Showing papers in "Journal of Oral Implantology in 2006"
TL;DR: The use of titanium mesh for localized alveolar ridge augmentation with a mixture of autogenous intraorally harvested bone graft and Bio-Oss offered adequate bone volume for placement of dental implants.
Abstract: The use of titanium mesh for localized alveolar ridge augmentation was evaluated by clinical, radiographic, laboratory, and histologic-histomorphometric evaluation. Seventeen patients participated in this study. All patients required localized alveolar ridge augmentation before placement of dental implants. An equal mixture of autogenous bone graft and inorganic bovine mineral (Bio-Oss) was used as a bone graft material. Autogenous bone graft was harvested intraorally. Titanium mesh was submerged for 8.47 months (SD 2.83). Impressions were taken intraorally before bone grafting, 6 months after bone grafting, and 6 months after implant placement. Impressions were used to measure the volume of alveolar ridge augmentation and provide linear laboratory measurements regarding the results of bone augmentation. Bone quality (type II–IV) was recorded during implant surgery. Standardized linear tomographs were taken before bone grafting and before implant placement. A biopsy was harvested with a trephine ...
114 citations
TL;DR: In vitro preparation with the piezoelectric device was more invasive to the bone than was a conventional diamond bur, and touching the inferior alveolar nerve resulted in roughening of the epineurium without affecting deeper structures.
Abstract: An in vitro comparison between a new ultrasound-based piezoelectric device and a conventional bur was performed for lateralization or transposition of the inferior alveolar nerve to evaluate the effects on soft and hard tissue. Transposition of the inferior alveolar nerve was performed in the cadaver mandibles of 10 sheep: the left nerve was uncovered with a saline-cooled diamond-coated spherical bur (2000 rpm), and the right nerve was uncovered with the piezoelectric device mounted with a spherical diamond tip. The surface, the zone of bone defect, and the nerve were examined by light microscopy and laser microscopy. Bone treated with the rotary bur showed significantly smoother surfaces and shallower defect zones (50 μm) in comparison with the piezoelectric device (150 μm). Lesions of the epineurium and an increased amount of bone particles were found in the lesions prepared with the piezoelectric device. In vitro preparation with the piezoelectric device was more invasive to the bone than was ...
98 citations
TL;DR: In the animal study, osseointegration was enhanced when the surface was covered with PRGF as shown by histomorphometry, and clinical use of this technique in oral implantology can improve the prognosis.
Abstract: Preparations of autologous plasma rich in growth factors (PRGF) are used to promote healing and tissue regeneration. We seek to determine whether covering the titanium implant surface with this preparation could enhance osseointegration. The interaction of PRGF with the surface of titanium implants was examined by environmental scanning electron microscopy (ESEM). A total of 23 implants were placed in the tibiae and radii of 3 goats; 13 implants were inserted after covering the surface and filling the alveolus with PRGF, and 10 more implants were inserted following a conventional protocol and served as controls. Histomorphometric analysis of the bone-implant interface was performed after 8 weeks. Finally, 1391 implants were placed in 295 patients after bioactivating the surface with PRGF. Stability and implant survival were evaluated. The implant surface adsorbed the protein-rich material as shown by ESEM. In the animal study, osseointegration was enhanced when the surface was covered with PRGF as shown by histomorphometry (bone-implant contact: 51.28% +/- 4.7% vs 21.89% +/- 7.36%; P < .01). Finally, studies in patients showed that 99.6% of the implants treated with PRGF were well osseointegrated. Clinical use of this technique in oral implantology can improve the prognosis.
95 citations
TL;DR: Evaluating the long-term survival and bone loss of immediate nonfunctional single implant restorations in a group of patients that were monitored for 5 years found immediate nonocclusal loading of single implants is a reliable surgical-prosthetic procedure with a low rate of implant loss and a low quantity of peri-implant bone loss over time.
Abstract: Immediate loading is a surgical-prosthetic procedure extensively used in implant dentistry. Despite its frequent use, minimal data are available on the long-term clinical success rate of immediate functional loading (IFL) and immediate nonfunctional loading (INFL) of implants. The aim of this study was to evaluate the long-term survival and bone loss of immediate nonfunctional single implant restorations in a group of patients that were monitored for 5 years. One hundred and eleven patients (41.4% men) with a median age of 40 years were included in this study. A total of 111 implants were placed. All implants were placed with a minimum insertion torque of 25 Ncm. A temporary restoration was relined with acrylic resin, trimmed, polished, and cemented or screw-retained 1 to 2 hours later. Occlusal contact was avoided in centric and lateral excursions. After provisional crown delivery, a periapical radiograph was performed by means of a customized Rinn holder device. Data were analyzed by means of K...
