Chinese Journal of Oral Implantology

Expert consensus on titanium mesh supported guided bone regeneration

Editorial Board of Chinese Journal of Oral Implantology

2024, 29(2): 95-100. DOI: 10.12337/zgkqzzxzz.2024.04.001

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Nowadays, the clinical application of titanium mesh supported guided bone regeneration (TMs-GBR), especially using 3D printing individualized titanium mesh (3D-PITM), is increasing, serving as a reliable solution for bone augmentation in various cases of bone defects, particularly complex ones encountered during implant surgery. Given the technical sensitivity of TMs-GBR and the higher risk of complications such as titanium mesh exposure, as well as the current lack of relevant guidelines or international consensus, the editorial board of the Chinese Journal of Oral Implantology organized discussions among relevant experts and drafted this consensus, aiming to provide clinical reference for practitioners.

Preface for the key column on transalveolar technique for sinus floor elevation

2024, 29(2): 101-102. DOI: 10.12337/zgkqzzxzz.2024.04.002

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Expert consensus on maxillary sinus floor elevation: maxillary sinus septum

Chinese Society of Oral Implantology

2024, 29(2): 103-108. DOI: 10.12337/zgkqzzxzz.2024.04.003

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The maxillary sinus septum is a common bony structure in the maxillary sinus. It is very important to understand the presence of the maxillary sinus septum when designing the sinus floor elevation. Therefore, this paper summarizes the classification of maxillary sinus septum, its anatomical and biological characteristics, its influence on maxillary sinus osteogenesis, and its treatment methods and principles, in order to provide a reference for the clinical implementation of sinus floor elevation with maxillary sinus septum, and to reduce the complications caused by the presence of maxillary sinus septum.

Current research status of transalveolar technique for sinus floor elevation with simultaneous placement of dental implants

Xia Haibin, Xu Junyi

2024, 29(2): 109-117. DOI: 10.12337/zgkqzzxzz.2024.04.004

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When the residual bone height is insufficient in the maxillary posterior region, the transalveolar technique for sinus floor elevation with simultaneous implant placement is less invasive, resulting in milder postoperative reactions and shorter treatment periods compared to the lateral window technique. However, due to the limited surgical vision and elevation technique, the transalveolar technique is susceptible to mucoperiosteal perforation or compromised osteogenesis and is therefore traditionally considered suitable only for cases where the residual bone height is mildly inadequate. With modifications to surgical instruments, improvements in clinical skills, and the assistance of digital technology, researchers have gained new insights into the indications and surgical protocols for transalveolar sinus floor elevation with simultaneous placement of dental implants. This paper presents an overview of the current basic and clinical research status of the transalveolar technique for sinus floor elevation with simultaneous implantation by reviewing recent literature.

"Improved" maxillary sinus lift surgery

Sun Xiaolin, Luo Jiaxin

2024, 29(2): 118-126. DOI: 10.12337/zgkqzzxzz.2024.04.005

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When posterior maxillary teeth are missing, the residual bone height required for implantation is insufficient due to the lack of functional stimulation from the teeth and pneumatization of the maxillary sinus. When residual bone volume cannot ensure the initial stability of the implant, a maxillary sinus floor elevation is needed to increase bone volume in the posterior maxillary region. The "PESS" procedure is a "modified" maxillary sinus floor elevation surgery that uses platelet-rich fibrin (PRF) as a single bone graft material, with the aid of an endoscope to elevate the maxillary sinus floor through the alveolar ridge and place implants simultaneously. The PESS procedure has optimized maxillary sinus floor elevation surgery to some extent and reduced surgical trauma. This article elaborates on the principles, indications, clinical procedures, and precautions of the "PESS" procedure to provide technical support for its clinical application.

