PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE CUIDADOS BUCALES - WWW.SECUB.ESY SOCIEDAD ESPAÑOLA DE ODONTOLOGÍA MÍNIMAMENTE INVASIVA - WWW.SEOMI.ES

ÁREA CIENTÍFICA> ELEVACIÓN DE SENO TRANS-ALVEOLAR CON PRGF UNIDA A LA INSERCIÓN DE IMPLANTES CON SUPERFICIE UNICCA. ESTUDIO RETROSPECTIVO

ÁREA CIENTÍFICA> EFFECT OF OPEN AND CLOSED RIDGE SPLIT TECHNIQUES ON IMPLANT STABILITY. A RANDOMIZED CONTROLLED TRIAL

SALUDBUCODENTALNº 14 - JUNIO 2018

REVISTA DE

EQUIPO EDITORIAL

2 // WWW.SECUB.ES

EDITASociedad Española de Cuidados BucalesFray Luis de León,14 - 28012 Madridwww.secub.es

DIRECTORAntonio F.-Coppel García

SECRETARÍA DE REDACCIÓNIrene Mateo

SECRETARÍA TÉCNICAJuana M. SantosJ. Prieto Alonso

COMITÉ DE REDACCIÓNL. Alou Cervera, C. AparicioC.M. Arias Macías, J. L. Calvo GuiradoO. Cantó Navés, Mª Jose Ciudad Cabañas, L. R. Collado Yurrita, A. Domínguez Gordillo,M. Fernández Domínguez, M. L. Gómez-Lus Centelles,S. Hernández Montero, F. Hervás Maldonado,A. López Farré, R. López Píriz, J. R. Maestre Vera, R. Medina, J. Megía Torres, B. Peláez Ros, B. PereaJ. Prieto Prieto, C. Ramos Tejera,E. Solá Linares

JUNTA DIRECTIVA SECUBPRESIDENTE: Roberto López Píriz

VOCALES:Juan Ramón Maestre VeraDavid Martínez HernándezJosé Prieto PrietoEva Solá Linares

D.L.: M-13051-2015La Revista de salud Bucodental tiene un carácter multidisciplinar y está dirigida a todos los profesionales implicados en las tareas epidemiológicas, terapéuticas, higié-nicas y sanitarias de la boca. Nace con vocación de ser una plataforma informativa y difusora de las experiencias profesionales, sin olvidar la educación y el humanismo sanitario.Fundada en 2015 por la Sociedad Española de Cuidados Bucales (SECUB)Reservados todos los derechos. Queda rigurosamente prohibida, sin la autorización escrita del editor, la reproducción parcial o total de esta publicación por cualquier medio o pro-cedimiento, comprendidos la reprografía y el tratamiento informático, y la distribución de ejemplares mediante alquiler o préstamo públicos, bajo las sanciones establecidas por la ley.

PROYECTO GRÁFICO Y DISEÑO

Vicente Aparisi (Dirección de Arte)creacion@acomm.es - www.acomm.es

Normas de publicación: http://secub.es/revista/normas-publicacion/Normas de cesión de derechos de autor: http://secub.es/revista/cesion-derechos-autor/

6

INTERIORESJUNIO 2018

5. EDITORIAL

ÁREA CIENTÍFICA6 ELEVACIÓN DE SENO TRANS-ALVEOLAR CON PRGF UNIDA A LA

INSERCIÓN DE IMPLANTES CON SUPERFICIE UNICCA. ESTUDIO RETROSPECTIVO

12 EFFECT OF OPEN AND CLOSED RIDGE SPLIT TECHNIQUES ON IMPLANT STABILITY. A RANDOMIZED CONTROLLED TRIAL

24. AGENDA PROFESIONAL

12

JUNIO 2018 // 3

EDITORIAL

Estimados lectores:

Os presentamos un nuevo número de nuestra revista de Salud Bucodental, este mes contamos con la participación de colaboradores internacionales desde la Universidad de El Cairo que nos presentan un ensayo controlado aleato-rizado sobre el efecto de las técnicas abierta o cerrada de expansión crestal en la estabilidad de los implantes den-tales. También incluimos un estudio retrospectivo sobre la elevación de seno trans-alveolar con PRGF.

En este número, y tras la celebración el pasado 31 de Mayo del Día Mundial Sin Tabaco, queremos unirnos a las advertencias de la OMS. El tabaco causa cada año más de 7 millones de defunciones, 900 000 de las cuales corres-ponden a personas no fumadoras en contacto con el humo del tabaco. En España, según la última Encuesta Nacional de Salud, un 18,6% de las mujeres y un 27,6% de los hombres fuman diariamente.

Se trata de un factor de riesgo importante de cardiopatía coronaria, accidente cerebrovascular y vasculopatía peri-férica, siendo el causante del 17% de las defunciones por cardiopatías (es la segunda causa de enfermedades cardio-vasculares después de la hipertensión arterial). En muchas otras patologías respiratorias, renales o neurológicas, se considera un factor de riesgo adicional o incluso principal desencadenante.

En el caso del cáncer oral, 9 de cada 10 pacientes son fumadores y, el riesgo de padecerlo, se multiplica por 3 en aquellos que además beben alcohol con frecuencia. El tabaquismo también se encuentra estrechamente relacio-nado con la enfermedad periodontal, aumentando por tres el riesgo de sufrirla, provocando en muchos casos un re-traso en el diagnóstico y una peor respuesta al tratamiento periodontal.

Desde la revista de Salud Bucodental apoyamos todas las iniciativas promovidas por la OMS destinadas a reducir el hábito tabáquico en la población mejorando así tanto la salud bucodental como la salud general.

Saludos.

El equipo de la Revista de Salud Bucodental.

En este número, y tras la celebración el pasado 31 de Mayo del Día Mundial Sin Tabaco, queremos unirnos a las advertencias de la OMS. El tabaco causa cada año más de 7 millones de defunciones, 900 000 de las cuales corresponden a personas no fumadoras en contacto con el humo del tabaco. En España, según la última Encuesta Nacional de Salud, un 18,6% de las mujeres y un 27,6% de los hombres fuman diariamente.

Normas de publicación: http://secub.es/revista/normas-publicacion/Normas de cesión de derechos de autor: http://secub.es/revista/cesion-derechos-autor/ JUNIO 2018 // 5

31 de mayo, Día Mundial Sin tabaco.

6 // WWW.SECUB.ES

ELEVACIÓN DE SENO TRANS-ALVEOLAR CON PRGF UNIDA A LA INSERCIÓN DE IMPLANTES CON SUPERFICIE UNICCA. ESTUDIO RETROSPECTIVO

AUTORES:Eduardo Anitua DDS, MD, PhD1,2,3

CORRESPONDENCIA:Dr. Eduardo Anitua,Eduardo Anitua Foundation;C/ Jose Maria Cagigal 19, 01007 Vitoria, Spain;Phone: +34 945160653, e-mail: eduardo@fundacioneduardoanitua.org

INTRODUCCIÓNEn 1986 Tatum describe la primera técnica de elevación de seno por abordaje externo con ventana lateral (técnica convencional)1. Esta técnica consiste en la realización de una osteotomía en la pa-red lateral del seno seguida del despegamiento de la membrana de Schneider y elevación de la misma sin su perforación y/o ruptu-ra para la colocación de un material (hueso autólogo, biomaterial o ambos) en la zona apical de la cavidad sinusal.2,3 Summers en 1994 describe la técnica con abordaje transalveolar o aproxima-ción a la membrana de Schneider mediante osteotomos desde la cresta. El uso de osteotomos, puede producir molestas sensacio-nes con el paciente al ser activados estos mediante golpeo con un martillo. Esta nueva técnica presenta un gran avance a este respecto ya que elimina los osteotomos cambiándolos por una fresa diseñada específicamente para este fin que reduce el riesgo de perforación de la membrana al mismo tiempo que minimiza las molestias durante la cirugía. La técnica de elevación crestal se en-cuentra hoy en día ampliamente extendida entre las opciones te-rapéuticas para el tratamiento del maxilar atrófico encontrándose indicada cuando existen al menos 5 mm de altura ósea residual,4-7 aunque recientemente existen publicaciones que demuestran que esta técnica puede ser también predecible en situaciones donde el volumen óseo se sitúe por debajo de estos 5 mm. Pueden ser utilizados diferentes injertos para lograr aumentar la altura en el procedimiento de elevación de seno siendo los más emplea-dos: hueso autólogo, hueso autólogo unido a un biomaterial o no utilizar ningún injerto, esperando que el gap generado entre la membrana de Schneider y la cresta ósea se rellene de hueso de forma espontánea por el mantenimiento de espacio generado por el implante. En cuanto al uso del plasma rico en factores de crecimiento como material de injerto en las elevaciones de seno existen diferentes estudios que lo recomiendan como carrier del injerto con propiedades como disminución del sangrado, inflama-ción o dolor post-operatorio6-9.

