Dan Holtzclaw

ABSTRACT: Introduction: To date, no study has compared success rates between different dental implant systems when utilized for the All-On-4 treatment concept. The aim of this retrospective analysis is to evaluate the outcomes of patients treated with the All-On-4 concept using a variety of dental implant systems. Materials and Methods: A retrospective chart review encompassing the dates July 2009 to January 2015 was performed in three private periodontal offices to assess the results of… Show more

ABSTRACT: Introduction: To date, no study has compared success rates between different dental implant systems when utilized for the All-On-4 treatment concept. The aim of this retrospective analysis is to evaluate the outcomes of patients treated with the All-On-4 concept using a variety of dental implant systems. Materials and Methods: A retrospective chart review encompassing the dates July 2009 to January 2015 was performed in three private periodontal offices to assess the results of patients treated with the All-On-4 treatment concept. Discussion: A total of 384 arches were treated, utilizing 1,704 dental implants from 4 different dental implant systems in 289 patients. Cumulative dental implant survival rate was 99.00% with an overall prosthetic survival rate of 100%. Conclusion: The All-On-4 treatment concept allows for predictable immediate full arch function and can be accomplished with a variety of dental implant systems. Show less

ABSTRACT: Schneiderian membrane perforation is the most common complication of maxillary sinus augmentation procedures and has been associated with a variety of post-surgical problems. Multiple techniques to repair perforated Schneiderian membranes have been reported in dental literature with materials such as connective tissue, buccal fat pads, and resorbable collagen membranes. While these reparative options have proven successful, they are technique sensitive and time consuming. The aim of… Show more

ABSTRACT: Schneiderian membrane perforation is the most common complication of maxillary sinus augmentation procedures and has been associated with a variety of post-surgical problems. Multiple techniques to repair perforated Schneiderian membranes have been reported in dental literature with materials such as connective tissue, buccal fat pads, and resorbable collagen membranes. While these reparative options have proven successful, they are technique sensitive and time consuming. The aim of this case series is to present a simplified method of Schneiderian membrane perforation repair with amnion-chorion membranes and results obtained from nine cases utilizing this technique. A consecutive retrospective record review was performed of all maxillary sinus augmentation cases performed during the past five years by a board certified private practicing periodontist. Seventy seven cases were identified with a total of 104 sinus augmentations, of which nine perforations were noted. None of the perforation cases were aborted mid-procedure and all perforations were repaired with amnion-chorion membranes. All cases were augmented with a combination of allograft and xenograft particulate bone. After an average healing time of 4.9 months, dental implants were placed in the grafted sinuses. This retrospective case series showed nine perforations during 104 lateral window maxillary sinus augmentation procedures. A total of 23 dental implants were placed in the augmented sinuses with perforated Schneiderian membranes and a one failure was noted according the Albrektsson success criteria. A total of 158 dental implants were placed in non-perforated augmented sinuses with a total of three failures noted. Show less

ABSTRACT: Background: Schneiderian membrane perforation is the most common complication of maxillary sinus augmentation and has been associated with a variety of post-surgical problems including infections, failed grafts, and grafts of inadequate magnitude to facilitate the placement of dental implants. The effects of perforated Schneiderian membranes can be somewhat mitigated through repair with a variety of different membrane materials. A number of studies have presented data comparing dental… Show more

