Clinical Evaluation of 262 Osseointegrated Implants Placed in Sites Grafted With Calcium Phosphosilicate Putty: A Retrospective Study
Along with the widespread use of dental implants, regenerative procedures have become an indispensable tool for implant surgeons in managing residual ridges and the surrounding bone. Putty bone grafts have significantly superior handling characteristics in comparison to particulates. These include ease of placement, enhanced particle containment, and a viscous consistency that has allowed for unique delivery systems to be developed. The aim of this study was to report the clinical efficacy of calcium phosphosilicate (CPS) putty in a wide variety of indications related to implant reconstruction and to report the survival rate of implants placed in these grafted sites. The CPS putty was used as the graft material of choice. Treatments were categorized into following groups: extraction graft, extraction with immediate implant placement, all-on-four concept, peri-implantitis treatment, bone augmentation before implant placement, implant replacement graft, and grafting around implant placed in resorbed ridges. Included in the analysis were 65 patients (36 men, 29 women) with a mean age of 63 ± 12 years. In total, 262 implants were placed. Four implants were diagnosed with peri-implantitis and were treated as described in category 4, for a total of 266 grafted sites. Two implants from the extraction graft category and 3 implants from the all-on-four group were lost and replaced with successfully osseointegrated implants during a mean study follow-up period of 12.24 ± 2.32 months. The implant success rate at 1 year was 98.1% (257/262). Based on results of this large-scale, retrospective study we conclude that (1) the use of putty bone grafts can simplify bone-grafting procedures and reduce intraoperative time in various grafting indications, (2) this study verified the efficacy of a CPS putty bone graft biomaterial in a large array of implant-related surgical indications, and (3) implants placed in sites grafted with CPS putty yield very high survival rates.
Figure 1. Frequency of distribution of grafted sites in the oral cavity. Figure 2. Treatment category 1 = extraction graft; treatment category 2 = extraction with immediate implant placement; treatment category 3 = all-on-four; treatment category 4 = peri-implantitis treatment; treatment category 5 = bone augmentation before implant placement; treatment category 6 = implant replacement graft; treatment category 7 = grafting around implants placed in resorbed ridges.
(a) Preoperative periapical radiograph demonstrating nonrestorable tooth. (b) Clinical view of fractured tooth. (c) Calcium phosphosilicate putty syringe at the surgical site. (d) Defect filled with graft material. (e) Clinical view after suturing. (f) Four-month postextraction radiograph. (g) Periapical radiograph with implant and healing abutment in a 1-stage procedure. (h) Periapical radiograph of completed case at 7 months after implant placement and 12 months after grafting.
(a) Preoperative periapical radiograph demonstrating nonrestorable tooth. (b) Precision drill used to create the initial implant receptor site in very compromised bone. (c) Clinical view of initial bony receptor site. (d) Final receptor site preparation. Note that the sinus membrane is visible. (e) The implant in position with a healing abutment in a 1-stage procedure. (f) Calcium phosphosilicate (CPS) putty cartridge delivering graft material. (g) Clinical view of socket filled with CPS putty. (h) Periapical radiograph of final crown in position at 7 months after immediate implant placement.
(a) Preoperative cone beam computed tomography scan. (b–d) Clinical view of postextraction sockets and all-on-four implant positions. Calcium phosphosilicate (CPS) putty graft filling extraction sockets. (c and e) Clinical view of postextraction sockets filled with CPS putty. (f) Clinical view of fixed screw-retained maxillary and mandibular definitive prosthesis. (g) Postoperative periapical radiographs demonstrating bone levels and homogenous bony profile at the 12-month follow-up appointment.
(a) Preoperative clinical view of 2 failing implants and lateral incisor with a periapical lesion. (b) Clinical view of mandibular ridge with nonrestorable implants. (c) Clinical view of residual bony defects after extraction of the 2 implants and lateral incisor. (d and e) Cartridge delivery system used to fill bony defects. (f) Periapical radiograph 5 months after the extraction graft procedure. (g) Clinical view of 2 Nobel Active implants. (h) Periapical radiograph with 2 Nobel Active implants in place in a classic 2-stage procedure at 6 months. (I and j) Clinical and periapical radiograph at final prosthetic reconstruction (8 months after loading).
(a) Clinical view with mucoperiosteal flap reflected to expose the buccal bone defect. (b) The 1% citric acid solution used to cleanse the area following debridement. (c) Clinical view of the bone defect. (d) Calcium phosphosilicate putty graft material at osseous defect area. (d) Graft material in final position filling osseous defect. (f) Mucoperiosteal flap repositioned and sutured. (g) Clinical appearance of the healed area 18 months later. (h) Periapical radiograph with final prosthesis at 14 months.
Two-year implant survival curve following Kaplan-Meier survival analysis
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