Michael Toffler

Bio: Michael Toffler is an academic researcher. The author has contributed to research in topics: Osteotome & Osseointegration. The author has an hindex of 3, co-authored 4 publications receiving 104 citations.

Osteotome-mediated sinus floor elevation using only platelet-rich fibrin: an early report on 110 patients.

Abstract: PURPOSE: This article describes a technique and reports on the early healing for localized sinus augmentation using a crestal approach in combination with an autologous leukocyte- and platelet-rich fibrin (PRF) concentrate. MATERIALS: From November 2008 to January 2010, 138 implants were placed in 110 patients using osteotome-mediated sinus floor elevation (OMSFE) with PRF. RESULTS: The mean residual subantral bone height of the alveolar ridge was 6.6 mm (range, 4-8 mm). The mean increase in the height of implant sites by OMSFE/PRF was 3.4 mm (range, 2.5-5 mm). A variety of 8- to 11.5-mm long (mean length, 10.1 mm) and 3.5- to 6-mm wide (mean width, 4.4 mm) screw-type implants were used. Of the 138 implants that had been placed, 97 have been restored and in function for an average loading time of 5.2 months (range, 1-11 months). The mean healing time for the loaded implants was 4 months until abutment insertion (range, 3-5 months). Three implants failed before loading for an early survival rate of both loaded and unloaded implants of 97.8%. CONCLUSIONS: Early review of the OMSFE/PRF technique presented for localized sinus floor elevation and implant placement demonstrates a high degree of safety and success at sites with 5- to 8-mm residual subantral bone height.

Horizontal Ridge Augmentation Utilizing a Composite Graft of Demineralized Freeze-Dried Allograft, Mineralized Cortical Cancellous Chips, and a Biologically Degradable Thermoplastic Carrier Combined With a Resorbable Membrane: A Retrospective Evaluation of 73 Consecutively Treated Cases From Private Practices

Abstract: Ridge deficiency is an unfortunate obstacle in the field of implant dentistry. Many techniques are available to rebuild the deficient ridge. Some of these techniques are associated with si...

Complications with transcrestal sinus floor elevation: etiology, prevention, and treatment

Abstract: The combination of postextraction ridge resorption [1] and pneumatization of the maxillary sinus [2, 3] often limits the bone available for implant placement in the posterior maxilla. Fortunately, the lateral and transcrestal approaches to sinus floor elevation (SFE) and augmentation can reproduce adequate subantral bone volumes for implant-supported rehabilitation in this region. The lateral window osteotomy (LWO) is the most frequently invoked method, providing ready access to the sinus, significant elevation of the floor, and creation of sufficient bone volume to provide long-term support for implants in the posterior maxilla [4–11]. However, this technique can be quite aggressive and often patients would prefer an option that stresses a less invasive (LI) approach. The LI transcrestal approach for SFE was first suggested by Tatum [12] and later developed as an osteotome technique by Summers [13, 14]. Summers’ boneadded osteotome sinus floor elevation (BAOSFE) procedure uses tapered concave-tipped osteotomes to reposition existing crestal bone under the sinus along with graft materials, elevating the sinus floor and increasing osseous support for the simultaneously placed implant [14] (Figs. 20.1 and 20.2). BAOSFE was recommended for patients with at least 5.0–6.0 mm of residual subantral bone height (RSBH). A number of case series reports [15–21] attest to the success of this procedure, furthering its popularity amongst clinicians. It was originally suggested that grafting material be used in combination with osteotome-mediated sinus floor elevation (OMSFE) to facilitate the postulated

Guided bone regeneration: materials and biological mechanisms revisited.

Abstract: Guided bone regeneration (GBR) is commonly used in combination with the installment of titanium implants. The application of a membrane to exclude non-osteogenic tissues from interfering with bone regeneration is a key principle of GBR. Membrane materials possess a number of properties which are amenable to modification. A large number of membranes have been introduced for experimental and clinical verification. This prompts the need for an update on membrane properties and the biological outcomes, as well as a critical assessment of the biological mechanisms governing bone regeneration in defects covered by membranes. The relevant literature for this narrative review was assessed after a MEDLINE/PubMed database search. Experimental data suggest that different modifications of the physicochemical and mechanical properties of membranes may promote bone regeneration. Nevertheless, the precise role of membrane porosities for the barrier function of GBR membranes still awaits elucidation. Novel experimental findings also suggest an active role of the membrane compartment per se in promoting the regenerative processes in the underlying defect during GBR, instead of being purely a passive barrier. The optimization of membrane materials by systematically addressing both the barrier and the bioactive properties is an important strategy in this field of research.

Role of Platelet rich fibrin in wound healing: A critical review.

