Fig. 5. Survival rate of dental implants after autologous bone augmentation
Fig. 5. Survival rate of dental implants after autologous bone augmentation
Fig. 4. Postoperative nerve alterations. Single asterisk, N refers to the total number of the surgical approaches in the mandible (N = 155). Double asterisk, N refers to the total number of the surgical approaches in the maxilla (N = 225)
Fig. 4. Postoperative nerve alterations. Single asterisk, N refers to the total number of the surgical approaches in the mandible (N = 155). Dou...
Fig. 3. Surgical outcome after autologous augmentation procedures from different donor sites
Fig. 3. Surgical outcome after autologous augmentation procedures from different donor sites
Fig. 2. Survival rate of autologous bone grafts
Fig. 2. Survival rate of autologous bone grafts
Fig. 1. Postoperative complications at the donor and recipient site, N refers to the total number of the donor sites (N = 300), N refers to the total number of the recipient sites (N = 378)
Fig. 1. Postoperative complications at the donor and recipient site, N refers to the total number of the donor sites (N = 300), N refers to the total number of the recipient sites (N = 378)
Postoperative complications
%/procedures (N)
At donor sitea
Wound infection
2.6% (8/300)
At recipient site...
Donor site
Bone grafts (N)/patients (N)
Lateral zygomatic buttress
113/112
Mandibular ramus (retromolar)
...
Patient characteristics
N (%)
Gendera
Male
250 (89.6%)
Female
29 (10.4%)
...
Sakkas, A., Wilde, F., Heufelder, M. et al. Autogenous bone grafts in oral implantology—is it still a “gold standard”? A consecutive review of 279 patients with 456 clinical procedures.
Int J Implant Dent 3, 23 (2017). https://doi.org/10.1186/s40729-017-0084-4
Download citation
Received: 27 February 2017
Accepted: 22 May 2017
Published: 01 June 2017
DOI: https://doi...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
Andreas Sakkas, Frank Wilde, Marcus Heufelder & Alexander Schramm
Institute of Anatomy, Medical Faculty of Leipzig University, Leipzig, Germany
Karsten Winter
Department of Oral and Plastic Maxillofacial Surgery, University Hospit...
The authors thank the patients for their kindness to participate as study cases and the whole medical team at the Bundeswehrkrankenhaus Ulm.
AS participated in its design and coordination, carried out the data selection, and drafted the manuscript, and is the corresponding author. FW participated in its design and coordination and helped in drafting the manuscript. MH participated in its design a...
Semper W, Kraft S, Mehrhof J, Nelson K. Impact of abutment rotation and angulation on marginal fit: theoretical considerations. Int J Oral Maxillofac Implants. 2010;25:752–8.
Wiltfang J, Jätschmann N, Hedderich J, Neukam FW, Schlegel KA, Gierloff M. Effect of deproteinized bovine bone matrix coverage on the resorption of iliac cortico-spongeous bone grafts—a prospective study of two cohorts....
Chiapasco M, Zaniboni M. Clinical outcomes of GBR procedures to correct peri-implant dehiscences and fenestrations: a systematic review. Clin Oral Implants Res. 2009;20:113–23.
Felice P, Pellegrino G, Checchi L, Pistilli R, Esposito M. Vertical augmentation with interpositional blocks of anorganic bovine bone vs. 7-mm-long implants in posterior mandibles: 1-year results of a randomized clinical...
Verdugo F, Castillo A, Moragues MD, Pontón J. Bone microbial contamination influences autogenous grafting in sinus augmentation. J Periodontol. 2009;80:1355–64.
Wiltfang J, Schultze-Mosgau S, Merten HA, Kessler P, Ludwig A, Engelke W. Endoscopic and ultrasonographic evaluation of the maxillary sinus after combined sinus floor augmentation and implant insertion. Oral Surg Oral Med Oral Pathol O...
von Arx T, Buser D. Horizontal ridge augmentation using autogenous block grafts and the guided bone regeneration technique with collagen membranes: a clinical study with 42 patients. Clin Oral Implants Res. 2006;17:359–66.
Levin L, Nitzan D, Schwartz-Arad D. Success of dental implants placed in intraoral block bone grafts. J Periodontol. 2007;78:18–21.
Andersson L. Patient self-evaluation of...
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;22:49–70.
Margonar R, dos Santos PL, Queiroz TP, Marcantonio E. Rehabilitation of atrophic maxilla using the combination of autogenous and allogeneic bone grafts followed by protocol-type prosthesis. J Craniofac Surg. 2010;2...
Schwartz-Arad D, Dori S. Intraoral autogenous onlay block bone grafting for implant dentistry. Refuat Hapeh Vehashinayim. 2002;19:35–9. 77.
Misch CM. Ridge augmentation using mandibular ramus bone grafts for the placement of dental implants: presentation of a technique. Pract Periodontics Aesthet Dent. 1996;8:127–35.
Altiparmak N, Soydan SS, Uckan S. The effect of conventional surgery and pi...
Jensen AT, Jensen SS, Worsaae N. Complications related to bone augmentation procedures of localized defects in the alveolar ridge. A retrospective clinical study. Oral Maxillofac Surg. 2016;20(2):115–22 [Epub ahead of print].
Buser D, Dula K, Hirt HP, Schenk RK. Lateral ridge augmentation using autografts and barrier membranes: clinical study with 40 partially edentulous patients. J Oral Maxill...
The results of the clinical study proves the reliability and low comorbidity of autologous bone grafts in preprosthetic alveolar ridge reconstructions prior to implant insertion. The high graft success rate (95.6%) and the low early implant failure rate (0.38%) in a surveillance of all patients treated in three following years with this technique showing no exclusion and no dropout of any case for...
Data on risk factors based on the original examination and documentation are difficult to assess the adverse effects of variable factors on the surgical prognosis because of the multifactorial genesis of surgical complications [73]. Factors such as gender, age, or smoking habit could be associated with postoperative complications after two-stage dentoalveolar reconstruction with autologous bone gr...
The results of the present study have to take into account the absence of a control group with patients undergoing bone augmentation procedures with bone substitutes (allogen, alloplastic, exogen). Without a comparative group of grafting surgeries using alternative bone material, only limited statements can be made.
