although a contraindication for implant placement in these patients does not exist, the predictability in the prognosis in the long term is not clear yet.

Objectives: The aim of this study was to evaluate the behavior of osseointegrated implants in postmenopausal patients.

Material and Methods: 24 postmenopausal female patients, who received 59 implants, 37 in the maxilla and 22 in the mandible (Group M) were selected. 23 premenopausal female patients, under the age of 50, who received 39 implants, 24 in the maxilla and 15 in the mandible, served as controls (Group C). Baseline Periotest values (PTV) were recorded at second stage surgery. The second measurement has been taken after 12 months of the placement of the prosthesis, and then at 24 and 36 months.

Results: Differences between both groups in the maxilla were observed for 2^nd stage surgery as well as at 12, 24 and 36 months. Nevertheless, the differences between both groups in the mandible were not significant.

Conclusions: In the mandible, local bony quality has shown to be more important, and it was not influenced by the postmenopausal condition. However, in the maxilla this condition seems to aggravate the local bony condition, as regards the controls. Postmenopause can be considered a relative risk factor in the maxilla, and of no importance to the mandible.

Periotest Device.

Periotest measurement of implant stability.

Periotest values compared with

Miller ´s index.

Table shown the average results and the

standard deviation for each group.

Progression of Periotest Values in the maxilla.

Progression of Periotest Values in the mandible.

Block Bone Xenograft

2007-03-24T23:01:00.005-03:00

Block Bone Xenograft: Evaluation of the Properties of a Bovine Substitute. Preliminary Report.
Cesar Luchetti, Mariano Lopez, Miguel Ayala, Adolfo Baez, Cecilia Carbone, Alicia Kitrilakis

Department of Implant Dentistry. National University of La Plata. Argentina

Block bone grafts are usually needed in oral reconstruction. Autografts still remains as the best, and almost the only, option in these cases. There are various bone block substitutes in the market, however the evaluation of their properties is lacking.

Aim: To evaluate the behavior of a bovine bone xenograft.

Material and Methods: 40 Wistar rats, SPF, 16 weeks old and 500 gr. of weight were used. A bovine bone xenograft was placed over the lateral face of the femur, which was previously perforated, and was immobilized by means of circumferential ligatures. The animals were divided in four groups, to be evaluated at 30 (T1), 60 (T2), 90 (T3) and 120 days (T4)

Results: Xenograft manipulation presented difficulties due to its fragility. It showed a great capillarity, which allows it to get imbibed in blood quickly after placed over the receptor area. At this moment we have evaluated the first group. Macroscopically, the xenograft was rigid, without signs of resorption and firmly joined with the receptor area. Microscopically, it showed a good integration, with a great quantity of cells and fiber, compatibles with an osseous matrix.

Conclusions: Within the limits of the present study, we can conclude that the xenograft was compatible with the receptor area. Evaluations at T2, T3 y T4 will permit to evaluate the evolution and the remodeling dynamics of the xenograft.

Block Bone Xenograft in its original package.

Macroscopic view of the block bone xenograft.

It is a bovine bone piece, without any

organic content.

Animal model. The skin over the femur is

shaved before the surgery.

A cylindrical bur is used to perforate the cortical

of the femur to activate a medullar response.

Xenograft is placed over the lateral face

of the femur.

Xenograft immobilized by means of

circumferential ligatures.

Suture. This is done in two planes separately:

muscles and skin.

Macroscopic view of block bone xenograft

integration.

The black line shows the original bone level.

Closer macroscopic view of block bone

xenograft integration.

Microscopic view of block bone xenograft

integration showing immature bone organization

between the remaining structure of the graft.

Nasal Cavity Lift

2007-03-17T15:12:00.006-03:00

Cesar Luchetti and Alicia Kitrilakis

Department of Implant Dentistry. National University of La Plata. Argentina

Nasal cavity lift associated with implant placement is not a common procedure. However, is useful in some cases with ridge atrophy and a low nasal floor. In this case we describe the technique to do the nasal lift. The surgery was performed by Dr. Luchetti and crowns were made by Dr. Kitrilakis.