Para los casos donde la técnica sea más arriesgada debido al volumen óseo residual o por la densidad ósea del hueso receptor la incorporación de iones de calcio a la superficie del implante puede favorecer la integración del mismo.

En este estudio, se evaluará la eficacia del uso de Plasma rico en factores de crecimiento (PRGF) como material de injerto en la elevación de seno trans-alveolar utilizado exclusivamente unido a la inserción de implantes con la superficie unicCa.

MATERIAL Y MÉTODOS

Selección de los pacientesFueron incluidos en el estudio pacientes consecutivos seleccionados de forma retrospectiva tratados en un centro clínico privado (Vito-ria, España) en las fechas comprendidas desde Enero de 2015 hasta Junio de 2015 con los siguientes criterios de inclusión: • Mayores de 18 años• Realización de elevación de seno trans-alveolar mediante la téc-

nica de fresado (no osteotomos)• Implantes cortos y extracortos insertados en el lugar de la ele-

vación (longitudes 7,5, 6,5 y 5,5. • Implantes con superficie UnicCa.

Todos los datos fueron recolectados en un cuaderno de recogi-da de datos para su posterior análisis estadístico siendo las princi-pales variables del estudio: la ganancia ósea en altura y la supervi-vencia de los implantes.

Tratamiento quirúrgicoTodos los pacientes fueron estudiados antes de la inserción de los implantes mediante modelos diagnósticos, exploración intraoral y realización de un TAC dental (Cone-beam) analizado posteriormen-te mediante un software específico (BTI-Scan II).

La elevación trans-alveolar fue realizada mediante fresado sin osteotomos, según la técnica descrita en anteriores publicaciones10.

1Private practice in oral implantology, Eduardo Anitua Foundation, Vitoria, Spain.2Clinical researcher, Eduardo Anitua Foundation, Vitoria, Spain.3University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain.

ÁREA CIENTÍFICA

JUNIO 2018 // 7

plantes son cortos o extracortos11. Por ello, una modificación de la superficie que facilite la integración y la estabilidad primaria inicial teóricamente mejoraría el resultado de los implantes inser-tados mediante esta técnica. La superficie unicCa resulta de la incorporación a la superficie multirrugosa optima de una capa de iones de calcio. Esta modificación química, higroscópica y polar le da al implante su aspecto húmedo único y característico pero, lo más importante, convierte la superficie en superhidrofílica. Esto implica el contacto completo de la sangre y el plasma con todos los puntos de la superficie, incrementando al máximo la super-ficie activa para la regeneración. Ya desde el posicionamiento del implante en el lugar de implantación, la superficie se recubre automáticamente por capilaridad12,13. Los estudios celulares con osteoblastos primarios obtenidos con consentimiento a partir de hueso de pacientes sometidos a cirugía oral, revelan que la super-ficie modificada con calcio unicCa permite una mayor adhesión y proliferación de los osteoblastos y también les induce a una mayor síntesis de matriz extracelular12. En los estudios realizados en animales esta superficie de implantes ha mostrado una dife-rencia significativa en el contacto implante-hueso comparado con la superficie sin tratamiento de calcio (optima).13 En este estudio, los implantes insertados mediante esta técnica con la superficie unicCa han mostrado una correcta oseointegración a pesar del volumen óseo remanente (al límite para la realización de una ele-vación transalveolar con éxito) y han favorecido la neoformación ósea intrasinusal sin el empleo de biomateriales para el relleno del seno, usándose únicamente PRGF-Endoret.

Esta técnica consiste en la realización de un fresado a bajas revo-luciones (fresado biológico) del lecho receptor del implante con-servando 1,5 mm de altura ósea hasta la membrana de Schneider. Este milímetro final es fresado con una fresa de corte frontal especí-ficamente diseñada para no dañar estructuras anatómicas como la membrana de Schneider. Una vez preparado el lecho del implante se introduce el mismo.

Posteriormente, los pacientes acuden cada 6 meses a la realiza-ción de radiografías panorámicas de control y sobre estas radiogra-fías se realizan las mediciones necesarias para comprobar la estabi-lidad y remodelación del hueso a nivel de la elevación transcrestal.

Las mediciones realizadas fueron: pérdida ósea crestal y ganan-cia ósea en la zona de la elevación.

La distribución normal de los datos fue analizada mediante el test de Shapiro-Wilk y se realizó una T de Student con muestras pareadas para el análisis de la ganancia ósea obtenida. Para la su-pervivencia de los implantes se realizó un análisis de supervivencia acumulada (Método de Kaplan-Meier).

Todos los análisis se realizaron con SPSS v15.0 (SPSS Inc. Chica-go, Il, USA) y se estableció el nivel de significación al 5% (p<0,05).

RESULTADOSFueron reclutados 7 pacientes en los que se insertaron 8 implan-tes cortos y extracortos con superficie UnicCa con elevación de seno transcrestal utilizando como único material de injerto la fi-brina obtenida del PRGF-Endoret. La edad media fue de 59 +/- 5 años en el momento de la cirugía y 4 de los pacientes fueron mujeres. El tiempo medio de seguimiento fue de 2 años desde la inserción, con un mínimo de 6 meses de carga.

La media de altura de hueso residual en la zona de inserción de los implantes fue de 5,05 mm (+/- 1,19). Los implantes fueron insertados en posición 27 en el 37,5% de los casos, en posición 26 y 17 en el 25% de los casos y en posición 16 en el 12,5% de los casos restantes. En la figura 1 se muestran las posiciones de los implantes insertados). Los diámetros y longitudes de los implantes insertados se muestran en la figura 2. Una vez realizada la técnica de elevación de seno crestal con PRGF-Endoret y la colocación de implantes la altura ósea de la cresta medida tras 6 meses tras la carga fue de 6,97 mm (+/- 1,41). La pérdida ósea mesial de los implantes estudiados fue de 0,03 mm en la zona mesial (+/- 0,23) y 0,37 mm en la zona distal (+/- 0,09). Ninguno de los implantes estudiados fracasó durante el período de seguimiento.

DISCUSIÓNLa elevación de seno transalveolar es una técnica que ha demos-trado ser altamente predecible y menos invasiva que la elevación de seno lateral. El principal inconveniente de esta técnica es lograr la estabilidad primaria del implante, sobre todo, cuando estos im-

En 1986 Tatum describe la primera técnica de elevación de seno por abordaje externo con ventana lateral (técnica convencional)1. Esta técnica consiste en la realización de una osteotomía en la pared lateral del seno seguida del despegamiento de la membrana de Schneider y elevación de la misma sin su perforación y/o ruptura para la colocación de un material (hueso autólogo, biomaterial o ambos) en la zona apical de la cavidad sinusal.2,3 Summers en 1994 describe la técnica con abordaje transalveolar o aproximación a la membrana de Schneider mediante osteotomos desde la cresta.

8 // WWW.SECUB.ES

ELEVACIÓN DE SENO TRANS-ALVEOLAR CON PRGF UNIDA A LA INSERCIÓN DE IMPLANTES CON SUPERFICIE UNICCA. ESTUDIO RETROSPECTIVO

the treatment of atrophied posterior maxilla. Clin Oral Implants Res

2015; 26:69–76.

