Albanese Massimo, Ricciardi Giulia, Luciano Umberto, Donadello Dario, Lucchese Alessandra, Gelpi Federico, Zangani Alessandro, De Santis Daniele, Rizzini Alessandro, Rossetto Alberto, Bertossi Dario
Section of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
Department of Orthodontics, Vita Salute San Raffaele University, Milan, Italy.
Minerva Stomatol. 2019 Feb;68(1):3-10. doi: 10.23736/S0026-4970.17.04006-7. Epub 2017 Jul 4.
Piezosurgery® represents a novel alternative technique. The Piezosurgery® is well tolerated and permits a large number of applications in described literature. The principle of Piezosurgery® consists into inducing micro-vibrations to a metallic insert with a particular custom. The aim of this article is to study and to evaluate the use of NobelActive implants in combination with piezosurgical split-crest technique in severe atrophy of the upper maxilla. This approach allows avoiding the use of onlay grafts, due to rise the trasversal width of the crestal bone, which could have more complications and uncertain prognosis. This technique allows reducing timing of implant insertion because it is not necessary to wait for the graft to heal.
Ten patients (age 45-58) are selected, presenting from class 4 to 5 by Cawood and Howell of jaws. Those underwent piezosurgical split-crest technique and simultaneous implants surgery and bone grafts. Preoperative X-ray evaluation included standard X-panoramic and CT Dental-scan. Standard chemoprophylaxis was administered to each patient. The piezosurgical split-crest procedure was combined with tissue bank fresh frozen chips and double-layer collagen membrane to improve the thickness of alveolar bone and simultaneous implant surgery. Every patient received simultaneously from 3 to 6 implants which diameter was 4.3 mm and length 10-11.5 mm. Healing abutments have been applied at 5 months from the first procedure.
Patients were clinically monitored, and marginal bone changes were calculated using periapical radiographs, which were taken with O-ring technique at placement and upon subsequent appointments and a 1-mm measurement grid for marginal bone remodeling, again at baseline and thereafter 3 months within loading. Cumulative implant survival was 97.8% (N.=45). Mean marginal bone resorption (SD) was 1.19 (1.01) mm for the early loading group after 1 year. The use of NobelActive implants seem to reduce peak stress in both cortical and trabecular bone.
The use of NobelActive implants was revealed ideal in patients presenting jaw atrophy. The tapered designs show an ability to dissipate the interfacial stresses of bone, therefore improving the stability and the osteointegration if used in association to split crest made with piezosurgical device.
超声骨刀手术是一种新型替代技术。超声骨刀手术耐受性良好，在已发表的文献中有大量应用。超声骨刀手术的原理是对具有特定定制的金属刀片施加微振动。本文的目的是研究和评估诺贝尔活性种植体与超声骨刀劈开牙槽嵴技术在上颌严重萎缩中的联合应用。这种方法可以避免使用外置骨块移植，因为它可以增加牙槽嵴骨的横向宽度，而外置骨块移植可能有更多并发症且预后不确定。该技术可以缩短种植体植入时间，因为无需等待移植骨愈合。
选择10例患者（年龄45 - 58岁），其颌骨根据Cawood和Howell分类为4级至5级。这些患者接受了超声骨刀劈开牙槽嵴技术、同期种植手术和骨移植。术前X线评估包括标准全景X线片和牙科CT扫描。对每位患者进行标准的化学预防。超声骨刀劈开牙槽嵴手术联合组织库新鲜冷冻骨块和双层胶原膜，以增加牙槽骨厚度并同期进行种植手术。每位患者同期植入3至6枚种植体，种植体直径为4.3mm，长度为10 - 11.5mm。在首次手术后5个月安装愈合基台。
对患者进行临床监测，使用根尖片计算边缘骨变化，在种植体植入时及后续复诊时采用O形环技术拍摄根尖片，并使用1mm测量网格测量边缘骨重塑，同样在基线时及加载后3个月内进行测量。种植体累积存留率为97.8%（N = 45）。早期加载组在1年后的平均边缘骨吸收（标准差）为1.19（1.01）mm。使用诺贝尔活性种植体似乎可以降低皮质骨和松质骨中的峰值应力。
对于存在颌骨萎缩的患者，使用诺贝尔活性种植体显示出理想效果。锥形设计显示出能够消散骨界面应力的能力，因此如果与超声骨刀设备制作的劈开牙槽嵴联合使用，可提高稳定性和骨整合。
