dr toffler - Academia.edu (original) (raw)

Papers by dr toffler

PubMed, Mar 1, 1999

Welcome to the dark side of implant reality: complications, esthetic, prosthetic and implant fail... more Welcome to the dark side of implant reality: complications, esthetic, prosthetic and implant failures, accompanied by personal and patient disappointments. Information on the "implant experience" gained personally and through communication with colleagues has been distilled into a dosage format to aid in reducing the more stressful aspects of implant dentistry.

John Wiley & Sons, Inc. eBooks, Oct 17, 2015

PubMed, Mar 1, 2014

Two of the fundamental requisites for guided bone regeneration (GBR) are space maintenance and pr... more Two of the fundamental requisites for guided bone regeneration (GBR) are space maintenance and primary soft-tissue closure. Allogeneic cortical bone pins measuring 2 mm in diameter in customized lengths can protect surrounding graft materials, support bioresorbable membrane barriers, and resist wound compression from the overlying soft tissues. In addition, a second-generation platelet concentrate, leukocyte- and platelet-rich fibrin (L-PRF), may be incorporated into the augmentation procedure to provide multiple growth factors, accelerate wound healing, and aid in the maintenance of primary closure over the grafted materials. Highlighting two case reports, this article features a GBR technique that uses bone pins in combination with L-PRF membranes to provide both horizontal and vertical ridge augmentation at severely compromised implant sites.

PubMed, Jun 1, 2006

Edentulous sites in the posterior maxilla are often compromised by reduced bone volume, prohibiti... more Edentulous sites in the posterior maxilla are often compromised by reduced bone volume, prohibiting the placement of 10-mm implants without sinus augmentation. The use of shorter implants minimizes the need for more extensive sinus floor elevation, thus reducing treatment duration and morbidity. Two implant designs are presented in combination with localized internal sinus floor elevation to restore the posterior maxilla. This simplified treatment modality can make implant rehabilitation of the atrophic posterior maxilla more accessible and more palatable to even the most reluctant patients and referring doctors.

PubMed, Sep 1, 2001

Implant placement in the posterior maxilla is often compromised by reduced bone quality and limit... more Implant placement in the posterior maxilla is often compromised by reduced bone quality and limited bone height beneath the sinus floor. Techniques have been developed using osteotomes to improve localized bone density through osteocompression and provide for additional implant length through apical alveolar displacement. The clinical indications and proposed limitations for these procedures are presented along with the biologic rationale based on relevant literature. The author cites his personal experience with osteotome procedures and presents procedural modifications to aid in simplifying staged sinus elevation. Localized internal sinus elevation may represent a more conservative approach to treat the deficient posterior maxilla, but at present the histologic and clinical comparisons to the traditional lateral sinus elevation are lacking.

PubMed, Feb 21, 2003

Staged sinus floor elevation allows predictable implant placement in the severely deficient poste... more Staged sinus floor elevation allows predictable implant placement in the severely deficient posterior maxilla. An alternative to the most commonly used lateral window approach involves the apical displacement of crestal core(s) using osteotomes and a composite graft. Crestal core elevation (CCE) incorporates specially designed osteotomes to minimize the incidence of membrane perforation and placement of a barrier membrane over the core osteotomy. This article presents the technique and instrumentation, as well as documentation of 43 patients demonstrating the efficacy of this modality.

PubMed, Nov 1, 2004

Osteotome techniques are used as a less invasive alternative to the lateral window osteotomy to i... more Osteotome techniques are used as a less invasive alternative to the lateral window osteotomy to increase the volume of bone in the posterior maxilla. Implants may be placed simultaneously for four to six months after performing osteotome-mediated sinus floor elevation, depending upon the residual crestal bone remaining beneath the sinus floor. This article describes the clinical indications and techniques for localized internal sinus elevation using osteotomes. The incorporation of this minimally invasive crestal approach to sinus augmentation into the clinical practice results in increased case acceptance with reduced treatment duration, trauma and cost.

PubMed, Apr 23, 2004

Purpose: It was the aim of the present study to clinically evaluate the success of osteotome-medi... more Purpose: It was the aim of the present study to clinically evaluate the success of osteotome-mediated sinus floor elevation (OMSFE) using autogenous and xenogenic bone and a variety of screw-type implants. Materials and methods: From August 1995 to February 2003, 276 OMSFE procedures with simultaneous implant placement were completed in 167 patients. Results: The mean residual bone height (RBH) of the alveolar ridge was 7.1 mm (range 3 to 10 mm). The mean increase in height of the implant sites using osteotome techniques was 3.8 mm (range 2 to 7 mm). Of the 276 implants placed, 240 had been loaded for an average of 27.9 months (range 1 to 84 months). There were a total of 18 failures: Ten implants failed to integrate, 3 implants were lost within the first 18 months of loading, 1 implant fractured after 3 years in function, and 4 implants demonstrated excessive bone loss. The overall survival rate was 93.5%. When only sites with an RBH of 4 mm or less were considered, the survival rate dropped to 73.3%. Small tears in the schneiderian membrane were clinically assessed at 13 sites, for a detectable perforation rate of 4.7%. Discussion: The primary determinant in implant survival with OMSFE procedures was the height of the residual alveolar ridge. Implant design, graft material, and the method of sinus floor infracture (direct or bone-cushioned) exerted minimal influence on survival outcome; however, factors such as edentulism, osteoporosis, and an overdenture prosthesis were shown to negatively influence postloading survival of implants placed in areas of limited RBH. Conclusion: OMSFE procedures can be used predictably for implant placement at sites with moderate vertical deficiencies in the posterior maxilla.

Implant Dentistry, Oct 1, 2010

Practical procedures & aesthetic dentistry : PPAD, 2006

PURPOSE It was the aim of the present study to clinically evaluate the success of osteotome-media... more PURPOSE It was the aim of the present study to clinically evaluate the success of osteotome-mediated sinus floor elevation (OMSFE) using autogenous and xenogenic bone and a variety of screw-type implants. MATERIALS AND METHODS From August 1995 to February 2003, 276 OMSFE procedures with simultaneous implant placement were completed in 167 patients. RESULTS The mean residual bone height (RBH) of the alveolar ridge was 7.1 mm (range 3 to 10 mm). The mean increase in height of the implant sites using osteotome techniques was 3.8 mm (range 2 to 7 mm). Of the 276 implants placed, 240 had been loaded for an average of 27.9 months (range 1 to 84 months). There were a total of 18 failures: Ten implants failed to integrate, 3 implants were lost within the first 18 months of loading, 1 implant fractured after 3 years in function, and 4 implants demonstrated excessive bone loss. The overall survival rate was 93.5%. When only sites with an RBH of 4 mm or less were considered, the survival rate ...