11. Rabel A, Kohler SG, Schmidt-Westhausen AM. Clinical study on the

primary stability of two dental implant systems with resonance fre-

quency analysis. Clin Oral Investig. 2007;11:257–65.

12. Anitua E, Piñas L, Murias A, Prado R, Tejero R. Effects of calcium

ions on titanium surfaces for bone regeneration. Colloids Surf B

Biointerfaces. 2015 ;130: 173-81.

13. Anitua E, Prado R, Orive G, Tejero R. Effects of calcium-modified

titanium implant surfaces on platelet activation, clot formation, and

osseointegration. J Biomed Mater Res A. 2015; 103: 969-80.

14. Torres J, Tamimi F,Martinez PP, et al. Effect of platelet-rich plasma

on sinus lifting: a randomized-controlled clinical trial. J Clin Perio-

dontol 2009; 36:677–687.

15. Taschieri S, Corbella S, Del Fabbro M. Mini-invasive osteotome sinus

floor elevation in partially edentulous atrophic maxilla using reduced

length dental implants: interim results of a prospective study. Clin

Implant Dent Relat Res 2014;16:185–193.

16. Anitua E. Plasma rich in growth factors: preliminary results of use

in the preparation of future sites for implants. Int J Oral Maxillofac

Implants 1999; 14:529–535.

17. Anitua E, Prado R, Orive G. Bilateral sinus elevation evaluating

plasma rich in growth factors technology: a report of five cases.

Clin Implant Dent Relat Res 2012; 14:51–60.

18. Rabel A, Kohler SG, Schmidt-Westhausen AM. Clinical study on the

primary stability of two dental implant systems with resonance fre-

quency analysis. Clin Oral Investig. 2007;11:257–65.

En cuanto al uso del plasma rico en factores de crecimiento como material de injerto en las elevaciones de seno existen dife-rentes estudios que lo recomiendan como carrier del injerto con propiedades como disminución del sangrado, inflamación o dolor post-operatorio14-17. Un ensayo clínico randomizado a boca partida han determinado además que el uso de plasma rico en factores de crecimiento asociado al injerto de hueso anorgánico bovino en la elevación de seno ha aumentado significativamente la formación ósea18. En este estudio se puede comparar la ganancia ósea ob-tenida en muchos de los casos con los estudios que utilizan otros materiales de relleno, habiéndose empleado únicamente el Endoret (PRGF).

En las figuras 3-7 mostramos uno de los casos incluidos en el estudio.

CONCLUSIONESLa técnica de elevación de seno trans-alveolar con el Endoret (PRGF) como único material de relleno unida a la inserción de implantes con superficie unicCa puede considerarse un tratamiento minima-mente invasivo para la atrofia ósea en zonas posteriores del maxilar superior.

BIBLIOGRAFÍA1. Tatum H. Maxillary and sinus implant reconstructions. Dent Clin

North Am 1986; 30:1207–1229.

2. Summers RB. A New Concept in maxillary implant sur-

gery: the osteotome technique. Compendium. 1994;15:

154–6.

3. Del Fabbro M, Corbella S, Weinstein T, Ceresoli V, Taschieri S. Im-

plant survival rates after osteotome-mediated maxillary sinus aug-

mentation: a systematic review. Clin Implant Dent Relat Res 2012;

14(Suppl 1):e159–e168.

4. Anitua E, Flores J, Alkhraisat MH. Transcrestal Sinus Floor Augmen-

tation by Sequential Drilling and the Use of Plasma Rich in Growth

Factors. Int J Oral Maxillofac Implants. 2017;32:e167–e173.

5. Anitua E, Flores J, Alkhraisat MH. Transcrestal Sinus Lift Using Pla-

telet Concentrates in Association to Short Implant Placement: A

Retrospective Study of Augmented Bone Height Remodeling. Clin

Implant Dent Relat Res. 2016;18:993-1002.

6. Torres J, Tamimi F,Martinez PP, et al. Effect of platelet-rich plasma

on sinus lifting: a randomized-controlled clinical trial. J Clin Perio-

dontol 2009; 36:677–687.

7. Taschieri S, Corbella S, Del Fabbro M. Mini-invasive osteotome sinus

floor elevation in partially edentulous atrophic maxilla using reduced

length dental implants: interim results of a prospective study. Clin

Implant Dent Relat Res 2014;16:185–193.

8. Anitua E. Plasma rich in growth factors: preliminary results of use

in the preparation of future sites for implants. Int J Oral Maxillofac

Implants 1999; 14:529–535.

9. Anitua E, Prado R, Orive G. Bilateral sinus elevation evaluating

plasma rich in growth factors technology: a report of five cases.

Clin Implant Dent Relat Res 2012; 14:51–60.

10. Anitua E, Alkhraist MH, Piñas L, Orive G. Association of transalveolar

sinus floor elevation, platelet rich plasma, and short implants for

La técnica de elevación de seno trans-alveolar con el Endoret (PRGF) como único material de relleno unida a la inserción de implantes con superficie unicCa puede considerarse un tratamiento minimamente invasivo para la atrofia ósea en zonas posteriores del maxilar superior.

ÁREA CIENTÍFICA

JUNIO 2018 // 9

Figura 1. Localización de los implantes del studio.

Figura 2. DIámetros y longitudes de los implantes del estudio.

10 // WWW.SECUB.ES

ELEVACIÓN DE FOSAS NASALES EN MAXILAR ATRÓFICO. A PROPÓSITO DE UN CASO

Figura 3. Medición de la cresta que llega a 3 mm en la zona de menor espesor óseo.

Figura 4. Planificación del Tac para la inserción del implante.

ÁREA CIENTÍFICA

JUNIO 2018 // 11

Figura 7. Implante tras un año de carga. Pode-mos observar el volumen óseo ganado única-mente con la fibrina.

Figura 5. Fresado desde la cresta ósea me-diante las fresas de corte frontal hasta exponer la membrane de Schneider.

Figura 6. Inserción de la membrane de fibrina a través del neo-alveolo para la inserción poste-rior del implante.

ABSTRACT Introduction: Applying Ridge split techniques enhance the neces-sary ridge foundation for implant replacement. Ridge split can be done by closed ridge splitting (minimum flap reflection) and open ridge splitting (full thickness flap reflection). Implant stability is a prime requisite for implant success. Material and methods: Twenty male patients were randomly al-located to two groups. In Group I, ten patients received simultane-ous implant placed in open ridge split flap reflection. In Group II, ten patients received simultaneous implant placed in closed ridge split without flap reflection. Resonance Frequency Analysis RFA was carried out to assess primary stability of the placed implants imme-diately and 4-5 months after surgery. Results. No significant difference in primary implant stability was detected between the closed and open ridge split techniques.Conclusion. Open and closed ridge split techniques did not affect primary implant stability.Keywords. ridge split with immediate implant, implant primary stability in ridge split, open ridge split, closed ridge split.

INTRODUCTIONAtrophic edentulous ridges can present a significant challenge to the successful use of endosseous implants for prosthetic reconstruc-tion of the edentulous maxilla.1- 3

Ridge split was advocated to widen the deficient ridge.4-6 Ridge split techniques is used for horizontal deficiency only by opening and subsequently split compromised alveolar ridge with special os-teotomes with / without bone substitutes packed between the two split alveolar ridges to avoid the collapse of expanded ridge. Ridge splitting can be done by either open ridge split (full thickness flap reflection) or closed ridge split (minimum flap reflection).

Open ridge split is carried out by full thickness flap reflection to provide better accessibility to alveolar ridge split. A crestal bone cut is initiated with two vertical bony cuts. Chisels and Osteotomes are introduced to increase bone width.