However, the excellent surgical outcome of autologous surgical methods providing ...
The use of autologous bone in this study has shown excellent graft survival and success rate (95.6%). This is equal to the results from the studies on implants inserted in reconstructed sites [6, 8, 24]. The early implant survival rate of 99.7% found in the present material is very high comparable to that in the previous systematic reviews after staged horizontal ridge augmentation [9, 10, 22, 62,...
Of the sinus floor elevations performed in this study, 84.8% were defined absolutely successful. Only two of our 72 patients having sinus lift operations could not finally be treated with dental implants. These results are comparable to other studies considering the sinus graft to be a safe treatment modality with few complications [6, 8, 51,52,53]. Raghoebar et al. reported incidences of sinus co...
Postoperative morbidity after mandibular bone harvesting procedures was reported to be mainly related to temporary or permanent neural disturbances involving the inferior alveolar nerve and its branches [19]. In this study, only the incidence of the temporary hypoesthesia of the mandibular and lingual nerve after harvesting from the retromolar area could be detected. It was 10.4 and 2.8%, respecti...
Systematic reviews have failed to find evidence that one particular grafting technique is superior to others [10]. Intraoral bone grafts from the mandibular symphysis, mandibular ramus, and maxillary tuberosity provide a good treatment modality for ridge augmentation, and the amount of bone available for harvesting is sufficient for defects up to the width of three teeth [42]. Harvesting of retrom...
Several grafting procedures have been described to create sufficient volume of bone for implant placement [8, 9]. Autologous bone grafts can be harvested by an intraoral approach (mandibular ramus, mandibular symphysis, zygomatic buttress) or from distant sites (iliac crest, calvaria, and etc.) [17, 36, 37]. However, bone harvesting potentially causes donor site morbidity which is a major issue fo...
The average healing period until implant placement after bone harvesting was 4.53 months. Initially, 546 implants in 279 patients were planned. After the healing period, it was possible to place 525 implants in 436 successfully augmented areas in 259 patients. Three hundred implants were inserted in the maxilla and 225 in the mandible. The remaining 21 implants planned for 20 patients could not b...
Regarding intraoperative complications, all sinus membrane perforations were covered with a resorbable collagen membrane (Bio-Gide®, Geistlich Biomaterials, Baden-Baden, Germany) which applied as sealant to overlap the site of perforation prior to insertion of the graft material. These patients were advised to avoid physical stress, blowing their noses, or sneezing for a period of 3 weeks, and n...
No permanent damage to any trigeminal nerves was evident in any of our entire cohort. All cases of postoperative hypoesthesia of the mental, lingual, or infraorbital nerve were just a temporary nature. At the time of implant surgery, none of these patients reported any persisting neural disturbances (Fig. 4).
In eleven patients, hypoesthesia of the mental area was mentioned, and three of them al...
Thirty-eight patients underwent a total of 116 augmentation procedures harvesting from the iliac crest. In 20 patients, a bone graft augmentation of the maxilla and the mandible in combination with bilateral sinus floor augmentations was performed. Eighteen patients had augmentations only in the maxilla, involving bone grafting and sinus lift elevations. Totally, 76 sinus lifts with bone material ...
In six patients, a partial graft resorption was detected at the time of implantation and an additional simultaneous augmentation with bone chips harvested with the Safescraper device (C.G.M. S.p.A., Divisione Medicale META, Italy) was then necessary in order to ensure the osseointegration of the implants. Two out of these six cases had grafts from the crista zygomatico-alveolaris, two from the ram...
A total of 112 sinus floor elevations were performed. In all of the cases, implants were inserted in a two-stage procedure. The donor site for harvesting the bone for the sinus elevations was in 76 procedures in the iliac crest area, and in 36 procedures, the bone was harvested with a bone scraper device from the lateral sinus wall at the site of sinus lifting.
The distribution and number of tran...
Two hundred seventy-nine patients—250 men and 29 women—underwent 456 augmentation procedures involving autologous bone grafts prior to implant placement. The patients ranged in age from 18.5 to 71.5 years (average 43.1 years) at the moment of augmentation surgery.
Of those patients, 162 (58.1%) were younger than 40 years of age and 117 (41.9%) were older than 40 years of age. Caries or pe...
Early and late implant loss was documented in this study, defining the clinical success of osseointegration. Early implant failures were assessed before the acquisition of osseointegration, i.e., before the placement of prosthodontic restorations. Early implant failure could occur from the time of placement, during the healing phase and before abutment connection. The implant inserted after re-aug...
Medical history of patient
Age of patient at the time of bone harvesting and augmentation
History of periodontal disease
Smoking habits
Donor site
Jaw area and dental situation of the recipient site
Intraoperative complications
Postoperative complications after augmentation
Management of complications
Bone graft stability and clinical resorption prior to implant placement
Complications a...
In addition to the bone already gained with the bone scraper device from the sinus wall during the antrostomy, bone was harvested with the same device from the maxillary buccal buttress, if more volume was needed. By taking this approach, the collection of enough bone for the augmentation of at least two implantation sites was feasible with a mean surgical time of 5 to 10 min for harvesting. In c...
Grafting from the iliac crest was always performed under general anesthesia in a two-team approach. The iliac crest was exposed and autogenous grafts from the anterosuperior inner edge of the iliac wing were harvested with an oscillating saw and/or a chisel, keeping a safe distance of around 2 cm from the anterosuperior iliac spine. After harvesting the bone grafts, the corticocancellous bone blo...
A standardized two-stage surgical protocol was used, and all sites were treated in a similar fashion. In the first intervention, a bone block harvested from the donor site was fixed with osteosynthesis titanium screws to the recipient site as an onlay graft to achieve a horizontal and/or vertical enlargement of the alveolar ridge. Placement of the bone graft was always guided by an augmentation te...
For this retrospective cohort study, we reviewed the records of all patients without exclusion criteria who were referred to the department of oral and plastic maxillofacial surgery at the military hospital of Ulm, Germany, between January 2009 and December 2011 for alveolar ridge augmentations prior to implant insertions using autologous bone grafts harvested from different donor sites and unilat...