The nasal cavity lift is some times easier than maxillary sinus lift. The pituitary mucosa is often more resistant than Schneider membrane and there is not need to make an access window.

The technique is simple. Once the incisions were made, the flap must be raised to reach the nasal cavity. Then, the mucosa is detached using the same curettes we use to use for sinus lift procedures and a bone graft is placed below the pituitary. Implant placement can be done simultaneously or in a two stage approach. The main difference with sinus lift is that is not recommendable to make a lift bigger than 3-4 millimeters.

Preoperative situation.

Flap raised. An old failing implant is present

and must be extracted.

Curette doing the pituitary lift before the final

placement of the implants.

Implants in position. Due to limitations in the

ridge anatomy, there were placed in the areas

where we achieved the best initial fixation.

The blue arrows point the nasal cavity.

Graft in nasal cavity placed.

In this case we use a bovine hidroxyapatite.

Graft placed in the ridge irregularities.

Polilactic Acid polimerizable membrane is

placed to protect the graft.

Suture.

Seven days postoperative.

Abutments in place.

Metal substructure try in.

Final ceramic crowns.

...

Surgical Treatment of Bisphosphonates Associated Osteonecrosis

2007-03-11T01:05:00.001-03:00

Cesar Luchetti

Department of Implant Dentistry. National University of La Plata. Argentina

Treatment of bisphosphonates associated osteonecrosis is very difficult, and surgery may not be indicated because of the probability of aggravate the condition, as many authors have pointed out. However, sometimes there is not other option. In these cases, my protocol is as follow:

1- If is possible, I take samples for bacterial and mycological analysis. (If this is not possible in the preop, I do it during surgery)

2- Pre-medication according with the test results or empirically, amoxicillin 1 gr plus clavulanic acid and Metronidazol 500 mg, both one every 12 hours. If the patient is immuno-suppressed, which is very common, and has been taking antibiotics for long periods, I assume that he/she could has mycosis also, so I prescribe Fluconazol 150 mg/week.

3- During surgery, I do a VERY conservative resection of the necrotic bone, and carefully eliminate every sharpened part of it. Then I place a membrane made of autologous high concentrated platelet rich plasma. Finally, I manipulate the soft tissue to achieve a complete closure without tension.

You can not regenerate bone, but is possible to stop the progression this way.

Case 1:
Multiple Myeloma patient. 15 days after the first signs of osteonecrosis. Antibiotics were adjusted to bacteriological test results plus local use of clorhexidine 0,12 %. This was my first attempt. After a month without healing, in fact with a situation aggravating, I decide to do surgery. The before, during and after pics are below. This was my second surgery case. Also was the one with the faster resolution. I think that may be because of I treated it quickly.

Case 2:
Multiple Myeloma patient. 4 years after his first sign of osteonecrosis. These days the bisphosphonates associated osteonecrosis had not been described yet. I saw the patient about a year ago. My first approach was palliative, with antibiotics and oral rinses just to try to maintain the bone clean as much as possible. On November 2006, the patient was felling very uncomfortable with the situation and ask me to try something. I told him the risks. He accepts it. The pictures show the before and after. We can not rebuild bone, but al least we were able to achieve soft tissue closure. The area will be reconstructed with a removable prosthesis next month.

Important note: This post is not trying to stimulate the surgery approach in bisphosphonates associated osteonecrosis. It just tries to stimulate debate. Surgery in these cases is very unpredictable and must be taken carefully. The results, as many authors have pointed out in the literature, could be worse than the preoperative situation.

I hope you have enjoyed it. I will try to post more about this subject in the near future.

...

Zirconia Dental Implant Video

2007-03-06T14:25:00.002-03:00

Although this blog was made to post our cases and also contributions from our visitors, I thought to post this video about zirconia dental implant that I found searching over the internet. The reason which I decided to do this is because we have been discussing a lot in our implant list about the subject in the past months.