Open ridge split procedures could be done either in single stage ridge split procedure or two stage ridge split procedure.7, 8 Single ridge split technique begin with corticotomy procedure (crestal and vertical bony cuts) then bone split procedure is carried out by os-teotomes and chisels for widening the bone. Both procedures are performed in the same surgical operation. This technique can be applied either in single step, which involves splitting of ridges and placement of implants or in two steps which involve splitting of ridges first and waits for a period of 4-6 months following the graft-ing procedures before implant placement surgery.9

Healing in single staged ridge split similar to an extraction socket. In one step implant is inserted into the expanded space between the medial and buccal bone walls and it allowed to heal in a submerged position. In this context bone splitting presents the advantage of simultaneous implant placement without bone graft taken from secondary donor sites and longtime waiting period.10

There is a difference in density between maxillary and mandib-ular bone. The use of a single-stage ridge split procedure has un-predictable outcome in mandibular alveolar ridges. In the mandible, the procedure usually involves two stages: stage 1 corticotomy is done and in stage 2 splitting of the ridge, is performed 3-5 weeks later.11-13

Sometimes buccal bone fragment dislodgment may occur. It is considered as a free bone graft which leads to bone devitalization and subsequent bone resorption. A mallet and some type of chisels and/or osteotomes are used in these procedures. Surgical care dur-ing cutting in the ridge should be carried out, and these procedures could be uncomfortable for patients.

A flapless approach to implant dentistry has become wide spread approach with the aim to relieve post treatment side ef-fects, accelerate healing and avoid bone loss caused by flap eleva-tion.14 Minimally-invasive flapless procedure has been dramatically expanding as it has been shown that its results are close, providing that the right protocol is followed, with the two-phase method.15

In a histological study implants placed without flap reflection stand

EFFECT OF OPEN AND CLOSED RIDGE SPLIT TECHNIQUES ON IMPLANT STABILITY. A RANDOMIZED CONTROLLED TRIAL

12 // WWW.SECUB.ES

AUTORES:Mohamed M. Dohiem1,Hussein El Charkawi2,Ahmed Barakat3

1Lecturer of Removable Prosthodontics Department, Future University, Cairo Egypt2Professor, Removable Prosthodontics Department, Future University, Cairo Egypt3Professor, Oral and Maxillofacial Surgery Department, Future University, Cairo Egypt

ÁREA CIENTÍFICA

JUNIO 2018 // 13

stable and showed clinically relevant osseoin-tegration comparable to when implants are placed with flapped procedures 16

Several advantages of flapless implant surgery for the patient as well as for the sur-geon have been reported. The periosteum is left intact and the blood supply to the site is maintained, healing is faster and the possibil-ity of crestal bone resorption and soft tissue inflammation are minimized substantially. Also, the anatomy of the alveolar ridge is not disturbed, reduced risk in medically-compro-mised patient, decreases over all treatment time with single-phase operation patients, and makes the treatment more acceptable to the patient.17

With the introduction of ultrasonic surgi-cal instruments “Piezotomes” it was possible to expand very narrow ridges width of 2 mm by the more bone-conserving primary oste-otomy.18 Piezotomes offer faster healing and less inflammation in contrast to the classical methods.19,20 Implant success rates reported in alveolar ridges split with piezoelectric surgical scalpel compare fa-vorably to those placed in intact ridges.19 One of the disadvantages associated with piezoelectric surgical scalpel is that the surgery re-quires a highly-experienced dental surgeon because it may slip and distract the alveolar ridge.20,21 Long term studies showed compara-ble results of bone loss with flapless (0.7–2.4 mm) and flap surgery (2–3 mm) during the healing period of 15 months.22-26

Implant stability Primary implant stability has been identified as a crucial criterion for attaining and maintaining osseointegration27. Initially, implant sta-bility is provided mechanically by macro-retention threads engaging the bony walls of the implant bed.28 Increased implant stability dur-ing treatment implicit a sufficient osseointegration of the implant with the nearby bone, while low implant stability may indicate early failure of the implantation.

Primary implant stability can be assessed by either a destructive or non-destructive methods. Histomorphologic research, tensional test, pull-out/ push-out test and removal torque test are classified as destructive methods. However, Percussion test, radiographic analy-sis, cutting torque test while placing implants, Periotest29, and reso-nance frequency analysis are considered non-destructive methods.30

This Resonance Frequency Analysis RFA method requires the screwing of an electronic transducer (smart peg) on the implant head or prosthetic abutment. A low voltage current is allowed to flow through the transducer (not painful to the patient). Vibration

of the transducer to the nearby bone is reg-istered in a small computer. These vibration measurements are recorded in hertz (Hz). These measurements for each transducer are calibrated and transformed to Implant Sta-bility Quotient (ISQ) units. ISQ values of 40 or less indicates that the implant is not an-chored enough to the bone with the risk of complications and lack of stability31.

On reviewing the literature, there is a paucity of published articles on comparing immediate stability of implants with differ-ent ridge splitting techniques. Most of the publications are case series or clinical re-ports. The literature lake randomized clinical studies that tackled the subject. The quality evidence that guide the selection of suitable techniques and materials are unclear. This study is an attempt to evolve and describe an evidence-supported decision making for the

selection of suitable techniques for various clinical circumstances. A description review of various techniques and materials is also, presented.

The aim of this study was to evaluate primary implant stabil-ity of simultaneously placed implants in two ridge split techniques which are full thickness flap and minimum flap reflection.

MATERIAL AND METHODSTwenty male patients were randomly selected from out clinic of Cairo & Future Universities. Number of patient was decided accord-ing to sample size calculation. Inclusion criteria for eligible patients were partially edentulous with missing teeth in the esthetic zone, bone height was more than 13mm with horizontal alveolar dimen-sion ranges from 3-5 mm at the crest from the labial cortex to the lingual cortex (Figures 1, 2), Patient age range from 20 to 45 year with mean range 33 year. All patients were free from any systemic disease that may affect bone healing. (as detected by lab investiga-tion), absence of any pathosis, absence of history related to grafting procedures, smoker patient were excluded, patients were free from abnormal oral habits such as bruxism, clenching, adequate interarch space for future prosthesis construction, adequate keratinized mu-cosa of about 2 mm covering alveolar ridge with optimal thickness of mucoperiosteum with no signs of inflammation, ulceration, scar tissue or any other local pathosis.

The patients were randomly allocated into 2 equal and parallel groups, the surgical intervention included that all patients received simultaneous implants (38 implants were placed) with ridge split techniques using either in Group I full thickness mucoperiosteal flap

Several advantages of flapless implant surgery for the patient as well as for the surgeon have been reported. The periosteum is left intact and the blood supply to the site is maintained, healing is faster and the possibility of crestal bone resorption and soft tissue inflammation are minimized substantially. Also, the anatomy of the alveolar ridge is not disturbed, reduced risk in medically-compromised patient, decreases over all treatment time with single-phase operation patients, and makes the treatment more acceptable to the patient.17

14 // WWW.SECUB.ES

EFFECT OF OPEN AND CLOSED RIDGE SPLIT TECHNIQUES ON IMPLANT STABILITY. A RANDOMIZED CONTROLLED TRIAL

(Control Group consisting of n= 10) and in Group II closed flap without reflection mucosal flap (minimum flap reflection as the Intervention Group consisting of n=10).

The study protocol was explained to each subject and a signed informed consent was obtained according to The Institutional Clinical Research Ethics Committee of Cairo University.

Primary outcome was to assess and compare implant stability with the two ridge split techniques. Secondary outcome was to assess immediate and one week later from the surgery the post-operative pain in the two groups.

Full set up of teeth on mounted cast according to proper jaw relation were made. Surgical guide was fabricated on the set up teeth. The surgical guide was used to guide placement of implants in the proper position despite bone defect.

Group I: full thickness mucoperiosteal flap All procedures were carried out under local anesthesia. Pyramidal flap was used, and a crestal incision was extended slightly palatal over the edentulous crestal alveolar ridge. In this technique sharp lancet was used to make the initial cut in the bone. This initial cut allowed placement of sequential chisels diameter and osteotomes without slip.