In our military outpatient center exclusively, autologous bone transplantations harvested from different donor sites were used intraorally (crista zygomatico-alveolaris, ramus mandible, symphysis mandible, anterior sinus wall) and extraorally (iliac crest) to reconstruct severe horizontal and/or vertical alveolar ridge atrophy prior to implant placement. The aim of this study was to assess the cli...
Although the iliac crest is most often used in jaw reconstruction, a significant bone resorption has been mentioned [12]. This disadvantage, and the fact that dental implants do not always require a large amount of bone, has increased the use of autologous block bone grafts from intraoral sources [13]. Bone grafts from intraoral donor sites offer several benefits like surgical accessibility, proxi...
Oral implantation has a significant role in the rehabilitation of patients. Bone reconstruction techniques have been advanced in order to optimize the esthetic and functional outcome. However, the restoration of the oral function of atrophic alveolar crests still remains a challenge in oral implantology. Bone augmentation procedures are often indicated to allow implant placement in an optimal thre...
This review demonstrates the predictability of autologous bone material in alveolar ridge reconstructions prior to implant insertion, independent from donor and recipient site including even autologous bone chips for sinus elevation. Due to the low harvesting morbidity of autologous bone grafts, the clinical results of our study indicate that autologous bone grafts still remain the “gold standar...
This study assessed the clinical outcomes of graft success rate and early implant survival rate after preprosthetic alveolar ridge reconstruction with autologous bone grafts.
A consecutive retrospective study was conducted on all patients who were treated at the military outpatient clinic of the Department of Oral and Plastic Maxillofacial Surgery at the military hospital in Ulm (Germany) in the ...
Fig. 6. Loading of implant off-axially
Fig. 6. Loading of implant off-axially
Fig. 5. Loading of implant axially
Fig. 5. Loading of implant axially
Fig. 4. Installation of strain gauges on surfaces of epoxy resin adjacent to mini implants
Fig. 4. Installation of strain gauges on surfaces of epoxy resin adjacent to mini implants
Fig. 3. Lava Ultimate Restorative crown on the two mini implants.
Fig. 3. Lava Ultimate Restorative crown on the two mini implants.
Fig. 2. Metal crown supported on two mini implants
Fig. 2. Metal crown supported on two mini implants
Fig. 1.
Fig. 1. a Standard, b short-wide, and c single-piece mini implants
Crown
Implant type
Axial
Off-axial
P-value
Mean
SD
...
Axial
Off-axial
P value
Mean
SD
Mean
SD
...
Lava Ultimate
crowns
Metal
crowns
P value
Mean
SD
Mean
...
Load
Crown type
Standard
Short-wide
Double mini
P value
...
Standard
Short-wide
Double mini
P value
Mean
SD
Mean
...
Elfadaly, L.S., Khairallah, L.S. & Al Agroudy, M.A. Peri-implant biomechanical responses to standard, short-wide, and double mini implants replacing missing molar supporting hybrid ceramic or full-metal crowns under axial and off-axial loading: an in vitro study.
Int J Implant Dent 3, 31 (2017). https://doi.org/10.1186/s40729-017-0094-2
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Received: 14 Februar...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
The authors L.S.Elfadaly, L.S.Kheirallah, and M.A.Alagroudy state that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Fixed Prosthodontics, Cairo University, Giza, Egypt
Lamiaa Said Elfadaly, Lamiaa Sayed Khairallah & Mona Atteya Al Agroudy
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Gracis S, Nicholls J, Chalupnik J, Yuodelis R. Shock-absorbing behavior of five restorative materials used on implants. Int J Prosthodont. 1990;4:282–91.
Skalak R. Biomechanical considerations in osseointegrated prostheses. J Prosthet Dent. 1983;49:843–8.
Misch C. Clinical biomechanics in implant dentistry, Contemporary Implant Dentistry. 3rd ed. 2008. p. 543–56. mosby,inc.
Lundgren D, La...
Himmlova L, Dostalova T, Kacovsky A, Konvickova S. Influence of implant length and diameter on stress distribution: a finite element analysis. J Prosthet Dent. 2004;91(1):20–5.
Shetty S, Puthukkat N, Bhat S, Shenoy K. Short implants: a new dimension in rehabilitation of atrophic maxilla and mandible. Journal of Interdisciplinary Dentistry. 2014;4(2):66.
Misch C, Bidez M. Contemporary implant d...
Barbier L, Vander SJ, Krzesinski G, Schepers E, Van der Perre G. Finite element analysis of non-axial versus axial loading of oral implants in the mandible of the dog. J Oral Rehabil. 1998;25(11):847–58.
Saime S, Murat C, Emine Y. The influence of functional forces on the biomechanics of implant-supported prostheses—a review. J Dent. 2002;30:271–82.
Balshi T, Hernandez R, Pryszlak M, Range...
Mazor Z, Lorean A, Mijiritsky E, Levin L. Replacement of a molar with 2 narrow diameter dental implants. Implant Dent. 2012;21(1):36–8.
Atwood D. Postextraction changes in the adult mandible as illustrated by micrographs of midsagittal sections and serial cephalometric roentgenograms. J Prosthet Dent. 1963;13:810–24.
Felice P, Pellegrino G, Checchi L, Pistilli R, Esposito M. Vertical augment...
Within the limitations of this in vitro study, the following conclusions could be drawn:
Implant design, superstructure material, and load direction significantly affect peri-implant microstrains.
The recorded compressive and tensile microstrains for the tested designs were within the physiologic loading range, as they did not exceed the compressive or tensile strength of the bone-implant interf...
Regarding the effect of superstructure material on induced microstrains, generally, different implant designs supporting Lava Ultimate crowns showed higher mean microstrain values(1927.3 ± 1536.6 μɛ), in comparison with those supporting metal crowns (1313.7 ± 973.1 μɛ).Theoretical considerations [44, 45] and in vitro experiments [46,47,48,49] suggest that an occlusal material with ...
Regarding the effect of direction of loading on induced microstrains, it was shown that changing the position of occlusal loading had a considerable effect on the amount of distribution of stresses where axial loading generated even distribution of load around the implant in comparison to off-axial loading where stresses were more pronounced in the area of load application. This might be due to th...
