A Comparative Study Of Mineralized Bone Allografts Versus Xenografts In Atrophic Human Maxillary Sinuses

The placement of dental implants in the posterior maxilla can sometimes be complicated due to the loss of bone below the maxillary sinuses. This is very common after maxillary molars have been lost or extracted and no bone preservation procedures provided at the time of extraction. Sinus graft/lift procedures are then necessary in order to create a proper foundation for implant placement. This article, published in June 2010 pp 47-60 in the Journal of Implant and Advanced Clinical Dentistry (www.JIACD.com)compares the amount of new bone formation and residual graft material when mineralized human dried bone (allografts) are used versus bovine bone (xenografts) are utilized to increase bone volume in maxillary sinus.  Sammy Noumbissi DDS MS

Clinical And Histologic Evaluation Of A Mineralized Bone Allograft (Puros) In Human Maxillary Sinuses

This study was conducted by Dr. Noumbissi in 2000 and published in the Journal od oral Implantology in 2005. This project was part of Dr. Noumbissi thesis project while in training in dental implantology at Loma Linda University’s Graduate Program in Implant Dentistry in California.

This evaluation of one 100% mineralized bone allograft was the first of  its kind and the results were groundbreaking. An allograft is bone harvested from another individual of the same species, that means in this case that the material used was human bone.This article  is often referenced in implant publications by other authors. It is also widely quoted by lecturers and speakers around the world.

Please follow this link to read the article: Noumbissi et al Article JOI

Clinical Histologic, Histomorphometric Evaluation of Mineralized Solvent-Dehydrated Bone Allograft (Puros) …

Ultrasonic Bone Surgery


This state of the art technology is also commonly called Piezosurgery and it has revolutionized surgery in medicine and oral implant surgery. The Sonic Surgeon 300 is an ultrasonic surgery uses precisely controlled, three-dimensional ultrasonic vibrations to cut bone without damaging surrounding tissues; in other words surgical procedures can now be performed with minimal trauma to soft tissue (gums), sinus membrane or nerves. This means that loss of blood is greatly reduced, post surgery discomfort minimal and in some cases eliminated. The Ultrasonic bone surgery is used at our office for a great variety of clinical applications, including: sinus lift, ridge augmentation, bone grafting, bone harvesting, tooth extraction, root extraction, implant site preparation, implant placement with virtually no damage to soft-tissue and nerves. This is a great benefit to patients because its use allows for less inflammation and faster healing.

Dental Implants

When a tooth is lost the specialized bony process that houses the tooth begins to resorb due to lack of stimulation. This causes a decrease in width and height of the bone in the area the tooth is lost. Neighboring teeth and opposing teeth begin to move into the space. This causes food lodgment, subsequent decay, gum disease and abnormal forces being transmitted to teeth leading to fracture of cusps which may necessitate root canal treatment or extraction. Loss of teeth can also cause the cheek and lips to collapse giving an aged look.

The consequences of tooth loss can be prevented by replacing the lost tooth in a timely manner. Although there are several options to replace a missing tooth the number one choice for replacing lost teeth are dental implants. Implants are tiny titanium screws or posts that are surgically placed in the bone. Once integrated into bone they act like roots onto which small posts are attached which protrude through the gums. These posts provide stable anchors to the replacement teeth. Implants maintain the bone height by stimulation and prevents unnecessary trimming of adjoining teeth for bridge placement. Since implants are titanium posts there is no chance for decay on implants. Implants can service you for several years with regular professional cleaning and proper home care.

Many people who are missing a single tooth opt for a fixed bridge; but a bridge may require the cutting down of healthy, adjacent teeth that may or may not need to be restored in the future. Then there is the additional cost of possibly having to replace the bridge once, twice or more over the course of a lifetime due to decay or gum problems affecting the anchor teeth.

Another option to replace missing teeth is a removable partial denture or complete denture depending on the number of teeth missing. The chewing efficiency with a denture is reduced to more than half of that of natural teeth. The teeth that support the partial denture are weakened due to the excessive loads acting on them and eventually are lost. The denture rests on the gum causing tissue abrasion and bone loss. Removable dentures may slip or cause embarrassing clicking sounds while eating or speaking.

Studies show that within five to seven years there is a failure rate of up to 30% in teeth located next to a fixed bridge or removable partial denture.

Who is a candidate for Implants?

Anyone who is missing one or several teeth is a candidate for implants. With the exception of growing children, dental implants are the solution of choice for people of all ages, even those with the following health concerns:

Existing Medical Conditions: If you can have routine dental treatment, you can generally have an implant placed. While precautions are advisable for certain conditions, patients with such chronic diseases as high blood pressure and diabetes are usually successful candidates for dental implant treatment.