Two oblique vertical incisions were then cut at the distal ends of the crestal incision 2 mm away from papillae of the teeth enclosing the edentulous area (papilla preservation incision); Labial muciperiosteal reflection was done exposing the whole length of the facial cortical plate of the alveolar ridge. (Figures 3a, 3b) Then a midcrestal and vertical bony cuts was done by using an electric saw1 (Figures 4a, 4b).

Figura 1. Cross section of a CBCT showing 3-4 mm alveolar ridge width in one of the patient in Group I

Figura 3a. Pyramidal flap

Figura 2. Cross section of a CBCT showing 3-4 mm alveolar ridge width in one of the patient in Group II

Figura 3b. Reflection of labial and palatal full thickness mucoperiosteal flap

1. Electric sew W&H Dentalwerk Bürmoos GmbH Ignaz-Glaser-Straße Bürmoos Austria.

ÁREA CIENTÍFICA

JUNIO 2018 // 15

Figura 4a. Midcrestal bony cuts using an electric saw

Figura 6. A Sequential rounded (expanders) osteotomes gradually created a channel along the crest of the bone

Figura 5a.

Figura 4b. Vertical bony cuts using an electric saw

Figura 5b.

Figura 5a,b. Sequential hand chisels used for ridge splitting saw

Sequential hand chisels2 (bi-beveled V-shaped) with sequential width were used for ridge splitting with light weight mallet in order to gradually split and expand the alveolar ridge longitudinally (Figure 5). Sequential rounded (expanders) osteotomes (2.8, 3.0, 3.5 and 4.00 mm) were gradually tapped inside the split by light weight mallet to a depth of 5-7 mm creating a channel along the crest of the bone for the future implant placement site (Figure 6).

2. ACE ridge splitting osteotomes ,USA

16 // WWW.SECUB.ES

EFFECT OF OPEN AND CLOSED RIDGE SPLIT TECHNIQUES ON IMPLANT STABILITY. A RANDOMIZED CONTROLLED TRIAL

Sequential implant drills were introduced. Tapered implants (4.2mm diameter and 13mm length)3 wider than the osteotomy were inserted in the osteotomy sites using torque-wrench engaging bone to ensure primary implant stability (Figure 7).

Figura 7a.

Figura 7a, b. Implants insertion in split ridge

Figura 7b.

Labial periosteum was scored with dissecting scissor at the basal portion of the flap for tension free closure. Surgical field was irrigated with normal saline and sutured.

Group II: Closed flap without mucosal flap. (Minimum flap reflection)Same procedure as first group except:A crestal flap was dissected only in alveolar crest. (Figure 8), Sagittal osteotomy was outlined in the bone by scoring it with surgical blade by hand pressure till full blade length was inserted (Figure 9)4.

Figura 8. A crestal flap was dissected only in alveolar crest Figura 9. A sagittal osteotomy was outlined in the bone by scoring it with Blade

3. Osteoseal internal hex Osteoseal CO.51 Dupont Drive,Irvine,92696,CA,USA 4. number 15 xinda .china

ÁREA CIENTÍFICA

JUNIO 2018 // 17

Once the bony incisions were outlined, a bone chisel5 was progressively driven deeper in the crestal osteotomy, and the implant site was prepared with the osteotome technique till the final drill was used to install the implant6. (Figure10,11)

Figura 10. Bone chisel driven deeper in the crestal osteotome

Figura 12. Implant Placement

Figura 11. Implant site was prepared with the osteotome technique

5. Split chisels mrcurette, Jungwon_gu. Seongnam-city.Gyeonggi-do 462-897. Korea6. Osteotome mrcurette, Jungwon_gu. Seongnam-city.Gyeonggi-do 462-897. Korea7. Osteoseal internal hex Osteoseal CO.51 Dupont Drive,Irvine,92696,CA,USA8. Osstell AB, Gamlestadsvägen 3B, SE415 02, Sweden

Tapered implants (4.2X13 mm)7 were gently tapped into position. Implant diameter was slightly wider than the osteotomy site to ensure primary stability (Figure 12).

In both groups; Implant stability was measured using the resonance frequency analyzer8. The magnetic smart peg was fully screwed to the implant using the peg holder, and the “electric probe” was approximated on top of the magnetic peg, till a reading was obtained, which indicates Implant Stability Quotient (ISQ).

Readings of the four surfaces were recorded (buccal, mesial, distal, and palatal). The device tip was positioned perpendicular to the sur-face and away 1 to 3 mm form the magnetic pig .Measurements were carried out in each group immediately after implant insertion (t=0), 3 months after placement during the uncover surgery and 4.5 months after ridge split before placement of final restoration (Figure 13,14).

18 // WWW.SECUB.ES

EFFECT OF OPEN AND CLOSED RIDGE SPLIT TECHNIQUES ON IMPLANT STABILITY. A RANDOMIZED CONTROLLED TRIAL

An interim removable partial denture was constructed at least one month postoperative, it’s fitting surface was relieved over the split areas and lined with a tissue conditioner and soft denture liner till final prosthesis fabrication.

Patients replied a questionnaire on immediate and one week later from the surgery post-operative pain.IBM® SPSS® (SPSS Inc., IBM Corporation, NY, USA) Statistics Version 22 for Windows was used for statistical analysis.

RESULTSAll 20 patients completed the follow-up period. None of them was lost to follow-up and excluded from analysis. Evaluation of implant survival and implant success was carried out according to clinical and radiographic parameters. The survival rate of the implants placed was considered 100% at the end of the follow-up period.

Implant Stability Quotient (ISQ) in different surfacesImplant Stability Quotient (ISQ) was recorded in all implants in both groups at the four surfaces; buccal, mesial, distal and lingual in each implant.Table (1) and Figure (14) showing mean and SD of ISQ in different surfaces. Both groups were comparable regarding stability. It was non-significant p > 0.05 in all surfaces except in buccal surface.

Buccal surface were lower in open ridge splitting (62.9±6.0) than closed ridge (66.6±8.8)

Figura 13a.

Figura 13a,b. The magnetic peg was fully screwed to the implant and the electric probe is approximated the peg

Figura 13b.

Figura 14. The implant placed in the ridge split

Table 1. IQS at different surfaces immediately after surgery

Open Ridge Splitting Closed Ridge Splitting

Stability   Mean SD Mean SD p value

Buccal 62.9 ±6.0 66.6 ±8.8 0.372

Palatal 64.1 ±5.0 65.9 ±8.3 0.648

Mesial 64.3 ±5.0 65.7 ±9.5 0.731

Distal 64.1 ±4.8 65.9 ±9.5 0.679

ÁREA CIENTÍFICA

JUNIO 2018 // 19

Implant Stability Quotient was recorded in all implants in both groups and the four surfaces were added and the mean value was used as an indication for (ISQ) for each implant. No statistically significant difference was found

Table (2) and figure (15) showing mean and SD of ISQ in all surfaces. Although the open ridge group showed overall less stability, it was non-significant with p value > 0.05

Figura 14. Barchart showing IQS in different surfaces immediately after surgery

Figura 15. Barchart showing mean and SD of stability of implants in all surfaces

Table 2. IQS in all surfaces

Closed ridge splitting Open ridge splitting

Stability Mean SD Mean SD p value

All surfaces 66.0 ±9 63.9 ±5.0 0.592

20 // WWW.SECUB.ES

EFFECT OF OPEN AND CLOSED RIDGE SPLIT TECHNIQUES ON IMPLANT STABILITY. A RANDOMIZED CONTROLLED TRIAL

Table III shows the IQS at the end of the follow-up period. In-spection of the means shows that an increase in the IQS was re-corded in both groups at the end of the follow-up period. However, the two groups showed insignificant difference

Patient satisfaction Assessment of pain immediately and one week after surgery showed that the closed technique was less painful to the patients.