76 citations
TL;DR: The protocol of MIAMBE results in an excellent success rate, low complication rate, minimal discomfort, and long-term safety and durability, and this clinical approach should be widely employed.
Abstract: The posterior maxillary segment frequently suffers from insufficient bone mass to support dental implants. Current bone augmentation methods, including the lateral maxillary approach (ie, hinge osteotomy) and sinus elevation by osteotome, have many shortcomings. The objective of our study was to assess the safety and efficacy of minimally invasive antral membrane balloon elevation (MIAMBE) followed by bone augmentation and implant fixation (executed during the same procedure). Alveolar crest exposure and implant osteotomy were followed by sequential balloon inflations yielding >10 mm MIAMBE. A mix of autologous fibrin and bone particles with bone speckles was injected beneath the antral membrane. Implants were fixated into the osteotomies, and primary closure was performed during the same sitting. A total of 24 patients were enrolled. Successful conclusion of this procedure was accomplished in 91.6% of the initial 12 patients and 100% in the second dozen cases without significant complications. P...
65 citations
TL;DR: 7 patients with overdentures supported by telescopic crowns who received 65 implants (ITI Straumann) are described, showing the use of telescopic Crowns as attachments for implant-supported overdenture may be a viable treatment option.
Abstract: The use of dental implants to support mandibular or maxillary overdentures is a widely used treatment modality. Advantages are an increase in retention, an increase in chewing ability, and...
47 citations
TL;DR: 2 cases, one in the maxilla and 1 in the mandible, for placement of endosseous dental implants with the use of a new bone-expansion osteotome kit that utilizes a screw-type configuration for bone condensing and expansion are presented.
Abstract: Placement of endosseous dental implants can be a problem due to bone resorption if the patient has been missing teeth for a considerable period of time. In the literature, bone-grafting te...
42 citations
TL;DR: This case report describes a systematic approach to the planning and surgical placement of a single implant-supported crown, utilizing CT-based dental imaging for implant plans and surgical guidance.
Abstract: Computerized tomography (CT)-based dental imaging for implant planning and surgical guidance carries both restorative information for implant positioning, as far as trajectory and distribution, and radiographic information, as far as depth and proximity to critical anatomic landmarks such as the mandibular canal, maxillary sinus, and adjacent teeth. This case report describes a systematic approach to the planning and surgical placement of a single implant-supported crown, utilizing CT-based dental imaging for implant planning and surgical guidance. The simple steps result in the accurate transfer of critical radiographic information to the surgical site.
42 citations
TL;DR: The results of this study show that porous HA can be a suitable synthetic material for bone regeneration in maxillary sinus augmentation procedures.
Abstract: Porous hydroxyapatite (HA) is a calcium-phosphate–based material that is biocompatible, nonimmunological, and osteoconductive, and has a macroporosity of about 200 to 800 μm. The pores see...
40 citations
TL;DR: It was concluded from this study that Ca phosphate can be deposited on Ti surfaces by anodization and the phenotypic expression of osteoblast was enhanced by the presence of Ca phosphate and higher roughness on anodized Ti surfaces.
Abstract: In this study, titanium (Ti) surface was modified by anodizing with a mixture of β-glycerophosphate sodium and calcium (Ca) acetate, and the anodized surfaces were characterized by scanning electron microscopy, X-ray diffraction, and electron probe microanalysis. In vitro osteoblast response to anodized oxide was also evaluated. The anodic oxide produced was observed to have interconnected pores (0.5–2 μm in diameter) and intermediate roughness (0.60–1.00 μm). In addition, anodic oxide was observed to have amorphous and anatase oxide. Calcium and phosphorus ions were deposited on the Ti oxide during anodization. Osteoblast differentiation, as indicated by alkaline phosphatase production, was enhanced on anodized surfaces. It was thus concluded from this study that Ca phosphate can be deposited on Ti surfaces by anodization. It was also concluded that the phenotypic expression of osteoblast was enhanced by the presence of Ca phosphate and higher roughness on anodized Ti surfaces.