Previous studies have shown that direct correlations exist between microstrain magnitudes and bone stability/instability conditions. This has been summarized by Frost, when bone is loaded below about 2000 microstrains, bone can easily repair what little microdamage occurs. Yet, when pathologic overloading occurs (over 4000 microstrains), stress and strain gradients exceed the physiologic tolerance...
To replace a missing lower molar in compromised ridge, different treatment options were suggested, using either a standard size implant with surgical procedures, short-wide implant, or two mini implants. Concerning the use of mini implant, splinted multiple implants increase the surface area that interfaces with the bone to lessen the per square millimeters of force borne by the bone [11]. The imp...
Results revealed that standard implant showed the statistically significantly highest mean microstrain values (3362.4 ± 757.4 μɛ). Double mini implant showed statistically significantly lower mean microstrain values (801.6 ± 251.4 μɛ), while short-wide implant showed the statistically significantly lowest mean microstrain values (697.6 ± 79.7 μɛ), with a P value
Data were presented as mean and standard deviation (SD) values. Data were explored for normality by checking data distribution and histograms, calculating mean and median values, and finally using Kolmogorov-Smirnov and Shapiro-Wilk tests of normality. Stress data showed non-parametric distribution, so the Kruskal-Wallis test was used to compare between the types of implants. The Mann-Whitney U te...
Each crown was cemented to its corresponding implant-abutment assembly using temporary cement (Cavex Temporary Cement, Cavex, Holland).
Each implant received 4 strain gauges (Kowa strain gages, Japan) placed on the mesial, distal, buccal, and lingual surfaces of the epoxy resin adjacent to the implants. At these selected sites, the thickness of the epoxy resin surrounding each implant was reduced...
In the present study, the following materials were used: titanium root form endosseous implants of standard diameter and length (4-mm platform, 3.8-mm diameter,12-mm length, fixture bevel 0.2 mm, Super Line System, Dentium, USA), short-wide implant (7-mm platform, 5.8-mm diameter, 7-mm length, Super Line System, Dentium, Seoul, Korea) with 1.5-mm machined surface and 5.5-mm threaded surface that ...
There are several factors that affect force magnitudes in peri-implant bone. The application of functional forces induces stresses and strains within the implant prosthesis complex and affect the bone remodeling process around implants [8, 9].
While there are several methods of measuring strain, the most common is with a strain gauge, a device whose electrical resistance varies in proportion to t...
The molars are one of the first teeth to be lost over lifetime; thus, their replacement is frequently needed. Implantation is generally the preferred choice to replace a missing single tooth avoiding vital teeth preparation and bridge fabrication [1].
The mandibular bone loss occurs as knife-edge residual ridge where there is marked narrowing of the labiolingual diameter of the crest of the ridge...
The aim of this study was to evaluate the biomechanical response of the peri-implant bone to standard, short-wide, and double mini implants replacing missing molar supporting either hybrid ceramic crowns (Lava Ultimate restorative) or full-metal crowns under two different loading conditions (axial and off-axial loading) using strain gauge analysis.
Three single-molar implant designs, (1) single, ...
Fig. 5. Survival rate of dental implants after autologous bone augmentation
Fig. 5. Survival rate of dental implants after autologous bone augmentation
Fig. 4. Postoperative nerve alterations. Single asterisk, N refers to the total number of the surgical approaches in the mandible (N = 155). Double asterisk, N refers to the total number of the surgical approaches in the maxilla (N = 225)
Fig. 4. Postoperative nerve alterations. Single asterisk, N refers to the total number of the surgical approaches in the mandible (N = 155). Dou...
Fig. 3. Surgical outcome after autologous augmentation procedures from different donor sites
Fig. 3. Surgical outcome after autologous augmentation procedures from different donor sites
Fig. 2. Survival rate of autologous bone grafts
Fig. 2. Survival rate of autologous bone grafts
Fig. 1. Postoperative complications at the donor and recipient site, N refers to the total number of the donor sites (N = 300), N refers to the total number of the recipient sites (N = 378)
Fig. 1. Postoperative complications at the donor and recipient site, N refers to the total number of the donor sites (N = 300), N refers to the total number of the recipient sites (N = 378)
Postoperative complications
%/procedures (N)
At donor sitea
Wound infection
2.6% (8/300)
At recipient site...
Donor site
Bone grafts (N)/patients (N)
Lateral zygomatic buttress
113/112
Mandibular ramus (retromolar)
...
Patient characteristics
N (%)
Gendera
Male
250 (89.6%)
Female
29 (10.4%)
...
Sakkas, A., Wilde, F., Heufelder, M. et al. Autogenous bone grafts in oral implantology—is it still a “gold standard”? A consecutive review of 279 patients with 456 clinical procedures.
Int J Implant Dent 3, 23 (2017). https://doi.org/10.1186/s40729-017-0084-4
Download citation
Received: 27 February 2017
Accepted: 22 May 2017
Published: 01 June 2017
DOI: https://doi...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
Andreas Sakkas, Frank Wilde, Marcus Heufelder & Alexander Schramm
Institute of Anatomy, Medical Faculty of Leipzig University, Leipzig, Germany
Karsten Winter
Department of Oral and Plastic Maxillofacial Surgery, University Hospit...
The authors thank the patients for their kindness to participate as study cases and the whole medical team at the Bundeswehrkrankenhaus Ulm.
AS participated in its design and coordination, carried out the data selection, and drafted the manuscript, and is the corresponding author. FW participated in its design and coordination and helped in drafting the manuscript. MH participated in its design a...
Semper W, Kraft S, Mehrhof J, Nelson K. Impact of abutment rotation and angulation on marginal fit: theoretical considerations. Int J Oral Maxillofac Implants. 2010;25:752–8.
Wiltfang J, Jätschmann N, Hedderich J, Neukam FW, Schlegel KA, Gierloff M. Effect of deproteinized bovine bone matrix coverage on the resorption of iliac cortico-spongeous bone grafts—a prospective study of two cohorts....