DISCUSSIONRCTs are evidence-based research tools that ensure reliability in obtaining results and outcome. In this study, the patients were al-located randomly to the two groups. All the interventions were par-allel to the control group. Ridge split aim to create a new implant bed by increase horizontal bone width using vertical osteotomy of the alveolar bone between buccal and palatal (lingual) cortical plates. The buccal bone is repositioned laterally by allowing green-stick fracture. This technique is more appropriate for the maxilla than the mandible owing to the thinner cortical plates and softer medullary bone 32. Ridge split could be carried out with open ridge split with full thickness flap or closed ridge split with minimum flap reflection.

A partial-thickness flap reflection and/or osteoperiosteal flap with minimal flap reflection at the crest were advocated to main-tain bone vitality,19 as it avoid bone fragment dislodgment or flap detachment of the out-fractured plate. If this happened it will be considered as a free bone graft which leads to bone devitalization and subsequent remodeling resorption 33.

Use of sequential chisels (bi-beveled) to achieve further lateral expansion allows widening and compaction the peri-implant bone to achieve excellent primary stability without losing any bone 34.

Ridge split can be performed either with immediate (simultane-ous) or delayed implant placement. In this study the two split tech-niques were performed with simultaneous implant placement 35.

Immediate implant placement in split alveolar ridges shortens the treatment time as one surgical operation is carried out. In this study

Follow-up(months) Buccal P value Palatal P value Mesial P value Distal P value

0Open Ridge Split 62.9±6.0

0.28664.1±5.0

0.4464.3±5.0

0.68564.1±4,8

0.599Close Ridge Split 66.6±8.8 65.9±8.3 65.7±9.5 65.9±9.5

3Open Ridge Split 69.2±6.0

0.2972.5±5.2

0.44971.3±5.2

0.33471.1±9.6

0.395Close Ridge Split 73.1±9.6 74.9±8.3 74.7±9.5 74.8±9.4

4.5Open Ridge Split 70.0±6.0

0.26473.5±5.2

0.50771.9±5.2

0.28272.1±9.6

0.391Close Ridge Split 74.1±9.5 75.6±8.2 75.7±9.5 75.8±9.2

Table 3. IQS in all surfaces after the follow-up period: Best regards

P value > 0.05 is insignificant

no complications were recorded related to the primary stability of the implants. Initial stability was gained by using tapered Implant evenly from top down to facilitate insertion at the surgical site.36

Assessment of osseointegration is based on mechanical sta-bility preferably than histological criteria. Primary implant stability (absence of mobility in bone bed after implant insertion) was con-sidered a precondition for achieving osseointegration. In the past, methods to determine implant stability relied on the visual and tactile sensation of the operator. Those were subjective methods, and they didn’t yield any numerical values to be used to evaluate implant stability and make sound comparison.

Resonance Frequency Analysis (RFA) is considered a us-er-friendly, clinically reliable, non-invasive method to assess implant stability and the osseointegration process. RFA is one such method which shows almost perfect reproducibility and repeatability after statistical analysis.36-39

In this study the Resonance Frequency Analysis RFA was used to evaluate implant stability, by recording Implant Stability Quotient value (ISQ) which was recorded at the day of implant installation, after 3 months and 4.5 months after the surgery. Huang et al in 200339 used ISQ to decide which technique could be loaded imme-diately and studied its behavior in different types of bone. Implant stability is expressed in terms of a defined threshold Implant Stabil-ity Quotient value (ISQ).40,41 In this study there was an increase in the total mean ISQ value during the osseointegration period prior to the final restoration placement.

However, the results of this study showed no significant differ-ence between closed and open ridge split techniques. This could be attributed to the apical part below the osteotomy responsible for the immediate primary stability. These results are in agreement with Palti et al 42, and Harrison et al43 Palti42 indicated that the implants engaged the vestibular bone beneath the vertical cut is responsible for primary stability. Furthermore Lames et.al 200844, agreed that in order to obtain an optimal implant primary stability, with split crest technique, it is necessary to place the implant apical to the end of the vertical lines.

ÁREA CIENTÍFICA

JUNIO 2018 // 21

However the results between different walls around implant showed different patterns, these results showed that the buccal wall in closed ridge split showed more primary stability than open ridge split. This could be attributed to the rebound of the buccal plate of bone as it is still adhered with periostum and mucosa in closed technique, Furthermore the length of the vertical split in open ridge split need long vertical cuts to gain elasticity for bone to allow split without fracture so the apical part that implant have to engage in bone is longer in closed than that in an open technique44.

These results are in agreement with González-Garcia et al 45, as they reported that since the loose cancellous bone is pressed during the procedure, they attain a more compact structure and there is a tendency of buccal cortical plate to turn into its former position.

The results of this study showed that closed ridge split allowed for one-stage bone expansion with simultaneous implant place-ment. The results also, showed that bone splitting/ expansion seem to be a reliable and relatively non-invasive technique to widen nar-row edentulous ridges 46, 47.

These results are in agreement with Fischer et al. 48, Huwiler et al. 49 who applied RFA at early stages of osseointegration and reported that ISQ values from 57-70 indicate adequate stability of dental implant.

According to the mean values of ISQ obtained in both groups (around 75 ISQ), This study could suggest that the bone density in those augmented areas allowed a good anchorage for the den-tal implants after 6 months of augmentation procedures. Some of these values are compatible with immediate loading protocol ISQ values.50

However, because the closed ridge split approach uses mini-mal flap and “blind”, the surgeon must be a highly experienced and have a good conceptualization of the alveolar anatomy in order not to miss the midpoint of the alveolus as the osteotome is apically inserted in the splitting procedure, which must extend to the vestibular depth. Too palatally directed osteotome instead can fracture the palatal plate of bone, defeating the purpose of the procedure, which is to place the implant in the proper position following prosthetically-driven implant placement concept 51, 52. It was shown recently that an improved outcome could be achieved when modified split technique is combined with the use of Plasma Rich Platelets PRF53.

In a Meta-Analysis study, it was concluded that no statistically significant effects of open flap surgery or flapless surgery of the occurrence of post infection and on the marginal bone loss 54. As-sessment of pain immediately and one week after surgery showed less pain with closed technique. Despite the fact that this a sub-jective methods of evaluations, still indicate some difference. This could be attributed to the less trauma, preservation of more blood

supply, minimum post-operative edema and no flap reflection44.The survival rate in this study was high which in agreement with many previous studies 55-63.

In this study both techniques showed high primary stability. However, to perform flapless technique, patients be properly se-lected and the surgeon must be competent to manage the surgery with flap elevation64. The main limitations of the present study were the relatively short follow-up period in comparison with other pre-vious studies and the passably small sample size.

CONCLUSIONSWithin the limitations of this study, Open and closed ridge split techniques showed no significant differences in primary implant stability immediately and 5 months post-operative. The results of this study suggest that ridge split techniques are predictable proce-dures that could be used in expanding narrow ridges of the max-illa. Assessment of pain immediately and one week post-operative showed less pain in closed ridge split technique.

FUNDING AND CONFLICT OF INTERESTThis study was self-funded by the authors. The authors declare that they have no financial interest in any of the materials related in this study

REFERENCES1. Santagata M, Guariniello L, D’Andrea A, Tartaro G. A modified crestal

ridge expansion technique for immediate placement of implants: A re-

port of three cases. J Oral Implantol 2008; 34; 6:319–324.

2. Laster Z, Rachmiel A, Jensen OT. Alveolar width distraction osteogenesis

for early implant placement. J Oral Maxillofac Surg 2005; 63; 12:1724–

1730.

3. Esposito M, Grusovin, MG; Kwan S, Worthington HV, Coulthard P. In-

terventions for replacing missing teeth: Bone augmentation techniques

for dental implant treatment. Cochrane Database Syst. Rev. 2008, doi:

10.1002/14651858.CD003607.pub3.

4. Van der Weijden F, Dell’Acqua F, Slot DE. Alveolar bone Dimensional

changes of post-extraction sockets in humans: a systematic review. J Clin

Periodontol 2009; 36; 12:1048-1058.

5. Tan WL, Wong TL, Wong MC, Lang NP. A systematic review of post-ex-

traction alveolar hard and soft tissue dimensional changes in humans.