Gum Disease or Problem Teeth: Almost all implants placed in patients who have lost their teeth to periodontal disease or decay has been successful.

Currently Wearing Partials or Dentures: Implants can replace removable bridges or dentures, or they can be used to stabilize and secure the denture, making it much more comfortable.

Smokers: Although smoking lowers the success rate of implants, it doesn’t eliminate the possibility of getting them.

Bone Loss: Bone loss is not uncommon for people who have lost teeth or had periodontal disease. Oral and maxillofacial surgeons are trained and experienced in grafting bone to safely and permanently secure the implant.

Implant tooth replacement in children is usually deferred until their jaw growth is complete. There are, however, some instances when a dental implant may be appropriate, such as when it is part of the child’s orthodontic treatment plan. Your family dentist or orthodontist can guide you in this instance.


Dental Implant placement usually takes two surgical appointments:

During the first surgical appointment the implant site is prepared to receive the implant following strict aseptic procedures. The selected size of the implant is placed in the prepared site. The gum tissue is sutured over the implant. The implant takes 4- 6 months to fuse with the bone.

During the second surgical appointment the implant is uncovered and the appropriate post is attached to which the replacement tooth is anchored. An impression of the post is taken and sent to the lab for the fabrication of the implant crown. During this time a temporary crown is placed. Once the final crown is back it is cemented with permanent cement.

Cosmetic Care

My old fillings in the front have turned dark, can they be bleached?

Unfortunately, dental bondings, composite resin fillings (tooth colored fillings) and old crowns cannot be bleached. Fillings that have discolored indicate that they are either leaking or have secondary decay, so it is best to replace them. A better choice may be to replace them with porcelain laminate/veneers for longer lasting results. Remember; only replace these fillings after bleaching in order to match the new improved color of your teeth. “How long does bleaching or laser teeth whitening really last?” It depends on many factors including your diet, the original color of your teeth, and your personal habits like smoking, drinking red wine, etc. Also darker teeth will need more than one whitening session to achieve the desired result. What’s most important is what you do for maintenance. Professional office visits are not enough. You must incorporate an effective maintenance regimen at home such as using whitening toothpaste which is specifically designed to non-abrasively remove surface stains like coffee, tea, tobacco and red wine, as well as remove plaque and bacteria. Also use the touch up kit given by your dentist to keep bleached teeth at their whitest.

I have one dark tooth in the front. Will regular at-home bleaching makes it lighter?

First of all, the cause of the dark tooth must be determined. It could be due to an earlier trauma to the tooth or previous root canal treatment. In such a case external teeth whitening treatments may not help. Your dentist may try internal bleaching which may take several sessions. If not, consider dental bonding, porcelain veneers, or capping the tooth to mask the darkness.

Will my teeth be sensitive following Bleaching?

Teeth may be sensitive during the week following the in–office bleaching. This can be dramatically reduced by using Sensodyne toothpaste to brush your teeth the week prior to and the week following the bleaching process. Also, your dentist may recommend fluoride treatment following the bleaching process.

What’s the difference between dental bonding and porcelain veneers?

Dental bonding is a plastic tooth colored (composite) resin material that is molded onto your teeth and hardened with a blue light. It is usually done in one visit. Little tooth reduction and usually no anesthesia is required.

The disadvantages of dental bonding are:

1. They stain over time, may chip and may need to be replaced more often.

2. Porcelain veneers are thin layers of stacked porcelain that are fabricated in the lab and bonded to teeth.

3. It usually takes 2 visits. Little tooth reduction and some anesthesia are required.

4. Porcelain veneers are stronger than dental bondings and less prone to staining.

I have a space between my two front teeth. How can it be closed?

There are several ways to correct it. Your Dentist may advice Dental Bondings, Veneers or Orthodontics. Again, seek the advice of your dental health professional to choose the procedure that’s best for you.

If I require fillings, what type should I get?

In the past, Silver or amalgam fillings were extensively used. They are not tooth colored, stain teeth over time and healthier tooth structure may have to be removed to retain them since they do not bond to your teeth. Also, since they are a alloy of silver with mercury, there is a risk of mercury poisoning. Now, depending on the extent of decay and amount of tooth structure that is lost, your dentist may advice composite (tooth colored fillings) or porcelain inlays or onlays. Since tooth colored fillings bond to your teeth, there is no need for removal of healthy tooth structure.

I have a “gummy” smile… can anything be done?

With the advent of laser dentistry, this can be done very easily and painlessly in most cases. Tissue sculpting (gingivectomy) is done in adjunct to any required cosmetic work to achieve beautiful, healthy smile.