ABSTRACT: Background: Schneiderian membrane perforation is the most common complication of maxillary sinus augmentation and has been associated with a variety of post-surgical problems including infections, failed grafts, and grafts of inadequate magnitude to facilitate the placement of dental implants. The effects of perforated Schneiderian membranes can be somewhat mitigated through repair with a variety of different membrane materials. A number of studies have presented data comparing dental implant success with repaired Schneiderian membranes to non-perforated membranes, but no studies have shown a direct split-mouth comparison within a single subject. The following Case Report shows a single patient who received bilateral maxillary sinus lifts in which one side was unintentionally perforated and repaired with amnion-chorion barrier while the other side was non-perforated. Complications, implant survival, clinical, and radiographic healing comparisons are presented and discussed. Methods: In a single patient, bilateral maxillary sinus lifts were performed via the lateral window method. Both sinuses were treated in the same exact fashion. During instrumentation for sinus membrane elevation, the right sinus membrane was unintentionally perforated and repaired with an amnion-chorion barrier while the left sinus membrane was not perforated. Both sinuses were then grafted with a combination of bone xenograft/allograft and the lateral windows were covered with amnion-chorion membranes. After four months of healing, a cone beam computed tomography scan was utilized to assess the results of healing and plan a guided dental implant surgery. Following placement of dental implants, the case was immediately loaded with a transitional prosthesis for four months and ultimately restored Show less

Abstract


CONTEXT:

The question that clinicians face is whether the use of bone replacement grafts and/or barrier membranes enhance their ability to provide for the future placement of a dental implant or to maximize ridge dimensions following the extraction of a tooth versus no additional treatments.

EVIDENCE ACQUISITION:

The evidence was obtained by search of Entrez PubMed and manual search of The International Journal of Oral and Maxillofacial Implants, The… Show more

Abstract


CONTEXT:

The question that clinicians face is whether the use of bone replacement grafts and/or barrier membranes enhance their ability to provide for the future placement of a dental implant or to maximize ridge dimensions following the extraction of a tooth versus no additional treatments.

EVIDENCE ACQUISITION:

The evidence was obtained by search of Entrez PubMed and manual search of The International Journal of Oral and Maxillofacial Implants, The International Journal of Periodontics & Restorative Dentistry, Clinical Oral Implant Research, The Journal of Periodontology, The Journal of Clinical Periodontology, and The Compendium of Continuing Education in Dentistry. Key search words included Guided Bone Regeneration, Dental Extraction, Tooth Extraction, Bone Replacement Graft, Alveolar Ridge. The years of search included from January 2011 through February 2012.

EVIDENCE SYNTHESIS:

The recurring theme was that there was considerable heterogeneity to study designs, time periods, and methods of evaluation. This created great difficulty in trying to answer with good high-quality evidence questions about the techniques and materials to be used for maximizing regeneration at the time of tooth extraction or in which situations this ought to be used.

CONCLUSIONS:

There appears to be consensus from the reviewed literature supporting ridge preservation techniques as a whole. Multiple studies demonstrated less ridge resorption occurring when alveolar ridge preservation procedures were used versus the placement of no graft material in fresh alveolar sockets. The analysis did not show any grafting materials demonstrating a clear benefit over any others or that a barrier membrane is necessary. The evidence is also too premature about whether socket preservation efforts require primary closure. In the emerging area of growth factors, there is no high-quality evidence to either support or refute their use.

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Abstract


Although every effort is made to place dental implants in a proper position, the restorative dentist does not always succeed. Historically, treatment options for poorly placed implants included removing the implant or leaving it "sleeping." Recent modifications of an existing technique, the segmental osteotomy, may offer hope in these situations by rendering many of these "hopeless" implants salvageable. This paper presents lessons learned from a series of cases in which… Show more

Abstract


Although every effort is made to place dental implants in a proper position, the restorative dentist does not always succeed. Historically, treatment options for poorly placed implants included removing the implant or leaving it "sleeping." Recent modifications of an existing technique, the segmental osteotomy, may offer hope in these situations by rendering many of these "hopeless" implants salvageable. This paper presents lessons learned from a series of cases in which segmental osteotomies were performed to improve the esthetic outcome of implant malpositioning. Two clinical cases (one successful, one failed) utilizing segmental osteotomy to surgically correct malposed implants are presented with a review of the literature associated with the technique. With adherence to proper case selection and detailed surgical protocol, segmental osteotomy is a viable treatment option to correct misaligned dental implants.
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Abstract
BACKGROUND: Reconstruction of alveolar defects in the posterior edentulous mandible can be a difficult task. In addition to complicating anatomic features, such as the inferior alveolar nerve, mental foramen, oblique ridge, and lingual undercut of the mylohyoid ridge, edentulous ridges in the posterior mandible have thicker cortices and decreased volumes of vascular trabecular bone than their maxillary counterparts. Traditionally, these areas have been treated with autogenous block… Show more