Clin Oral Implants Res 2012; 23; suppl 5: 1-21.

6. Araújo MG, Lindhe J. Dimensional ridge alterations following tooth ex-

traction: an experimental study in the dog. J Clin Periodontol 2005; 32;

2:212-218.

7. Schropp L, Wenzel A, Kostopoulos L, Karring T. Bone healing and soft

tissue contour changes following single-tooth extraction: a clinical and

radiographic 12-month prospective study. Int J Periodontics Restorative

Dent 2003; 23;4:313-323.

22 // WWW.SECUB.ES

EFFECT OF OPEN AND CLOSED RIDGE SPLIT TECHNIQUES ON IMPLANT STABILITY. A RANDOMIZED CONTROLLED TRIAL

and using osteotome technique: A clinical study. J Oral Implantol 2010;

36:475-83

24. Preti G, Martinasso G, Peirone B, Navone R, Manzella C, Muzio G, Cy-

tokines and growth factors involved in the osseointegration of oral tita-

nium implants positioned using piezoelectric bone surgery versus a drill

technique: a pilot study in mini pigs. J Periodontol 2007 78:716–722

25. Buser D., Belser U, Wismeijer D.: Implant Therapy in the Esthetic

Zone for Single-Tooth Replacements Quintessence, 2006 ITI Treat-

ment Guide, Vol I

26. Al-Ansari BH, Morris RR. Placement of dental implants without flap

surgery: a clinical report. Int J Oral Maxillofac Implants.1998 Nov-Dec;

13(6):861-5.

27. Javed F, Ahmed HB, Crespi R, Romanos GE. Role of primary stability for

successful osseointegration of dental implants: Factors of influence and

evaluation. Int. Med. Appl. Sci. 2013, 5, 162–167.

28. Sennerby L., Meredith, N. Resonance frequency analysis: measuring im-

plant stability and osseointegration. Compendium in continuing Educa-

tion in Dentistry 1998; 19:493-502.

29. Meredith N, Friberg B, Sennerby L, Aparicio C. Relationship between

contact time measurements and PTV values when using the Periotest to

measure implant stability. Int J Prosthodont. 1998; 11:269-75.

30. Alsaadi G, Quirynen M, Michiels K, van Steenberghe D. biomechanical

assessment of the relation between the oral implant stability at insertion

and subjective bone quality assessment. J Clin Periodontol 2007, 34: 359-

366

31. Demetriades N, Park J, Laskarides C Alternative Bone Expansion Tech-

nique for Implant Placement in Atrophic Edentulous Maxilla and Mandi-

ble Journal of Oral Implantology. ol. XXXVII/No. Four/2011

32. Abdel-Dayem H, Hassan ShR, Hala M. Abdelalim. Piezoelectric Osteot-

omy and ridge expansion technique in edentulous mandible for dental

implants. J Am Sci 2012; 8(9):120-247.

33. Martin W, Lewis E, Nicol A. Local risk factors for implant therapy. Int J

Oral Maxillofac Implants 2009; 24(Suppl.):28–38.

34. Summers RB. A new concept in maxillary implant surgery: The osteotome

technique. Compendium 1994; 152, 154-6, 158 passim; 162

35. Sohn DS, Lee HJ, Heo JU, Moon JW, Park IS, Romanos GE. Immediate

and delayed lateral ridge expansion technique in the atrophic posterior

mandibular ridge. J Oral Maxillofacial Surg 2010; 68:2283–90.

36. Shalabi M., Wolke Johannes G.C, Jansen John A. The effect of implant

surface roughness and surgical technique on implant fixation in an in

vitro model. Clin Oral Implant Research 2006; 17:172-178.

37. Balleri P, Cozzolino A, Gheli L, Momicchioli G, Varriale A. Stability meas-

urements of osseointegrated implants using Osstell in partially edentu-

lous jaws after 1 year of loading: a pilot study. Clinical Implant Dentistry

and Related Research 2002; 4:128-132.

38. Lachmann SJ, Ger B, Avmann D., Gomez-Roman G, Groten M, Weber H.

Resonanace frequency analysis and damping capacity assessment. Part I;

An in vitro study on measurement reliability and methods of comparison

8. Aghaloo TL, Moy PK. Which hard tissue augmentation techniques are the

most successful in furnishing bony support for implant placement? Int J

Oral Maxillofac Implants. 2007; 22; suppl: 49-70.

9. Chiapasco M, Zaniboni M, Boisco M. Augmentation procedures for the

rehabilitation of deficient edentulous ridges with oral implants. Clin Oral

Implants Res. 2006; 1; suppl 2:136-159.

10. Annibali S, Bignozzi I, Sammartino G, La Monaca G, Cristalli MP. Horizon-

tal and vertical ridge augmentation in localized alveolar deficient sites: a

retrospective case series. Implant Dent. 2012; 21- 175-185

11. Pikos MA. Mandibular block autografts for alveolar ridge augmentation.

Atlas Oral Maxillofac Clin North Am. 2005; 13:91-107.

12. Tolstunov L. Maxillary tuberosity block bone graft: innovative technique

and case report. J Oral Maxillofac Surg. 2009; 67:1723-1729.

13. Kempton SJ, McCarthy JE, Afifi AM. A systematic review of distraction

osteogenesis in hand surgery: What are the benefits, complication rates,

and duration of treatment? Plast. Reconstr. Surg. 2014, 133: 1120–

1130.

14. Verlinden CR, van de Vijfeijken SE, Tuinzing DB, Jansma EP, Becking AG.,

Swennen GR. Complications of mandibular distraction osteogenesis for

developmental deformities: A systematic review of the literature. Int. J.

Oral Maxillofac. Surg. 2015, 44: 44-49.

15. Laster Z, Reem Y, Nagler R. Horizontal alveolar ridge distraction in an

edentulous patient. J Oral Maxillofac Surg. 2011; 69: 502-506.

16. Becker W, Wikesjo UM, Sennerby L, Qahash M, Hujoel P, Goldstein M,

Turkyilmaz I. Histologic evaluation of implants following flapless and

flapped surgery: a study in canines. J Periodontol. 2006 Oct; 77(10):1717-

22.

17. Chiang T, Roca AL, Rostkowski S, Drew HJ, Simon B. Reconstruction of

the narrow ridge using combined ridge split and guided bone regener-

ation with rhPDGF-BB growth factor enhanced allograft. International

Journal of Periodontics and Restorative Dentistry 2014; 34: 123-130.

18. Crespi R, Cappare P, Gherlone EF. Electrical mallet provides essential ad-

vantages in split-crest and immediate implant placement. Journal of Oral

Maxillofacial Surgery 2014; 18: 59–64.

19. Jensen OT, Cullum DR, Baer D. Marginal bone stability using 3 different

flap approaches for alveolar split expansion for dental implants: a 1-year

clinical study. J Oral Maxillofac Surg. 2009; 67:1921-1930.

20. Vercellotti T, Nevins ML, Kim DM ,Nevins M, Wada K , Schenk RK Osse-

ous response following resective therapy with piezosurgery. Int J Perio-

dontics Restorative Dent 2005 25:543–549

21. Danza M, Guidi R, Carinci F Comparison between implants inserted

into piezo split and unsplit alveolar crests. J Oral Maxillofac Surg 2009

67:2460–2465

22. Becker W, Goldstein M, Becker BE, Sennerby L. Minimally invasive flapless

implant surgery: a prospective multicenter study. Clin Implant Dent Relat

Res. 2005; 7 Suppl 1:S21-7.

23-.Padmanabhan TV, Gupta RK. Comparison of crestal bone loss and im-

plant stability among the implants placed with conventional procedure

ÁREA CIENTÍFICA

JUNIO 2018 // 23

52. El Charkawi HG Prosthetically-driven implant placement. A functional

and esthetic approach in the compromised anterior region of the

maxilla. Proceedings of the 7th. Int. Implantology Conference. J of

ESSDI April 2007.