I hope you enjoy it.

Zirconium is a grayish-white metal, lustrous and exceptionally corrosion resistant (1). However, as Dr. Gary Henkel has pointed out in our list, “in the form we utilize it; its properties are those of a ceramic. But most ceramics are non metallic so it is somewhat unusual in that regard”.

Some studies are showing similar osseointegration levels with respect to titanium. (2).

The proposed benefits are esthetics, non allergy problems and less corrosion. Regard the last issue, in the last Argentinian Society for Dental Research (IADR division) it was presented a paper who showed less corrosion and mobilization into target organs of zirconium compared to titanium (3)

Today, long term studies seem to be lacking. But we think that in the short time we will have more answers regarding zirconia.

References

1. http://en.wikipedia.org/wiki/Zirconium

2. J Periodontol. 2004 Sep;75(9):1262-8.

3. Olmedo, DG. et al. SAIO, 2006

...

Immediate Implant Placement in Upper 2nd Premolar

2007-03-01T21:11:00.010-03:00

Cesar Luchetti

Department of Implant Dentistry. National University of La Plata. Argentina

The immediate implant placement is today a routine approach. However, it must fulfill a series of conditions, between which is the achievement of a good initial anchorage, like in conventional implantology. This initial fixation normally is looked for creating the bed beyond the apex of the extracted piece, that is why some colleagues also denominate them trans-alveolus immediate implants.

Nevertheless, in certain situations it is not possible to go beyond the apex, due to anatomical limitations, as in the case of the upper second premolars and its proximity with the maxillary sinus.

Here we presented a case of immediate placement where the anchorage is obtained by means of the sidewalls of the residual alveolus.

Pre-operative situation. Root non-recoverable.

In the x-ray, the intimate relation of contact

between the apex of the piece and the cortical

of the maxillary sinus is observed.

After extraction socket with oval shape.

We decide the direct placement, without using

other instrument to modify the socket.

An implant of 4.5 mm of diameter (Steri-Oss)

was chosen to maximize the contact with the

mesial and distal walls.

The residual spaces are completed with a

bovine hidroxyapatite graft and soft tissue

closure was obtained with a partial thickness

palatal flap. X-ray shows the intimate position

of the implant respect the sidewall and the floor

of the maxillary sinus.

Implant uncovering and placement of the

definitive abutment

Metal substructure try in and definitive

metal-ceramic crown in place

...

Immediate Implant Placement in Upper Incisor Area

2007-02-28T16:59:00.002-03:00

Cesar Luchetti

Department of Implant Dentistry. National University of La Plata. Argentina

We are presenting a case of immediate implant placement in an upper incisor. Twenty years old patient came to us presenting mobility of the upper right central incisor with compromised esthetics. He has an antecedent of exfoliation and re-implantation during his childhood due to a bike accident. X-rays showed root resorption. We decide the extraction followed by an immediate implant placement.

Pre-operatory situation.

The tooth is extracted and the root

resorption is visualized.

The bone presents loss of the buccal wall.

An osteotome preparation is performed in

order to expand the bone and then

the implant is placed.

A small autogenous bone graft is placed in

the buccal side.

Suture. Coronal repositioned flap is used to

compensate the soft tissue deficiency present

at pre-operative stage

After two months, 2^nd stage surgery is

performed together with a micro-polishing of

the gum’s surface to improve the future esthetics.

After seven days the tissue is healed

and the abutment is placed.

Definitive porcelain crown, together with a

small angle reconstruction with composite of

the adjacent central incisor.

Pre and post comparison.
The management and improvement of the

tissues contour, both hard and soft, played a

major role in the esthetic obtained.

...

Articles Archive

2007-02-28T16:57:00.006-03:00

LAST UPDATE February 1, 2011

Welcome to Dental Implant Articles, a periodic publication related to oral implantology.

You may use the links in the left panel to know about us, search articles archive or archives by subject.

Below are the articles published up to date. Enjoy your visit.