Abstract: Aim: The aim is to review and discuss the strategies available for use of platelet rich fibrin as healing aid in dentistry. Background: Platelet rich fibrin (PRF) is a fibrin matrix in which platelet cytokines, growth factors, and cells are trapped and may be released after a certain time and that can serve as a resorbable membrane. Choukroun and his associates were amongst the pioneers for using PRF protocol in oral and maxillofacial surgery to improve bone healing in implant dentistry. Autologous PRF is considered to be a healing biomaterial, and presently, studies have shown its application in various disciplines of dentistry. Materials and Methods: By using specific keywords, electronic search of scientific papers was carried out on the entire PubMed database with custom range of 5 years. The electronic search yielded 302 papers; based on inclusion and exclusion criteria which were specifically predetermined, 72 papers were identified as suitable to the inclusion criteria and the remaining 230 papers were excluded. After adding three more selected papers through hand search, full text of all the articles retrieved and review was done. By pooling the extracted data from selected papers, the reviewed data was synthesized. Conclusion: Recently by showing good promising results with use of the PRF, it has proved to have a good prospect for its use as healing aid in various aspects of the dentistry.

The use of leucocyte and platelet-rich fibrin in socket management and ridge preservation: a split-mouth, randomized, controlled clinical trial.

Abstract: Aim To investigate the influence of the use L-PRF as a socket filling material and its ridge preservation properties. Materials and Methods Twenty-two patients in need of single bilateral and closely symmetrical tooth extractions in the maxilla or mandible were included in a split-mouth RCT. Treatments were randomly assigned (L-PRF socket filling versus natural healing). CBCT scans were obtained after tooth extraction and three months. Scans were evaluated by superimposition using the original DICOM data. Mean ridge width differences between timepoints were measured at three levels below the crest on both the buccal and lingual sides (crest −1 mm (primary outcome variable), −3 mm and −5 mm). Results Mean vertical height changes at the buccal were −1.5 mm (±1.3) for control sites and 0.5 mm (±2.3) for test sites (p < 0.005). At the buccal side, control sites values were, respectively, −2.1 (±2.5), −0.3 mm (±0.3) (p < 0.005) and −0.1 mm (±0.0), and test sites values were, respectively, −0.6 mm (±2.2) (p < 0.005), −0.1 mm (±0.3) and 0.0 mm (±0.1). Significant differences (p < 0.005) were found for total width reduction between test (−22.84%) and control sites (−51.92%) at 1 mm below crest level. Significant differences were found for socket fill (visible mineralized bone) between test (94.7%) and control sites (63.3%). Conclusion The use of L-PRF as a socket filling material to achieve preservation of horizontal and vertical ridge dimension at three months after tooth extraction is beneficial.

Bone Grafts and Substitutes in Dentistry: A Review of Current Trends and Developments.

Abstract: After tooth loss, bone resorption is irreversible, leaving the area without adequate bone volume for successful implant treatment. Bone grafting is the only solution to reverse dental bone loss and is a well-accepted procedure required in one in every four dental implants. Research and development in materials, design and fabrication technologies have expanded over the years to achieve successful and long-lasting dental implants for tooth substitution. This review will critically present the various dental bone graft and substitute materials that have been used to achieve a successful dental implant. The article also reviews the properties of dental bone grafts and various dental bone substitutes that have been studied or are currently available commercially. The various classifications of bone grafts and substitutes, including natural and synthetic materials, are critically presented, and available commercial products in each category are discussed. Different bone substitute materials, including metals, ceramics, polymers, or their combinations, and their chemical, physical, and biocompatibility properties are explored. Limitations of the available materials are presented, and areas which require further research and development are highlighted. Tissue engineering hybrid constructions with enhanced bone regeneration ability, such as cell-based or growth factor-based bone substitutes, are discussed as an emerging area of development.

Regenerative potential of leucocyte- and platelet-rich fibrin. Part B: sinus floor elevation, alveolar ridge preservation and implant therapy. A systematic review.

Abstract: Aim To analyse the effect of Leucocyte- and Platelet Rich Fibrin (L-PRF) on bone regeneration procedures and osseointegration. Materials and Methods An electronic and hand search was conducted in three databases (MEDLINE, EMBASE and Cochrane). Only randomised clinical trials, written in English where L-PRF was applied in bone regeneration and implant procedures, were selected. No follow-up restrictions were applied. Results A total of 14 articles were included and processed. Three subgroups were created depending on the application: sinus floor elevation (SFE), alveolar ridge preservation, and implant therapy. In SFE, for a lateral window as well as for the trans-alveolar technique, histologically faster bone healing was reported when L-PRF was added to most common xenografts. L-PRF alone improved the preservation of the alveolar width, resulting in less buccal bone resorption compared to natural healing. In implant therapy, better implant stability over time and less marginal bone loss were observed when L-PRF was applied. Meta-analyses could not be performed due to the heterogeneity of the data. Conclusions Despite the lack of strong evidence found in this systematic review, L-PRF might have a positive effect on bone regeneration and osseointegration. This article is protected by copyright. All rights reserved.