Abstract
BACKGROUND: Reconstruction of alveolar defects in the posterior edentulous mandible can be a difficult task. In addition to complicating anatomic features, such as the inferior alveolar nerve, mental foramen, oblique ridge, and lingual undercut of the mylohyoid ridge, edentulous ridges in the posterior mandible have thicker cortices and decreased volumes of vascular trabecular bone than their maxillary counterparts. Traditionally, these areas have been treated with autogenous block grafts. Significant resorption of these grafts, in combination with patient morbidity at secondary donor sites, has led clinicians to seek alternatives for augmenting the edentulous posterior mandible. The aim of this retrospective consecutive case series is to report on both the technique of the piezoelectric hinge-assisted ridge split procedure for augmenting these sites and the results that were achieved.

METHODS: Thirteen patients with 17 horizontal alveolar ridge deficiencies of the posterior mandible were treated with the piezoelectric hinge-assisted ridge split procedure. After an average healing period of 14 weeks, dental implants were placed into the augmented sites. Intrasurgical alveolar ridge measurements taken at the initial surgery and subsequently at the time of implant placement documented the horizontal gains achieved by this procedure.

RESULTS: Overall mean gain in horizontal width was 4.03 mm (± 0.67). For single implant-site augmentations, the mean gain was 3.38 mm (± 0.25). For multiple adjacent implant-site augmentations, mean gain was 4.25 mm (± 0.62). A total of 31 dental implants were successfully placed in all sites and none required additional augmentation procedures. There were no instances of adverse outcomes, such as neurosensory deficits or sequestration of mobilized buccal plates. After a minimum of 6 months of loading, all dental implants have been successful.

CONCLUSIONS: This retrospective observational [truncated for brevity]

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Abstract
PURPOSE: This article describes a technique and reports on the early healing for localized sinus augmentation using a crestal approach in combination with an autologous leukocyte- and platelet-rich fibrin (PRF) concentrate.

MATERIALS: From November 2008 to January 2010, 138 implants were placed in 110 patients using osteotome-mediated sinus floor elevation (OMSFE) with PRF.

RESULTS: The mean residual subantral bone height of the alveolar ridge was 6.6 mm (range, 4-8… Show more

Abstract
PURPOSE: This article describes a technique and reports on the early healing for localized sinus augmentation using a crestal approach in combination with an autologous leukocyte- and platelet-rich fibrin (PRF) concentrate.

MATERIALS: From November 2008 to January 2010, 138 implants were placed in 110 patients using osteotome-mediated sinus floor elevation (OMSFE) with PRF.

RESULTS: The mean residual subantral bone height of the alveolar ridge was 6.6 mm (range, 4-8 mm). The mean increase in the height of implant sites by OMSFE/PRF was 3.4 mm (range, 2.5-5 mm). A variety of 8- to 11.5-mm long (mean length, 10.1 mm) and 3.5- to 6-mm wide (mean width, 4.4 mm) screw-type implants were used. Of the 138 implants that had been placed, 97 have been restored and in function for an average loading time of 5.2 months (range, 1-11 months). The mean healing time for the loaded implants was 4 months until abutment insertion (range, 3-5 months). Three implants failed before loading for an early survival rate of both loaded and unloaded implants of 97.8%.

CONCLUSIONS: Early review of the OMSFE/PRF technique presented for localized sinus floor elevation and implant placement demonstrates a high degree of safety and success at sites with 5- to 8-mm residual subantral bone height.