Chiapasco M, Zaniboni M. Clinical outcomes of GBR procedures to correct peri-implant dehiscences and fenestrations: a systematic review. Clin Oral Implants Res. 2009;20:113–23.
Felice P, Pellegrino G, Checchi L, Pistilli R, Esposito M. Vertical augmentation with interpositional blocks of anorganic bovine bone vs. 7-mm-long implants in posterior mandibles: 1-year results of a randomized clinical...
Verdugo F, Castillo A, Moragues MD, Pontón J. Bone microbial contamination influences autogenous grafting in sinus augmentation. J Periodontol. 2009;80:1355–64.
Wiltfang J, Schultze-Mosgau S, Merten HA, Kessler P, Ludwig A, Engelke W. Endoscopic and ultrasonographic evaluation of the maxillary sinus after combined sinus floor augmentation and implant insertion. Oral Surg Oral Med Oral Pathol O...
von Arx T, Buser D. Horizontal ridge augmentation using autogenous block grafts and the guided bone regeneration technique with collagen membranes: a clinical study with 42 patients. Clin Oral Implants Res. 2006;17:359–66.
Levin L, Nitzan D, Schwartz-Arad D. Success of dental implants placed in intraoral block bone grafts. J Periodontol. 2007;78:18–21.
Andersson L. Patient self-evaluation of...
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;22:49–70.
Margonar R, dos Santos PL, Queiroz TP, Marcantonio E. Rehabilitation of atrophic maxilla using the combination of autogenous and allogeneic bone grafts followed by protocol-type prosthesis. J Craniofac Surg. 2010;2...
Schwartz-Arad D, Dori S. Intraoral autogenous onlay block bone grafting for implant dentistry. Refuat Hapeh Vehashinayim. 2002;19:35–9. 77.
Misch CM. Ridge augmentation using mandibular ramus bone grafts for the placement of dental implants: presentation of a technique. Pract Periodontics Aesthet Dent. 1996;8:127–35.
Altiparmak N, Soydan SS, Uckan S. The effect of conventional surgery and pi...
Jensen AT, Jensen SS, Worsaae N. Complications related to bone augmentation procedures of localized defects in the alveolar ridge. A retrospective clinical study. Oral Maxillofac Surg. 2016;20(2):115–22 [Epub ahead of print].
Buser D, Dula K, Hirt HP, Schenk RK. Lateral ridge augmentation using autografts and barrier membranes: clinical study with 40 partially edentulous patients. J Oral Maxill...
The results of the clinical study proves the reliability and low comorbidity of autologous bone grafts in preprosthetic alveolar ridge reconstructions prior to implant insertion. The high graft success rate (95.6%) and the low early implant failure rate (0.38%) in a surveillance of all patients treated in three following years with this technique showing no exclusion and no dropout of any case for...
Data on risk factors based on the original examination and documentation are difficult to assess the adverse effects of variable factors on the surgical prognosis because of the multifactorial genesis of surgical complications [73]. Factors such as gender, age, or smoking habit could be associated with postoperative complications after two-stage dentoalveolar reconstruction with autologous bone gr...
The results of the present study have to take into account the absence of a control group with patients undergoing bone augmentation procedures with bone substitutes (allogen, alloplastic, exogen). Without a comparative group of grafting surgeries using alternative bone material, only limited statements can be made.
However, the excellent surgical outcome of autologous surgical methods providing ...
The use of autologous bone in this study has shown excellent graft survival and success rate (95.6%). This is equal to the results from the studies on implants inserted in reconstructed sites [6, 8, 24]. The early implant survival rate of 99.7% found in the present material is very high comparable to that in the previous systematic reviews after staged horizontal ridge augmentation [9, 10, 22, 62,...
Of the sinus floor elevations performed in this study, 84.8% were defined absolutely successful. Only two of our 72 patients having sinus lift operations could not finally be treated with dental implants. These results are comparable to other studies considering the sinus graft to be a safe treatment modality with few complications [6, 8, 51,52,53]. Raghoebar et al. reported incidences of sinus co...
Postoperative morbidity after mandibular bone harvesting procedures was reported to be mainly related to temporary or permanent neural disturbances involving the inferior alveolar nerve and its branches [19]. In this study, only the incidence of the temporary hypoesthesia of the mandibular and lingual nerve after harvesting from the retromolar area could be detected. It was 10.4 and 2.8%, respecti...
Systematic reviews have failed to find evidence that one particular grafting technique is superior to others [10]. Intraoral bone grafts from the mandibular symphysis, mandibular ramus, and maxillary tuberosity provide a good treatment modality for ridge augmentation, and the amount of bone available for harvesting is sufficient for defects up to the width of three teeth [42]. Harvesting of retrom...
Several grafting procedures have been described to create sufficient volume of bone for implant placement [8, 9]. Autologous bone grafts can be harvested by an intraoral approach (mandibular ramus, mandibular symphysis, zygomatic buttress) or from distant sites (iliac crest, calvaria, and etc.) [17, 36, 37]. However, bone harvesting potentially causes donor site morbidity which is a major issue fo...
The surgical outcome after augmentation and implantation procedures is presented in Fig. 5.
The average healing period until implant placement after bone harvesting was 4.53 months. Initially, 546 implants in 279 patients were planned. After the healing period, it was possible to place 525 implants in 436 successfully augmented areas in 259 patients. Three hundred implants were inserted in the maxilla and 225 in the mandible. The remaining 21 implants planned for 20 patients could not b...
Regarding intraoperative complications, all sinus membrane perforations were covered with a resorbable collagen membrane (Bio-Gide®, Geistlich Biomaterials, Baden-Baden, Germany) which applied as sealant to overlap the site of perforation prior to insertion of the graft material. These patients were advised to avoid physical stress, blowing their noses, or sneezing for a period of 3 weeks, and n...
No permanent damage to any trigeminal nerves was evident in any of our entire cohort. All cases of postoperative hypoesthesia of the mental, lingual, or infraorbital nerve were just a temporary nature. At the time of implant surgery, none of these patients reported any persisting neural disturbances (Fig. 4).
In eleven patients, hypoesthesia of the mental area was mentioned, and three of them al...
