The surgical management of osseous defects associated with endosteal hydroxyapatite-coated and titanium dental...

As more and more patients choose implant therapies it will be incumbent upon the dentists placing, restoring, and maintaining endosseous implants to be armed with the most current information. There is a need for further research to answer the many significant questions in the management of osseous defects associated with dental implants. Some of these questions include: Which grafting materials yield the greatest repair? If resorbable materials (for example, DFDB) are not replaced by bone, are residual defects and peri-implant tissues similar to those which existed prior to osseous grafting procedures? If so, perhaps the combination of a nonresorbable graft like HA with DFDB may yield the wound-healing potential of both materials; for example, osseoinduction by DFDB and the benefits of a radiographic marker and defect filler provided by HA. Can reintegration occur on previously pathologically exposed implant surfaces? Do biodegradable barriers yield significant GTR, and do they resorb predictably? Is complete detoxification of the infected HA-coated surface possible or necessary for regeneration to occur? Which chemotherapeutic modality detoxifies HA-coated surfaces best clinically and at the histologic level? Or should infected HA coatings be removed before attempting implant repair? Are regenerative techniques (for example, GTR) predictable enough to treatment plan for them when we know there will be residual osseous defects after placing fixtures in their most ideal prosthetic position? If so, what defect types resolve most predictably following surgical correction? Should barriers be used in conjunction with grafting when placing 2-stage blade implants to generate bone in the slot preparation coronal to the shoulder of the blade? It is evident from the growing popularity and acceptance of implant therapies that these and other questions will need to be answered to continue the evolution of the science of this discipline. This author would encourage practitioners to keep abreast of the current research and developments in this field as new techniques, materials, and therapies are in a constant state of flux.