PMID: 20881816 [PubMed - indexed for MEDLINE]

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Abstract
BACKGROUND: Peripheral giant cell granuloma (PGCG) is a reactive hyperplastic lesion involving the gingiva or alveolar mucosa consisting of proliferating endothelial cells, a rich capillary bed, chronic inflammatory cells, fibroblasts, and giant cells. After complete clinical removal of PGCG recurrence occurs in about 10% of cases, and may result in an esthetic and functional soft tissue defect. This report describes a surgical procedure involving complete removal of a gingival PGCG… Show more

Abstract
BACKGROUND: Peripheral giant cell granuloma (PGCG) is a reactive hyperplastic lesion involving the gingiva or alveolar mucosa consisting of proliferating endothelial cells, a rich capillary bed, chronic inflammatory cells, fibroblasts, and giant cells. After complete clinical removal of PGCG recurrence occurs in about 10% of cases, and may result in an esthetic and functional soft tissue defect. This report describes a surgical procedure involving complete removal of a gingival PGCG in the maxillary esthetic zone and immediate tissue restoration achieving complete gingival augmentation.

METHODS: A 15-year-old female presented with a red, nodular, asymptomatic lesion, approximately 3.5 mm in diameter, located above the maxillary left lateral incisor. The lesion was excised down to the underlying root resulting in a 6 x 5-mm mucogingival dehiscence defect. Corrective surgery included a subepithelial connective tissue graft peripherally covered by the surrounding gingiva and stabilized by 5/0 resorbable sutures.

RESULTS: Healing was uneventful, resulting in healthy and esthetic gingiva. Microscopic examination of the biopsy specimen was consistent with the diagnosis of PGCG.

CONCLUSIONS: PGCG may follow an aggressive course, sometimes requiring preemptive surgical intervention. Grafting a subepithelial connective tissue graft peripherally covered by the surrounding gingiva, without raising a gingival flap, successfully eliminated the gingival defect. The free gingival margin of the neighboring teeth and the mucogingival junction remained unchanged.

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Abstract
Ridge deficiency is an unfortunate obstacle in the field of implant dentistry. Many techniques are available to rebuild the deficient ridge. Some of these techniques are associated with significant morbidity and often require a second surgical site. With the advent of guided bone regeneration (GBR), one may now graft the deficient ridge with decreased morbidity and without a second surgical site. The purpose of this retrospective consecutive case series from 5 private practices is… Show more

Abstract
Ridge deficiency is an unfortunate obstacle in the field of implant dentistry. Many techniques are available to rebuild the deficient ridge. Some of these techniques are associated with significant morbidity and often require a second surgical site. With the advent of guided bone regeneration (GBR), one may now graft the deficient ridge with decreased morbidity and without a second surgical site. The purpose of this retrospective consecutive case series from 5 private practices is to report on the outcomes of a composite material of demineralized freeze-dried allograft, mineralized cortical cancellous chips, and a biologically degradable thermoplastic carrier (Regenaform RT) when combined with a resorbable membrane for GBR of lateral ridge defects in human patients. The specific aim was to quantify clinical results through direct measurement. Data were obtained from 73 consecutively treated lateral ridge augmentations performed on 67 partial and/or completely edentate patients. Clinical data (presurgical ridge width, ridge width at implant placement, and bone density at implant placement) were obtained retrospectively from 5 private practices via an exhaustive retrospective chart review, which was pooled and averaged for analysis. The average gain in horizontal ridge width was 3.5 mm (range, 3-6 mm). The density of the bone was noted to be type 2 to 3, with type 3 being the predominant finding. This retrospective case series from 5 clinical private practices suggests that the use of a composite material of demineralized freeze-dried allograft, mineralized cortical cancellous chips, and a biologically degradable thermoplastic carrier, when covered by a resorbable collagen membrane for GBR, is an effective means of horizontal ridge augmentation.