36 citations
TL;DR: An estimate of the holding power of these screws is provided and an understanding of early biological healing response associated with self-drilling screws is understood to provide the clinical orthodontist with an estimate.
Abstract: Maxillofacial screws are increasingly being used in orthodontics to provide anchorage for tooth movement. The objective of this study was to determine the biomechanical stability as well as the bone tissue response of screws at 6 weeks postinsertion in a canine model. Seven skeletally mature male dogs received 102 screws (2 × 6 mm or 2 × 8 mm) at predetermined sites. Twenty screws became loose or were lost during the 6-week undisturbed healing period. Forty-eight screws were randomized for mechanical testing and 34 for histology. Peak pullout strength was recorded and ∼80-μm sections were examined for histomorphometric parameters. Statistical analyses were conducted by analysis of variance and Tukey-Kramer method. Mean ± SE peak pullout strengths for the various sites ranged from 153.5 ± 37.6 N to 389.3 ± 32.5 N with no significant (P < .05) differences at immediate placement and 6 weeks postinsertion. Bone contact ranged from 79% to 95%. Histomorphometric analyses indicated higher bone formation...
TL;DR: Concerns that tapered implant designs may be more prone to crestal bone loss than cylinder designs are unsupported by the results of this study.
Abstract: This prospective study evaluated the long-term performance of tapered screw implants placed in patients with a variety of potentially compromising clinical variables. Sixty patients were treated with 218 implants; each case included one or more potential risk factors associated with increased rates of implant failure, peri-implant bone loss or clinical complications in the dental literature: short implants (23%), comorbid conditions (25%), maxillary implants (61%), immediate loading (88.5%), placement into extraction sockets (91%), and partial edentulism (97%). The implants were restored with a variety of prostheses. Marginal bone changes were calculated utilizing periapical radiographs taken at placement and at all subsequent appointments utilizing a standardized paralleling device and a 1-mm measurement grid. Mean clinical follow-up was 67.5 (range: 1–94) months for implants and 60 (range: 15–74) months for prostheses. Four implants failed to integrate and were immediately replaced by wide-diam...
TL;DR: The first longitudinal results of an alumina-zirconia ceramic restorative system for implant-supported, single-tooth replacement in the anterior maxillary jaw with up to 30 months of clinical function are reported on.
Abstract: This study reports on the first longitudinal results of an alumina (70%)-zirconia (30%) ceramic restorative system for implant-supported, single-tooth replacement in the anterior maxillary jaw. Eighteen patients (9 men, 9 women, mean age = 42.4 years) were treated with 22 implants placed into 19 extraction sockets and 3 residual ridges. Eight implants were immediately loaded with nonoccluding provisional prostheses. All implants were definitively loaded with fully occluding ceramic restorations after osseointegration and soft tissue maturation. Patients were monitored from 7 to 30 months (mean = 18.1 months) after loading. All implants osseointegrated and were successfully restored. One case of abutment screw loosening occurred because of patient parafunction (bruxing), and another patient reported chewing pain attributed to malocclusion. Both problems were successfully resolved without further incidence. Within the context of this study, single-tooth replacement in the anterior maxillary jaw was successfully achieved with alumina-zirconia ceramic single-tooth restorations with up to 30 months of clinical function.
TL;DR: This article reports on the surgical treatment and immediate restoration of a patient who received mini implants that were 2.4 mm in diameter, a more conservative form of tooth replacement than conventional fixed partial dentures.
Abstract: Numerous long-term studies have shown that treatment with dental implants can provide edentulous patients with a more stable alternative to complete dentures and partially edentulous patients with a more conservative form of tooth replacement than conventional fixed partial dentures. Until recently, commercially available dental implants have been limited to diameters ranging from 3.0 mm to 7.0 mm. Although this range of diameters has been able to address most clinical needs, partially edentulous patients who could not accommodate a 3.0-mm-diameter implant without damaging adjacent dental structures were excluded from implant therapy. This article reports on the surgical treatment and immediate restoration of a patient who received mini implants that were 2.4 mm in diameter.
TL;DR: The surgical and prosthetic use of very small-diameter dental implants is discussed and such implants can be successfully used in appropriate sites where there is adequate bone density for immediate implant stability and an implant-protected occlusal scheme.