Thirty-eight patients underwent a total of 116 augmentation procedures harvesting from the iliac crest. In 20 patients, a bone graft augmentation of the maxilla and the mandible in combination with bilateral sinus floor augmentations was performed. Eighteen patients had augmentations only in the maxilla, involving bone grafting and sinus lift elevations. Totally, 76 sinus lifts with bone material ...
A total of 104 retromolar bone graft procedures in 86 patients were conducted. Twenty-two harvesting procedures were performed for augmentation of the maxilla and 82 for the mandible. Seven retromolar bone grafts (93.2%) in seven single-tooth gap dental regions by seven patients had been lost. Therefore, seven implants could not be inserted in augmented alveolar sites after graft failure. Three of...
In six patients, a partial graft resorption was detected at the time of implantation and an additional simultaneous augmentation with bone chips harvested with the Safescraper device (C.G.M. S.p.A., Divisione Medicale META, Italy) was then necessary in order to ensure the osseointegration of the implants. Two out of these six cases had grafts from the crista zygomatico-alveolaris, two from the ram...
A total of 112 sinus floor elevations were performed. In all of the cases, implants were inserted in a two-stage procedure. The donor site for harvesting the bone for the sinus elevations was in 76 procedures in the iliac crest area, and in 36 procedures, the bone was harvested with a bone scraper device from the lateral sinus wall at the site of sinus lifting.
The distribution and number of tran...
Two hundred seventy-nine patients—250 men and 29 women—underwent 456 augmentation procedures involving autologous bone grafts prior to implant placement. The patients ranged in age from 18.5 to 71.5 years (average 43.1 years) at the moment of augmentation surgery.
Of those patients, 162 (58.1%) were younger than 40 years of age and 117 (41.9%) were older than 40 years of age. Caries or pe...
Early and late implant loss was documented in this study, defining the clinical success of osseointegration. Early implant failures were assessed before the acquisition of osseointegration, i.e., before the placement of prosthodontic restorations. Early implant failure could occur from the time of placement, during the healing phase and before abutment connection. The implant inserted after re-aug...
Medical history of patient
Age of patient at the time of bone harvesting and augmentation
History of periodontal disease
Smoking habits
Donor site
Jaw area and dental situation of the recipient site
Intraoperative complications
Postoperative complications after augmentation
Management of complications
Bone graft stability and clinical resorption prior to implant placement
Complications a...
In addition to the bone already gained with the bone scraper device from the sinus wall during the antrostomy, bone was harvested with the same device from the maxillary buccal buttress, if more volume was needed. By taking this approach, the collection of enough bone for the augmentation of at least two implantation sites was feasible with a mean surgical time of 5 to 10 min for harvesting. In c...
Grafting from the iliac crest was always performed under general anesthesia in a two-team approach. The iliac crest was exposed and autogenous grafts from the anterosuperior inner edge of the iliac wing were harvested with an oscillating saw and/or a chisel, keeping a safe distance of around 2 cm from the anterosuperior iliac spine. After harvesting the bone grafts, the corticocancellous bone blo...
A standardized two-stage surgical protocol was used, and all sites were treated in a similar fashion. In the first intervention, a bone block harvested from the donor site was fixed with osteosynthesis titanium screws to the recipient site as an onlay graft to achieve a horizontal and/or vertical enlargement of the alveolar ridge. Placement of the bone graft was always guided by an augmentation te...
For this retrospective cohort study, we reviewed the records of all patients without exclusion criteria who were referred to the department of oral and plastic maxillofacial surgery at the military hospital of Ulm, Germany, between January 2009 and December 2011 for alveolar ridge augmentations prior to implant insertions using autologous bone grafts harvested from different donor sites and unilat...
In our military outpatient center exclusively, autologous bone transplantations harvested from different donor sites were used intraorally (crista zygomatico-alveolaris, ramus mandible, symphysis mandible, anterior sinus wall) and extraorally (iliac crest) to reconstruct severe horizontal and/or vertical alveolar ridge atrophy prior to implant placement. The aim of this study was to assess the cli...
Although the iliac crest is most often used in jaw reconstruction, a significant bone resorption has been mentioned [12]. This disadvantage, and the fact that dental implants do not always require a large amount of bone, has increased the use of autologous block bone grafts from intraoral sources [13]. Bone grafts from intraoral donor sites offer several benefits like surgical accessibility, proxi...
Oral implantation has a significant role in the rehabilitation of patients. Bone reconstruction techniques have been advanced in order to optimize the esthetic and functional outcome. However, the restoration of the oral function of atrophic alveolar crests still remains a challenge in oral implantology. Bone augmentation procedures are often indicated to allow implant placement in an optimal thre...
This review demonstrates the predictability of autologous bone material in alveolar ridge reconstructions prior to implant insertion, independent from donor and recipient site including even autologous bone chips for sinus elevation. Due to the low harvesting morbidity of autologous bone grafts, the clinical results of our study indicate that autologous bone grafts still remain the “gold standar...
This study assessed the clinical outcomes of graft success rate and early implant survival rate after preprosthetic alveolar ridge reconstruction with autologous bone grafts.
A consecutive retrospective study was conducted on all patients who were treated at the military outpatient clinic of the Department of Oral and Plastic Maxillofacial Surgery at the military hospital in Ulm (Germany) in the ...
Fig. 6. Loading of implant off-axially
Fig. 6. Loading of implant off-axially
Fig. 5. Loading of implant axially
Fig. 5. Loading of implant axially
Fig. 4. Installation of strain gauges on surfaces of epoxy resin adjacent to mini implants
Fig. 4. Installation of strain gauges on surfaces of epoxy resin adjacent to mini implants
Fig. 3. Lava Ultimate Restorative crown on the two mini implants.
Fig. 3. Lava Ultimate Restorative crown on the two mini implants.
Fig. 2. Metal crown supported on two mini implants
Fig. 2. Metal crown supported on two mini implants
Fig. 1. a Standard, b short-wide, and c single-piece mini implants
Crown
Implant type
Axial
Off-axial
P-value
Mean
SD
...
Axial
Off-axial
P value
Mean
SD
Mean
SD
...
Lava Ultimate
crowns
Metal
crowns
P value
Mean
SD
Mean
...