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Abstract
Surgeons may be confronted with providing periodontal plastic or implant therapy for patients with gingival manifestations of systemic conditions. These conditions (often referred to as mucocutaneous disorders) commonly present with features of desquamative gingivitis, which was once believed to represent a disease entity. However, today, the term desquamative gingivitis is used to describe clinical features of various local or systemic diseases or disorders that result in chronic… Show more

Abstract
Surgeons may be confronted with providing periodontal plastic or implant therapy for patients with gingival manifestations of systemic conditions. These conditions (often referred to as mucocutaneous disorders) commonly present with features of desquamative gingivitis, which was once believed to represent a disease entity. However, today, the term desquamative gingivitis is used to describe clinical features of various local or systemic diseases or disorders that result in chronic gingival lesions characterized by epithelial desquamation, erythema, ulceration, and/or vesiculobullous lesions of the gingiva. Often, other oral tissues also are involved. Mucocutaneous disorders include such disease entities as lichen planus, graft-versus-host disease, pemphigoid, pemphigus vulgaris, lupus erythematosus, erythema multiforme, and linear IgA disease. Surgeons should be able to recognize these disorders and have the tools necessary to treat these conditions so that they can render the appropriate surgical care. This article describes the diagnosis, etiology, and clinical manifestation of these disease entities, as well as the surgical considerations and management in providing care to these patients.

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Abstract
BACKGROUND: A 22-year-old African American female was referred for augmentation of keratinized gingiva around implants at the right and left maxillary second premolar sites. Presurgical evaluation revealed generalized melanosis of the buccal gingiva and a lack of keratinized tissue around implants at sites #4 and #13. No pigmentation was noted on the palatal tissues.

METHODS: Thick free gingival grafts were harvested bilaterally from the non-pigmented palate and secured to… Show more

Abstract
BACKGROUND: A 22-year-old African American female was referred for augmentation of keratinized gingiva around implants at the right and left maxillary second premolar sites. Presurgical evaluation revealed generalized melanosis of the buccal gingiva and a lack of keratinized tissue around implants at sites #4 and #13. No pigmentation was noted on the palatal tissues.

METHODS: Thick free gingival grafts were harvested bilaterally from the non-pigmented palate and secured to the recipient sites with bioabsorbable sutures. Hemostasis was achieved at the palatal donor sites with moistened gauze, and an acrylic stent was delivered for patient comfort.

RESULTS: Both palatal donor sites healed with spontaneous pigmentation. The pigmentation intensified with time but resulted in no adverse outcome.

CONCLUSIONS: Post-surgical healing in patients with gingival pigmentation is not entirely predictable, as multiple studies have demonstrated widely inconsistent results in regards to gingival pigmentation upon healing. When performing periodontal plastic surgery in patients with pigmented oral tissues, it is important to discuss all possible outcomes, including spontaneous pigmentation.

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Abstract
BACKGROUND: The lateral window approach to maxillary sinus augmentation is a well-accepted treatment option in implant dentistry. The most frequent complication reported with traditional techniques has been the perforation of the Schneiderian membrane, with perforation rates ranging from 11% to 56%. The purpose of this retrospective, consecutive case series from two private practices was to report on the rate of Schneiderian membrane perforations and arterial lacerations when a… Show more

Abstract
BACKGROUND: The lateral window approach to maxillary sinus augmentation is a well-accepted treatment option in implant dentistry. The most frequent complication reported with traditional techniques has been the perforation of the Schneiderian membrane, with perforation rates ranging from 11% to 56%. The purpose of this retrospective, consecutive case series from two private practices was to report on the rate of Schneiderian membrane perforations and arterial lacerations when a piezoelectric surgical unit was used in conjunction with hand instrumentation to perform lateral window sinus elevations.

METHODS: Clinical data (Schneiderian membrane perforation, Underwood septa, and laceration of the lateral arterial blood supply to the maxillary sinus) were obtained retrospectively from two private practices and pooled for analysis. The information was collated after an exhaustive chart review. Fifty-six consecutively treated lateral window sinus lifts were performed on 50 partially or completely edentate patients.