Research progress on the effect of Schneider membrane thickening on transalveolar sinus floor elevation

Li Xiaoyu, Yu Huan, Meng Weiyan

2024, 29(2): 127-132. DOI: 10.12337/zgkqzzxzz.2024.04.006

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Transalveolar sinus floor elevation is recognized as a minimally invasive and reliable bone augmentation surgery for the posterior maxillary region in implant clinical practice. However, the therapeutic effect remains uncertain when there is Schneider membrane thickening in the maxillary sinus. Given that Schneider membrane thickening is the most common lesion in the maxillary sinus, it is of great clinical significance to clarify its impact on the prognosis of transalveolar sinus floor elevation. In response to this clinical issue, this article provides a review of three aspects: the characteristics of normal Schneider membrane, the manifestations and causes of Schneider membrane thickening, and the impact of Schneider membrane thickening on transalveolar sinus floor elevation, to provide a theoretical basis for the preoperative evaluation of the transalveolar sinus floor elevation.

Influence of maxillary sinus anatomical characteristics on the operation of internal sinus floor elevation

Luo Zixin, Hu Dandan, Geng Wei

2024, 29(2): 133-137. DOI: 10.12337/zgkqzzxzz.2024.04.007

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Maxillary sinus floor elevation is one of the main methods to increase the vertical bone volume for implants in the maxillary posterior region. According to the surgical approach, it can be divided into two surgical procedures: external sinus floor elevation and internal sinus floor elevation. The latter has the advantages of safety, minimally invasiveness, and economy compared with the former. The anatomical morphology of the maxillary sinus is one of the important factors affecting the operation of maxillary sinus floor elevation. This article reviews and analyzes the main anatomical factors such as the morphology of the maxillary sinus floor, the residual bone height, the maxillary sinus septum, and the Schneiderian membrane, in order to help the application of internal sinus floor elevation in clinical work.

Analysis of factors related to complications of transalveolar technique for sinus floor elevation

Qian Yuxin, Wu Wei, Zhou Yongmiao, Wang Mingxi, Tang Chunbo

2024, 29(2): 138-143. DOI: 10.12337/zgkqzzxzz.2024.04.008

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In cases of insufficient bone in the maxillary posterior region, the transalveolar technique is a common, safe, and effective method to increase the amount of bone required for implantation. However, this technique may also lead to various intraoperative and postoperative complications. Clinicians need to pay attention to various risk factors to minimize the incidence of complications. The purpose of this article is to discuss the risk factors associated with complications of internal sinus floor elevation, which are categorized into intraoperative and postoperative complications. The most common intraoperative complications are perforations of the sinus floor mucosa and ectopic insertions of implants into the sinus. Postoperative complications, such as maxillary sinus infection and postoperative maxillary sinusitis, displacement of implants after surgery, and benign paroxysmal positional vertigo (BPPV), deserve more attention. Given these complications, this article provides a detailed description of the risk factors, hoping to help clinical doctors in using the internal sinus floor elevation more safely and effectively in the clinic.

Current clinical applications of scaffold materials for maxillary sinus floor elevation

Liu Chengwu, Xu Leyao, Liu Yuanxiang, Chen Zhuofan

2024, 29(2): 144-149. DOI: 10.12337/zgkqzzxzz.2024.04.009

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Maxillary sinus floor elevation is a commonly used surgical technique to improve the insufficient height of the residual alveolar ridge bone in the posterior maxilla. The application of scaffolding materials can effectively maintain the stability of the elevation space. Based on the biological principles of maxillary sinus floor elevation, we briefly envisage the properties of ideal scaffolding materials and focus mainly on the current application of scaffold materials in maxillary sinus floor elevation. Finally, this paper summarizes the current clinical applications and provides an outlook on scaffolding materials for maxillary sinus floor elevation.

The role of the angiogenic properties in bone augmentation materials

Liao Hongbing, Mai Yuying

2024, 29(2): 150-158. DOI: 10.12337/zgkqzzxzz.2024.04.010

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Bone augmentation is a necessary method to solve the problem of insufficient bone in implant therapy. One of the keys to the success of bone augmentation is that the bone augmentation material should be capable of angiogenesis, forming a network for effective blood-oxygen exchange with the host tissue. In this paper, we review the progress and shortcomings of different bone grafting materials on the properties of angiogenesis, and provide suggestions and references for promoting research and development in bone augmentation materials and their clinical translation.