Abstract: A case report is presented where an edentulous mandibular anterior site is restored with very small- or mini-diameter (1.8-mm) dental implants. The surgical and prosthetic use of very small-diameter dental implants is discussed. Such implants can be successfully used in appropriate sites where there is adequate bone density for immediate implant stability and an implant-protected occlusal scheme.
TL;DR: A 2% residual calcium level in human DFDBA appears to significantly enhance osseous wound healing in the rat calvarium, and periodontal patients may benefit from further standardization of human-allograft processing.
Abstract: Demineralized freeze-dried bone allograft (DFDBA), a widely used graft material in periodontal regenerative procedures, is processed with hydrochloric acid in the attempt to expose proteins located within the bone matrixes that are capable of inducing new bone formation. However, the degree of DFDBA demineralization varies between tissue banks, which may have an effect on clinical regeneration. This study uses the critical-sized defect (CSD) model to evaluate the wound-healing response to the residual calcium of donor bone. If the percentage of residual calcium in a graft were demonstrated to significantly enhance wound healing, then periodontal patients may benefit from further standardization of human-allograft processing. Sixty adult, male, Harlan Sprague-Dawley rats (Rattus norvegicus) were randomly and equally divided into 4 test groups (ie, DFDBA at 1%, 2%, and 3% to 6% residual calcium levels and FDBA at 23% residual calcium) and a control group (no allograft). An 8-mm-diameter craniotomy was made in the rat calvarium, and polytetrafluoroethylene membranes with pore sizes of 0.50 microm were placed intracranially and ectocranially. Treatment materials were carefully placed into the CSD with a new sterilized dental amalgam carrier. Tetracycline hydrochloride was injected intraperitoneally for labeling new bone growth, and animals were euthanized 12 weeks postsurgery. As a result, histomorphometric bone fill at 12 weeks showed a statistically significant increase in the 2% DFDBA group as compared to all other groups. The authors conclude that a 2% residual calcium level in human DFDBA appears to significantly (P < or = .05) enhance osseous wound healing in the rat calvarium.
TL;DR: This report attempts to provide an argument for the development of evidence-based research on the utility of CT-image-based information and surgical guidance systems and their effect on outcome in oral implantology.
Abstract: Computerized tomography (CT)-based imaging and surgical guidance carry both radiographic information such as height, density, and width of bone and clinical information such as axis of orientation for a successful prosthodontic result, thus determining the trajectory, depth, and distribution of the implants. The objective of this report is to review the associated literature and recent developments in CT-image–based information and surgical guidance systems. This report attempts to provide an argument for the development of evidence-based research on the utility of such systems and their effect on outcome in oral implantology.
TL;DR: A simple and reliable method to fabricate a retrievable cemented prosthesis is described that combines the advantages of cement- and screw-retained restorations.
Abstract: Retrieval of cemented implant restorations can be difficult for both the patient and the dentist. The method described in this article combines the advantages of cement- and screw-retained restorations. Abutment screws can be easily reached by the screw access channel prepared in the waxing phase; the restoration can be retrieved without destroying the implants and prosthesis. This article describes a simple and reliable method to fabricate a retrievable cemented prosthesis.
TL;DR: The findings of this study compare favorably with published studies and were unexpected in light of the residents' limited clinical experience.
Abstract: Survival rates of multiple implant designs placed in various clinical situations average more than 90%. However, little data have been published on the survival rates of implants placed in dental residency programs. This study reports on the outcome of dental implants placed by first-year general dentistry residents in the University of Florida College of Dentistry–Jacksonville Clinic. The patients for this study received both surgical and restorative implant therapy from 1998 to 2005. A total of 263 patients (147 women, 116 men) were treated with dental implants. On average, a patient was 55.5 years old and received 3 implants. A variety of simple and complex restorative procedures were performed. Advanced general dentistry residents in conjunction with supervisory faculty treated all cases. The cumulative implant survival was 96.6%. Follow-up varied from 6 months to 7 years after placement. Cases included implants not yet loaded as well as implants loaded for 6 years or more. The findings of th...
TL;DR: In this article, the authors evaluated the peri-implant tissues of an immediately loaded blade implant retrieved for abutment fracture after a 20-year loading period and found that bone-to-bone contact was 51% ± 6%.
