Quintessence International, 05/2018

Rehabilitation with implants in the esthetic zone is one of the most demanding tasks due to the importance of obtaining an optimum esthetic result. The aim of this article was to present a workflow to create, preserve, transfer and support the emergence profile in anterior maxillary implants. Different methods are used surgically as well as prosthetically to construct an ideal restoration. When immediate loading can be applied in cases of increased primary stability, a provisional restoration is placed with occlusal contacts. In cases not permitting the above procedure and requiring extensive augmentation, a resin-bonded partial coverage fixed partial denture can be a predictable and reliable treatment option until the final restoration is delivered. Creating or preserving the emergence profile at immediate post-extraction and delayed implants, respectively, is achieved through customized provisional, healing abutments, a combination of prefabricated healing abutments and partial coverage provisional restoration, or utilization of the patient's own tooth crown. Transferring the individualized soft tissue contour to the final restoration can be achieved by modifying the impression coping intraorally with composite resin, fabricating a cast mimicking the soft tissue contour in the laboratory, or by the use of CAD/CAM technology. A customized abutment is necessary in order to maintain the emergence profile that has been created during the previous stages. The objective of this paper was to present a detailed workflow for the restoration of anterior maxillary implants focused on the creation, preservation, support, and transfer of the emergence profile of the soft tissues through a series of clinical cases. Schlagwörter: anterior maxillary implants, customized prosthetic components, emergence profile

Dental implantology is one of the most attractive and dynamic fields of work within clinical dentistry. It provides many patients with new and improved opportunities for stable (implant-supported) rehabilitation and also offers dentists a field that is interesting in both technical and economic terms. Adverse clinical outcomes are, however, often the subject of discussion. These relate both to prosthetic failure and to biologic complications and side effects, namely persistent infections surrounding implants. A further point of discussion relates to the question as to how far the triumphant march of implantology is accompanied by a reduction in the willingness to retain teeth. It thus appears all the more important to ask some questions regarding the normative overall conditions of responsible implantologic care on the basis of the present state of research and currently available studies. In line with this, this paper deals with both existing preconceptions and ethically relevant parameters of responsible implantology. These function simultaneously as concrete clinical-ethical guidelines for dentists practicing implantology. Schlagwörter: dental functional capacity, ethics, implants, patient perspective, professional etiquette

Objectives: The purpose of this study was to evaluate the influence of leukocyte- and platelet-rich fibrin (L-PRF) on impacted mandibular third molar (IMTM) extraction wound healing, patient postoperative discomfort, and incidence of alveolar osteitis. Method and Materials: Thirty-four patients (20 female, 14 male) who met the inclusion criteria for this split-mouth randomized clinical trial were enrolled and 30 patients completed the study. Patients were randomized and underwent bilateral IMTM surgical extractions. Following extraction, one socket randomly received L-PRF, and the other socket served as a regular blood clot control. Postoperatively, the soft tissue healing index (HI), pain according to visual analog scale (VAS), facial swelling using a horizontal and vertical guide, and incidence of alveolar osteitis were evaluated 1, 3, 7, and 14 days after surgery. Results: Sites treated with L-PRF resulted in improved HI (P = .001) and lower pain VAS scores (P = .001) in the first postoperative week. Significant reduction of facial swelling was recorded on first (P = .035) and third (P = .023) postoperative days in L-PRF sites versus controls, ceasing to nonsignificant difference at day 7 (P = .224). None of the L-PRF sites and four control sites were affected by alveolar osteitis (P = .001). Conclusion: Within the limitations of this split-mouth study, L-PRF improved soft tissue healing and reduced postoperative pain, swelling, and incidence of alveolar osteitis after IMTM surgical extractions. Schlagwörter: impacted tooth, pain, platelet-rich fibrin, third molar, tooth extraction, wound healing

A case of a 60-year-old man with severe trismus after inferior alveolar nerve block is presented. MRI scans as well as histologic examination revealed muscle fibrosis and degeneration of the medial part of the left temporal muscle due to myotoxicity of a local anesthetic agent. Schlagwörter: anesthesia, fibrosis, myotoxicity, temporal muscle, temporomandibular joint, toxicity, trismus

Advances in transplant medicine and availability of effective immunosuppressive regimens have dramatically improved survival for patients afflicted with end-stage organ failure. However, chronic immunosuppression predisposes transplant patients to infection caused by a wide spectrum of endogenous or exogenous pathogens as well as necrotizing periodontal conditions. This article reviews clinical features, diagnosis, and management of necrotizing stomatitis in the context of therapeutic immunosuppression and discusses the integral function of dentists in eliminating oral foci of infection in preparation for transplantation as well as life-long maintenance of oral health post-transplant. We also present a renal transplant patient who developed massive soft and hard tissue necrosis in the anterior mandible. Disproportionate periodontal destruction in relation to local factors raised suspicion of iatrogenic overimmunosuppression, and he was hospitalized for management of profound neutropenia. Schlagwörter: immunosuppression, infection, necrosis, stomatitis, transplant

Multiple invasive cervical resorption (MICR) is a rare disease of unknown etiology. A case of a patient with MICR of six teeth, with low vitamin D3 level detected, is presented. Applied surgical and general treatments were only partially effective, as they failed to stop the resorption, although the parameters of calcium-phosphate management appreciably improved, and secondary hyperparathyroidism was successfully resolved. Schlagwörter: celiac disease, cone beam computed tomography, multiple invasive cervical resorption, secondary hyperparathyroidism, vitamin D3

Supernumerary teeth are an uncommon occurrence that have the ability to arise anywhere in the dental arch. Mesiodens is a specific type of supernumerary tooth that occurs in the vicinity of the maxillary central incisors. Mesiodens are the most common among all supernumerary teeth, almost always impacted, and may also be seen in various positions based on the eruption status. The formation of mesiodens is a much-debated topic and many theories have been proposed. The reports also include its common radiographic findings and a pertinent literature review. This study reports a case of an impacted, inverted mesiodens incidentally discovered on a preimplant examination of maxilla. This article demonstrates the scope of eruption of an impacted and inverted mesiodens. Various methods of treatment plan are discussed and a new classification system of mesiodens is proposed. Schlagwörter: cone beam computed tomography, mesiodens, nasal fossa, nasal septum, supernumerary

Objective: Several incidental findings with varying degrees of clinical significance are often found on cone beam computed tomography (CBCT) scans of the maxillofacial skeleton acquired for dental procedures. The present study analyzed CBCT scans of dental implant therapy patients to identify incidental findings and assign those findings an appropriate clinical significance. Method and Materials: A total of 500 CBCT scans of patients were evaluated for this study. The incidental findings recorded in different anatomical regions were assigned a clinical significance score of mild, moderate, or severe. These findings were further segregated based on age and sex to evaluate specific trends for prevalence of incidental findings and their clinical significance. Results: Out of the 298 intracranial findings, four were categorized as moderate. Out of 407 sinonasal findings, 19 were categorized as severe. Most (43%) of the airway findings were classified as mild. Among the cervical vertebrae findings the severe category included degenerative changes and vertebral-body fusion along with other degenerative changes. Most (259 [51.8%]) of the vascular findings were categorized as severe. Conclusion: Patients referred for dental implant treatment present with a myriad of incidental radiographic findings in the head and neck region. It is important that care providers recognize and understand these findings so appropriate care and timely intervention may be initiated. Schlagwörter: calcifications, cone beam computed tomography, dental implants, pineal, vascular incidental findings