Load
Crown type
Standard
Short-wide
Double mini
P value
...
Standard
Short-wide
Double mini
P value
Mean
SD
Mean
...
Elfadaly, L.S., Khairallah, L.S. & Al Agroudy, M.A. Peri-implant biomechanical responses to standard, short-wide, and double mini implants replacing missing molar supporting hybrid ceramic or full-metal crowns under axial and off-axial loading: an in vitro study.
Int J Implant Dent 3, 31 (2017). https://doi.org/10.1186/s40729-017-0094-2
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Received: 14 Februar...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
The authors L.S.Elfadaly, L.S.Kheirallah, and M.A.Alagroudy state that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Fixed Prosthodontics, Cairo University, Giza, Egypt
Lamiaa Said Elfadaly, Lamiaa Sayed Khairallah & Mona Atteya Al Agroudy
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Felice P, Pellegrino G, Checchi L, Pistilli R, Esposito M. Vertical augment...
Within the limitations of this in vitro study, the following conclusions could be drawn:
Implant design, superstructure material, and load direction significantly affect peri-implant microstrains.
The recorded compressive and tensile microstrains for the tested designs were within the physiologic loading range, as they did not exceed the compressive or tensile strength of the bone-implant interf...
Regarding the effect of superstructure material on induced microstrains, generally, different implant designs supporting Lava Ultimate crowns showed higher mean microstrain values(1927.3 ± 1536.6 μɛ), in comparison with those supporting metal crowns (1313.7 ± 973.1 μɛ).Theoretical considerations [44, 45] and in vitro experiments [46,47,48,49] suggest that an occlusal material with ...
Regarding the effect of direction of loading on induced microstrains, it was shown that changing the position of occlusal loading had a considerable effect on the amount of distribution of stresses where axial loading generated even distribution of load around the implant in comparison to off-axial loading where stresses were more pronounced in the area of load application. This might be due to th...
Previous studies have shown that direct correlations exist between microstrain magnitudes and bone stability/instability conditions. This has been summarized by Frost, when bone is loaded below about 2000 microstrains, bone can easily repair what little microdamage occurs. Yet, when pathologic overloading occurs (over 4000 microstrains), stress and strain gradients exceed the physiologic tolerance...
To replace a missing lower molar in compromised ridge, different treatment options were suggested, using either a standard size implant with surgical procedures, short-wide implant, or two mini implants. Concerning the use of mini implant, splinted multiple implants increase the surface area that interfaces with the bone to lessen the per square millimeters of force borne by the bone [11]. The imp...
Results revealed that standard implant showed the statistically significantly highest mean microstrain values (3362.4 ± 757.4 μɛ). Double mini implant showed statistically significantly lower mean microstrain values (801.6 ± 251.4 μɛ), while short-wide implant showed the statistically significantly lowest mean microstrain values (697.6 ± 79.7 μɛ), with a P value
Data were presented as mean and standard deviation (SD) values. Data were explored for normality by checking data distribution and histograms, calculating mean and median values, and finally using Kolmogorov-Smirnov and Shapiro-Wilk tests of normality. Stress data showed non-parametric distribution, so the Kruskal-Wallis test was used to compare between the types of implants. The Mann-Whitney U te...
Each crown was cemented to its corresponding implant-abutment assembly using temporary cement (Cavex Temporary Cement, Cavex, Holland).
Each implant received 4 strain gauges (Kowa strain gages, Japan) placed on the mesial, distal, buccal, and lingual surfaces of the epoxy resin adjacent to the implants. At these selected sites, the thickness of the epoxy resin surrounding each implant was reduced...
In the present study, the following materials were used: titanium root form endosseous implants of standard diameter and length (4-mm platform, 3.8-mm diameter,12-mm length, fixture bevel 0.2 mm, Super Line System, Dentium, USA), short-wide implant (7-mm platform, 5.8-mm diameter, 7-mm length, Super Line System, Dentium, Seoul, Korea) with 1.5-mm machined surface and 5.5-mm threaded surface that ...
There are several factors that affect force magnitudes in peri-implant bone. The application of functional forces induces stresses and strains within the implant prosthesis complex and affect the bone remodeling process around implants [8, 9].
While there are several methods of measuring strain, the most common is with a strain gauge, a device whose electrical resistance varies in proportion to t...
The molars are one of the first teeth to be lost over lifetime; thus, their replacement is frequently needed. Implantation is generally the preferred choice to replace a missing single tooth avoiding vital teeth preparation and bridge fabrication [1].
The mandibular bone loss occurs as knife-edge residual ridge where there is marked narrowing of the labiolingual diameter of the crest of the ridge...
The aim of this study was to evaluate the biomechanical response of the peri-implant bone to standard, short-wide, and double mini implants replacing missing molar supporting either hybrid ceramic crowns (Lava Ultimate restorative) or full-metal crowns under two different loading conditions (axial and off-axial loading) using strain gauge analysis.
Three single-molar implant designs, (1) single, ...
Fig. 1. The frequency of each training standard covered by CPD courses
Fig. 1. The frequency of each training standard covered by CPD courses
Selection criteria for NHS dental implant therapy
1
People with congenital conditions resulting in deformed and/or missing teeth
2
...
Qualification
Duration (years)
Study mode
Mean tuition fee—per course (£)
CPD (11 verifiable, 2 non-verifiable)
...
Level of qualification
Mean duration (years)
Study mode
Mean tuition fee—per course (£)
FT
...
Dental institutions
BPP University
Cardiff University
Edge Hill University
Faculty of General Dental Practitioners
...
Training Standards in Implant Dentistry, 2016
1
Basic sciences: surgical anatomy, pathological process, bone defects, healing processes
2
...
Kim, N.Y., Stagnell, S. Postgraduate education in dental implantology in the United Kingdom: a review.