RESULTS: Zero perforations of the Schneiderian membrane occurred during the piezoelectric preparation of the lateral antrostomies, whereas two perforations were noted during subsequent membrane elevations using hand instrumentation. In both instances, membrane perforations were associated with sinus septa. The overall sinus perforation rate was 3.6%. Arterial branches of the posterior superior alveolar artery were encountered in 35 cases, and there were zero instances of arterial laceration.

CONCLUSIONS: This retrospective case series from clinical private practices confirmed that a lateral window approach to sinus elevation incorporating piezoelectric technology in conjunction with hand instrumentation was an effective means to achieve sinus elevation while minimizing the potential for intraoperative complications. Further prospective and randomized controlled studies are warranted to qualify these observations.

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Abstract
Periodontal maintenance (PM) is a critical factor in the long-term success of both periodontal and dental implant therapy. Studies have shown both modern periodontal and dental implant therapies are effective in maintaining natural teeth and replacing lost teeth, respectively. However, without a regular program of clinical reevaluation, plaque control, oral hygiene instruction, and reassessment of biomechanical factors, the benefits of treatment often are lost and inflammatory… Show more

Abstract
Periodontal maintenance (PM) is a critical factor in the long-term success of both periodontal and dental implant therapy. Studies have shown both modern periodontal and dental implant therapies are effective in maintaining natural teeth and replacing lost teeth, respectively. However, without a regular program of clinical reevaluation, plaque control, oral hygiene instruction, and reassessment of biomechanical factors, the benefits of treatment often are lost and inflammatory disease in the form of recurrent periodontitis or periimplantitis may result. This article reviews the goals, types, and appropriate frequency of PM in periodontal and dental implant therapy, as well as the incidence and etiology of periimplant disease and strategies for management when recurrent disease develops during the maintenance phase of treatment.

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Abstract
There are times when referred pain makes it difficult to locate the source of odontogenic pain. In those situations, additional evaluation or referral is needed to determine the cause of the chief complaint. This article presents two cases that illustrate the difficulty and frustrations of referred pain for both patients and dentists. After a thorough evaluation and diagnosis, the true sources of the patients' chief complaints were identified and treated, leading to complete… Show more

Abstract
There are times when referred pain makes it difficult to locate the source of odontogenic pain. In those situations, additional evaluation or referral is needed to determine the cause of the chief complaint. This article presents two cases that illustrate the difficulty and frustrations of referred pain for both patients and dentists. After a thorough evaluation and diagnosis, the true sources of the patients' chief complaints were identified and treated, leading to complete resolution of their symptoms. These cases emphasize the importance of listening to the patient, obtaining a detailed dental history, collecting comprehensive diagnostic data, and developing an accurate diagnosis before initiating treatment. When a definitive diagnosis cannot be determined, referral may be necessary to provide the best treatment possible.

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Abstract
BACKGROUND: Speech disruption secondary to excessive gingival tissue has received scant attention in periodontal literature. Although a few articles have addressed the causes of this condition, documentation and scientific explanation of treatment outcomes are virtually non-existent. This case report describes speech pattern improvements secondary to periodontal surgery and provides a concise review of linguistic and phonetic literature pertinent to the case.

METHODS: A… Show more

Abstract
BACKGROUND: Speech disruption secondary to excessive gingival tissue has received scant attention in periodontal literature. Although a few articles have addressed the causes of this condition, documentation and scientific explanation of treatment outcomes are virtually non-existent. This case report describes speech pattern improvements secondary to periodontal surgery and provides a concise review of linguistic and phonetic literature pertinent to the case.

METHODS: A 21-year-old white female with a history of gingival abscesses secondary to excessive palatal tissue presented for treatment. Bilateral gingivectomies of palatal tissues were performed with inverse bevel incisions extending distally from teeth #5 and #12 to the maxillary tuberosities, and large wedges of epithelium/connective tissue were excised.

RESULTS: Within the first month of the surgery, the patient noted "changes in the manner in which her tongue contacted the roof of her mouth" and "changes in her speech." Further anecdotal investigation revealed the patient's enunciation of sounds such as "s," "sh," and "k" was greatly improved following the gingivectomy procedure.