Peri-implant Bone Lesions and Re-osseointegration
Cesar Luchetti

Successful Management of a Severe Case of Bisphosphonates Related Osteonecrosis of the Jaw in a Multiple Myeloma Patient
Cesar Luchetti, Sebastian Yantorno, Julian Barrales, Juan Napal, Jorge Milone, Alicia Kitrilakis.

XVIII Congress – European Association for Osseointegration
Comments: Cesar Luchetti

All Ceramic Crowns for the Upper Incisors
Cesar Luchetti

Immediate Implant Placement in Maxillary Molars using Threaded Expanders
Cesar Luchetti, Gregori Kurtzman and Alicia Kitrilakis

Immediate Dental Implants After Extraction
Cesar Luchetti

Flapless Surgery and Immediate Loading. Definitive Crown
Cesar Luchetti

Ridge Splitting, Nasal Cavity Lift and Simultaneous Dental Implants Placement
Cesar Luchetti

Maxillary Sinus Lift in a Case with a Complete Partition Wall and Simultaneously Placement of Dental Implants
Cesar Luchetti

Treatment of the agenesis of a lateral incisor

Daniel Ostrowicz

Dental Implants. Flapless Surgery and Immediate Loading
Cesar Luchetti

Bone Expansion by means of Ridge Splitting
Cesar Luchetti, Alicia Kitrilakis

Bone Expansion Using Threaded Expanders
Cesar Luchetti

Instruments for Bone Expansion: Threaded Expanders
Cesar Luchetti

XVIII Congresss of the Argentine Society of Hematology
Comments: César Luchetti
XL Annual Meeting of the Argentine Society for Dental Research
Argentine Division of the International Association for Dental Research
Comments: César Luchetti

Implantar 2007 Congress - Sao Paulo, Brasil
Comments: Cesar Luchetti

Dr. Ostrowicz course - National University of La Plata, Argentina - August, 2007
Comments: Cesar Luchetti

Instruments for Bone Expansion: Osteotomes
Cesar Luchetti

Cemented vs Screwed Prosthesis
Daniel Ostrowicz

Determination of the Oseointegration of Dental Implants in Postmenopausal Women.
Alicia Kitrilakis, Cesar Luchetti

Maxilary Sinus Lift and Sinus Membrane Reparation with Simultaneous Ridge Augmentation.
Cesar Luchetti

Restoring a Natural Tooth Adjacent to a Dental Implant
Cesar Luchetti

Immediate Implant Placement in Upper 2nd Premolar
César Luchetti

Zirconia Dental Implant Video
Video: © CeraRoot -Text: César Luchetti

Surgical Treatment of Bisphosphonates Associated Osteonecrosis
César Luchetti

Nasal Cavity Lift
Cesar Luchetti, Alicia Kitrilakis

Block Bone Xenograft: Evaluation of the Properties of a Bovine Substitute. Preliminary Report
Cesar Luchetti, Mariano Lopez, Miguel Ayala, Adolfo Baez, Cecilia Carbone, Alicia Kitrilakis

Immediate Implant Placement in Upper Incisor Area
César Luchetti

...

Articles by Subject

2007-02-28T04:56:00.005-03:00

LAST UPDATE February 1, 2011

All articles published here are in this index, grouped in the following sections.

1) GENERAL ASPECTS

2) DIAGNOSIS

3) SURGERY

Immediate Implant Placement in Upper Incisor Area
César Luchetti

Immediate Implant Placement in Upper 2nd Premolar
César Luchetti

Zirconia Dental Implant Video
Video: © CeraRoot -Text: César Luchetti

Nasal Cavity Lift
Cesar Luchetti and Alicia Kitrilakis

Block Bone Xenograft: Evaluation of the Properties of a Bovine Substitute. Preliminary Report
Cesar Luchetti, Mariano Lopez, Miguel Ayala, Adolfo Baez, Cecilia Carbone, Alicia Kitrilakis