53. Cortese A, Pantaleo G, Amato M, Howard CM, Pedicini L, Claudio PP.

Platelet-rich fibrin (PRF) in implants dentistry in combination with new

bone regenerative flapless technique: evolution of the technique and fi-

nal results. Published Online: 2017-03-09 | DOI: https://doi.org/10.1515/

med-2017-0005

54. Chrcanovic BR, Albrektsson T, Wennerberg A. Flapless versus Conven-

tional Flapped Dental Implant Surgery: A Meta-Analysis. Published: June

20, 2014, https://doi.org/10.1371/journal.pone.0100624

55. Crespi R, Bruschi G, Gastaldi G, Capparé P , Gherlone E Immediate

Loaded Implants in Split-Crest Procedure Clinical Implant Dentistry and

Related Research, Volume *, Number *, 2015

56. Garcez-Filho J, Tolentino F, Sukekava F, Seabra M, . Cesar-Neto JB,

Araújo M G. Long-term outcomes from implants installed by using split-

crest technique in posterior maxillae: 10 years of follow-up. Clinical Oral

Implants Research 2015 26:10.1111/clr.2015.26.issue-3, 326-331. On-

line publication date: 1Mar-2015.

57. Goyal M, Mittal N, Gupta GK, Singhal M. Ridge augmentation in implant

dentistry. J Int Clin Dent Res Organ 2015; 7, Suppl S1:94-112

58. Yoon J, Kim Y, Jang Y, Park J ,Choi S ,Cho K, Kim C. The long-term clin-

ical stability of implants placed with ridge splitting technique The Journal

of Korean Academy of Implant Dentistry 2011;30(1):1-

59. Moraschini, V. Velloso, D. Luz, E, Barboza P. Implant survival rates, mar-

ginal bone level changes, and complications in full-mouth rehabilitation

with flapless computer-guided surgery: a systematic review and me-

ta-analysis. International Journal of Oral and Maxillofacial Surgery. Online

publication date: 1-Mar-2015

60. Deshpande S, Deshmukh J, Deshpande S, Khatri R, Deshpande S. Vertical

and horizontal ridge augmentation in anterior maxilla using autograft,

xenograft and titanium mesh with simultaneous placement of endosse-

ous implants. J. Indian Soc. Periodontol. 2014, 18: 661–665.

61. Jensen OT, Kuhlke KL, Cottam J, Foley BD. Maxillary alveolar split horse-

shoe osteotomy. In: Jensen OT (Ed). The osteoperiosteal flap. A simplified

approach to alveolar bone reconstruction. Chicago: Quintessence Books,

2010, p.189-201.

62. Anitua E, Begona L, Orive G. Two stage split- crest technique with

ultrasonic bone surgery for controlled ridge expansion: a novel

modified technique. Oral Surg Oral Pathol Oral Radiol Endod 2011;

112:708–10.

63. Kheur M, Gokhale SS, Jambekar S. Staged ridge splitting technique for

horizontal expansion in mandibleA case report. J Oral Implantol 2012;

Epud ahead of print, PMID: 22906165

64. Jané-Salas, E., Roselló-LLabrés, X., Jané-Pallí, E. et al. Odontology. Open

flap versus flapless placement of dental implants. A randomized con-

trolled pilot trial (2018)https://doi.org/10.1007/s10266-018-0343-8

in determination of primary dental implant stability .Clin Oral Implants

Res 2006; 17; 75-79.

39. Huang H.M., Chiu C.L., Lin L.H., Lee S.Y. Early determination of implant

healing process using resonance frequency analysis. Clinical Oral Implant

Research 2003; 14:437-443.

40. Satwalekar P, Nalla S, Reddy R, Chowdary SG. Clinical evaluation of os-

seointegration using resonance frequency analysis. J Indian Prosthodont

Soc.2015 Jul-Sep;15(3):192-9. doi: 10.4103/0972-4052.165171.

41. Friberg B, Henningsson C, Jemt T. Rehabilitation of edentulous mandibles

by means of turned Brånemark system References 140 implants after

one-stage surgery: a 1 year retrospective study of 152 patients. Clin Im-

plants Dent Relat Res 2005; 7:1-9.

42. Palti A. Ridge splitting and implant techniques for the anterior maxilla.

Dent Implantol Update 2003; 14:25–32.

43. Harrison K, Leblebicioglu B,.Chien H-H. Alveolar Bone Expansion Follow-

ing Ridge Split Technique. J.Dent.Res. 90 (Special issue) Abstract 2169

IADR 2011.

44. Lamas Pelayo J,Peñarrocha Diago M,Martí Bowen E,Peñarrocha

Diago M, Intraoperative complications during oral implantology,

Medicina Oral, Patología Oral y Cirugía Bucal, 2008,vol. 13, no. 4,

pp. E239–E243,

45. González-García R, Monje F, Moreno C. Alveolar split osteotomy for the

treatment of the severe narrow ridge maxillary atrophy: a modified tech-

nique. Int J Oral Maxillofac Surg 2011; 40(1):57-64. Jensen OT, Ellis E. The

book flap: a technical note. J Oral Maxillofac Surg 2008; 66; 5:1010-4.

46. Brugnami F, Caiazzo A, Mehra P. Piezosurgery-Assisted, Flapless Split

Crest Surgery for Implant Site Preparation. Journal of Maxillofacial and

Oral Surgery, 2014; 13: 67-72.

47. Blus C, Szmukler-Moncler S, Vozza I, Rispoli L, Polastri C. Split-Crest and

Immediate Implant Placement with Ultrasonic Bone Surgery (Piezosur-

gery): 3-Year Follow-Up of 180 Treated Implant Sites. Quintessence In-

ternational, 2010 41, 463-469.

48. Fischer, K., Stenberg, T., Hedin, M. & Sennerby, L. Five-year results from

a randomized, controlled trial on early and delayed loading of implants

supporting  full-arch prosthesis in the edentulous maxilla. Clinical oral

implants research 2008; 19: 433- 441

49. Huwiler MA, Pjetursson BE, Bosshardt DD, Salvi GE, Lang NP. Resonance

frequency analysis in relation to jawbone characteristics and during early

healing of implant installation. Clin Oral Implants Res. 2007; 18:275-80.

50. Dottore A, Kawakami P, Bechara K, Rodrigues J, Cassoni A, Figueiredo

L, Piattelli A, Shibli J. Stability of Implants Placed in Augmented Posterior

Mandible after Alveolar Osteotomy Using Resorbable Nonceramic Hy-

droxyapatite or Intraoral Autogenous Bone: 12-Month Follow-Up. Clini-

cal Implant Dentistry and Related Research, Volume *, Number *, 2012

51. Shalabi MM, Manders P, Mulder J, Jansen JA, Creugers NHJ A meta-anal-

ysis of clinical studies to estimate the 4.5 year survival rate of implants

placed with the osteotome technique. Int J Oral Maxillofac Implants 2007

22:110–116

Fecha Titulo Lugar

MARZO TÍTULO LUGAR

7/03/2018 Reunión de invierno SEPES Baqueira-Beret

15-17/03/2018 Expodental Madrid

ABRIL TÍTULO LUGAR

21/04/2018 II Jornada Multidisciplinar para Higienistas Bucodentales Avilés (Asturias)

26-28/04/2018 Oral Reconstruction Global Symposium Rotterdam (Paises Bajos)

MAYO TÍTULO LUGAR

17-19/05/2018 International Symposium Series Dubrovnick(Croacia)

17-19/05/2018 XL Reunión anual Sociedad Española de Odontopediatría SEOP Palma de Mallorca

JUNIO TÍTULO LUGAR

6-9/06 64 Congreso Sociedad Española de Ortodoncia SEDO Tarragona

8-9/06/2018 XXX Congreso Nacional y XXIII Internacional Sociedad Española de Implantes SEI Alicante

9/06/2018 I Congreso Multidisciplinar de Salud Bucodental Madrid

20-23/06/2018 EuroPerio Amsterdam

CONGRESOS

AGENDA

24 // WWW.SECUB.ES