Abstract: Immediate loading of root-form dental implants has shown promising results and offers treatment cost and convenience advantages to patients. Although blade implants have been immediately loaded for over 2 decades, the ability of this implant design to achieve osseointegration has been debated. The aim of the present study was to histologically evaluate the peri-implant tissues of an immediately loaded blade implant retrieved for abutment fracture after a 20-year loading period. Histologic samples were prepared and examined by light microscope. Compact, cortical, mature bone with well-formed osteons was present at the interface of the implant. Bone-to-implant contact was 51% ± 6%. The histologic data showed that osseointegration was obtained in an immediately loaded blade implant inserted into the mandible, and that mineralized tissues were maintained at the interface over a long period (20 years).
TL;DR: The aim of this study was to see if there were differences in the vascular endothelial growth factor expression, microvessel density (MVD), proliferative activity (MIB-1), and inflammatory infiltrate in the soft tissues around implants with screwed and cemented abutments.
Abstract: Crestal bone loss has been reported to occur around dental implants. Even if the causes of this bone loss are not completely understood, the presence of a microgap between implant and abut...
TL;DR: The data suggest that dental students had the most difficulty determining the correct hue group for unmarked shade tabs, and incorrect responses tended to remain in the same value and chroma range but were selected in a different hue group.
Abstract: Dental students achieved a high identification rate for darker shades (P14 and P24) on the Portrait IPN shade guide, which represent the highest chroma and lowest value in the grayish and reddish yellow hue groups. A high identification rate was also obtained for P32, representing the lowest chroma and highest value in the reddish gray hue group. The data suggest that dental students had the most difficulty determining the correct hue group for unmarked shade tabs. Incorrect responses tended to remain in the same value and chroma range but were selected in a different hue group.
TL;DR: The use of bone morphogenic protein in combination with allogenic bone substitute (Puros) to reconstruct the maxilla in preparation for dental implant placement is described.
Abstract: Reconstruction of the atrophic maxilla is a difficult task. The gold standard for such reconstruction is autogenous bone. Presently, many excellent products are available to the dental surgeon to facilitate alveolar reconstruction in the absence of autogenous bone. This study describes the use of bone morphogenic protein in combination with allogenic bone substitute (Puros) to reconstruct the maxilla in preparation for dental implant placement.
TL;DR: A case report of retrograde peri-implantitis is presented and special emphasis is placed on the management of the condition, and different strategies are critically evaluated.
Abstract: The term retrograde peri-implantitis has been commonly used to describe lesions in the periapical region of dental implants. There are very few reports on this condition, and the exact eti...
TL;DR: The findings of other authors who support the conservative approach to jaw cysts in a young population are discussed, and the concerns that exist in the literature about the ability of osseoconductive graft materials to generate vital bone and achieve implant-to-bone contact are discussed.
Abstract: This paper presents a case of a dentigerous cyst accompanied by a history of inflammation, resorption of the roots of the first molar and the lingual aspect of the distal root of the second molar, and devitalization of the 2 premolars. The treatment option chosen was marsupialization of the cyst, extraction of the involved teeth, endodontic treatment of both premolars, and implant insertion in the area of the first mandibular molar at a later stage. Twelve months postsurgery the area of interest was almost flattened and the radiographic examination revealed total disappearance of the radiolucency. An implant of 15 x 4 mm was inserted in the area of the first mandibular molar. Despite the excellent implant stability achieved, a thin central zone of the defect remained void of bone. After complete excision of soft tissue the defect was filled with an alloplastic bone substitute. Eight months later (20 months postsurgery), the implant was uncovered and the restorative procedure completed. The implant and the crown have been functioning sign and symptom free for 48 months. Marsupialization was preferred instead of enucleation due to (1) proximity of the cyst to the mandibular canal; (2) need for apicectomy of both premolars to gain good access for enucleation; (3) refusal of the patient to undergo a second surgery for bone harvesting; (4) lower probability for postoperative contamination; (5) need of small quantity of bone substitute; (6) easier extraction of the impacted second molar due to its coronal movement. The disadvantages of the treatment were the long healing period and the discomfort of the patient at the early stages of marsupialization. It was judged that the advantages outweighed the disadvantages in this case. We discuss the findings of other authors who support the conservative approach to jaw cysts in a young population, and the concerns that exist in the literature about the ability of osseoconductive graft materials to generate vital bone and achieve implant-to-bone contact.
TL;DR: In this ectopic model, predifferentiation using a combination of vitamin D and ascorbic acid failed to increase subsequent bone formation by implanted cells, and osteogenic potential of predifferentiated and undifferentiated bone marrow-derived, culture-expanded hMSCs was compared.