Maxilary Sinus Lift and Sinus Membrane Reparation with Simultaneous Ridge Augmentation.
Cesar Luchetti

Instruments for Bone Expansion: Osteotomes
Cesar Luchetti

Instruments for Bone Expansion: Threaded Expanders
Cesar Luchetti

Bone Expansion Using Threaded Expanders
Cesar Luchetti

Bone Expansion by means of Ridge Splitting
Cesar Luchetti, Alicia Kitrilakis

Dental Implants. Flapless Surgery and Immediate Loading
Cesar Luchetti

Treatment of the agenesis of a lateral incisor
Daniel Ostrowicz

Maxillary Sinus Lift in a Case with a Complete Partition Wall and Simultaneously Placement of Dental Implants
Cesar Luchetti

Ridge Splitting, Nasal Cavity Lift and Simultaneous Dental Implants Placement
Cesar Luchetti

Immediate Dental Implants After Extraction
Cesar Luchetti

Immediate Implant Placement in Maxillary Molars using Threaded Expanders
Cesar Luchetti, Gregori Kurtzman and Alicia Kitrilakis

Peri-implant Bone Lesions and Re-osseointegration
Cesar Luchetti

4) PROSTHESIS

Restoring a Natural Tooth Adjacent to a Dental Implant
Cesar Luchetti

Cemented vs Screwed Prosthesis
Daniel Ostrowicz

Dental Implants. Flapless Surgery and Immediate Loading
Cesar Luchetti

Flapless Surgery and Immediate Loading. Definitive Crown
Cesar Luchetti

All Ceramic Crowns for the Upper Incisors
Cesar Luchetti

5) RELATED CONDITIONS

Surgical Treatment of Bisphosphonates Associated Osteonecrosis
César Luchetti

Determination of the Oseointegration of Dental Implants in Postmenopausal Women.
Alicia Kitrilakis, Cesar Luchetti

Successful Management of a Severe Case of Bisphosphonates Related Osteonecrosis of the Jaw in a Multiple Myeloma Patient
Cesar Luchetti, Sebastian Yantorno, Julian Barrales, Juan Napal, Jorge Milone, Alicia Kitrilakis.

6) EVENTS

Dr. Ostrowicz course - National University of La Plata, Argentina - August, 2007
Comments: Cesar Luchetti

Implantar 2007 Congress - Sao Paulo, Brasil
Comments: Cesar Luchetti

XL Annual Meeting of the Argentine Society for Dental Research
Argentine Division of the International Association for Dental Research
Comments: César Luchetti

XVIII Congresss of the Argentine Society of Hematology
Comments: César Luchetti

XVIII Congress – European Association for Osseointegration
Comments: Cesar Luchetti

...

Welcome

2007-02-21T02:05:00.003-03:00

This is a new blog about dental implants.

We are a group of people working at Department of Implant Dentistry at National University of La Plata, Buenos Aires, Argentina.

The aim of this blog is to publish articles and post implant related cases in order to share our experience with others.

We hope you like it.

If you want to know more about us, go to the department site at implantologia-unlp.com

Prof. Dr. César Luchetti

Disclaimer

Disclaimer

2007-02-20T16:10:00.006-03:00

All users of this web site acknowledge and accept the disclaimers contained herein.

No relationship has been established by the use of this site. No diagnosis or treatment is being provided. No guarantees or warranties are made regarding any of the information contained within this website. This website is not intended to offer specific medical, dental or surgical advice to anyone.

Although we make our best effort to provide accurate information, anyone reviewing this site should take appropriate precautions to verify all information.

This website is provided for information purposes only. Pages may be viewed, copied or printed from this site solely for personal, noncommercial purposes. You may not otherwise use, modify, copy, print, display, reproduce, distribute or publish any information from this site without the express permission of the webmaster.

The information on this site can be updated or withdrawn at any time without notice.

The webmaster will not be liable for any damages from the use of or inability to use the site, or any of its contents, or from any action or omission taken as a result of using the site or any such contents.