Papers by Michael Toffler
Implant Dentistry, 2010
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I n the moderately to severely atrophic max-illa, trephined cores measuring 3 to 6 mm in height a... more I n the moderately to severely atrophic max-illa, trephined cores measuring 3 to 6 mm in height and 5 to 6 mm in diameter may be apically displaced to facilitate sinus aug-mentation and staged implant placement. The crestal core elevation (CCE) procedure incor-porates specially designed core osteotomes to minimize membrane perforation and the mal-leting force associated with core intrusion. This report reviews the technique, instrumen-tation and indications for CCE and presents two clinical cases clearly demonstrating the efficacy of this less invasive alternative to the more commonly used lateral window osteotomy.
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Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995), 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.
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It was the aim of the present study to clinically evaluate the success of osteotome-mediated sinu... more 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. From August 1995 to February 2003, 276 OMSFE procedures with simultaneous implant placement were completed in 167 patients. 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%. 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. OMSFE procedures can be used predictably for implant placement at sites with moderate vertical deficiencies in the posterior maxilla.
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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 augmenta- tion. 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
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The New York state dental journal, 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.
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Compendium of continuing education in dentistry (Jamesburg, N.J.: 1995)
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.
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Patients with fully or partially edentulous alveolar ridges comprised of markedly reduced bone vo... more Patients with fully or partially edentulous alveolar ridges comprised of markedly reduced bone volume must accept the higher risk of complication, extended treatment duration, and heav-ier financial burden associated with their implant-supported rehabilitation. 1 The clinical challenge is exacerbated by post-extraction ridge resorption and increased pneumatization of the maxillary sinus often creating proximity to both the in-ferior alveolar nerve and antral floor. This reduced residual bone volume fre-quently prohibits the placement of im-plants 10 mm in length or longer without invoking ridge augmentation, 2,3 sinus floor elevation, 4-6 alveolar osseosdistrac-tion, 7 or nerve transpositioning 8 proce-dures. As a less invasive alternative, the placement of short implants (9 mm or less) often minimizes or obviates the need for more extensive surgery, reduc-ing treatment duration, morbidity, and associated costs. In this article, five cases are presented that clearly demonstrate the ...
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The New York state dental journal, 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.
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Practical procedures & aesthetic dentistry : PPAD
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.
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Practical procedures & aesthetic dentistry : PPAD, 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.
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P latelet-rich fibrin (PRF), developed in France by Choukroun et al (2001), is a second gen-erati... more P latelet-rich fibrin (PRF), developed in France by Choukroun et al (2001), is a second gen-eration platelet concentrate widely used to accelerate soft and hard tissue healing. Its advan-tages over the better known platelet-rich plasma (PRP) include ease of preparation/application, min-imal expense, and lack of biochemical modification (no bovine thrombin or anticoagulant is required). PRF is a strictly autologous fibrin matrix containing a large quantity of platelet and leukocyte cytokines. Abstract KEY WORDS: Platelet rich fibrin, platelet rich plasma, autologous growth factors
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Implant Dentistry, 2010
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Journal of Oral Implantology, 2010
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Papers by Michael Toffler