Finite element analysis of the effect of implant design on stress distribution at the bone interface for different jaw densities

Wang Qi, Yang Bo, Liu Lu, Li Cuiying, Wang Xinyu

2024, 29(2): 159-168. DOI: 10.12337/zgkqzzxzz.2024.04.011

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Objective To evaluate the effects of various implant shape designs on initial stability under different bone conditions, and to provide biomechanical experimental data and theoretical reference for the optimization of implant structure design. Methods SolidWorks software was used to establish the jaw models and implant models. The jaw models included neck, body, and bottom models, and were divided into type I, type II, and type III bones. The implant models were divided into neck, body, and bottom models. The peak equivalent stress values of the models under a vertical 100N load were analyzed by Ansys finite element analysis software, so as to screen the structures whose peak equivalent stress value was below the bone yield strength value. Orthogonal experiments were further conducted on these structural designs to compare and analyze the peak equivalent stress values of various structural combinations of implants in different bone types under a vertical 100N loading mode, so as to obtain the effects of each design on the initial stability and determine the optimal combination of structural designs. Results In the neck type I and II jaw models, the design of the implant neck depth had the greatest effect on the initial stability. In the neck type III jaw model, the design of the implant neck pitch had the greatest effect on the initial stability. Among the various body jaw models, the implant pitch design had the greatest effect on the initial stability. In addition, the implant bottom cutting edge design could not increase the initial stability of the implant. Conclusion Different design parameters should be selected according to different bone types in clinical implant selection and further implant design. In type I and type II bones, more attention should be paid to the selection of neck and body thread depth. In type III bone, more attention should be paid to the selection of neck pitch and body depth.

A clinical retrospective study of GBR based on 3D printing individualized titanium mesh (3D-PITM) and onlay bone grafting in reconstruction of complex alveolar bone defects

Su Yadi, Zou Jiejuan, Wang Chao, Huang Yuanding

2024, 29(2): 169-177. DOI: 10.12337/zgkqzzxzz.2024.04.012

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Objective A clinical retrospective study was proposed to compare the bone augmentation effect of GBR based on 3D printing individualized titanium mesh (3D-PITM) with onlay block autogenous bone grafting in the reconstruction of complex alveolar bone defects. Methods This study included 39 patients with alveolar bone defects who attended the Implant Department of the Affiliated Stomatological Hospital of Chongqing Medical University from May 2018 to January 2022. According to bone grafting methods, they were divided into 3D-PITM+GBR group (19 patients) and Onlay group (20 patients). Preoperatively, Cone-Beam Computed Tomography (CBCT) images of the patients were imported into Mimics Research and 3-Matic Software for 3D reconstruction and digital design. 3D-PITM was fabricated by CAD/ selective laser melting (SLM) technology. Intraoperatively, bone augmentation surgery was completed with fixed 3D-PITM or autologous bone block. CBCT imaging data were collected preoperatively, immediately postoperatively, 6~9 months postoperatively and after implant placement. Based on the digital radiographic data, the gained bone height on the implant axis and the gained bone width at 0 mm, 2 mm and 4 mm under the implant platform were measured. Results The 3D-PITM+GBR group had higher vertical bone increments [2.68 mm (0.45,4.23), 2.27 mm (0.49,3.27)] than onlay group [1.60 mm (0.33,1.62), 1.74 mm (0.53,1.60)] before/after bone grafting and before/after implant placement respectively. The 3D-PITM+GBR group had higher mean bone width increments at 0 mm, 2 mm, and 4 mm below the alveolar ridge before and after bone grafting [(1.97±0.97) mm, (2.59±1.22) mm, (2.94±1.50) mm)] than that of onlay group [(1.06±0.99) mm, (1.45±1.25) mm, (2.32± 1.23) mm]. In the 3D-PITM+GBR group, the mean bone width increments at 0 mm, 2 mm, and 4 mm below the implant platform before and after implantation [(2.34±1.09) mm, (2.53±1.48) mm, (2.85±2.20) mm)] were lower than those of onlay group [(2.51±1.34) mm, (3.04±1.73) mm, (3.38±1.94) mm]. The 3D-PITM+GBR group had higher osteogenesis rates in both horizontal and vertical directions (66.8%, 68.8%) than the Onlay group (64.6%, 62.6%).3D-PITM for reconstruction of complex alveolar bone defects was able to significantly increase the height and width of alveolar bone reconstruction compared with onlay block autogenous bone grafting, but the implant exposure rate (21%) was still higher than that of the onlay group (5%). Conclusion 3D-PITM+GBR technique can be used instead of block autogenous bone grafting for reconstruction of complex alveolar bone defects, obtaining ideal bone augmentation results and stable bone contours, but titanium mesh exposure is still a common complication in its application.