Abstract: Adult mesenchymal stem cells (MSCs) are used in contemporary strategies for tissue engineering. The MSC is able to form bone following implantation as undifferentiated cells adherent to hydroxyapatite (HA)/tricalcium phosphate (TCP) scaffolds. Previous investigators have demonstrated that human MSCs (hMSCs) can be differentiated to osteoblasts in vitro by the inclusion of vitamin D and ascorbic acid. The aim of this study was to compare the osteogenic potential of predifferentiated and undifferentiated bone marrow-derived, culture-expanded hMSCs adherent to synthetic HA/TCP (60%/40%) following subcutaneous engraftment in severe combined immunodeficiency (SCID) mice. During the final 3 days of culture, cells were grown in Dulbecco's modified Eagle's medium containing 10% fetal calf serum and antibiotics or media containing 25-mM calcium supplementation with vitamin D and ascorbic acid. Four weeks following implantation in SCID mice, scoring analysis of bone formation within the cubes revealed the absence of bone formation in unloaded cubes. Bone formation compared by a qualitative bone index was 7.23% for undifferentiated cells compared to 5.20% for differentiated cells. Minimal resorption was observed at this early time point. In this ectopic model, predifferentiation using a combination of vitamin D and ascorbic acid failed to increase subsequent bone formation by implanted cells. Following implantation of hMSCs adherent to an osteoconductive scaffold, host factors may contribute dominant osteoinductive signals or impose inhibitory signals to control the fate of the implanted cell. Predifferentiation strategies require confirmation in vivo.
TL;DR: This study investigated the bone-to-implant contact (BIC) and osteoconductive capacity (OC) of 6 different implant surfaces after early loading in humans and found that in native bone, the acid-etched surface achieved a higher BIC value than the HA surface, and lowest values were exhibited by the TPS surface.
Abstract: This study investigated the bone-to-implant contact (BIC) and osteoconductive capacity (OC) of 6 different implant surfaces after early loading in humans Two implants with different surfa
TL;DR: A full-scale model produced by multislice helical computerized tomography (CT) was made by using the binder jet method and applied for presurgical diagnosis, surgical simulation, and the production of surgical templates for dental implant treatment.
Abstract: A full-scale model produced by multislice helical computerized tomography (CT) was made by using the binder jet method and applied for presurgical diagnosis, surgical simulation, and the p...
TL;DR: It was hypothesized that the bone functional strain caused by immediate loading correlated well with the collagen fiber organization occurring after both short- and long-term functional healing, and seemed to determine and maintain the collagen Fiber's orientation over a long period.
Abstract: Immediate loading of dental implants offers treatment cost advantages to patients and avoids the functional and psychological problems caused by the wearing of provisional dentures. There is evidence that the amount of transverse collagen fiber orientation in bone is influenced by mechanical stresses and strains. Two osseointegrated dental implants in humans were used in the present study. Two implants inserted in the maxilla were analyzed: 1 short-term implant (implant A) immediately loaded and retrieved after 4 months of loading and 1 long-term implant (implant B) immediately loaded and retrieved after 12 years. We hypothesized that the bone functional strain caused by immediate loading correlated well with the collagen fiber organization occurring after both short- and long-term functional healing. Circularly polarized light (CPL) was used to assess the area fraction extension related to the transverse collagen fiber orientation in the bone matrix. After evaluating a total of 68 digitized imag...
TL;DR: Results of this pilot study suggest that EMD and the type of cell populations present in the implant wound-healing environment may alter the implant-connective tissue interface.
Abstract: We have developed an experimental model to help identify and characterize factors necessary for periodontal connective tissue attachment formation on dental implants. In this pilot study, we report the effect of autogenous periodontal cell grafts, with and without the application of enamel matrix derivative (EMD), on the implant–connective tissue interface. Periodontal ligament (PDL) and gingival connective tissue (GCT) cultures were established from an adult minipig. Implants were placed in osteotomies prepared with exaggerated countersinks that served as recipient sites for autogenous cell grafts in bilateral edentulated posterior mandibular sextants. In addition, 1 side received an application of EMD before placement of the autogenous cell grafts. A bioabsorbable membrane covering the coronal portion of the implants was placed before closure. After 8 weeks, quantitative histomorphometric and qualitative light microscopic analyses revealed that the implants that received gelatin vehicle alone w...