Int J Implant Dent 4, 8 (2018). https://doi.org/10.1186/s40729-017-0115-1
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Received: 27 August 2017
Accepted: 28 December 2017
Published: 29 January 2018
DOI: https://doi.org/10.1186/s40729-017-0115-1
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
Author Na Yeoun Kim and Sami Stagnell declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Dover Health Centre Dental Department, Maidson Dieu Road, Dover, CT16 1RH, UK
Na Yeoun Kim
Southampton NHS Treatment Centre, Royal South Hants Hospital, Brinton Terrace, Southampton, Hampshire, SO14 0YG, UK
Sami Stagnell
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Author Na Yeoun Kim and Sami Stagnell state that no funding was received.
Marketsandmarkets. Dental Implants and Prosthetics Market by Type (Implant, Crown, Bridge, Denture, Abutment, Veneer, Inlay, Onlay), Material (Titanium, Zirconium, Ceramic, Porcelain-Fused-to-Metal), Type of Facility (Hospitals, Dental Laboratories) - Forecast to 2021. Available from: http://www.marketsandmarkets.com/Market-Reports/dental-implants-prosthetics-market-695.html [Accessed 16 April 201...
Continuing professional development
Faculty of General Dental Practice (United Kingdom)
General Dental Council
National Health Service
Royal College of Surgeons of England
Training Standards in Implant Dentistry
Universities and Colleges Admissions Services
United Kingdom
Development of FGDP (UK) TSID guidelines has led to a significant improvement in the quality of postgraduate education in Dental Implantology in the UK. However, not all courses are fully compliant with these guidelines, and the provision of mentoring for implant placements also needs to be standardised. Quality-assured training is directly related to patient safety, and therefore, all UK postgrad...
Teaching experience and formal qualifications of speakers were shown to be the most important criterion for quality assurance of the courses, and it is fundamental that more nationally or internationally accredited courses with quality teaching staff become widely available throughout the country. In addition, all courses should have clear aims and learning objectives as well as formal end-of-cour...
This study revealed the variation that exists amongst the postgraduate academic and CPD courses in Dental Implantology in terms of level of qualification, duration, study mode, tuition fee, entry requirements and core modules. The level of qualification ranged from non-verifiable CPD to masters level, and the duration of courses also varied in accordance with the level of qualifications. Most of t...
Due to the design of the study, the data collection was only based on the information available online or in dental journals. This inevitably carried the risk of the information being outdated or exclusion of further details that were available via other methods. This was particularly relevant when reviewing the core modules of the academic courses identified. A considerable number of courses only...
A total of 13 CPD courses were included in this study. The mean duration for CPD courses was 0.94 years, and all courses were delivered in part-time mode. The mean tuition fee per course was £7543.08. Eleven of these courses were verifiable CPD courses, and two courses were providing certificates only, which would be considered as non-verifiable CPD courses. Of 11 institutions who declared that ...
All the academic courses identified from this process were included in this study, and a total of 18 courses were included in the study. The list of ten dental institutions offering postgraduate academic courses in Dental Implantology is shown in Table 2.
There were eight master level courses with three full-time options and five part-time options, and the mean duration of the courses was 2.50 ...
This article aims to evaluate the current standards of the postgraduate education in Dental Implantology in the UK by identifying all postgraduate academic qualifications and CPD courses available in the field of Dental Implantology and comparing their core modules against the FGDP (UK) TSID 2016 guidelines.
Completion of specialist training in another field of dentistry, such as oral surgery, pe...
The global dental implants and prosthetics market is expected to reach USD 12.32 billion by 2021, at a compound annual growth rate of 7.2% from 2016 to 2021 [1]. Although Europe accounted for the largest share of the global dental implants and prosthetics market in 2015 [1], the number of implants placed per 10,000 people in the United Kingdom (UK) is significantly lower than many comparable Europ...
The qualified dentists in the United Kingdom (UK) are not expected to be competent in practising implant dentistry without further training in the subject and there is now greater emphasis on postgraduate training in Dental Implantology. There are three main education pathways at present, yet their training standards vary significantly.
This study aims to identify UK postgraduate academic qualifi...
Beberapa organisasi berikut ini menjadi rujukan sehubungan dengan standar pengujian dan bagaimana cara menyiapkan sampel untuk pengujian implant in vitro, termasuk:
Organization for Standardization (ISO) : Organisasi Standar Internasional
Ente Nazionale Italiano di Unificazione (UNI) : Badan Standar Nasional Italia
British Standards Institute (BSI) : Institut Standar Inggris
Deutsches In...
Gejala/ tanda abses gigi
Abses gigi tidak selalu terasa sakit. Hal ini membuat abses terlambat ditangani. Padahal, ada tanda selain rasa sakit yang bisa dikenali sebagai gejala abses gigi.
Rasa sakit
Alasan penderita abses gigi periksa ke dokter adalah rasa sakit. Penderita bisa terlambat ditangani apabila rasa sakit tidak menyertai abses. Jika Anda mengalami abses tanpa rasa sakit, per...
Tanda & gejala infeksi gigi adalah sebagai berikut:Gigi rasanya sakit bangetSakit gigi berlangsung terus-menerus, bukan hilang timbul hilang timbul.Gigi terasa nyut-nyutanNgilu terasa menusuk-nusukTerasa sakit buat mengunyahGigi jadi sensitif pada suhu panas atau dinginMulut terasa pahitMulut berbau tidak enakBisa disertai demamKelenjar di leher membengkakBadan terasa tidak enakAda bengkak di daer...
Tanda dan gejala periodontitis tahap purwa tidak terasa sakit dan hanya punya sangat sedikit gejala sehingga banyak orang mengabaikannya dan menganggapnya enteng. Akibatnya, banyak orang terlambat mengobati penyakit ini dan datang ke dokter gigi sudah dalam keadaan parah. Senyum sarasTanda dan gejala periodontitis meliputi:Gusi jadi berwarna merah sekali atau merah lembayung, lebih merah daripad...
Tanya:Saya perokok berat selama bertahun-tahun dan cemas kalau-kalau saya mengalami kanker mulut. Apa tanda dan gejala kanker mulut?Jawab:Pendarahan yang tidak dapat dijelaskan sebabnya. Bila terjadi pendarahan di mulut, pastikan Anda tahu penyebabnya. Jika Anda tidak tahu penyebab pendarahan tersebut, maka segera periksakan ke dokter.Bengkak yang tidak dapat dijelaskan.Segera periksakan ke dokte...