Feasibility study of artificial intelligence in immediate implant measurements and analysis in the mandibular molar region

Zhao Wenbo, Li Xinru, Su Hang, Teng Weiwei, Cai Wenyu, Zhou Libo

2024, 29(2): 178-183. DOI: 10.12337/zgkqzzxzz.2024.04.013

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Objective To analyze and validate the feasibility of an artificial intelligence software, ITK-SNAP, in identifying the distance between mandibular molars and the inferior alveolar nerve canal. Methods The cone-beam CT (CBCT) image data of 100 college students were selected, and 30 cases were randomly selected as the experimental group, and the remaining 70 cases were used as the validation group together with the 30 cases in the experimental group. The distances from the apices of the mandibular molar roots and the tops of the alveolar septa to the inferior alveolar nerve canals were measured using CBCT image analysis software and ITK-SNAP, respectively. Results The differences in the distances between mandibular molars and the inferior alveolar nerve canals measured by CBCT and ITK-SNAP software were not statistically significant in intergroup comparisons (P>0.05), and had a high correlation with r>0 (correlation coefficients r were all greater than 0.9); in both males and females, the distances from the mesial apices, the distal apices, and the tops of the alveolar septa to the upper walls of the inferior alveolar nerve canals of the mandibular first molars were significantly greater than those of the second molars (P<0.05), and the distances from each point of the mandibular first molars to the upper walls of the inferior alveolar nerve canals were significantly greater than those of the second molars in both the right and left sides (P<0.05). Conclusion The artificial intelligence software ITK-SNAP for measuring the distance between mandibular molars and the mandibular canal is feasible, which provides a reference for the preoperative planning of immediate implant placement in the mandibular molar region.

Advances of yttrium-containing zirconia materials in dental clinical applications

Xie Hailin, Guo Xueqi, Wang Liping

2024, 29(2): 184-189. DOI: 10.12337/zgkqzzxzz.2024.04.014

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Yttrium-containing zirconia ceramic (YCZC) has been widely used in field of implant and restorative dentistry. It has good mechanical and biological properties when compared with other types of zirconia ceramics. Different types of zirconia ceramics have been used in clinical application, such as Yttrium-stabilized tetragonal zirconia polycrystal (Y-TZP)with high mechanical properties, and Yttrium-partially stabilized zirconia (Y-PSZ)with high aesthetic properties. Therefore, understanding the physical and chemical properties of different YCZC can improve the clinical success of dental restorations. This article summarizes the available literature concerning the physical and chemical properties of YCZC and their clinical applications in the field of dentistry.

Research progress of dental implants in patients with solid organ transplantation

Zhao Ke, Zhu Jieying, Gu Xinhua

2024, 29(2): 190-194. DOI: 10.12337/zgkqzzxzz.2024.04.015

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With the development of solid organ transplantation treatment technology, the survival period of patients is gradually extended, and the demand to restore missing teeth is increasing. In long-term clinical practice, implant therapy can be used as a safe and effective program to restore stomatognathic function. However, the impacts of primary disease and lifelong immunosuppressive therapy after transplantation on bone metabolism increase the risk of osteoporosis, fracture, and other diseases, and bring potential hazards to implant osseointegration. Therefore, stability of condition after transplantation, control of oral infection during the perioperative period of implantation, implant loading time, and regular follow-up examination are particularly important in the implantation treatment of such patients. In this review, we discuss the effects of solid organ transplantation on bone and implant osteoporosis, the progress and precautions of oral implant treatment, so as to provide guidance for dentists.

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