CONCLUSIONS: Palatometric research clearly demonstrates that the tongue has intimate contact with the lateral aspects of the posterior palate during speech. Gingival excess in this and other palatal locations has the potential to alter linguopalatal contact patterns and disrupt normal speech patterns. Surgical correction of this condition via excisional procedures may improve linguopalatal contact patterns which, in turn, may lead to improved patient speech.

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Abstract
BACKGROUND: Maxillary periodontal surgery typically requires multiple injections and may inadvertently affect facial structures such as the upper lip, lateral aspect of the nose, and lower eyelid. To minimize these sequelae and reduce the number of total injections, a relatively new injection technique has been proposed for maxillary procedures. The anterior middle superior alveolar (AMSA) injection is reported to effectively anesthetize maxillary teeth and associated gingival… Show more

Abstract
BACKGROUND: Maxillary periodontal surgery typically requires multiple injections and may inadvertently affect facial structures such as the upper lip, lateral aspect of the nose, and lower eyelid. To minimize these sequelae and reduce the number of total injections, a relatively new injection technique has been proposed for maxillary procedures. The anterior middle superior alveolar (AMSA) injection is reported to effectively anesthetize maxillary teeth and associated gingival tissues extending from the buccal root of the first molar mesially to the central incisor with a single injection while avoiding undesirable side effects. The purpose of this article is to provide background information on the AMSA injection and demonstrate its use in a variety of maxillary periodontal surgeries.

METHODS: Anesthesia was provided for five separate maxillary periodontal surgeries with unilateral or bilateral AMSA injections. Injections were administered via conventional syringe with a 27-gauge needle. Confirmation of anesthesia was subjectively tested with buccal mucosal sticks and palatal transgingival probing.

RESULTS: The AMSA injection provided promising results for a variety of maxillary periodontal surgical procedures. Benefits of the AMSA injection included outstanding palatal hemostatic control, avoidance of undesirable collateral anesthesia, and a reduced number of cumulative injections. Drawbacks of the AMSA injection included occasionally inadequate buccal hemostatic control and short-lived anesthesia of the maxillary central incisors.

CONCLUSION: The AMSA injection is a novel anesthetic technique that may prove useful for certain maxillary periodontal surgeries.

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Abstract
BACKGROUND: Recent media reports concerning "stolen body parts" have shaken the public's trust in the safety of and the use of ethical practices involving human allografts. The authors provide a comprehensive review of the safety aspects of human bone allografts.

METHODS: The authors reviewed U.S. government regulations, industry standards, independent industry association guidelines, company guidelines and scientific articles related to the use of human bone allografts in… Show more

Abstract
BACKGROUND: Recent media reports concerning "stolen body parts" have shaken the public's trust in the safety of and the use of ethical practices involving human allografts. The authors provide a comprehensive review of the safety aspects of human bone allografts.

METHODS: The authors reviewed U.S. government regulations, industry standards, independent industry association guidelines, company guidelines and scientific articles related to the use of human bone allografts in the practice of dentistry published in the English language.

RESULTS: The use of human bone allografts in the practice of dentistry involves the steps of procurement, processing, use and tracking. Rigorous donor screening and aseptic proprietary processing programs have rendered the use of human bone allografts safe and effective as a treatment option.

CONCLUSIONS: When purchasing human bone allografts for the practice of dentistry, one should choose products accredited by the American Association of Tissue Banks for meeting uniformly high safety and quality control measures.

CLINICAL IMPLICATIONS: Knowledge of human bone allograft procurement, processing, use and tracking procedures may allow dental clinicians to better educate their patients and address concerns about this valuable treatment option.

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Abstract
Platelet-rich plasma is an autologous source of platelet-derived growth factors that enhance surgical soft- and hard-tissue wound healing. Surgeons should be aware of its mechanisms of action and benefits, as well as the controversy regarding its use