Bibliographic reviews

The International Journal of Oral & Maxillofacial Implants, 2012; 27: 1144-50

120 implants were inserted in 80 patients while at the same time sinus floor elevation was performed in the Control Group using osteotomes with a manual mallet and in the Test Group with the Magnetic Mallet. The total implant survival at 24 months was 98.33%, the bone gain was on average about 4 mm, without any significant differences in the two groups, and this gain, found after the first 6 months, was stable at 24 months. 3 patients treated using osteotomes with a manual mallet complained of benign paroxysmal positional vertigo, whereas the use of the Magnetic Mallet did not give rise to complications.

Numeri Uno 13, 2012, 16-18.

SURGICAL ADVANTAGES OF USING THE MAGNETIC MALLET

Bone expansion techniques, conceived to increase peri-implant bone volumes using the native bone of the site where the implant is to be inserted and the use of bone expanders to stabilise implants in type 3 and 4 bone structures, are well documented techniques recognised as valid and reliable by surgeons and by the
literature. The critical point of these techniques is that the protocol contemplates the use of a surgical mallet to guide the instruments in creating the implant bone socket. The impact produced by the surgical mallet may cause a vertigo syndrome in patients which may also be very annoying and sometimes long-lasting.
To avoid or reduce this symptom to a very significant extent, last year Sweden & Martina introduced the Magnetic Mallet, a dynamic magnetic instrument consisting of a handpiece powered by an electronic control unit which controls the forces and times of application. The aim is to bind an adjustable shock wave, with calibrated force application time, to the handpiece of the bone expanders and to transmit this shock wave to the tips of the bone expanders.
The Magnetic Mallet produces a greater energy with elevated accelerations applied in much shorter times compared with the classic surgical mallet. In this way a plastic deformation of the bone can be induced which absorbs the whole shock wave, thus avoiding the creation of inertia affecting the rest of the cranium.
The shock waves generated using the traditional surgical mallet and using the Magnetic Mallet have been measured on natural models.
1) With the surgical mallet the shock wave generated was 40 Dan (Deca Newton) (40 Kg) for a time of 200 µs; much of the energy thus obtained was not exhausted in the plastic deformation of the bone, but went on to influence the whole maxillary mass;
2) with the Magnetic Mallet the shock wave generated was 130 Dan (130 Kg) applied for 80 µs.
In this  way the plastic deformation of the bone was enormously facilitated and allowed the total absorption of the energy, while the acceleration on the maxillary mass remained minimum and indeed negligible.
The instrument perfectly performs the function for which it was designed, that is to make the manoeuvres more acceptable for the patient when it is necessary to divide the bone structure, widening it to create an adequate surgical socket, with an adequate position and thickness of the most critical walls of the socket
(namely the vestibular and the oral wall), in which to insert the implant.

Clinical Oral Implant Research, 2012; 23: 542-549

The implants were positioned in vivo in standard sites (Control Group), in sights with small circumferential defects (Test Group 1) and in sites with large circumferential defects (Test Group 2). No bone regeneration technique was used in the Test Groups, and the implants were left to heal in the void. At three months osteointegration was observed around all the implants, though in the Test Groups 1 and 2 the BIC was still low and a layer of dense connective tissue, directly proportional to the extent of the defect, had filled the gap. The dimensions of the defects were therefore able to influence the results. So clinically it should be borne in mind that non regenerated bone defects show longer healing times.

Clinical Implant Dentistry and Related Research, Early View, First Published online on 2012, January, 11th

36 patients received 50 implants with the manual osteotomic technique (Control Group) and with the Magnetic Mallet (Test Group). At the 12-month follow-up the height of the bone had increased significantly in both groups, and at the next control at 24 months the height had remained stable. 2 patients in the control group had reported benign paroxysmal positional vertigo following the use of osteotomes with hand hammer. At 24 months the cumulative survival rate was 86%, the bone gain did not present any differences in the two groups. The Magnetic Mallet offered important clinical advantages for patients in the post-surgical phase.

Implantologia, 4:63-65, 2008

FUNCTIONAL AND AESTHETIC REHABILITATION OF IMPLANT-SUPPORTED PROSTHESIS WITH UNILATERAL SINUS LIFT A CASE REPORT

Clinical Oral Implants Research, first published online 2010 Nov 19

A radiographic survey was conducted on the behaviour of bone around 282 implants inserted in lifted sinuses with different variables: autologous bone from the iliac crest compared to bovine bone, implants placed at the same time as the sinus lift procedure compared to deferred implant placement. At 24 months, the implant survival rate was higher in the group rehabilitated with implants placed at the same time as the sinus lift procedure (99.3%) compared to deferred implant placement (96.5%); crestal bone reabsorption was signifi cantly lower in the group treated with bovine bone compared to the one treated with autologous bone. Within the fi rst group, the crestal bone reabsorption at 2 years was in turn signifi cantly less in cases where the implants were placed at the same time as the sinus lift procedure compared to deferred implants.

Journal of Periodontology, 81:344-349, 2010

The authors fi lled 30 extraction sockets presenting residual bone defects with magnesium-enriched hydroxyapatite. After a period of 3 months, implants were inserted with simultaneous sinus lifting via crestal approach. At 36 months all implants are in place and signifi cant bone augmentation is reported.

Journal of Periodontology, 80 (10):1616-1621, 2009

In this study, the rehabilitation of extraction sites in the presence of a bone defect to be regenerated obtained positive results regardless of the type of graft material used (magnesium-enriched hydroxyapatite, swine bone, calcium sulphate).

Clinical Oral Implant Research, 2012; 23 Suppl 6: 136-146

In the authors’ opinion, the studies included in the review are not sufficient to uphold the necessity for the presence of keratinised mucosa around implants. However, the most frequent clinical indication is to adopt surgical techniques able to maintain not only the bone complex but also the mucosa, so as to preserve tissue stability over time and a good aesthetic result.

The International Journal of Oral & Maxillofacial Implants, 2014;29:699-704

This study involved 23 patients who all needed two teeth extracted. In each patient, one site was left to heal without using biomaterials. The other site was treated with the insertion of porcine bone. After 3 months, Outlink2 implants were inserted, and 3 months later the width of the buccal ridge was measured. The sites treated with porcine bone maintained significantly greater bone volume at molar positions, but there were no statistically significant differences at other positions (incisors, canines, premolars).